Challenging the evidence based medicine principles among clinical obesity treatments

Obesity is among the greatest health problems worldwide. However, there is a certain lack in regard to objective evidence-based clinical therapeutic algorithms. The conservative therapy (lifestyle changes, pharmacotherapy) often fails to attain clinically significant weight lost. For this reason, more effective forms of treatment were developed (for example bariatric surgery or newly emerging field of endoscopic gastroenterological devices). The implementation of surgical therapy is marked with relatively narrowly stated indication parameters. The endoscopic methods showed promising results in weight loss, within satisfying safety profiles, although there are no clear defined positions of endoscopic devices in the treatment of obesity. Endoscopic treatment seems to be especially interesting as an alternative to surgery, because of significant surgical risk reduction. This review presents an analysis of the position of invasive treatments of obesity.