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Israeli technology tackles obesity12/09/2007. Source: IVCJ (Israel Venture Capital & Private Equity Journal).
 There are 60 million Americans who are spending over $100 billion annually in the hope of winning their war against obesity, this IVCJ article states. Worldwide, the figure for overweight and obese adults is closer to one billion. In this IVCJ article Rachelle Gershovitz examines what Israeli companies are going to combat this weighty healthcare issue.
Why is obesity looming as the killer illness of the 21st century? Doctors point an accusing finger at our modern day lifestyles. People are eating more and exercising less. Food is cheap, available, and social pressure to "eat out" or indulge in processed fast foods with little or no health value has become the norm rather than the exception in our lives. Although the current medical guidelines urge us to be physically active everyday, most adults - and children, too - disregard this and therefore are becoming the new statistics of obesity.
But overweight is only the beginning of the problem. The complications associated with overweight, obesity and morbid obesity (measured as more than 100 pounds overweight) such as type two diabetes, cardiovascular disease, heart attack, and stroke among other health problems, are especially grave. The expenses involved in treating obesity and its related health dangers exceed $300 billion annually. And one more startling and thought-provoking figure - 300,000 Americans die every year from obesity and associated illnesses. As of now, there is no "miracle" procedure that can be considered a major breakthrough in the obesity impasse. So what does the future hold in store for the obese patient?
Dr. Mike Arad, CEO of StimPulse and ObesiTx, is confident that obesity can be beaten. "There are different ways technology is working around the clock to solve the problem of obesity," he explains, from his Herzliya office. "The current 'gold standard' treatment is surgical intervention. There are a variety of procedures used worldwide, such as gastric bypass, laparascopic gastric band surgery and surgically resecting the stomach, just to name a few. But surgery has its drawbacks. We are talking about very complicated, irreversible procedures that reshape the anatomy of the digestive system. And we can't overlook the fact that surgery is very expensive. In the US, there are 200,000 such operations annually, but there are over five million obese Americans who hesitate to turn to surgery as their dream cure. Anything that is life-threatening cannot be considered a preferred solution."
Then what about diet drugs? Arad is emphatic. "There are companies working on drug solutions, but it's a very long march. It can take 15 to 20 years until one knows just how the drug works and if it is really effective. An added problem is the commercial aspect. Obesity in many cases is a chronic disease. For a relatively young patient who will be forced to take drugs for the rest of his life, the cost of buying these pills is prohibitive." Are there any other solutions? Arad smiles. With good reason. StimPulse and ObesiTx are both committed to anti-obesity solutions that seem to be straight out of a science fiction novel. Both companies are in the early development stage and part of the Meytav Technological Incubator. Kibbutz Lahav hosts the animal lab, where testing is being carried out on pigs - whose digestive system is very similar to the human one - that weigh at least 45 kilograms.
StimPulse uses electrical stimulation applied to the digestive system. The electrodes and sensors are implanted in a minimally invasive manner over the peritoneum, without actually penetrating the abdominal cavity. Since all the organs in our body, including the stomach, are connected with the central nervous system, when food is ingested, the sensors begin their work, stimulating the receptors and telling the brain: You don't need to send anything, I'm full.
Sounds far-fetched? Arad doesn't think so. "I find it fascinating. We have recruited two of the top leading bariatric surgeons in America, Raul Rosenthal, Medical Director of The Bariatric Institute of the Cleveland Clinic, and Professor Shikora from the Taft Medical Center in Boston. They are both leading opinion leaders who are intrigued by our findings and will be working closely with an enlarged scientific advisory board, consisting of Japanese, Chinese, American and European experts in the field of endoscopy and electrical stimulation."
