Is this medical bulimia?

Resultado de imagem para Photo by Lew Robertson/Getty

Photo by Lew Robertson/Getty

A new medical device enables the expulsion of stomach contents for weight loss. Are you feeling disgusted? Should you be?

Nitin K Ahuja is a gastroenterology fellow at Johns Hopkins University in Maryland. He received his MD from the University of Michigan. He lives in Baltimore.

Edited by Pam Weintraub

The AspireAssist could be the most intuitive weight-loss therapy ever proposed. It works as a feeding tube in reverse: with the aid of an endoscope and a tiny blade, a physician places an internal catheter into the stomach and pulls it out through the skin. Shortly thereafter, the patient wakes up and goes home with a circular plastic window into the belly. For the next several months, about 20 minutes after every meal, the patient affixes an external drain to this implanted skin-port and spills a good bit of his or her gastric contents directly into the toilet.

This intervention is the latest in a series of minimally invasive devices approved by the United States Food and Drug Administration (FDA) for the treatment of obesity. Its proponents cite data: there is no argument that ‘aspiration therapy’ helps people lose weight. Its detractors cite their revulsion: many argue that if one wanted to surgically induce an eating disorder, this would be the way. The tenor of grievances raised by both professional and lay observers has ranged from eye-rolling snark to complete outrage. For the bluntness of its method, this novel treatment strategy has struck numerous onlookers as ugly, reckless and dangerously transgressive.

These objections speak to a fundamental misunderstanding of obesity as a biological process. Indeed, the vocal anxiety over what constitutes morally acceptable intervention lays bare tacit and stubborn assumptions about weight as a reflection of character. The AspireAssist highlights an ongoing tension between two duelling narratives: obesity as a multifactorial epidemic, and obesity as a failure of will. A conscious acceptance of the former often masks a knee-jerk adherence to the latter, leaving the issue, at its roots, unresolved.

The steady rise in overweight and obese individuals on a global scale has been particularly noticeable since the mid-20th century, and a few sweeping cultural forces can help to explain it. The stage was likely set by industrialisation, which facilitated sedentary lifestyles and a progressive abundance of calorie-rich nourishment. More specific sociopolitical factors, such as income disparities, agricultural investment priorities and the recent ubiquity of highly processed foods, have also been scrutinised as drivers of obesity’s regional variation. These forces are pitted against metabolic tendencies that evolved over millennia in a very different milieu – that is, one of relative scarcity, where one ate when one could. In recent years, research into human physiology has provided a wealth of new insight about this system’s intricacy, variability and vulnerability.

The emerging science of weight gain has supported ‘the medicalisation of obesity’ – its configuration as a disease that should be addressed by healthcare providers in clinical spaces. This concept in turn has led to the development of a whole suite of dedicated obesity therapies over and above the conventional recommendation of diet and exercise. Multiple prescription medications are currently approved for weight loss. Bariatric surgery, in which parts of the stomach and small intestine are cut out and rearranged, dates back decades; it has become increasingly common thanks to improvements in technique and outcomes over time.

In an already crowded field of weight-loss therapies, however, there are no magic bullets: diets and drugs yield dividends that are often modest and temporary, while surgical intervention is relatively expensive and can bring complications. Thus, a spate of novel alternatives, more aggressive than dieting but less invasive than surgery, have emerged. These include devices that occupy space inside the stomach, creating a sense of fullness;bypass sleeves that physically separate food from the intestinal tissue that would otherwise absorb; and, of course, the AspireAssist. All are predicated on the same understanding of obesity as a mechanistic problem worthy of a mechanistic fix.

In this era of medicalised obesity, however, a quiet moral calculus about weight management still operates in the background. Being overweight is stigmatised despite its rising prevalence. Even when the pounds are successfully shed, the method of doing so is itself subject to judgments of personal virtue. Social science research, for instance, shows that patients who lose weight through bariatric surgery are viewed as lazier and less competent than those who lose weight through diet and exercise alone. Because the AspireAssist seems to work through an even more rudimentary approach, it has ushered these lingering prejudices into the light and provides a valuable opportunity to interrogate them explicitly.

Aesthetic objections to the AspirAssist have been raised on a fairly general basis, as reflected by the number of headlines that describe it as ‘disgusting’. Use of the AspireAssist trespasses the body’s natural boundaries, revealing its private workings rather unceremoniously to the world. The mental image of chyme – the half-digested slurry of our meals as they enter the bowels – can be as viscerally unpleasant as that of emesis or faeces. Yet the artificial exposure of stomach contents seems to be uniquely bothersome to others in the context of this intervention, this condition…





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