Intragastric Injections of Botox for Weight Loss

 

 

You may be well-acquainted with Botox’s uses beyond reducing the appearance of facial wrinkles; as a cure for migraine, or excessive sweating, a condition also known as hyperhidrosis, but there is another seeming benefit of this application that you may not have heard of before: weight loss.

Before we proceed further, let us provide some background information on what ‘Botulinum Toxin’(BTX, aka Botox) is, its history, how it works and its uses.

 

What is Botulinum Toxin?

 

Botox is the brand name of a drug made of botulinum toxin; a neurotoxin produced by a specific type of bacterium called ‘Clostridium botulinum’.This bacteria can be found in soil and its spores can be traced on fruits and vegetables.

This toxin can be very poisonous when used in higher amounts. However, the botox injections that are commercially used both for cosmetic and therapeutic purposes, only require very small doses of Botulinum toxin.

 

Botox: How it Works

 

Botulinum toxin functions by blocking the release of acetylcholine; a neurotransmitter (chemical messenger) of the parasympathetic nervous system that widens blood vessels, contracts smooth muscles, slows heart rate and increases bodily secretions, acting as an important link between the brain and muscle functions.

When Botulinum toxin is injected, it temporarily paralyzes the muscles within the treated area by blocking certain nerve signals that causes muscles to contract. By restricting muscle contraction, the muscles are able to relax and soften.

 

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What is Gastric Botox?

 

Known under different names such as; stomach botox, botox injections for weight loss and intragastric injection of Botulinum toxin A, gastric botox is a relatively new non-surgical procedure that is performed endoscopically on an outpatient basis.

 

Over the past 15 years researchers have been able to achieve promising results from using botox injections for weight loss that works by blocking certain nerve signals in the muscles of the stomach wall that regulate feelings of satiety and hunger.

Several clinical studies have been conducted to evaluate the safety and efficacy of this application, documenting that in fact, it can be an effective treatment and help patients to lose weight with an estimated average between 10-15 kilograms within 3 to 6 months.

Here is some data from previous research findings that have assessed the effectiveness of the use of intragastric botox injections in patients who are overweight or slightly obese;

 

  • Three different reports published by scientists in the years respectively; 2005, 2008 and 2015, demonstrated that botulinum toxin-A injected into the fundus and antrum of the stomach slowed the process of gastric emptying and modified gastric motility, which had resulted in rapid weight loss. Additionally, in both human and animal experimental studies that had been conducted, the administration of BtXA on the stomach wall had shown to reduce food ingestion and body weight.
  • In a placebo-controlled study conducted by Foschi et.a l in 2008, a total Botulinum Toxin-A dose of 200 Units had been administered into the submucosa layers of antrum and fundus of 12 patients with Class I/II obesity. At the end of 2 months the patients had reported an average weight loss of around 12 kg.
  • In another small study conducted in 2014 by a team of Norwegian scientists from the Norwegian University of Science and Technology, botox was injected into the stomachs of 20 obese patients, with the shots repeated at 6-month intervals for a total duration of 18 months. By the end of 18 months, 75% of the patients had lost approximately 28% of their excess body weight on average.

 

There is also a very recent study that was conducted in 2019 by 3 Turkish researchers who evaluated the efficacy of Botulinum toxin injections for weight loss. For this study, a total of 56 patients were studied.

 

The inclusion criteria of the study included;

  • Ages ranging between 18 and 65 years
  • Body mass index (BMI) ˃ 25 kg/m2

With 50 of the patients being females and 6 males.

 

Before the procedure, the patient’s body weight, height was measured and BMI was calculated. BMI and body weight were measured on a monthly basis until the end of the study, which lasted for 5 months. 

 

 

Table 1

 

Demographic findings of patients

Finding

    Mean ± SD

Number

Age

    38.97 ± 9.90           

56

Gender

 

6 male/50 female (10.7%–89.3%)

Obesity in family

 

19 patients (33.9%)

Psychiatric problems

 

5 patients (8.9%)

Comorbidities

 

 

Diabetes mellitus

 

6 patients (10.7%)

Hypertension

 

4 patients (7.1%)

Hypothyroid

 

2 patients (3.5%)

Polycystic ovary syndrome           

 

1 patient (1.7%)

 

 

Table 2

 

Average weight and BMI loss

 

Mean ± SD

Min–max

Weight before gastric Botox           

85.25 ± 14.02

             61–123 kg

Weight after gastric Botox

76.98 ± 12.68

             54–123 kg

Average time for weight loss

60.39 ± 37.43

 7–150 days

BMI before gastric Botox

  30.79 ± 4.25 

              25–43.6

BMI after gastric Botox

               27.95 ± 3.76

             38.3–20.6

 

 

 

 

 

 

 

 

 

Table 3

 

Effect of gastric Botox on appetite of patients

 

Number of Patients

               Appetite

Appetite before gastric Botox           

33

High

 

13

Normal

Appetite after gastric Botox           

49

Decreased

 

7

Not Changed

 

 

All of the study results demonstrate that botox for weight loss is safe for patients to undergo and that it can actually promote weight loss, especially when combined with a good diet and exercise program. However, researchers still emphasize the need for further studies to be conducted especially with larger sample sizes in order to evaluate how well the sample will reflect the population and therefore how valid the conclusions will be.

 

How Does Gastric Botox Work?

