10 Reasons to be optimistic about Medtech IPOs in 2015

In 2014: Medical Device IPO Revitalized!  Predicting: 2015-2018 as Medtech IPO wave
 

Revitalized medical technology IPO market has captured the imagination of many new issuers and venture backed med-tech sector. The there were as many completed medtech IPOs in the last six months

as in the prior five year.

As we approach the beginning of 2015, the medical technology IPO market is showing signs of life following a six-year coma. This long-anticipated development is a result of the following:

1.     FDA has approvals  more medical devices in the last year. Medtech sector has a more predictable regulatory path than biotech and pharma.

2.     Increased demand of US made medical devices in the emerging markets.

3.     International investors are understanding the business of life sciences and it value in the IPO market place.

4.     Unrealistic valuations of IT sector. 

5.     Medical Device IPOs are more value as they can generate more milestone fairly quickly. Outside US market for medical devices is growing.

6.     IPO market of 2010 to 2014 has been so heavily weighted toward biopharma. In the last six years, biopharma IPOs have outnumbered medtech IPOs by a factor of 10 to 1. Institutional investors have expressed an interest in rebalancing their portfolios with new medtech companies targeting variety of diseases. Obesity, Diabetes, Metabolic Syndrome, Cardio-vascular, ENT, Women’s health, Spine and Orthopedics.

7.     With many existing public companies coming off of spikes in their stock price and looking richly valued at higher-than-normal trading multiples, investors are pleasantly surprised by the return potential of this new wave of medical device IPOs.

8.     Many top-notch, emerging-medtech IPO candidates have overemphasized M&A as “Plan A,” believing that the acquisition valuations and back-end earn out structures would be far more attractive than the corresponding public values. Besides, it takes a certain conviction to be the guinea pig who lines up first to go public. That hurdle has been overcome.

9.     The return of the medtech IPO market arguably could have been started in 2012. Many believe that the public markets were ready and willing to invest in medtech IPOs for quite a while. However, as often is the case, it is difficult for private companies to control their M&A destiny and a subset of these companies are now embarking on “Plan B,” the IPO.

10.  The there were as many completed medtech IPOs in the last six months as in the prior five years.The medical device valuations are strong and realistic.

In 2014: Medical Device IPO Revitalized! Predicting: 2015-2018 as Medtech IPO wave

1)      In 2014: Medical Device IPO Revitalized!  Predicting: 2015-2018 as Medtech IPO wave

Revitalized medical technology IPO market has captured the imagination of many new issuers and venture backed med-tech sector. The there were as many completed medtech IPOs in the last six months

as in the prior five year.

As we approach the beginning of 2015, the medical technology IPO market is showing signs of life following a six-year coma. This long-anticipated development is a result of the following:

1.     FDA has approvals  more medical devices in the last year. Medtech sector has a more predictable regulatory path than biotech and pharma.

2.     Increased demand of US made medical devices in the emerging markets.

3.     International investors are understanding the business of life sciences and it value in the IPO market place.

4.     Unrealistic valuations of IT sector. 

5.     Medical Device IPOs are more value as they can generate more milestone fairly quickly. Outside US market for medical devices is growing.

6.     IPO market of 2010 to 2014 has been so heavily weighted toward biopharma. In the last six years, biopharma IPOs have outnumbered medtech IPOs by a factor of 10 to 1. Institutional investors have expressed an interest in rebalancing their portfolios with new medtech companies targeting variety of diseases. Obesity, Diabetes, Metabolic Syndrome, Cardio-vascular, ENT, Women’s health, Spine and Orthopedics.

7.     With many existing public companies coming off of spikes in their stock price and looking richly valued at higher-than-normal trading multiples, investors are pleasantly surprised by the return potential of this new wave of medical device IPOs.

8.     Many top-notch, emerging-medtech IPO candidates have overemphasized M&A as “Plan A,” believing that the acquisition valuations and back-end earn out structures would be far more attractive than the corresponding public values. Besides, it takes a certain conviction to be the guinea pig who lines up first to go public. That hurdle has been overcome.

9.     The return of the medtech IPO market arguably could have been started in 2012. Many believe that the public markets were ready and willing to invest in medtech IPOs for quite a while. However, as often is the case, it is difficult for private companies to control their M&A destiny and a subset of these companies are now embarking on “Plan B,” the IPO.

