Nature：有人靠“胃折叠术”告别司美格鲁肽，“肠道加热”真能逆转代谢？

Core Insights - The article discusses the challenges faced by millions who stop using GLP-1 weight loss drugs due to side effects, high costs, or supply issues, and highlights emerging alternatives for weight management [11]. Group 1: Demand for Alternatives Due to GLP-1 Drug Discontinuation - GLP-1 drugs like Semaglutide (Ozempic, Wegovy) and Tirzepatide (Zepbound) have a high discontinuation rate of 37% to 81% within the first year [12]. - Patients are seeking sustainable alternatives due to unstable drug supply, annual costs averaging tens of thousands of dollars, and side effects like nausea [12]. - The popularity of GLP-1 drugs has led to renewed interest in traditional weight loss methods, creating a new treatment paradigm of "drug initiation followed by diverse follow-up" [12]. Group 2: Innovations in Surgical and Endoscopic Techniques - Traditional weight loss surgeries, such as gastric bypass and sleeve gastrectomy, have shown long-term weight loss effects of 30% to 50%, but global surgical penetration remains below 1% due to patient concerns about surgical trauma [13]. - The 2022 international guidelines lowered the BMI threshold for surgery, and institutions are exploring "drug-surgery sequential treatment" to enhance outcomes [13]. - Endoscopic techniques are gaining attention, such as Endoscopic Sleeve Gastroplasty (ESG) and Gastric Mucosal Ablation (GMA), which are less invasive and have shown promising results [14]. Group 3: Challenges in Popularization and Payment Systems - Despite the potential of endoscopic techniques, their global adoption faces challenges, including limited insurance coverage and the need for standardized operational techniques [16]. - The average out-of-pocket cost for ESG is approximately $6,000, and GMA is not yet covered by insurance [16]. - Establishing multidisciplinary weight management centers is being promoted to integrate drug, endoscopic, and surgical resources, enhancing overall treatment quality [16].