Beyond Stomach Stapling: What's New and Better

Twenty years later, two doctors are picking up the thread. Robert Lustig, MD, a professor of clinical pediatrics in the division of endocrinology at the University of California, San Francisco, has been studying weight loss associated with the vagus. He's been severing the nerve surgically, but he has now teamed up with EndoVx, a startup company looking to block the vagus by "frying" it with an ultrasound machine. The product is still in development, but Lustig's research so far is promising. "We found that for the vast majority of those who were obese, severing the nerve spurred a loss of 20 percent of their excess weight."

EndoVx will have competition: Mark Knudson, a Minnesota-based physiologist, also plans to target the vagus nerve but by a slightly different method. Knudson's device, called Maestro, works like a pacemaker for the stomach. Two electrodes are laparoscopically placed on the vagus nerve, where they electronically disrupt the nerve's signals for five minutes and then pause for the same length of time before starting up again. Within nine months, studies show, patients can drop about 30 percent of their excess weight. The company is now recruiting for its last clinical trial, and if all goes well, that product will also be available by 2010.

With three of the five devices rolling out in the next three years, this race is just heating up. Whichever approach takes off, one thing is certain: Patients struggling with obesity have plenty to be hopeful about.

Sara Reistad-Long lives in New York and has written for Esquire and The New York Times.