BlueCross BlueShield of Tennessee Medical Policy Manual

Vagal Nerve Blocking Therapy for Treatment of Obesity


Vagal nerve blocking therapy for the treatment of obesity consists of an implantable device (e.g., Maestro┬« System) that delivers electrical stimulation to branches of the vagus nerve on the anterior abdominal wall.  The intent is to intermittently block signals to the intra-abdominal vagus nerve to disrupt hunger sensations and induce feelings of satiety. The Maestro system is intended for individuals with a BMI of 40 - 45 or with a BMI of 35 - 39.9 and one or more obesity-related health condition.




The evidence for vagal nerve blocking therapy consists of two industry-sponsored, randomized controlled trials and the primary efficacy outcomes were not met for either trial.


BlueCross BlueShield Association. Evidence Positioning System. (4:2021). Vagal nerve blocking therapy for treatment of obesity. (7.01.150). Retrieved September 9, 2021 from (12 articles and/or guidelines reviewed)

Ikramuddin, S., Blackstone, R., Brancatisano, A., Toouli, J., Shah, S., Wolfe, B., et al. (2014). Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the recharge randomized clinical trial. Journal of American Medical Association, 312 (9), 915-922. (Level 1 evidence)

Sarr, M., Billington, C., Brancatisano, R., Brancatisano, A., Toouli, J., Kow, L., et al. (2012). The EMPOWER study: randomized, prospective, double-blind, multicenter trial of vagal blockade to induce weight loss in morbid obesity. Obesity Surgery, DOI 10.1007/s11695-012-0751-8. (Level 1 evidence)

U. S. Food and Drug Administration. (January, 2015). Center for Devices and Radiologic Health. (PMA) Pre-market approval decisions for January 2015. Retrieved June 22, 2015 from




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