Obesity has become an epidemic in recent years, contributing to significant morbidity and mortality worldwide. Genetic, social, psychological, and behavioral factors are important in obesity. It is well known that obesity increases the risk of some disorders including diabetes, arterial hypertension, hyperlipidemia, sleep apnea syndrome, and cerebral stroke. While various approaches exist, including lifestyle modifications, pharmacologic agents, and bariatric surgery, the quest for less invasive and more widely applicable treatments continues. One such emerging therapy is the use of botulinum toxin A (BTX-A) injections into the stomach lining, also known as intragastric BTX-A injection. This article aims to provide a comprehensive overview of the current understanding of Botox for weight loss, analyzing its efficacy, mechanisms of action, and potential benefits and drawbacks.
Understanding Botulinum Toxin and its Mechanism
Botulinum neurotoxin, produced by the Gram-positive, anaerobic bacterium Clostridium botulinum, has been used widely for many diseases. It was first injected into extraocular muscles for treatment of ocular strabismus. Botulinum toxin, derived from the bacterium Clostridium botulinum, is a potent inhibitor of muscle contraction that works by blocking the release of acetylcholine in the neuromuscular area. BTX-A inhibits acetylcholine release at neuromuscular junctions, resulting in temporary paralysis of targeted gastric smooth muscles. When injected into the antrum and/or fundus, this can slow gastric emptying and increase the sensation of fullness, thereby reducing caloric intake.
The rationale behind using BTX-A for weight loss lies in its ability to temporarily paralyze smooth muscles. After the use of botulinum toxin A (BTX-A) in experimentally obese rat models, endoscopic intragastric BTX-A injection has been attempted for the treatment of morbid obesity. The mechanism of action is related to gastric emptying delay and early satiety, resulting in weight loss. Previous studies evaluating intragastric injection of BTX-A as a treatment for obesity have been associated with conflicting results. By injecting BTX-A into the gastric wall, specifically the antrum and/or fundus, gastric motility can be slowed, delaying gastric emptying. This delayed emptying leads to an increased sensation of fullness, or early satiety, which in turn can reduce food intake and potentially lead to weight loss.
The Procedure: Intragastric BTX-A Injection
The procedure for intragastric BTX-A injection involves upper GI endoscopy under sedation for the injection of BTX-A. After 6-12 hours of fasting, the patients were submitted to upper GI endoscopy under sedation for the injection of BTX-A. A total of 250 units of BTX-A was diluted with 10 ml of 0.9% saline. Injections were administered into the gastric antrum, each containing 1 ml of prepared solution (25 U BTX-A + 1 ml saline). Technically, the antral region of the stomach was punctured, and BTX-A was injected into the gastric wall slowly, using a standard 5 mm sclerotherapy needle in a circular direction. There were no significant acute complications during the procedures except a minor bleeding that stopped without any intervention. All patients were observed for 4 h after the procedure. Only one patient complaining of abdominal pain and vomiting was observed for 12 h. All patients were suggested to visit a dietitian immediately after the endoscopic procedure.
Patients are typically monitored for a few hours post-procedure. The patients were suggested to take the pure liquid diet within 72 hours after the procedure. All patients were consulted by the dietitian. At the end of 3 days, a 1200 kcal (protein 30%, carbohydrate 30%, and lipid 40%) was given. All patients were invited for control at the end of the first and fifth months. Patients are often advised to follow a specific diet plan to maximize the potential benefits of the injection.
Read also: Your Guide to Facials After Botox
Clinical Evidence: Does Botox Lead to Weight Loss?
The efficacy of intragastric BTX-A injection for weight loss has been a subject of much debate and research. There have been few conflicting results about intragastric Botox injection including body weight reduction, gastric emptying, induction of early satiety, and weight gain after the procedure. While some studies have shown promising results, others have yielded conflicting or negative findings.
For example, one prospective study evaluated the efficacy of intragastric BTX-A injection for the treatment of obesity. This study was performed between January and August 2019. A total of 56 patients were studied. Mean weight before gastric Botox was 85.25 ± 14.02, and mean weight after gastric Botox was 76.98 ± 12.68. Mean weight loss was approximately 9 kg in studied patients. BMI decreased about 3 units. The mean time for maximum weight loss was 60.39 ± 37.43 days. A total of 49 patients (87.5%) had reported decrease in appetite and early satiety. About 53.6% of patients were satisfied. No complications resulting from the endoscopic procedure were observed in this series. It is shown that the intragastric BTX-A injection can be beneficial in weight loss. It is a minimally invasive, cost-effective procedure, without serious side effects.
Another retrospective cohort study conducted between 2020-2022, 500 patients were included in this study who had undergone gastric botulinum toxin-A application and completed at least 6 months of regular follow-up. Patients were injected intramuscularly with 1000 U of botulinum toxin-A in the antrum and fundus regions of the stomach via endoscopy under sedation anesthesia (midazolam and propofol). At the end of the third and sixth months, all subjects lost body weight, with mean weight loss of 10.54 ± 3.36 kg (13.9 ± 4.4%) (Group 1), 13.54 ± 4.57 kg (15.1 ± 4.9%) (Group 2), 16.76 ± 3.86 kg (16.0 ± 3.6%) (Group 3), and 20.6 ± 5.33 kg (16.4 ± 4.2%) (Group 4) at the third month; and 14.50 ± 4.95 kg (19.2 ± 6.6%) (Group 1), 18.39 ± 6.49 kg (20.5 ± 7.0%) (Group 2), 23.37 ± 5.51 kg (22.4 ± 5.2%) (Group 3), and 29.17 ± 7.96 kg (23.2 ± 6.3%) (Group 4) at the sixth month, respectively. The differences between the third and sixth months were statistically significant (p < 0.05). The body mass index values of the patients also showed significant reductions at the end of the third and sixth months (p < 0.05). The study found that intraparietal gastric botulinum toxin-A injection can lead to significant weight loss and may contribute to the development of effective, minimally invasive approaches for the management of obesity.