 

Inhibiting muscle contraction within the specified regions of the stomach wall through the administration of botox injections help slow down the digestive process (gastric emptying) and stomach motility. This in turn prolongs the sense of satiety (the feeling of fullness experienced after eating a meal that results in a decrease in appetite) which reduces the overall amount of the patients’ food intake and facilitates weight loss.

s to slow the passage of food through the stomach.

Previous studies have also shown that botox injections administered into these regions can reduce the amount of the Ghrelin peptide hormone released.

The ghrelin hormone, which is considered as one of the primary hormones that stimulates the feeling of hunger, is distributed throughout the gastric mucosa.

So as the ghrelin levels decrease, the feeling of fullness will increase, which in turn will keep the patient satisfied for a longer period of time.

 

Who Qualifies for Gastric Botox?

 

  • Individuals who have not been able to achieve satisfactory results in previous attempts to lose weight through other methods such as diet and exercise
  • Individuals who have realistic expectations
  • Individuals with a BMI higher than 25 kg/m² but lower than 35 kg/m² who are overweight and do not qualify for bariatric surgery.
  • Individuals with a BMI ranging between 35 kg/m² to 40 kg/m² who fall within the class I/II obesity range but are not in demand of a surgical intervention such as bariatric surgery.
  • Individuals who have obesity-associated comorbidities such as Type 2 diabetes and hypertension.

 

Gastric Botox is Not Suitable For:

 

  • Women who are pregnant or breastfeeding
  • Morbidly obese patients and

Individuals who have;

  • A history of chronic (heart, kidney, liver etc.) or autoimmune disease,
  • An ulcer or tumor in the stomach,
  • Severe eating disorders
  • Undergone gastric sleeve or gastric bypass surgery
  • An allergy or sensitivity to any ingredient in botox
  • An infection in the injection site
  • A progressive muscle or neurological condition that may cause muscle weakness

 

How Do I Prepare for the Procedure?

 

On the day before the procedure, the patient is required to fast overnight and avoid food or drinks for around 6-12 hours. An empty stomach will help minimise the risk of aspiration during the procedure which will be performed under sedation.

Additionally, one week prior to their procedure we evaluate each patient together with our dietitian and determine a diet plan specific to their individual needs.

We advise our patient to follow this preoperative diet until the day of their procedure.

 

How is the Procedure Performed?

 

The application requires minimal preparation and usually takes an average of 20 minutes under sedation.

After the patient is administered sedation and made comfortable, by using a sclerotherapy needle we then inject a total dose of 300 U of BtxA in a circular pattern into approximately 40 different points (with equal space between) on the gastric mucosa layer of the stomach wall. The areas of application mainly consist of the; fundus (the upper portion of the stomach), the corpus (the main part of the stomach) and the antrum (the lower portion of the stomach).

 

Are There Any Associated Risks and Side Effects?

 

Botox for weight loss is a relatively safe procedure, with generally no serious side effects experienced by the patients. Some of the possible side effects include;

  • Nausea
  • Vomiting
  • Headache
  • Feeling of bloating and mild abdominal pain

 

However in rare cases, Botox can cause;

  • Muscle weakness all over the body
  • Pain or swelling
  • Breathing difficulties
  • Double vision
  • Gastric necrosis
  • Loss of bladder control
  • Pain or swelling

 

What Can I Expect After the Procedure?

 

After completion of the procedure, the patient will rest for the effects of the sedation to wear off. Dissolution of sedation may last around 1 to 2 hours. Following this, the patient may choose to be discharged or remain at the hospital until he/she feels well enough to leave for home. On the following day of the procedure the patient will be recommended a liquid-based diet. It is normal to feel slightly weak for a few days but these symptoms are temporary and will gradually disappear within a short period of time.

It is important to follow the recommended dietary guidelines as well as a personalized workout plan to help promote weight loss and prevent the patient from regaining any weight. Encouraging new habits such as healthy eating and food portions is essential.

For this reason we always ensure that our patients get the necessary support needed to comfortably adapt to their new diet and exercise plans, after their procedures.

Making the necessary lifestyle and behavior changes will positively affect their health and improve the effectiveness of the intragastric injection of botulinum toxin for weight loss.

 

How Long Does the Effects Last For?

 

The effects of botox injections are usually noticeable within three to five days following the application, with its maximum effect typically seen after a week following the procedure.

Intragastric botox injections generally last up to 6 months, where weight loss is usually observed during the 3rd, 4th and 6 months following the application. Patients may expect to lose a total of around 8 to 15 kgs, especially if they follow a low-calorie diet and exercise under the supervision of a dietitian.

At the end of 6 months, we will be evaluating the patient (the physical condition, the amount of weight loss achieved and other indications) and then determine if the application of botox injections may be continued for a period up to 18 months. The patients may choose to receive a second or third injection to induce further weight loss. 

 

What are the Pros & Cons of Gastric Botox?

 

Pros

  • Does not require any surgical intervention,
  • No stitches or wound dressings are needed,
  • Involves minimal risks and side effects,
  • Faster recovery compared to other weight loss procedures such as bariatric surgery,
  • Immediate return to the activities of daily living,

Cons

  • The results are temporary and may require follow-up sessions up to 18 months,
  • The amount of weight loss is relatively low compared to bariatric surgery,
  • Requires proper weight management after the procedure,
  • Low chances of success if the patient does not comply with the recommended dietary guidelines and exercise programs