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The Vomitorium —

January 22, 2013

Trigger warning: This post is about a surgical implantation that is essentially medically-assisted bulimia.

There’s an apocryphal story of Julius Caeser narrowly escaping an early assassination attempt by returning to his room to puke up his supper rather than visit the bathroom, where the assassins awaited him. Thanks to Aldous Huxley (my favorite author), people have misinterpreted the term “vomitorium” as a special room where the Roman elites would purge after their grand feasts.

While there are vomitoria built into ancient Roman amphitheaters, they are nothing more than large exits for the crowds to “spew forth” after a show. Even though there isn’t an official room for a post-binge expulsion, there does seem to be a history of vomiting after meals. The advantages are obvious: you can indulge as much as you want without the discomfort or weight gain associated with binge eating. The disadvantages are also obvious: food is meant to be eaten and digested, not regurgitated, and there are health consequences for doing so.

These days, vomiting after meals to prevent weight gain is recognized as a serious eating disorder (ED) known as bulimia nervosa.

According to the Mayo Clinic, the risk factors for bulimia include being female (of course), age, family history, psychological or emotional issues, societal pressure, and performance pressure in sports. You’ll notice that the psychological aspect is just one of several contributors to bulimia. The fact that females are vastly more susceptible to bulimia shows that developing an ED is not some uncontrollable affliction of unknown origins, but one of the many inevitable consequences of the inordinate amount of pressure society puts on women to be as thin as possible.

There are a range of serious and life-threatening health complications due to the effects of bulimia and expelling food from one’s stomach, rather than allowing the natural process of digestion to proceed:

  • Dehydration, which can lead to major medical problems, such as kidney failure
  • Heart problems, such as an irregular heartbeat and heart failure
  • Severe tooth decay and gum disease
  • Absence of a period in females
  • Digestive problems, and possibly a dependence on laxatives to have bowel movements
  • Anxiety and depression
  • Drug and alcohol abuse

Bulimia is a serious issue that affects between 1-3% of the population, though stigma ensures that it’s an under-reported issue. Recognizing the symptoms of bulimia is vital for preventing a person’s condition from escalating. Those symptoms include:

  • Being preoccupied with your body shape and weight
  • Living in fear of gaining weight
  • Feeling that you can’t control your eating behavior
  • Eating until the point of discomfort or pain
  • Eating much more food in a binge episode than in a normal meal or snack
  • Forcing yourself to vomit or exercise too much
  • Misusing laxatives, diuretics or enemas after eating
  • Using dietary supplements or herbal products for weight loss

So, there are three components to bulimia: obsession with body image and weight, uncontrolled binge eating, and a method of expulsion.

Until recently, the method of expulsion has been the most disturbing aspect of bulimia. If you chose to throw up, the acidity can erode your teeth and cause esophageal damage. This leads to people joking that bulimia is awesome, if only they didn’t have to throw up!

Thankfully, Aspire Bariatrics has figured out a way to make that dream a reality!

You’ve no doubt heard about Aspiration Therapy by now, either from Rebecca Jane Warren or Ragen Chastain.

Good Morning America even lauded the invention as “a gadget that lets people eat pretty much what they want and forget about the calories.” Others criticize the Aspire Assist for being “disgusting.” And concern for health problems abound:

The bad news? Well, where to start?

How about with a problem that Aspire already knows about: “Initial setbacks — and here’s the really yucky part — have occurred because the pump struggles to break up large foods,” like cauliflower, steak, pretzels, and Chinese food, says Gillian Orr at Britain’s The Independent, so the tube sometimes gets clogged. There are also “significant doubts about the safety of this product,” says Dr. Manny Alvarez at Fox News. Draining 30 percent of your stomach is a recipe for dehydration, irritation of the stomach lining, and depriving your organs of a third of “vital electrolytes such as sodium, potassium, and calcium.”

There’s also the problem of how permanent the surgery is. In an interview with GMA, Katherine D. Crothall, president and CEO of Aspire Bariatrics, explains that they haven’t really examined this issue:

Crothall said that her company hadn’t looked at how weight loss is maintained once the device is removed but was marketing the device for long-term use. She said that trial participants were offered counseling to help them modify their eating habits, but there was only anecdotal evidence that any of them made changes.

But considering the fact that people who have bariatric surgery reversed will inevitably regain the weight, it stands to reason that the same will happen the minute you remove the bulimic port your body. Perhaps you can fool your body into accepting the removal of 30% of your calories for a while, but restore that 30% and your body will sock it away in fat tissue for a rainy day.

But the most disturbing thing of all is that the Aspire Assist is not actually an improvement to one’s health. To improve your health, you need to eat healthier foods and get some exercise. These changes alone will not result in much weight loss for most people, which becomes discouraging and often leads to the abandonment of those lifestyle changes.