Electrical stimulation is not the only extraordinary process that StimPulse is working on. Another study is being done on the chewing system. Instead of implanting electrodes to the stomach, Arad's company is focusing on the moment food enters the mouth and is being chewed, which is the focal start of the digestive system. Arad's theory is this: If we reduce - or limit - the chewing ability of obese patients, they will automatically be consuming less food. This second approach by StimPulse will program the amount of chewing "permitted." Furthermore, the program will calculate how much protein and carbohydrates the patient has already ingested, so as to "allow" him more chewing if he has not received his daily quota of nutrients.
ObesiTx is Arad's second company dedicated to finding a cure for obesity. Using outpatient endoscopic procedures which are less invasive and less costly than surgery in a hospital, ObesiTx plans on reducing the volume of the stomach by inserting an implant inside, via the mouth and esophagus. Once it reaches the stomach it will attach to its walls and reduce the stomach size or create "pouches." Since many obese patients complain that after eating they still do not feel "sated," and therefore continue eating, and eating…. this procedure, by shrinking and causing pressure on the stomach, will provide a "sated" feeling long before ingesting huge amounts of fat and calories. Dr. Raul Rosenthal: "When the stomach is full and stretched, it releases signals and hormones to the brain. Once you have a small pouch instead of the full volume stomach, these signals will be achieved much earlier."
Are StimPulse and ObesiTx the forerunners of a new approach to dealing with obesity? Dr. Rosenthal picks his words carefully. "When we say "obesity", we are talking about 30 percent of the American population, and another 11 percent who are morbidly obese. Unfortunately, obesity is spreading all over the world. I can see the Israeli technology handling certain degrees of obesity, but the magnitude of this illness is so great that I can't see it being able to handle all of it. Time is of the essence, and the Israeli companies are only at the trial stage. It will be another 10, or even 15 years, before they will be able to try it on humans. Until that time, we must save as many obese patients as possible." How? "Through surgery. I see nothing life-threatening in a surgical operation, carried out by a trained surgeon. It's safer than driving a car - especially in Israel!"
Yaffa Beck, CEO of ObeCure, located in Ramat Gan, disagrees. "Surgery is so dangerous. It's a highly invasive procedure with medical dangers. Many turn to surgery because they are desperately trying to lose weight. This only goes to prove just how desperate people are, and how difficult it is for them to deal with their obesity."
Beck offers a different option - OBE101, ObeCure's lead drug candidate comprised of betahistine, which has been used for years to treat vertigo sufferers. It was taken off the market because of lack of efficacy. However, Israel-born Dr. Nir Barak, ObeCure's Chief Scientific Officer, made a remarkable discovery - betahistine was greatly effective in weight loss and in effecting a reduction of fat intake. "Nir conducted a pilot study with 20 obese women. He looked at both parameters - weight loss and caloric intake. He discovered that not only did the women lose weight, but they also had less cravings for fat." Presently, ObeCure is preparing for clinical tests in the US and Canada. The first will include 280 men and women in 20 investigative sites throughout the US.
Beck: "We are very excited about this study, as it will validate our claims that betahistine effectively causes weight loss, plus has a positive impact on fat intake. And then, of course, there are the additional parameters that boggle the mind even to think of them - if the drug affects fat intake, as we claim it does, then think of the effect it will have on a stream of health disorders, like those involving cholesterol, LDL, HDL, lipids, and other fat-related diseases."
The second study will be held in seven different sites in Canada, but will be unlike the US one. Beck: "This study will be dealing with psychotic disorders and weight gain. A significant percentage of the population suffers from obesity not because of caloric intake, but because they are being treated for psychotic disorders, such as schizophrenia. The anti-psychotic drugs most often prescribed - risperidone (Risperdal®) and olanzapine (Zyprexa®), lead to rapid weight gain, as much as a kilo a week. They not only interfere with patient compliance to take the drug, but can also lead to other diseases, such as diabetes. In this study, we will be giving them our drug on top of their anti-psychotic drugs in the hope that the weight gain will be avoided. Obviously, it is much easier to prevent weight gain than to treat it after it happens." According to Beck, the anti-psychotic drugs block histamine receptors, thus causing the weight gain. ObeCure's drug does just the opposite - it activates the histamine.