10.  The there were as many completed medtech IPOs in the last six months as in the prior five years.The medical device valuations are strong and realistic.

Small, rich and overweight: How Abu Dhabi is tackling its obesity problem

ONE OF THE most ambitious plans to combat chronic diseases is being introduced in Abu Dhabi, the biggest state in the United Arab Emirates. Nearly one in five of the UAE’s population is diabetic. Abu Dhabi is small enough and rich enough to tackle the problem comprehensively. A top-down political system helps.
In 2006 the emirate recruited Oliver Harrison, a psychologist and then a consultant at McKinsey, to its new health authority to help tackle chronic disease. When the government launched a health-insurance scheme in 2008, all adult Emiratis were offered a comprehensive health screening. By May 2010 some 92% of them had enrolled in the programme. The results were alarming.
Thirty-five per cent of those screened were obese and a further 32% were overweight. These figures were similar to those in America, but, worryingly, Emiratis were fatter at younger ages. Some 18% of those screened had diabetes and a further 27% were at high risk of developing it.
Patients are asking for less invasive surgery as treatment options. Surgeons are looking at less invasive solutions like the treatment from USA. Like the Onciomed, Gastric Vest System (GVS  system). GVS system is in clinical trials in Asia and Latin America.
Also, there are request for gastric balloon in younger patients who are in late teens. GVS request are from patients who are over 18 and up to 60 years. This product is in clinical trial and already there are patients wanting to get this procedure. For more details go to: www.onciomed.com
More Emiratis are looking for investment opportunity in obesity and diabetes. Typically, companies tackling large healthcare needs tend to be very lucrative.

MedTech Fund

Medtech Fund is an investment outfit created for physician and life science entrepreneurs, The fund's goal is to register over 1000 accredited physician investors. The analyst at Medtech fund explores the deals and offer up to 3 deals to the registered physicians.  All phyicians act as independent investors. Medtech Fund is an enabler, to bring new cutting edge technology descritely to its exclusive members in for a small fee. No management fees are associated with the fund.

Kara Reed is the key medical technology analyst associated with the fund.

Medtech fund has successfully invested in 8 deals to date. The deals range from $2M to $10M.

The process: Entrepreneurs  are requested to send non-proprietary information such as:
a) Executive summary
b) Current sales and future sales projections
c) If company is revenue +ve. Then sales numbers and details.
d) Team and their profiles
Medtech fund is very descrete and does not share information with anyone until the interest is developed and all due diligence is done. This is what makes the fund special for the investors and members. The fund is not a venture capital firm and act like a special family office and offers its exclusive members the privilege of discrete investment  does not post details on the web.

For Physicians:
The medtech fund selects investors based on their interest and their appetite for risk. Investors typically invest $250,000 to $500,000 per deal. The minimum investment can be $100,000.
Fund focuses on Medical devices, life science IT and healthcare IT.
Companies range from start ups to revenue positive companies.

Bariatric Surgeries Increased by 300% in 2012-2013

The number of bariatric surgeries performed on obese Canadians rose by 300 per cent in recent years, a new report suggests.

The number of these surgeries performed in 2012-2013 across the entire country was just under 10,000 according to an obesity expert.
With one million Canadians meeting the eligibility criteria for bariatric surgery, the number of surgeries performed is a drop in the bucket. Dr Freedhoff suggested that while the surgery counts will continue to rise, bariatric surgeries cannot solve the country's obesity problem. Currently, the lap band is a popular procedure. Newer procedures are awaited. One such technology is GVS from Onciomed, Inc. Onciomed has a technology called the gastric vest system that imitates gastric surgery without cutting and removing portions of the stomach. The number of bariatric surgeries are expected to double by 2015. Once technologies like the GVS system from Onciomed  and the endo barrrier from GiDynamics is introduced in Canada the number of procedures will increase exponentially. The primary reason is these technologies can be minimally invasive and yet have the opportunity to lose weight.

"We clearly will never have the capacity in Canada to help all of those who would qualify for bariatric surgery with bariatric surgery," say Freedhoff, an assistant professor of family medicine at the University of Ottawa and founder of Ottawa's Bariatric Medical Institute, a nutrition and weight management centre.
"We are not going to cut this problem away.". The answer to this problem is to bring less invasive technologies. Endobarrier is for Gastro-enterologist while Onciomed'd GVS system is for bariatric surgeons.