Now, patients can completely skip those lifestyle changes and just have a bulimic port installed, so you can still eat crap food and be sedentary, but now you can lose approximately 50 pounds doing it.

THIS IS NOT HEALTH!

This is a simulation of health in a culture that equates thinness with health. Thanks to this completely fucked up paradigm of healthcare, physicians have prioritized weight over lifestyle, which justifies any and all methods of getting thin, regardless of the side effects.

And I guaran-damn-tee that Aspire Assist has some unpleasant side effects, though the research is largely preliminary. Regarding these risks, Dr. Yoni Freedhoff weighs in:

So is the Aspire Assist brilliant or brutal? Given it’s just been born, it’s going to be at least a decade before we’ll even have the chance of having the robust long term data to make an informed decision. Until then all I can really say is that I’m looking forward to reading it.

I’m sorry, but it is barbaric that surgeons have used human guinea pigs for decades to “perfect” bariatric surgery, which has cost countless lives and healthy constitutions in an attempt to short-cut healthy lifestyles. And now, here we stand again, selling fat people a product that has barely been tested because obesity is seen as such a life-threatening emergency that we can’t wait for the long-term trials to finish.

Aspire Assist is not healthy in any way, shape or form. The unhealthy aspect of bulimia is not just the vomiting or laxative use, it’s the nutritional deficiencies created by the expulsion of food, however that expulsion occurs, period.

With all of this in mind, I had the opportunity to interview the man who first proposed the idea of aspiration therapy. Dr. Samuel Klein is the Director of the Weight Management Program at Washington University. He’s also on the Board of Directors for Aspire Bariatrics. Last week, I posted my interview with Dr. Klein on the traditional methods of weight loss and why they don’t work.

As I mentioned in that post, I was absolutely giddy at the prospect of interviewing Dr. Klein because of his leading role in the Weight of the Nation documentary. As a result, I did a lot of research on him, which is when I first stumbled across Aspire Bariatrics. I kept it under my belt because I wanted to ask him some tough questions about the company and, as far as I knew, nobody else was really talking about it.

The interview took place just before Thanksgiving, and I’ve been waiting for the opportunity to publish it ever since. So here it is, in its entirety, my interview with Dr. Klein on Aspire Bariatrics.

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18 Comments leave one →
  1. Vaecordia permalink
    January 22, 2013 11:15 am

    Gobsmacked. Just gobsmacked.
    What the hell are we doing to ourselves?

  2. vesta44 permalink
    January 22, 2013 11:28 am

    I’m sorry, but the opportunity for this to be abused is just too great. One woman has already used it to completely empty her stomach after eating. How on earth are they going to be able to ensure that only 30% of what is eaten is expelled (geez, that’s just too gross to even think about)? And what about complications? Do they have any idea what those could be? I mean, they should know some of the complications of this contraption – it’s basically just the reverse of a feeding tube, and the complications from that should be well-documented by now (problems with the port, problems with germs and unwanted bacteria getting ingested, etc). Do they really hate fat people so much that they have to come up with more medically-induced ways of forcing starvation and malnutrition on us? It wasn’t bad enough that they’re killing us by mutilating our digestive systems, now they want to help us with a medically induced ED? This just enrages me and makes me really dislike the medical establishment that is so focused on “thin=healthy” and ignores actual health.

  3. January 22, 2013 12:09 pm

    At least he’s honest. His knowledge is limited, but he doesn’t gloss over what this really is. I have to give him credit for that. Aspire (which he implied is now owned by Venture Capital) will never be so honest. That is what I find most shocking about the video and mostly why I think it’s important. No doubt he will be “encouraged” to shut the hell up when they find out what he is saying.

  4. Duckie Graham permalink
    January 22, 2013 12:17 pm

    “The unhealthy aspect of bulimia is not just the vomiting or laxative use, it’s the nutritional deficiencies created by the expulsion of food, however that expulsion occurs, period.”

    I would also argue that at least as damaging as the nutritional deficiencies and other medical side effects is the mental health issues at work here….feeling desperate enough to have this kind of ridiculous surgery and think it’s a completely rational decision is merely a side effect of the mental illness.

  5. January 22, 2013 12:57 pm

    My god that is disgusting. I am horrified. Why would you make a vent into your stomach? The chances of infection and scar tissue must be extremely high in both your internal organs and the entry site. What happens if it leaks? Will it become socially acceptable to sneak off to the loos and vent your stomach contents?

