Image-Guided Approaches for Management of Obesity in Interventional Radiology

Obesity affects over 40% of adults in the United States and is associated with major comorbidities, including type 2 diabetes, cardiovascular disease, and mental health disorders. While lifestyle modification and bariatric surgery remain foundational treatments, limitations such as access, cost, and procedural risk have driven interest in minimally invasive, image-guided alternatives. This review highlights recent advances in interventional radiology-based strategies for obesity management, with a focus on bariatric artery embolization (BAE), bariatric arterial radioembolization (BARE), and MRI-guided vagal cryoablation. These techniques act peripherally, modulating appetite via ghrelin suppression, vagal input, or local metabolic effects, and may offer synergistic benefits when combined with centrally acting anti-obesity medications (AOMs), enhancing weight loss durability while reducing medication burden. Additionally, image-guided procedures may serve as rapid, organ-sparing strategies for preoperative optimization in patients requiring time-sensitive surgeries such as joint replacement or organ transplantation, where even modest weight loss improves eligibility and perioperative outcomes. Together, these modalities represent a shift toward multimodal, personalized obesity care. As pharmacologic therapies continue to evolve, integrating image-guided interventions into multidisciplinary care pathways may expand treatment options and improve outcomes for patients with obesity.