On Tuesday, June 14th, the Food and Drug Administration approved a new, highly controversial weight loss device called AspireAssist, which functions by allowing the user to "pump and dump" about one-third of their stomach contents straight into the toilet. The device includes a tube that goes from the inside of the stomach, running to a port on the outside of the body. The pump itself can be attached to the outside port as needed to remove stomach contents.
Clinical trials indicate that the pump is considerably effective with weight loss: The average patient saw a loss of 46 pounds lost in the first year and 50 pounds in the following year. However, the good press gave no mention of their change in critical nutritional markers such as electrolyte, vitamin and mineral levels. These levels could be expected to be off kilter as a result of side effects such as vomiting and diarrhea over a sustained period of time. Either of these bodily functions, even in the short term, can cause dehydration, throwing an individual's electrolyte balance off.
However, there may be an even more grave concern.
"The AspireAssist device should not be used on patients with eating disorders, and it is not intended to be used for short durations in those who are moderately overweight," the FDA said in a statement.
In my estimation, the lack of judgment and foresight in this approval is irresponsible beyond reason. This is not a gray area. This is crossing the line from medical intervention and "assistance" into the territory of enabling disordered behavior and purging pathology.
Others have made mention that the process smacks of "assisted bulimia" as well.
In defense of the opprobrium, Dr. Shelby Sullivan of Washington University in St. Louis, who helped test the AspireAssist told NBC News,"There is no such thing as medical bulimia or assisted bulimia. Bulimia is an eating disorder defined by overeating and then purging, often though forced vomiting. Patients eat less with this therapy then they did before. People think patients can eat whatever they want and then aspirate it and that's just not true. It has to be liquid enough and the particles have to be small enough to get through the tube."
When I read her rebuttal, I almost snorted coffee from my nose.
This is forced purging calories after eating, is it not? And the fact of the matter is, many obese patients — and candidates for this type of elective procedure — are compulsive overeaters, binge eaters in the habitual and pathological sense. Because this medical intervention can arguably be looked at as a "quick fix" and not necessarily a lifestyle change, most patients will not be deterred from continuing to eat in the quantities in which they are accustomed.
What I have just described to you is bulimia nervosa.
Compulsive overeaters and binge eaters (those with Binge Eating Disorder) are actually quite similar to bulimics in that they both typically consume large amounts of food privately, in a discrete period of time. Although Sullivan implies they are not, many potential candidates for AspireAssist are, in fact, eating-disordered because they meet the DSMV criteria for Binge Eating Disorder.
I'm curious what this medical doctor knows about eating disorders that makes her an authority to make an argument that bulimic behavior is so vastly different from binge-eating behavior. I'd also like to know how she thinks AspireAssist's methodology of purging calories bears such little resemblance to purging behavior in bulimia when the food eaten winds up in the toilet either way. But most of all, and likely most importantly, on what grounds can she guarantee that the patients won't overeat as they'd compulsively and habitually done for long enough to arrive at their weight in the first place?
Those who have established compulsions, obsessions and addictions do not stop behaviors without a multifaceted approach. Inserting a foreign object in an organ will not change the disordered behavior. It will only cause the disordered behavior to adapt and mutate so that it may live on and thrive.
Allow me to provide you a nearly analogous example in the scope of medical intervention concerning obesity:
When many obese patients have received gastric bypass surgery, they have experienced bulimic effects due to the continuation of the same binge-eating compulsions; due to the fact that the stomach now lacks capacity to hold the same large quantity of food in so short a span of time, they find themselves involuntarily regurgitating the food. This happened so often, that the vomiting became habitual and a part of the process, thus the vicious cycle of bulimia is formed by way of medical intervention.
And this isn't a one-off occurrence. All one has to do is Google the words "bariatric" and "bulimia" and their search results overfloweth.
According to Angela Guarda, director of the Eating Disorders Program at Johns Hopkins Medicine, in 2014 alone, eight percent of patients admitted to the Johns Hopkins Eating Disorders Program had a history of bariatric surgery. Some patients developed their eating disorder after their surgery, and others had a pre-existing condition that worsened after the procedure.
Janelle Coughlin, the director of obesity behavioral medicine at Hopkins, who also works with the Johns Hopkins Eating Disorder Program, confirmed that binge eating is the root problem prior to surgery. After surgery, physical reality limits the amount one can eat in a sitting, but she said that doesn't stop some of them from grazing all day long because the overeating habit is ingrained. Conversely, some develop anorexia or bulimia because they obsess over every calorie or utilize the vomiting after gastric bypass surgery advantageously and habitually.
Sullivan argued that AspireAssist would not lead to bulimia and that there is "no such thing as medically assisted bulimia." She says that by using AspireAssist, patients will reduce their overall intake because the food must be broken down into small enough particles to fit through the tube so it can then be aspirated into the toilet and flushed away.
OK, so...what? Chewing is what I am missing here?
It concerns me that one of their lead doctors considers her patients in control of their binge eating to the extent that she wouldn't characterize their eating behavior as disordered, although it is outlined as such by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Dr. Shelby Sullivan and her team would benefit from looking at the correlation between eating disorders and bariatric surgery because they are working with patients within the identical demographic. Arming themselves with the knowledge regarding how some of those situations played out could help them anticipate problems and perhaps even make this device safer and less likely to cause a secondary disorder.
If someone is absolutely required to use such a device for a life-sustaining purpose, say, in the event that they needed it to support their digestive system due to ostomy surgery, then I would be more than supportive. However, this device for weight loss is controversial at best, and dangerous at worst. It is absolutely triggering and harmful to the eating-disordered community in all stages of recovery.