Outsmarting Your Appetite

Nov. 25, 2005 — -- At 5 feet tall and 300 pounds, Candy Bradshaw was morbidly obese -- which made her five times more likely to have a heart attack -- and twice as likely to die young. As frightening as those statistics may be, they were no more daunting than the emotional pain Bradshaw's obesity caused her. An incident one day at her son's preschool drove that home.

"The children were in the corner laughing and I went over to see what they were laughing about. The kids had drawn a picture of this severely obese person and had written my name on it. And my son was absolutely devastated," Bradshaw told "20/20."

Over the years, Bradshaw had tried and failed at countless attempts to lose weight. She said she tried "the grapefruit diets, the low-carb diets, the low-fat diets, the all-water diets, the all-banana diets and whatever diet there was out there."

It seemed the only option left was gastric bypass surgery, but Bradshaw did not want to undergo such a major and risky operation. She felt she had run out of options and hope.

"It was a kind of quiet despair, because it wasn't where I wanted to be, but yet I settled for that," she said.

Meanwhile at Tufts-New England Medical Center in Boston, Dr. Scott Shikora had learned about a most unusual obesity therapy from Italy. The procedure was far less drastic than gastric bypass.

"I'm very excited," said Shikora. "I've been excited about it from the beginning, because it just has this feel of this great breakthrough -- a safer, better way of doing what we've been doing all these years."

Shikora learned that pacemakers -- like ones commonly used to treat heart problems -- were being attached to the stomachs of obese patients. And an amazing thing was happening.

"It reduces appetite. But unlike the other procedures, it doesn't change the shape or the size of the stomach," he said.

Shikora began to test the gastric pacemaker in American patients in a clinical trial in 1999. Bradshaw was one of the first volunteers for the study.

The device itself is similar to a heart pacemaker and about the size of a silver dollar. It is implanted in a one-hour procedure with general anesthesia. Surgeons use a laparoscope to make small holes in the abdominal wall down to the stomach and then attach two electrical wires right into the outer wall of the stomach. The wires send mild bursts of electricity throughout the stomach wall. The wires are powered by a battery in the pacemaker which is placed under the skin on the abdomen.

The result is that the stomach's nerves are stimulated, which fool wearers into thinking their stomach is full.

Bradshaw said she feels no pain or discomfort from the device. "I did not feel the pacer itself. I felt an intense fullness. If you kept eating once you reached that full feeling, then it did become extremely uncomfortable. I won't say I ever felt pain. I would just call it extreme discomfort," she said.

The pounds started to come off. A year later Bradshaw had dropped from a size 28 to a size 14. It's still a bit of a mystery how the pacemaker makes people feel less hungry. There are at least three possibilities:

However it works, it only controls appetite -- you still control what you eat.

"The pacer does not tell you what to put in your mouth," Bradshaw said. "There are several factors to weight loss, including the exercise, the nutrition and most importantly the emotional-spiritual aspect, I ultimately found out."

Bradshaw now watches what she eats, exercises every day, and she's digging deep into the emotional issues that fuel her appetite.

"It gave me the jump-start I needed to really take a look at the issues behind my obesity," she said.

After six years on the pacemaker, Bradshaw feels ready to tackle weight loss on her own.

"Once the battery is dead ... that will be the end of my participation in the study," she said.

In fact, no one knows how long patients need the gastric pacemaker in order to keep the weight off.

Some patients, like Charlie Trowbridge, a security guard at Tufts-New England Medical Center, are happy to have it for life. "It's working. I mean, I'm happy with it and don't want to lose it," he told ABC Medical Editor Dr. Tim Johnson.

Before he received the device, Trowbridge said, he simply didn't know when to stop eating.

When Trowbridge received his gastric pacemaker more than a year ago, he weighed 330 pounds. His obesity was crippling him. He'd sometimes collapse in the summer heat just mowing the lawn.

With the device, he noticed a change in his appetite right away. "I had a four-ounce steak and a salad, and I was saying, 'What did I eat that much for?' Because I was really uncomfortable," he said.

Now Trowbridge is exercising regularly and eating well. So far, he's lost 60 pounds and his waist size has shrunk from a 52 to a 42. His wife, Sandy, says he's a different person.

"He's happier, he's more outgoing." And, she added, he's a "much better husband."

But the gastric pacemaker isn't a miracle cure. It doesn't work by itself if you're not motivated to make lifestyle changes. So one big question remains for obesity experts. Who exactly should get this device?

"We know that there are people who lose large amounts of weight. The question is, can you pick those people out? Do you know who is going to lose weight? And that's the purpose of the study that's currently going on," said Dr. Louis Aronne, clinical professor of medicine at Weill-Cornell Medical College and former president of The Obesity Society.

The study is using a screening questionnaire to identify the people who can benefit from a pacer. Early results look positive -- some patients have lost 35 percent of their excess weight. And so far, the device has caused no deaths and seems remarkably free of complications. Currently in Europe it's being tested on people who are not obese -- just overweight.

Shikora says that could be good news for moderately overweight patients."There are millions of people with diabetes, with high blood pressure and other conditions that fall through the cracks -- not heavy enough to qualify for surgery. This device may fit very nicely into that category," said Shikora.

For Bradshaw, her future is already brighter thanks to the gastric pacemaker -- and a return to her son's classroom, as a new person.

"When the kids in the classroom saw me they were amazed," she said. "And I looked out at him and he was just so proud, and he said, 'This is my mom. Now you can draw a picture of her.'"

It's expected that the gastric pacemaker will go to the Food and Drug Administration after the first of the year, to begin the approval process.