The figures were contained in a report on bariatric surgeries released Thursday by the Canadian Institute for Health Information. It covers the seven-year period from 2006-2007 to 2012-2013.
The report only captures surgeries performed by provincial health-care programs. So gastric bypass surgeries that were paid for by individuals or which were done outside of Canada would not be included.
Figures on three main types of gastric surgeries were included in the report: gastric bypass, where the size of the stomach is reduced and part of the small intestine is bypassed; sleeve gastrectomy, where 80 to 85 per cent of the stomach is removed; and adjustable gastric banding, where a band is placed around the upper portion of the stomach, limiting its capacity. Of the three, gastric bypass is the most commonly performed. Surgeons are requesting the government to approve newer technologies quicker to make it available for patients who do not want to be subjected to cutting and removing portions of the stomach and the intestines. Some of these private companies get acquired by larger firms for a very large premium and it takes forever for the large medical technology companies to introduce the product to the market.
Most of the increase in procedures occurred in Ontario, which went from 297 operations at the beginning of the study period to 2,846 in 2012-2013.

In fact, about 80 per cent of the 2012-2013 surgeries were performed in Ontario and Quebec. The provinces with the highest obesity rates -- the four Atlantic provinces, Manitoba and Saskatchewan -- performed less than eight per cent of the bariatric surgeries recorded in Canada in 2012-2013.
Women made up nearly four out of five people who got bariatric surgery in Canada, with the typical patient being a woman in her 40s with obesity and related conditions such as diabetes, high blood pressure or sleep disorders.
Freedhoff believes bariatric surgery should be part of the "constellation of care" used to deal with obesity. But he said it is not the most pressing issue related to obesity in this country.
"Really, what we need to look to is: Why are so many Canadians struggling with their weight?"
Canadian life is like a perfect storm for inciting weight gain, he suggested. Food advertising is ubiquitous, and foods are engineered to appeal to the taste buds rather than simply nourish.
"The 'bet you can't eat just one' phenomenon is a very real and engineered phenomenon," he said, referring to the tag line of a commercial for a popular snack food.
"It is not a personal choice. People aren't going to bed wanting and hoping and planning to continue to gain weight or not to lose. Quite the opposite. ... This is not something people desire or strive for. And if guilt and shame and desire were sufficient to lead people to sustainably lose weight, the world would be thin."

Technologies mentioned in the article: Gastric Banding, Onciomed's GVS system, Endobarrier by GiDynamics, Sleeve Gastrectomy uses J&J & COVIDIEN (Now Medtronic) staplers.

Obesity Epidemic in Canada 2014: Demands for treaments create new market for new obesity technologies and innovations

Obesity in Canada is a growing health concern, which is "expected to surpass smoking as the leading cause of preventable morbidity and mortality … and represents a burden of Can$3.96 (US$4.16/€2.85) billion on the Canadian economy each year.
Canadian waistlines are expanding, and the global recession is partly to blame, according to a new report from the Organization for Economic Cooperation and Development.
The latest findings show 25 per cent of adult Canadians are obese. That's higher than the average rate of obesity among OECD countries (18 per cent). Still, the report notes Canada's rate of increase is one of the slowest in the group of 34 countries.
Children in Canada registered the same obesity rate as their adult counterparts — also higher than the OECD average.

The first National Obesity Summit was held May 7–10 at the Delta Lodge in Kananaskis, Alberta. This was Canada's first "all-obesity" meeting and was a huge success. Almost 500 delegates attended the conference, which surpassed the venues capacity. Researchers, practitioners and other stakeholders from a wide range of disciplines and interests came to Kananaskis to share with and learn from their peers in a unique and interactive environment. The oral presentations, poster sessions, workshops and seminars represented a fascinating cross-section of thought and novel findings on many of the key issues in obesity today. Plenary Sessions included: 1) Obesity and Mental Health, 2) Behavioural and Biological Determinants of Obesity, 3) Obesity Management and 4) Health Economics & Policy of Obesity. Please see the final programme for further details.

The 4th National Obesity Summit will take place in Toronto, Ontario from April 28 - May 2, 2015

There are many lap band clinics in Canada. The challenge is what's next?

The next technologies are: 

When diet, exercise and pills dont work, patients will try products that are inserted via mouth into the stomach by a GI doctor. The products can be intra-gastric balloon which is a glorified breast implant stuffed in the stomach to fill the stomach. Patients can lose up to 20 lb to 30 lb in period of 6 months. This implant has to be removed after 6 months. Patients typically gain the weight back.

