The Complexity of Health

By Lorrie Bouley.

Recently in the media, buzzwords have been thrown around calling the new stomach-draining device, AspireAssist “medical bulimia,” and “automatic bulimia machine.” This demonstrates a huge misunderstanding of both the psychiatric illness Bulimia Nervosa and the challenges that come from losing complexity-is-worrisome-casey-kotasweight when one lives with morbid obesity.

Bulimia has specific behaviors and traits: self-induced vomiting, a feeling of being out of control, guilt and shame. The illness has detrimental effects from compensatory behaviors. Frequent episodes of forceful vomiting can damage the digestive system due to electrolyte and chemical imbalances caused by dehydration and loss of potassium and sodium from the body. While the concept of this new obesity treatment seems like it is similar to compensating the calories one takes, it prevents several health consequences that can be extremely harmful to the body.

First, the FDA requires a screening to be done on patients to determine whether or not the patient has struggled with bulimia or eating disorders in the past because the device could enable their eating disorder or encourage disordered eating habits. ApsireAssist is not intended to be used for those who are moderately overweight. It is designed for those who live with morbid obesity, with a BMI of 35-55 and in patients who have not been successful losing weight from non-surgical therapies. The device is placed near the top of the stomach, meaning very little stomach acid will be removed during draining. Also, it is impossible to completely empty the stomach from the tube, it only allows the patient to drain up to 30% of the calories from a meal.

In addition to using the device, the patient receives lifestyle therapy at the same time, including nutrition and exercise counseling. There is value in not only learning what to eat, but how to eat. Clinical trials show that most participants demonstrated a decrease in their average portion sizes, perhaps because they must chew more carefully, as food could possibly become lodged in the tube.

There are risks to all actions we take. A person living with morbid obesity and who has attempted countless times to lose weight, is at risk to possibly be diagnosed with or worsen other issues such as diabetes, high blood pressure and other major health concerns. Allowing patients with morbid obesity the option to choose an approach that may come with side effects is their choice, and it shows to be effective and less invasive than gastric bypass surgery, the only other technical solution that has been effective.

Gastric bypass surgery is an inpatient procedure and can take up to 3 weeks in recovery, whereas AspireAssist is done through an outpatient visit in about 15-20 minutes and does not permanently alter your anatomy like bypass surgeries thus far. There are benefits to keeping the stomach intact – it aids absorption of vital nutrients, which the tube can provide. Though the device aims to be used long-term, patients may choose to remove the tube anytime, which is similar to the 15-20-minute placement procedure. Patients are typically told of these risks to determine if this is the right approach — there is no one way to treat obesity, just like there is no one way to treat an eating disorder.

Before jumping to conclusions and assuming the worst of new medical advances to treat obesity, we need to inform ourselves about the outcomes. There are still questions that need to be asked, and we need to focus on the patient’s overall health after completing the therapy. How often did they feel shame or guilt in using this device? Was there any? Did they receive the appropriate support they needed from health care providers? Nevertheless, both obesity and eating disorders have their challenges when recovering. It’s not as simple as eat more or eat less, and as a society we need to learn how to understand both illnesses and support both fights, in a healthy way.

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