There Is NO Reasonable Objection to New FDA-Approved, Stomach-Emptying Weight Loss Device

The FDA approved a new (and unusual) weight-loss device this week. AspireAssist is an external pump that empties up to a third of stomach contents into the toilet.

Predictably, many people are MORALLY OUTRAGED! by this device -- and some are going so far as to call it "assisted bulimia." 

Even more predictably, not a single one of these objections is rational or based in reality. In this post, I will walk you through the four main objections to AspireAssist, and why they are ridiculous.

1. "It will cause bulimia."

There is absolutely no evidence to support this claim. In fact, there is evidence to the contrary. Early data on the device -- which, it's worth noting, is not peer-reviewed -- actually showed that, of the 111 patients who were randomly selected to receive an AspireAssist, none developed an eating disorder as a result. Meanwhile, one control subject developed bulimia.

Obviously, with a device like this, disordered eating patterns were a serious consideration. Each study participant was screened for binge-eating, bulimia, and night eating syndrome, and eating behaviors were monitored throughout the yearlong study. 

The results? Self-reported data actually demonstrated improvements in AspireAssist subjects' eating: more thorough chewing, greater water consumption, more mindful meal planning, more mindful eating, and decreased calorie consumption. While self-report has its limitations, this data was supported by the fact that losses were greater than would be predicted by simple aspiration.

In fact, let's take a moment to appreciate just how freaking effective AspireAssist was in the study:

For those who don't like graphs: after a simple, 15-minute outpatient endoscopic procedure, subjects lost nearly 40 pounds on average (and went on to lose another 50 the second year) -- that's 15% of their weight!

Meanwhile, the control group (which received lifestyle counseling and no AspireAssist) lost about four pounds.

Also worth noting: the FDA has approved this device for extremely obese people over the age of 22 who have already (unsuccessfully) tried other weight loss methods. It was not approved for healthy teenage girls who think they're fat.

Given the complete lack of data to support this claim, I'm disappointed by the advocates and so-called social scientists who suggest it. That said, if new data comes out showing a spike of disordered eating in AspireAssist users, I will reconsider this position.

But until then, it makes no sense for the FDA to pull its approval based on intuitive, emotional feelings, rather than empirical evidence.


2. "Fat people should just eat healthier and exercise more."

I am all for personal accountability. I am all for instilling a greater sense of agency, self-efficacy and autonomy in people who feel stigmatized and disempowered. I do believe there is some degree of controllability when it comes to obesity...

However.​

There is a lot we don't know about obesity -- or even just fat cells. (Fun fact: the number of fat cells in your body is set by adolescence, and you will basically always have that number of fat cells. If you gain or lose weight, it's because your fat cells got bigger or smaller, not more or less plentiful. But if you gain too much weight, the fat cells start dividing. But why? Is there any way to change that number? When exactly is that number set? What determines how many fat cells are in a person's body? We have no idea.)

The more we learn about science, the more we know we don't know. Obesity is a hugely complicated sociocultural, genetic, epigenetic and biological issue.

New research shows that the bacteria in your gut (your microbiome) can have a huge impact on your weight -- and scientists are working on "poop transplants" to help restore a healthy microbiome to people with certain diseases. Early evidence shows poop transplants could help obese people lose weight.

(Note: it's not literally a poop transplant in the surgical sense -- it's more like freeze-dried poop in a pill.)

Then there's epigenetics, or the study of changes in gene expression, rather than changes in the actual genome. These changes in gene expression are heritable -- and different epigenetic biomarkers have been identified as early predictors of weight loss and maintenance of body weight after weight loss. (Though obviously, healthy lifestyle choices can help attenuate this.) 

Then there's the question of whether and how the obesity epidemic is affected by hormones in our food and water. And whether pumping our livestock full of antibiotics, which makes they get big, fast, on less food, can have negative health consequences on humans who eat said livestock. (Read more in one of my favorite books ever,  The Dorito Effect: The Surprising New Truth About Food and Flavor.) 

Or the question of how we can make sure poor folks with limited access to transportation can get to grocery stores that sell fruits and vegetables, instead of the potato chips and sodas that are available at the neighborhood convenience store. (This problem is known as "food deserts," or urban areas where it is difficult to buy fresh food.)

Or the billion other factors that play into obesity in the modern world. 

"Just eat less and exercise more" may be great advice for someone who just wants to lose a few pounds. But -- reality check -- obesity is much more complicated that calorie consumption and exercise. 

(Not to mention new research by James Levine, MD PhD, who found that non-exercise calorie burn is much more important than exercise when it comes to weight loss, weight maintenance and positive health outcomes. But that's a whole other story. One I also highly recommend taking the time to read.) 

A final thought, here. Even if you are a staunch believer in meritocracy, hard work, punishment for negative behaviors like overeating, the total controllability of one's weight, etc...

Can't you admit that you would be better off with fewer obese people? Regardless of how they lose the weight? Obesity is extremely expensive. It is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States. Currently, estimates for these costs range from $147 billion to nearly $210 billion per year. It's also associated with job absenteeism, costing approximately $4.3 billion annually, and lower productivity at work, costing employers $506 per obese worker per year.

AspireAssist is cheap, safe and effective -- users lost an average of 40 pounds the first year they used it, and 50 pounds the second year they used it. That. Is. Amazing.

Is it really more important to you to punish people who have a body or lifestyle you disagree with, than it is for you to have lower healthcare premiums and higher wages? Is that really a rational standpoint? 


3. "Ew! That's so gross!"

I will concede this point. Watching the blueberry yogurt get dumped in the toilet was pretty gnarly.