The makers of the balloon include: Reshape Medical, Obalon and Apollo.

Other technologies include a plastic liner that lines the intestines called endobarrier. A Gi doctor is trained to insert this product. One of the popular procedure is called endo-barrier which is made by GiDynamics. 

Bariatric surgeons are not trained GI doctors so conducting procedure via mouth can put their practices at risk in the US. Outside US doctors can cross train, but respective medical specialty associations want to reserve the technique for themselves.. triggering a turf war.

Gi doctors are not laparoscopic surgeons so cannot insert a gastric band.

Similarly, plastic surgeons are not qualified bariatric surgeons or obesity surgeons and therefore cannot treat obese patients with gastric band technology. Gastric band is reversible technology that acts like a speed breaker for food consumption. Gastric band is approved by the US FDA  for bariatric surgeons. The device is a silicone implant that is tied around the top portion of the stomach.  Patients are known to lose weight over time and if not complied to, can lead to weight regain. The companies that make a gastric band is: Apollo and J&J

There are some versions of this technology called the Minimizer ring.

Bariatric surgeons or obesity surgeons are also qualified to use a device called endo-stapler. This device staples and cuts tissue at the same time.

Staplers are made by two companies: J&J and Covidien. Both companies are leaders in obesity space.

A surgeon will cut portions of the stomach and intestines and remove it permanently. The procedure is called Gastric bypass and Sleeve gastrectomy. "tomy" means "CUT". It sounds terrible, but believe it or not, bariatric surgery is the most effective form. Also the most lucrative for surgeons. 

Recently, new reversible technology promises to imitate gastric surgery without cutting portions of the stomach is gaining popularity. Product is called Gastric Vest System made by a company called Onciomed.  Typically, technologies like the gastric band and the GVS are taken over by one of the large companies even before it can hit the market. The GVS product is in clinical trials in Latin America.

As the turf battle for obesity patients increases between GI doctors and Bariatric Surgeons. There is another quite battle raging between the large players wanting to be in the obesity space. These large companies are waiting for the oven to bake new technologies, ready or not these technologies will be acquired at a large premium. These new technology products are acquired to refresh the pipeline and capture market share or make a new entry into the obesity market.

Surprise players in this space could be: Medtronic and Boston Scientific . Medtronic has recently announced purchase of Covidien which is a maker of stapler technology, laparascopic instruments and has history of distributing gastric bands. Medtronic can play a big role in acquiring new technologies. It spends Billions of dollars to acquire new technologies.

Boston Sci recent history of swift acquisitions suggest that its aggressive acquisition strategy can lead them to become leaders in innovative technologies. Something J&J needs to worry about. Other nimble players can be Bard, Teleflex, Gore and even drug companies. 

Allergan a drug manufacturer purchased the maker of Lap Band and did well.

Obesity was recently identified as a disease by AMA and since them the large and small players in the drug, device industry are scrambling to take a spot in the innovation space.  Even FDA and international regulatory agencies are easing the approval process for such product that can help patients and reduce the burden on the health care system.

VCs and investors who were on the sidelines are starting to jump in. Several VCs were burnt with poor performance of Satiety and Vibrynt, Inc. Both technology had limitations and adoption issues. 

VCs are putting that experience behind them, some VC firms have raised new money and are looking to invest in obesity.  Suddenly, investors realize that obesity companies can offer multi X returns.

Several companies have lined up new products. My favorite amongst obesity innovations are:

Obesity Drug: Vivus Pharmaceutical Inc

Obesity Device for GI doctors: GiDynamics, Inc

Obesity Device for Bariatric Surgeons: Onciomed, Inc

Disclaimer: I do not have financial interest in any of the above companies. I independently evaluate companies that can help patients.

When diet, exercise and pills dont work, patients will try products that are inserted via mouth into the stomach by a GI doctor. The products can be intra-gastric balloon which is a glorified breast implant stuffed in the stomach to fill the stomach. Patients can lose up to 20 lb to 30 lb in period of 6 months. This implant has to be removed after 6 months. Patients typically gain the weight back.

The makers of the balloon include: Reshape Medical, Obalon and Apollo.

Other technologies include a plastic liner that lines the intestines called endobarrier. A Gi doctor is trained to insert this product. One of the popular procedure is called endo-barrier which is made by GiDynamics. 

