Why you should care
Shantanu Gaur had a eureka moment during a nutrition class: The world is too fat, and he knew he could change it.
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It’s painful to watch people pick through the plunder at a salad bar. The mind says “salad,” but the heart says “bacon bits, cheese, ranch dressing and … screw it, switch to ice cream and call it a day.” The reality is we’re addicted to feeling bad about ourselves, and nowhere is this more evident than in how we feel about our weight. According to a just-released World Health Organization report, worldwide obesity has tripled since the late ’70s, and as recently as 2016, more than 1.9 billion adults were overweight.
Enter Dr. Shantanu Gaur, whose Allurion Technologies has raised $27 million in the past year as it gets ready for FDA approval of Elipse Therapy, a novel nonsurgical treatment for obesity: a pill that inflates a balloon in your stomach. It started back in 2010 when, as a Harvard medical student, Gaur took a nutrition class, with a focus on clinical trials with diets. It was an easy jump to make for a lifelong physical fitness and sports nut, growing up as the son of Indian immigrants to Canada and then western Pennsylvania. But when the discussion turned toward surgical options for obesity, the 31-year-old recalls, an idea began to take shape: There’s got to be a better way.
Most told us we were completely crazy. So the responses to our plans were really quite negative.
Dr. Shantanu Gaur
“We started to think, If you could occupy space in the stomach, then people would eat less,” Gaur says — the “we” referring to his classmate, Dr. Samuel Levy. Not an entirely new idea, considering that obese patients have for years resorted to bariatric surgery, gastric bypass, gastric bands and even balloons to reduce the size of their stomach.
But, according to Dr. Steve Ballinger, a surgeon and lifelong athlete, the complications from bariatric surgeries are significant. “Bowel obstructions, hernias and internal bleeding are not on many people’s to-do lists,” he says. “And people who are dead or dying tend to not have weight problems.” Which underscores the first of a few problems: These surgical solutions are complex. And with complexity comes cost. In only extreme cases is a medical response to obesity deemed necessary, which means most individuals pay for treatment out of pocket for non-extreme cases, ranging from $14,500 on average for a lap band to $23,000 for a gastric bypass.
Of course, there are the fitness mavens, from Charles Atlas to Richard Simmons, who preach that weight is a function of exercise and diet. “My training day starts at 5 a.m.,” says Doyle Childs, owner of Studio 360 Fitness, a high-end Silicon Valley sweatshop for the hardcore-minded, and a former fat man. “I make more time to train than I do to eat. A pretty simple arithmetic.”
Simple for some. “Weight gain and loss is pretty complex,” Gaur says. Why people eat, what they eat, genetics, age and class are just some of the free-floating change agents that can make or break even the best attempts to avoid obesity. And roads to avoiding obesity are littered with failed attempts. Which prompted Gaur to analyze the reasons why, only to be thrown back to the complex mesh of factors.
So he hit on something as crazily simple as it is infuriating. Simple because it involves the aforementioned balloon “technology” and infuriating because it’s probably something you could have thought of — but you didn’t.
Gaur and Levy conceived of a pill that, once swallowed, releases a balloon made of thin polymer film with a tube trailing behind it. As soon as it hits your stomach, about 2.5 cups of water mixed with preservative is pumped through the tube into the balloon. The tube is removed through the mouth, the balloon’s inflated and you’re left feeling full. Total elapsed time: 15 minutes.
Dr. Ioannis Raftopoulos, medical director at the Holyoke Medical Center Weight Management Program, was involved in the 2016 clinical trials for Gaur and Levy’s procedure in Greece (U.S. trials started this past February). He is not unaware that a pill of this sort poses a financial threat to his surgical business model. “I was attracted to the field not because of money but because of the relationship with the patients,” he says, ”and the fact that these procedures affect everything: diabetes, thyroids, weight loss, depression.”
Since meeting Gaur in 2014, Raftopoulos has done more than 50 placements for the clinical trials, and would have stopped after the first had he been unhappy with the outcome. What he liked most? “The simplicity,” Raftopoulos says.
“Four months later,” Gaur explains of the procedure, “the balloon is absorbed all on its own.” During which time, he continues, you have lost 10 to 15 percent of your body weight because your food intake has been drastically reduced. Simple, elegant and … widely derided.
“Most told us we were completely crazy,” Gaur laughs. “So the responses to our plans were really quite negative, save for a couple of individuals.” Which makes sense when you tally up how many quack claims are made by so-called specialists in the weight loss field.
Diets that work, then don’t. Pills that work, then really don’t. And, in the end, weight lost that doesn’t stay lost for long. But Gaur is undaunted, noting that obesity is a global “epidemic,” singling out northern Africa and the Middle East, where more than a third of the adult population is obese.
So, after the European Economic Area approved the procedure in 2016 with a CE mark for certain health and safety standards, and with U.S. trials currently underway, he looks at a field of two or three competitors offering variations on the gastric balloon theme who are already FDA-approved but whose systems involve surgery, and he feels sanguine about Allurion’s success. “Our procedure is nonsurgical,” Gaur repeats for emphasis. “And I expect it will be on the market in 2020.”
A few years won’t hurt — after all, obesity is an expanding dilemma. “Truth is,” says gym owner Childs, “my whole business model is built on the fact that more people are gaining weight than losing it, and they need help losing it.” Which is probably a load off of Gaur’s mind.