A third study will be conducted by the National Institutes of Health in their own facilities. Beck: "They have a huge interest in the drug. They want to understand how it works, and why it has such a powerful effect on energy consumption."
What about side effects of the drug? Yaffa Beck is emphatic. "This drug has been on the market for 30 years, treating more than 130 million people worldwide without any side effects." According to Beck, all three classes of drugs currently available on the market and proven to aid in weight loss - phetamines, those that inhibit the absorption of fat in the intestines, and sibutramine - cause undesirable side effects.
Yet another Israeli company with a unique view towards combating obesity is Brainsway. Founded by Uzi Sofer and Avner Hagai in January 2003, this Jerusalem-based firm uses TMS - Transcranial Magnetic Stimulation, a non-invasive technique used to apply brief magnetic pulses to the brain. The pulses are administered by passing high current through an electromagnetic coil placed upon the patient's scalp. The Brainsway team is planning two different studies. One will research feeding regulation centers within the brain, and the second study will test the effects of deep stimulation in controlling food cravings. At present, the company's clinical trials are focused on depression, schizophrenia, autism, Alzheimer's disease and bipolar disease, but obesity will be next in line within the coming years.
In January, 2007, Brainsway went public, raising NIS 33 million. According to Sofer: "The money will be going towards clinical trials this year for Israel, Europe and the United States. We already received authorization from the FDA as to the safety of our product." Dr. Yiftach Roth, chief scientist in the company, spoke glowingly of the new procedure. "The good news is that there are no side effects. There is no actual electrical contact with the body, just the coils on top of the skull. The FDA is always wary of new products. In our procedure, the problem of passing the blood brain barrier is non-existent, since the procedure is noninvasive and directly affects the brain, with no systemic effect." The clinical trials will be taking place five days a week in 15 minute sessions, and have generated widespread interest in the medical world.
And what does Mor Israeli, a clinical dietician preparing her doctorate at the Faculty of Medicine in Hadassah Ein Kerem, have to say about all the latest technologies?
"Unfortunately, I don't believe that any of the above mentioned technologies will have a lasting effect on an obese individual," she says flatly. "Companies are spending millions of dollars on new technologies, but I treat the patients who have taken diet pills, undergone gastric band surgery, have had their teeth wired, and after having had all their excess weight removed through these technologies, went back to their old eating habits and became obese once more." Why? "Because obesity is not caused by a huge appetite. It's either genetics, psychological problems, stress, or even boredom that are the causes." What is the solution? "Education. Educating new mothers and fathers so that they realize that they can make the difference by putting healthy food on their child's plate instead of junk food or processed meals. Educating children, teenagers and adults that exercise does not have to be at a ritzy health club or with expensive sports equipment, but rather it must be incorporated into our daily lifestyles. Get off a bus 10 blocks before your building and walk. Take the stairs and forget about the elevator. Instead of watching athletes play sports on TV, go to your backyard and act as if you are that athlete. In extreme cases, where surgery must be performed - as in the case of morbid obesity - I would recommend counseling many months before the operation, and counseling afterwards, in order to help the patient modify his outlook on eating habits, help him understand what comprises a healthy lifestyle, and in many cases, offer psychological help. CBT - Cognitive Behavioral Therapy, is recommended as one of the most efficient guidance plans that teaches the (previously) obese person that in order to lead a healthy life, it's not enough to have an operation done or swallow a diet pill. He must modify his destructive eating habits and add exercise as part of his daily regime - not for a day, week or month - but rather for each and every day of his life."
This article appeared in the Israel Venture Capital & Private Equity Journal (IVCJ). IVC Research Center publishes the Israel Venture Capital & Private Equity Journal, a quarterly review of trends and developments in the Israeli-related venture capital industry. IVCJ, distributed worldwide, is dedicated to provide wide-range coverage of Israel's venture capital industry. For more information please visit www.ivc-online.com.
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