Bariatric surgeons are not trained GI doctors so conducting procedure via mouth can put their practices at risk in the US. Outside US doctors can cross train, but respective medical specialty associations want to reserve the technique for themselves.. triggering a turf war.

Gi doctors are not laparoscopic surgeons so cannot insert a gastric band.

Similarly, plastic surgeons are not qualified bariatric surgeons or obesity surgeons and therefore cannot treat obese patients with gastric band technology. Gastric band is reversible technology that acts like a speed breaker for food consumption. Gastric band is approved by the US FDA  for bariatric surgeons. The device is a silicone implant that is tied around the top portion of the stomach.  Patients are known to lose weight over time and if not complied to, can lead to weight regain. The companies that make a gastric band is: Apollo and J&J

There are some versions of this technology called the Minimizer ring.

Bariatric surgeons or obesity surgeons are also qualified to use a device called endo-stapler. This device staples and cuts tissue at the same time.

Staplers are made by two companies: J&J and Covidien. Both companies are leaders in obesity space.

A surgeon will cut portions of the stomach and intestines and remove it permanently. The procedure is called Gastric bypass and Sleeve gastrectomy. "tomy" means "CUT". It sounds terrible, but believe it or not, bariatric surgery is the most effective form. Also the most lucrative for surgeons. 

Recently, new reversible technology promises to imitate gastric surgery without cutting portions of the stomach is gaining popularity. Product is called Gastric Vest System made by a company called Onciomed.  Typically, technologies like the gastric band and the GVS are taken over by one of the large companies even before it can hit the market. The GVS product is in clinical trials in Latin America.

As the turf battle for obesity patients increases between GI doctors and Bariatric Surgeons. There is another quite battle raging between the large players wanting to be in the obesity space. These large companies are waiting for the oven to bake new technologies, ready or not these technologies will be acquired at a large premium. These new technology products are acquired to refresh the pipeline and capture market share or make a new entry into the obesity market.

Surprise players in this space could be: Medtronic and Boston Scientific . Medtronic has recently announced purchase of Covidien which is a maker of stapler technology, laparascopic instruments and has history of distributing gastric bands. Medtronic can play a big role in acquiring new technologies. It spends Billions of dollars to acquire new technologies.

Boston Sci recent history of swift acquisitions suggest that its aggressive acquisition strategy can lead them to become leaders in innovative technologies. Something J&J needs to worry about. Other nimble players can be Bard, Teleflex, Gore and even drug companies. 

Allergan a drug manufacturer purchased the maker of Lap Band and did well.

Obesity was recently identified as a disease by AMA and since them the large and small players in the drug, device industry are scrambling to take a spot in the innovation space.  Even FDA and international regulatory agencies are easing the approval process for such product that can help patients and reduce the burden on the health care system.

VCs and investors who were on the sidelines are starting to jump in. Several VCs were burnt with poor performance of Satiety and Vibrynt, Inc. Both technology had limitations and adoption issues. 

VCs are putting that experience behind them, some VC firms have raised new money and are looking to invest in obesity.  Suddenly, investors realize that obesity companies can offer multi X returns.

Several companies have lined up new products. My favorite amongst obesity innovations are:

Obesity Drug: Vivus Pharmaceutical Inc

Obesity Device for GI doctors: GiDynamics, Inc

Obesity Device for Bariatric Surgeons: Onciomed, Inc

Disclaimer: I do not have financial interest in any of the above companies. I independently evaluate companies that can help patients.

- See more at: http://medicaldeviceipo.blogspot.com/search?updated-min=2014-01-01T00:00:00-08:00&updated-max=2015-01-01T00:00:00-08:00&max-results=18#sthash.J5RlRFCt.dpuf

When diet, exercise and pills dont work, patients will try products that are inserted via mouth into the stomach by a GI doctor. The products can be intra-gastric balloon which is a glorified breast implant stuffed in the stomach to fill the stomach. Patients can lose up to 20 lb to 30 lb in period of 6 months. This implant has to be removed after 6 months. Patients typically gain the weight back.

The makers of the balloon include: Reshape Medical, Obalon and Apollo.

Other technologies include a plastic liner that lines the intestines called endobarrier. A Gi doctor is trained to insert this product. One of the popular procedure is called endo-barrier which is made by GiDynamics. 