However, other studies and meta-analyses have presented conflicting results. Bustamante et al. designed a meta-analysis with four randomized clinical trials. They concluded that homogeneous randomized controlled studies did not find superiority of BTX-A versus placebo. de Moura et al. also studied the effect of BTX-A in super-obese patients.
A review of published papers on the subject, the WCM-Q and HMC researchers found no evidence that stomach botox injections in obese patients leads to effective long-term weight loss. The quality of the studies examining the role of stomach botox in weight loss was generally poor, the WCM-Q and HMC researchers found. Some studies reviewed by the researchers reported that obese patients who had stomach botox injections had lost weight after one month, and patients reported feeling full earlier after eating less food than previously. But in most studies, after three to six months, patients had either regained the weight they had lost, weighed more than they did before the procedure, or had minimal total body weight loss. Other studies examined by the team found little difference in appetite, weight loss and feelings of fullness between subjects who had botox injections with those who had saline injections. The only trial that demonstrated significant total body weight loss placed all participants on a very low-calorie liquid diet for eight weeks.
Read also: Combining Facials and Botox
These conflicting results highlight the need for more rigorous and well-designed studies to definitively determine the efficacy of intragastric BTX-A injections for weight loss. The conflicting results in previous studies may be attributed to variations in sample size, BTX-A dose, injection site, and methodological differences in study design.
Factors Influencing the Outcome
Several factors can influence the outcome of intragastric BTX-A injections for weight loss.
Dosage and Injection Site: Studies examining the effect of Btx-A injection at different doses on gastric emptying are available. Topazian et al compared the effects of different doses of Btx-A injection on gastric antral muscularis propria and found that low doses were not associated with early satiety, changes in eating behavior, or weight loss, but higher doses (300 units) resulted in delayed gastric emptying. Similarly, Gracis et al suggested that the effect of Btx-A on the stomach could be related to the width and number of areas injected into the organ. The dose and distribution of BTX-A within the stomach may represent critical determinants of treatment efficacy. BTA is usually injected in a circular manner (at least four for each area); the number of injections depends on the selected anatomical sites. Acetylcholine-mediated gastric antral contraction is essential for the passage of food into the duodenum. In the first studies evaluating the efficacy of IBI for obesity, the antro-pyloric-pyloric region was the only injection site. Trials have since been initiated to consider the fundus as an injection site. While the fundus does not have a role in food propulsion as the antrum does, the rationale for including the fundus is its role in gastric accommodation and regulation of gastric capacity, which induces early satiety.
Diet and Lifestyle: Diet is one of the most important issues in weight loss during obesity treatment. In our study, all our patients were enrolled in a low-calorie diet program after the procedure. Diet can also be a confusing factor when investigating the effectiveness of Botox in weight loss. In our study, we observed significantly higher weight loss rates in patients who adhered to diet and exercise programs. Adherence to the standardized post-procedure low-calorie diet and physical activity recommendations was monitored through monthly in-person follow-up visits and direct interviews with the dietician. Patients were asked to self-report their daily food intake and physical activity patterns, and these reports were reviewed during each visit.
Patient Selection: Obesity may not be an adequate factor to determine a patient’s candidacy for IBI. One of the proposed mechanisms by which IBI promotes weight loss is through the inhibition of stomach muscle contraction, reduction of GE, and decrease in satiety. Therefore, it can be hypothesized that patients with rapid GE may benefit more from IBI than those with delayed GE. Consequently, baseline gastric scintigraphy before IBI can be utilized as a screening tool or predictor of IBI success.
Read also: Botox and Massage: A Safe Combination?
Safety and Side Effects
Intragastric BTX-A injection is generally considered a minimally invasive procedure with a good safety profile. No method, including stomach botox, is guaranteed to enable of weight lost. It is not right to name stomach botox as a miraculous treatment. It is known that the full effect of the drug used in stomach botox is completely erased from the body within 4-6 months. The feeling of hunger decreases within 2-3 days after applying stomach botox. Loss of weight begins to appear after 2 weeks. Since stomach botox application is a standard endoscopic procedure, there is no an important stomach botox damage reported in the literature. Botox has been used in medicine for years and There is no harm known if it is applied in the right dosage by a specialist.
However, like any medical procedure, there are potential side effects to be aware of. Although a wide range of side effects such as fatigue, headache, and gastrointestinal symptoms have been reported after Btx-A injection, we observed gastrointestinal symptoms such as nausea and vomiting in 8 patients (1.6%), abdominal pain in 23 (4.6%), and constipation in 55 (11%) of our patients in our study. Overall, no side effects were observed in 82.8% of our patients.
tags: #botox #for #weight #loss #effectiveness