The FDA approved, in mid-June, a new obesity device that seems to come from a medieval concept of how to prevent overeating. A tube is inserted into the stomach and the outside end fitted with a valve that can be opened or closed, sort of like a faucet. After eating, the patient opens the valve or faucet so the contents of the stomach can empty into the toilet (or a bucket or some container that can be washed out). The procedure is like throwing up to get rid of the contents of the stomach, but with this device you don’t have to gag. Just open the valve.
When I saw an announcement of this device I thought it was a hoax or something thought up by people who compete in ‘all the hot dogs you can eat’ contests. But no, the device, called AspireAssist, is recommended for those who cannot control their food intake. Instructions for its use are quite specific: At least 20 or 30 minutes have to elapse between the completion of a meal and the emptying of the stomach. This is to make sure that some nutrients and calories are passed into the intestines where they are absorbed into the body. If the stomach was emptied immediately, the result would be similar to starvation. Moreover, the binge eaters and others with eating disorders such as anorexia are not to be allowed to use the device, as it would only enable such individuals to continue on with their disordered eating. And it is not to be used for a short period of time like a few weeks. It is not the modern day equivalent of the way Roman nobles would eat at one of their banquets when, if they had eaten to their full, they would disgorge the contents of their stomach (there really is no way of saying this euphemistically) so they could feast all over again. This means that you cannot take this device with you if you are going on a cruise, for example, and want to make sure that you are eating enough to justify the cost of the trip.
The FDA is limiting use of the device to patients who are obese with a body mass index of 35 to 55, and who are unable to lose or maintain their weight loss through non-surgical interventions. In clinical trials of the device, it was very effective in supporting weight loss in this very obese population. After a year, patients using the stomach-emptying device lost 12 percent of their weight compared to control patients who lost 3.6 percent. The amount of weight loss is less than what is typically found among people who have had bariatric surgery such as the gastric sleeve. There are many obese patients who have too many health problems to risk having general anesthesia, yet their obesity is so severe that unless reversed it will shorten their life. An acquaintance who must be at least 250 pounds overweight can barely walk, and now has been diagnosed with a heart problem. She is unable to lose more than 10-15 pounds even when living in a residential weight-loss clinic and would be a candidate for bariatric surgery except for her cardiovascular problems. So perhaps a tube that empties partially digested food from the stomach into a pail might help her.
Safety features are built into the use of the AspireAssist device to make sure it is not abused by, for example, someone who sees it as a way of eating unlimited quantities of everything. It can only be used for a certain number of ‘drains’ and then will stop working. The patient must return to the physician who inserted it to get a replacement part and be evaluated for weigh-loss progress.
Aside from the mechanical disposal of food that otherwise would contribute unneeded calories, how will the patient benefit from this new obesity device? Ideally, food intake, or perhaps the frequency of eating, might decrease. Stopping for coffee and a pastry or piece of pizza while shopping is tempting, but the mechanics of draining the stomach in a small bathroom stall in a mall could be awkward. Also, there is the time factor. Does one go out to eat with friends and then on the way home, thirty minutes after dinner is over, look for a public restroom? Maybe there is a manual that comes with the device that answers these pesky questions.
But an obvious question remains: Why would a device, really a plumbing tool, that removes food from the stomach affect how the brain controls eating? If eating is an almost automatic response to stress – and who doesn’t have stress – this response is not going to be altered by draining the stomach. If eating is a response to lack of sleep, or boredom, or too much work, or too little relaxation time, how can a device that removes semi-digested food in the stomach change this? In a sense, allowing the stomach to feel somewhat empty after the food is removed may promote another bout of eating as it did with the Romans.
There has to be a better way to allow fewer calories into the body. A tapeworm perhaps?