Bariatric surgeons are not trained GI doctors so conducting procedure via mouth can put their practices at risk in the US. Outside US doctors can cross train, but respective medical specialty associations want to reserve the technique for themselves.. triggering a turf war.

Gi doctors are not laparoscopic surgeons so cannot insert a gastric band.

Similarly, plastic surgeons are not qualified bariatric surgeons or obesity surgeons and therefore cannot treat obese patients with gastric band technology. Gastric band is reversible technology that acts like a speed breaker for food consumption. Gastric band is approved by the US FDA  for bariatric surgeons. The device is a silicone implant that is tied around the top portion of the stomach.  Patients are known to lose weight over time and if not complied to, can lead to weight regain. The companies that make a gastric band is: Apollo and J&J

There are some versions of this technology called the Minimizer ring.

Bariatric surgeons or obesity surgeons are also qualified to use a device called endo-stapler. This device staples and cuts tissue at the same time.

Staplers are made by two companies: J&J and Covidien. Both companies are leaders in obesity space.

A surgeon will cut portions of the stomach and intestines and remove it permanently. The procedure is called Gastric bypass and Sleeve gastrectomy. "tomy" means "CUT". It sounds terrible, but believe it or not, bariatric surgery is the most effective form. Also the most lucrative for surgeons. 

Recently, new reversible technology promises to imitate gastric surgery without cutting portions of the stomach is gaining popularity. Product is called Gastric Vest System made by a company called Onciomed.  Typically, technologies like the gastric band and the GVS are taken over by one of the large companies even before it can hit the market. The GVS product is in clinical trials in Latin America.

As the turf battle for obesity patients increases between GI doctors and Bariatric Surgeons. There is another quite battle raging between the large players wanting to be in the obesity space. These large companies are waiting for the oven to bake new technologies, ready or not these technologies will be acquired at a large premium. These new technology products are acquired to refresh the pipeline and capture market share or make a new entry into the obesity market.

Surprise players in this space could be: Medtronic and Boston Scientific . Medtronic has recently announced purchase of Covidien which is a maker of stapler technology, laparascopic instruments and has history of distributing gastric bands. Medtronic can play a big role in acquiring new technologies. It spends Billions of dollars to acquire new technologies.

Boston Sci recent history of swift acquisitions suggest that its aggressive acquisition strategy can lead them to become leaders in innovative technologies. Something J&J needs to worry about. Other nimble players can be Bard, Teleflex, Gore and even drug companies. 

Allergan a drug manufacturer purchased the maker of Lap Band and did well.

Obesity was recently identified as a disease by AMA and since them the large and small players in the drug, device industry are scrambling to take a spot in the innovation space.  Even FDA and international regulatory agencies are easing the approval process for such product that can help patients and reduce the burden on the health care system.

VCs and investors who were on the sidelines are starting to jump in. Several VCs were burnt with poor performance of Satiety and Vibrynt, Inc. Both technology had limitations and adoption issues. 

VCs are putting that experience behind them, some VC firms have raised new money and are looking to invest in obesity.  Suddenly, investors realize that obesity companies can offer multi X returns.

Several companies have lined up new products. My favorite amongst obesity innovations are:

Obesity Drug: Vivus Pharmaceutical Inc

Obesity Device for GI doctors: GiDynamics, Inc

Obesity Device for Bariatric Surgeons: Onciomed, Inc

Disclaimer: I do not have financial interest in any of the above companies. I independently evaluate companies that can help patients.

- See more at: http://medicaldeviceipo.blogspot.com/search?updated-min=2014-01-01T00:00:00-08:00&updated-max=2015-01-01T00:00:00-08:00&max-results=18#sthash.J5RlRFCt.dpuf

Obesity Epidemic Worldwide Has Created a Turf Battle Between Doctors, Pharma & Medcial Device  Manufacturers-May Lead to a M&A Frenzy

Over 400 Million people suffer from obesity Worldwide. The market may reach $139 Billion for medical devices in the US. 

US represents half of the world market. EU, Australia and Latin America are the hot beds for obesity.  

As the rest of the world worries about heart disease and Ebola. Obesity is killing over 300,000 people every year. Obesity is #1 preventable cause of death and causes heart disease, diabetes and 20 + morbidities.

Obesity treatments will be soon be treated by 3 specialist.

1) Bariatric Surgeon or Obesity Surgeon

2) GI Doctors

3) Bariatric Physicians.

