Abstract
Diet and exercise, except in controlled circumstances, have not been shown to provide effective and prolonged weight loss for the majority of those who are obese. Several older drugs intended to reduce weight have been withdrawn from the market, and the new drugs show only modest weight loss. Surgical intervention, specifically procedures that alter the normal gastrointestinal anatomy, does provide prolonged periods of sustained weight loss, with rebound weight gain over time. A variety of medical devices to assist in weight reduction have been studied, but only two are legally marketed devices for obesity. The authors propose a new paradigm for devices intended to treat obesity, based on a benefit-risk determination, with the hope to provide sponsors an a priori tool for systematic assessment of the risks associated with the devices intended for treatment of obesity and to suggest appropriate levels of benefit for devices with different risk levels. The paradigm is not intended to determine the class of a device from a regulatory perspective. This approach was conceived at a Food and Drug Administration (FDA) co-sponsored workshop in October, 2011 and formally presented to an FDA advisory panel for discussion in May 2012.
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Acknowledgments
The authors acknowledge the FDA Obesity Devices Working Group for their efforts in promoting the public health, especially in the area of obesity. The members of that group include the authors, Carolyn Neuland, PhD; Megan Shackelford, MS; David Pudwill; Kathleen Olvey; Martin Golding, MD; Priya Venkataraman-Rao, MD; Patricia Beaston, MD, PhD; Linda Dart; Martin Ho; and Benjamin Fisher, PhD.
Disclosures
Herbert Lerner, Joyce Whang, and Rebecca Nipper have no conflicts of interest or financial ties to disclose.
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Lerner, H., Whang, J. & Nipper, R. Benefit-risk paradigm for clinical trial design of obesity devices: FDA proposal. Surg Endosc 27, 702–707 (2013). https://doi.org/10.1007/s00464-012-2724-3
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DOI: https://doi.org/10.1007/s00464-012-2724-3