Why a draconian weight-loss device may help solve a complex issue

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It sounds too outlandish to be true: a weight-loss device that uses a tube surgically implanted in the stomach to pump out the contents of a meal minutes after eating. But the device, called AspireAssist, is most definitely real. It was approved last month by the U.S. Food and Drug Administration and could hit the market in Canada soon.

The reaction to AspireAssist has been, for the most part, disbelief, disgust and horror. The reasons for concern seem obvious: enabling a person to expel the contents of his or her stomach at will seems like a dangerous way to lose weight and an open door to eating disorders.

On the other hand, the introduction of a product as seemingly outlandish as AspireAssist raises a more pressing issue. Is this patronizing response really the best we can do for people with obesity?

The basics

AspireAssist was developed by U.S. doctors as a weight-loss tool for obese people that provides a less invasive alternative than other methods, such as bariatric surgery, said Katherine Crothall, president and CEO of Aspire Bariatrics Inc., which produces and sells the device.

"When I first saw it, I said 'This is crazy,'" Crothall said in an interview.

But the more she looked into it, the more Crothall was convinced the product could be effective and profitable.

Doctors place the device in a patient's stomach during a relatively quick day surgery, then install a port a few inches above the belly button. The port can be opened after eating and attached to an external tubing system to expel a portion of the meal just consumed.

On June 14, the FDA announced it was approving AspireAssist, saying in a press release it "helps provide effective control of calorie absorption." Crothall says the company is preparing a submission to Health Canada to seek approval for AspireAssist here.

But so far, few are welcoming this new technology with open arms. After news of the FDA's approval, the website xoJane published a critical article that claimed AspireAssist "assisted bulimia," saying the device enables dysfunctional eating and puts people at risk. The British Medical Journal also published a news article that says AspireAssist "surely marks the end of civilization as we know it." On his late night show last fall, Stephen Colbert mocked the device, calling it a "barf bot" akin to "machine assisted abdominal vomiting."

What the data says

What those criticisms don't mention is that so far, clinical-trial results show the device helps obese people who have failed to lose a substantial amount of weight using other methods. According to a clinical study used to approve the device, patients using AspireAssist in conjunction with diet and exercise counselling lost about 12 per cent of their body weight after one year, on average, compared to 3.6 per cent among a control group who received counselling alone.

Two prominent obesity experts in Canada say while the concept is certainly different, AspireAssist may help some patients.

"People are desperate to find solutions that work," said Dr. Arya Sharma, chair for obesity research and management at the University of Alberta and scientific director of the Canadian Obesity Network.

"Ultimately, I look forward to seeing long-term data on this. I'm not going to judge the device simply because it seems like an odd way to approach things," said Dr. Yoni Freedhoff, assistant professor of family medicine at the University of Ottawa and medical director of the Bariatric Medical Institute.

Also, AspireAssist isn't meant for people looking to lose a few unwanted pounds. It is designed to help people struggling with extreme excess weight. According to the FDA, patients must be at least 22 and have a body mass index of 35 to 55, which Crothall says translates into people who are at least 75 pounds overweight. Candidates for AspireAssist must also have failed with other non-surgical, weight-loss therapies. The FDA also noted that AspireAssist has a safety feature tracking how many times the food draining tube is connected to the stomach port. After about six weeks, the tube stops working and patients must see their doctor to get a replacement so they can continue the therapy.

Another important point to note: AspireAssist doesn't expel everything an individual eats. According to the company, up to 30 per cent of the calories consumed during the previous meal can be pumped out using the device.

When asked about the concern AspireAssist will enable bulimia, Crothall pointed out that the stomach tube is about the diameter of a pencil. In order for food to pass through it, individuals have to chew their food slowly and carefully. Crothall says that for most people, it takes up to three times longer to finish a meal when they are using AspireAssist and that this makes binge eating and purging more difficult.

Freedhoff also questioned the link to bulimia, pointing out that it is typically a psychological disorder.

"It smacks of weight bias"

That's not to say AspireAssist is risk-free. It can cause bleeding, infections, nausea, abdominal pain and other side effects. There are also concerns the device could be marketed by some medical professionals as a quick-fix weight-loss device.

But what experts like Sharma and Freedhoff find most egregious is not the device itself, but the fact society is passing moral judgment on one of the few products on the market that may help with a serious, chronic health condition.

"Fear of misuse should never be an argument not to approve an effective treatment," Sharma said.

If that was the case, plenty of drugs and medical devices currently on the market would never have been approved. Take prescription opioids, for instance. They are linked to what federal Health Minister Jane Philpott has described as a public health crisis of addiction and abuse. But no one is calling for them to be banned from the market.

The reaction to AspireAssist shows that obesity is still treated as a second-class disease. It's still acceptable to mock overweight people and see obesity as an individual's fault for eating too much.

"It smacks of weight bias," Freedhoff said.

In reality, obesity is a complex health issue linked to a changing world: reliance on cars, the rise of desk jobs, marketing of unhealthy foods to children, a host of socioeconomic issues, as well as genetic and metabolic factors.

One in four Canadians – or 6.3-million people – are obese, according to Statistics Canada. More than six per cent of young people between ages 12 and 17 are obese. Obesity is linked to high blood pressure, diabetes, heart disease, arthritis and numerous other health problems that experts predict will reduce life expectancy.

It's safe to say AspireAssist is not going to be the solution to this issue. But instead of mocking its arrival on the scene, we should stop and think carefully about why a group of doctors felt the need to develop it, and why some obesity experts welcome it. Obesity is a very real threat to the health of millions of Canadians and it's time to have an adult conversation about what can be done to help.