Bariatric Physicians: Will be using drugs, exercise and counseling to treat obesity. New drugs are known to help patients lose 10% of extra weight. Probably not enough for patients who want to lose 50lbs. Popular companies in this catagory are Arena Pharma, Vivus Pharmaceuticals and Orexigen.

When diet, exercise and pills dont work, patients will try products that are inserted via mouth into the stomach by a GI doctor. The products can be intra-gastric balloon which is a glorified breast implant stuffed in the stomach to fill the stomach. Patients can lose up to 20 lb to 30 lb in period of 6 months. This implant has to be removed after 6 months. Patients typically gain the weight back.

The makers of the balloon include: Reshape Medical, Obalon and Apollo.

Other technologies include a plastic liner that lines the intestines called endobarrier. A Gi doctor is trained to insert this product. One of the popular procedure is called endo-barrier which is made by GiDynamics. 

Bariatric surgeons are not trained GI doctors so conducting procedure via mouth can put their practices at risk in the US. Outside US doctors can cross train, but respective medical specialty associations want to reserve the technique for themselves.. triggering a turf war.

Gi doctors are not laparoscopic surgeons so cannot insert a gastric band.

Similarly, plastic surgeons are not qualified bariatric surgeons or obesity surgeons and therefore cannot treat obese patients with gastric band technology. Gastric band is reversible technology that acts like a speed breaker for food consumption. Gastric band is approved by the US FDA  for bariatric surgeons. The device is a silicone implant that is tied around the top portion of the stomach.  Patients are known to lose weight over time and if not complied to, can lead to weight regain. The companies that make a gastric band is: Apollo and J&J

There are some versions of this technology called the Minimizer ring.

Bariatric surgeons or obesity surgeons are also qualified to use a device called endo-stapler. This device staples and cuts tissue at the same time.

Staplers are made by two companies: J&J and Covidien. Both companies are leaders in obesity space.

A surgeon will cut portions of the stomach and intestines and remove it permanently. The procedure is called Gastric bypass and Sleeve gastrectomy. "tomy" means "CUT". It sounds terrible, but believe it or not, bariatric surgery is the most effective form. Also the most lucrative for surgeons. 

Recently, new reversible technology promises to imitate gastric surgery without cutting portions of the stomach is gaining popularity. Product is called Gastric Vest System made by a company called Onciomed.  Typically, technologies like the gastric band and the GVS are taken over by one of the large companies even before it can hit the market. The GVS product is in clinical trials in Latin America.

As the turf battle for obesity patients increases between GI doctors and Bariatric Surgeons. There is another quite battle raging between the large players wanting to be in the obesity space. These large companies are waiting for the oven to bake new technologies, ready or not these technologies will be acquired at a large premium. These new technology products are acquired to refresh the pipeline and capture market share or make a new entry into the obesity market.

Surprise players in this space could be: Medtronic and Boston Scientific . Medtronic has recently announced purchase of Covidien which is a maker of stapler technology, laparascopic instruments and has history of distributing gastric bands. Medtronic can play a big role in acquiring new technologies. It spends Billions of dollars to acquire new technologies.

Boston Sci recent history of swift acquisitions suggest that its aggressive acquisition strategy can lead them to become leaders in innovative technologies. Something J&J needs to worry about. Other nimble players can be Bard, Teleflex, Gore and even drug companies. 

Allergan a drug manufacturer purchased the maker of Lap Band and did well.

Obesity was recently identified as a disease by AMA and since them the large and small players in the drug, device industry are scrambling to take a spot in the innovation space.  Even FDA and international regulatory agencies are easing the approval process for such product that can help patients and reduce the burden on the health care system.

VCs and investors who were on the sidelines are starting to jump in. Several VCs were burnt with poor performance of Satiety and Vibrynt, Inc. Both technology had limitations and adoption issues. 

VCs are putting that experience behind them, some VC firms have raised new money and are looking to invest in obesity.  Suddenly, investors realize that obesity companies can offer multi X returns.

Several companies have lined up new products. My favorite amongst obesity innovations are:

Obesity Drug: Vivus Pharmaceutical Inc

Obesity Device for GI doctors: GiDynamics, Inc

Obesity Device for Bariatric Surgeons: Onciomed, Inc

Disclaimer: I do not have financial interest in any of the above companies. I independently evaluate companies that can help patients.