But guess what?

So are poop transplants -- that doesn't stop them from being a promising new treatment for various digestive diseases. 

So is shoulder surgery -- a few years ago, a doctor cut open my arm, drilled five holes into the head of my humerus, and stuffed a bunch of torn tissue into the holes, before glueing me shut again.

So are breast implants -- out of morbid curiosity, I watched a video of this procedure on youtube once, and it was far from delicate. 

So is having a baby -- women get torn from vagina to anus. They sometimes poop while they're pushing. Babies are all purple and misshapen when they're born, like gross little aliens. 

Just because medical treatments and natural bodily processes are subjectively gross, doesn't mean they aren't important, powerful, or even essential for survival.

If bodily grossness is something that bothers you, don't become a doctor. Don't get an AspireAssist. But don't say other people shouldn't get one because you think it's gross.

Or I'll tell you not to have a baby, because I think it's gross. 

Sound good?


4. "Children in Africa are starving!"

Yeah. Kids all over the world -- even here -- are suffering from hunger and malnutrition. This was true long before the AspireAssist was even an idea. 

Here's the thing: people don't starve because of availability problems. They starve because of distribution problems. 

Like, if you skip lunch today, does that mean the children in Africa won't starve? No. 

I can see how, on principle, you might think AspireAssist is "wrong" because it's a "waste of food." But -- once again -- do you truly believe that if the food didn't get dumped down the toilet post-consumption, it would somehow save the children?

No. Because it's not an availability problem. It's a distribution problem. 

On a related note, 40% of the food in the US goes uneaten. Uneaten food ends up rotting in landfills as the single largest component of U.S. municipal solid waste, and it accounts for a large portion of U.S. methane emissions.

I don't know why. I love leftovers! I pay little mind to expiration dates, and generally have no problem eating around​ the mold. On a possibly related note, I have never had travelers diarrhea. 

If you really care about the starving children... maybe instead of criticizing the 0.0000001% of the population that has an AspireAssist, do something actually useful.

Learn how to reduce food waste in your home. Volunteer for a food recovery event. Start a social media campaign urging people to eat cosmetically imperfect produce. 

Or. If you really want to have an impact, become a GMO/agricultural biotechnology activist. We now have the ability to solve many of the world’s food shortages and vitamin deficiencies with biotechnology.

We can make completely safe crops that are resistant to blight, drought and other catastrophes. We can reclaim unfarmable fields the size of France. We can eradicate Zika, Malaria, dengue fever and other mosquito-borne diseases that claim millions of lives per year. 

Any of these options will help a lot more poor and starving people than banning the AspireAssist (which would help about zero people).
 
Also worth noting: as I already mentioned above, AspireAssist users came to be more mindful eaters than the control group that received lifestyle counseling but no AspireAssist. The device actually led to less, not more, consumption. 

(As an aside: want to benefit from a more mindful approach to eating? Then check out Savor: Mindful Eating, Mindful Live, by Thich Nhat Hahn and Dr. Lilian Cheung. You'll learn about a lot more than food.)

***

Now, I know I said I would talk about the four AspireAssist objections I've heard. I'll admit, there was a fifth one I expected to see, but didn't. It was:


5. "There's nothing wrong with obesity. Stop fat shaming fat people."

Body acceptance has become a big part of the far left feminist movement, and this totally seemed like the kind of thing they would say. Like, seriously. I read Everyday Feminism and I read Jes Baker's "bestseller," Things No One Will Tell Fat Girls, and would have been 0% surprised if social justice warriors took issue with a device designed to combat obesity. 

Let's get one thing straight: I am all for body acceptance. I am all for rejecting the beauty standard. If you're obese and happy -- awesome! Good for you.

But don't be narrow-minded. Not everyone who is obese wants to be obese. It causes health and joint problems. It can damage an individual's self-esteem. If you are truly a feminist, if you truly care about body acceptance, then accept that different bodies experience obesity differently. 

Also wanted to take this chance to dispel some misinformation about obesity. 

In 11 Reasons Your 'Concern' For Fat People Isn't Helping Anyone, Linda Bacon and Melissa Fabello attempted to rebut a 2004 CDC study that found that obesity is the second leading cause of preventable death in the US by saying:

"In 2005, the same journal published a re-analysis with more scientifically accurate results, putting the number closer to 25,000 – a 94% difference."

However, the article didn't say what they claimed it said. It wasn't a correction of the previous study. It was a completely different study that used different methodologies and data sets. Nowhere in that study was the number 25,000 mentioned. What it actually said was,

"Relative to the normal weight category (BMI 18.5 to <25), obesity (BMI > or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064)."

Meanwhile, the 2004 study was examining the effects of "poor diet and physical inactivity," not BMI:

"The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365,000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%)."

Stay skeptical, folks!

***

What this all boils down to, then, is:

1. There is no evidence that the AspireAssist causes eating disorders. In fact, it has been linked to healthier eating behaviors.
2. If you think obesity is a simple matter of self-control, you haven't been paying attention to the scientific literature.
3. Just because you think something is gross, doesn't mean other people shouldn't have an important medical procedure that can transform their lives.
4. The AspireAssist is not responsible for the food distribution problem.
5. Body acceptance is great -- but not everyone who is obese wants to stay that way. Respect their autonomy. 

I had an amazing time reading about this device and the science behind it. It was especially interesting to witness the outrage while in the midst of reading Jonathan Haidt's The Righteous Mind: Why Good People are Divided by Religion and Politics, which you should probably read right away if you still have an unfounded moral objection to this or other weight loss devices.