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UNITED STATES regulators recently approved a device, nicknamed the “stomach tap”, that allows obese people to drain part of the contents of their stomach directly into the toilet after every meal.
This is how the Food and Drug Administration (FDA) described the AspireAssist device’s operation when announcing the approval:
“Approximately 20 to 30 minutes after meal consumption, the patient attaches the device’s external connector and tubing to the port valve [which surgeons have installed on the abdomen], opens the valve and drains the contents. Once opened, it takes approximately 5 to 10 minutes to drain food matter through the tube and into the toilet.”
According to the manufacturer, users need to chew thoroughly to prevent blockages in the tube. “You get some solid chunks,” a company spokeswoman was quoted as saying in one report.
Unlike the FDA, the manufacturer avoids the use of words like “drain” in describing how the device works, instead saying that users need to “aspirate” after each meal. Which sounds so much nicer.
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I know obesity is a huge health issue, that it can be agonisingly difficult to overcome, and that diet and lifestyle interventions generally don’t cut it … but, seriously, what is wrong with us?
When I’m on the treadmill at my local gym, consuming fossil fuels to keep a band of rubber revolving so that I’m forced into physical activity, I find myself thinking our ancestors would be bewildered by the world we’ve created.
Lack of exercise and excess of kilojoules were not problems faced by most of our predecessors on this planet.
That remains the case for many. The United Nations estimates nearly 800 million people, spread across parts of Africa, Asia and Latin America, are chronically undernourished.
Those numbers have been improving in recent years, though who knows what lies ahead as the global population explodes, heading for a projected 12 billion by the end of the century.
The planet is already groaning at the effort required to keep today’s seven billion supplied with fast foods and smart phones.
But, hey, why not send a message that it’s okay to gorge on whatever we want without worrying about the consequences?
As long as we make sure to “aspirate” afterwards.
This might seem like just the next step on from bariatric surgery, which has become more accessible in recent years thanks to increased Medicare coverage for the procedure.
But there is at least one fundamental difference: bariatric surgery helps people to eat less, whereas the stomach tap could actually have the opposite effect.
That’s likely to be a real problem in parts of the world, such as the US, where weight loss surgery tends to be an option reserved for the wealthy.
In fact, part of the pitch from the manufacturers of the stomach tap is that it may be “affordable for patients who cannot afford bariatric surgery”.
In approving this device, the FDA noted the results of one clinical trial, which found an average loss over 1 year of 12.1% of body weight in 111 patients treated, compared with 3.6% for 60 patients in the control group.
Both groups received lifestyle therapy and, perhaps as a result, both showed small improvements in outcomes often associated with obesity, such as diabetes, hypertension and quality of life.
By comparison, this much larger longitudinal study of patients undergoing weight loss surgery found weight reduction after 1 year ranged from around 15% to nearly 35%, depending on the procedure.
In an ideal world, of course, we would not need either of these desperate measures.
Physical activity and healthy eating would be habits ingrained in us from childhood. In obesity, as in all things, prevention is better than cure.
Jane McCredie is a science and medical writer based in Sydney.
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Its not just diet and exercise. Off the top of my head…
1. Computer games (fault of the parent)
2. More protective parenting, where children are no longer ordered out of the house and told to come back before dark.
3. People no longer walking long distances to school (culturally, people used to walk a long way. I wonder if tolerance of body odor has changed over the years. People in those old photos with heavy suits.)
4. Air conditiioning at home (remember when hot weather made you feel sick (and eat less) and exhausted (because cooling oneself takes energy as you went to sleep with a damp washer on your head? What, didn’t grow up in Dirranbandi?)
5. Air conditioning at school (children will be less tolerant of heat at breaks, so will play less)
6. People born to much older mothers (and fathers) when the mother are more overweight. (this might be a really big deal).
7. The great variety of food: that tastes better (Would we be obese if all we ate were mutton, three veg, bread and jam?) (Sick of Thai, have Japanese, sick of Japanese, have Mc Donalds…)
8. Take-away food with both parents working.
9. People owning cars (in the 50s you could go on a date on the bus as adults, apparently!)
10. All the psychotropics I prescribe which are needed because…
11. Jobs are sedentary (and exercise is as effective as an antidepressant, apparently)
12. Corn syrip.
13. Better health care, so obese people don’t simply drop dead
It stands to reason that the increase in obesity is not due to lack of will power (I am not saying that you are saying that it is). Human nature is the same but weight has increased. It’s environmental, not moral.
It seems that Jane might actually be advocating for that most terrible of concepts (decried by the latte set at the ABC): personal responsibility……… Surely not 🙂
How dare anyone suggest that people who use the AspireAssist device can have ANY control over what they eat.
Maybe then, the “stomach tap” might represent the high water mark for the politically correct trend of describing everything and anything as merely a phenomenon.
“There but for the grace of god go I” is a saying we should all remember, and we should feel empathy for and want to help people struggling with obesity and other addictions. But we need a sensible middle ground between disease and moral fibre.
The fact that this device is effective in producing weight loss says something about the relationship of overeating and obesity in our society. There are other effective devices such as the Endobarrier duodenal sleeve which simulates a Roux -en-Y bypass and is removed after a maximum of one year. It is interesting that when one looks at weight loss surgery there is a tendency to gain weight after five years.
See http://link.springer.com/article/10.1007/s11695-007-9265-1 and
http://archsurg.jamanetwork.com/article.aspx?articleid=2422341
The question here is to what extent surgical type approaches can be used to address what is an emerging public health crisis in this country.
See http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia/
Surgical waiting list in Australia have been an issue for long time and if we went down the surgical route for tackling diabetes, an increase in surgical capacity of around 100,000 weight loss procedures per year would be necessary to keep surgical wating lists from blowing out further.
It is at this point that enhanced lifestyle interventions and public education begin to look more attractive.
Essentially AspireAssist is an illustration of why we need to focus on the underlying causes of obesity rather than simply pumping out the stomach of obese patients.
This sounds like a FDA approved surgical intervention to facilitate bulimia. Unbelievable. We live in crazy times when surgery trumps behavioural interventions and appropriate psychiatric/psychological management of the complex issues of overeating.
In a world where millions are desperate for dwindling food supplies the first word that springs to mind is ‘obscene’.