  6. The Real Cie permalink
    January 22, 2013 3:11 pm

    High tech bulimia. The scary thing is that, as a bulimic (not currently an active one) the thought did pass through my mind–could this work to make me a socially acceptable weight? Yes, I think it is awful and wrong. But being honest, I must admit that the thought crossed my mind.

  7. Ann Mouse permalink
    January 22, 2013 4:35 pm

    There is not enough ewwww in the world to express this incarnation of two nightmares: 1) surgery, 2) throwing up. I notice he failed to cover any complications that could arise from the implantation itself, such as infection. I hope this thing fails clinical trials in the U.S.

  8. lifeonfats permalink
    January 22, 2013 5:11 pm

    It’s extremely disgusting but not surprising. We’re in the era of medical professionals believing that disordered eating, starving ourselves and any other ED-type behaviors are not only acceptable for fat people, but suggested and encouraged. Which begs the question: What ultimately is going to be better in the long run? Physically and mentally healthy fat people, or thinner fat people with a high risk of long-term, debilitating health problems? I know what I think is better. I wish the medical community would think it too.

  9. January 22, 2013 5:15 pm

    You have GOT to be kidding me. I have no words.

  10. Lindsay permalink
    January 22, 2013 8:08 pm

    As a former bulimic, this product makes me so, so sad. I recurring have stomach pain to this day from damage I did to my stomach/esophagus (they still don’t know quite what it is – possibly a sliding hernia) even though I have not engaged in symptoms in almost two years. Sadly, people are so afraid of staying fat that they will be desperate enough to try it. . They will think the risk of side effects are worth it. Some will abuse it, eating and then using the tube over and over, damaging their bodies in the process. Really hope this product gets banned before it kills someone…

  11. January 24, 2013 1:20 am

    Oh, I have some words all right…. (disclaimer, nothing about your interview, except if I had the opportunity to interview him, I would’ve eviscerated him, I’m thinking you didn’t because you appreciated him either taking the time to give the interview to pick his brain( which I find to be a very, very, VERY scary place)

    WHERE THE FUCK DID HE GO TO MEDICAL SCHOOL, WALMART??? I mean REALLY????. 1st off, there is 17 million things wrong with what he said, and only one with what you said, Shannon. I, normally because of my cognitive damage, wouldn’t disagree with you so passionately except I know this from my research of wls and my own experience as I’m still a part of that community as reversed gastric bypass patient who has a technically performed laproscopic roux-en-y gastrojeunostomy, 11 years ago and open reversal of a lap rny almost 2 1/2 years ago .

    First off, very few people are reversed as far as gastric bypass.I’m an anamoly as far as rare is reversals of gastric bypasses are, because surgeons will not do them usually unless like in my case, it was done to save my life, but I was heavier then most reversed gastric bypass patients even though I didn’t malabsorb calories anymore, I malsorbed nutrients severely even at my heaviest post gastric bypass where I regained almost all my weight back. As far as lap band people, whether they lose weight or they don’t, if their surgery is “deemed” some how a mechanical failure, usually they can and usually WILL if at all possible get revised to either a rny gastric bypass,duodenal switch or now the vertical sleeve gastrectomy.

    All the weight loss surgeries can be considered a form of surgically induced bulemia. If one doesn’t find the words “ethical Bariatric Surgeon” an oxymoron, they will say that nausea and vomiting is one of the risks people take when they have weight loss surgery, whether they have a surgery that bypasses the intestinal tract to cause dumping syndrome or not, or whether people have a surgery such as duodenal switch which is meant to do the same thing as this procedure, most of the intestinal tract is bypassed so people can eat more but they malabsorb everything.

    Ask many of the laproscopic band patients who’s bands tighten regardless without a fill, they slip and adhere to internal organs such as their livers, they will tell you that.Or those who live to tell about the fact they cannot revise their surgeries or get their band out because there is too many adhesions or they can get the band out but they cannot and due to societies stigma of fat people are devastated they cannot get a revision.

    I’ve seen everything in my years of researching due to all the disabilities I have and not being able to do much else like drive a car ever again or work, almost every scenario weight loss surgery wise. I’ve seen people who were a rare reversal of a rny converted to a sleeve who were severely underweight and severely malnourished because their surgeons would’ve rather risked them dying of starvation then apparently just straight out reversing them and so would they.

    He’s double speaking. He can’t say this won’t as others on here, encourage bulemia when it is surgical induced bulemia. He also can’t guarantee that people will not malabsorb nutrients but not malabsorb calories. I was bulemic, 10 years prior to my gastric bypass (I cop I lied about that on my psych eval) that only allowed me to bounce about 10 lbs in 10 years however I went up 4 sizes because of lifelong dieting by the time I had my weight loss surgery.

    I’m still bouncing weight wise due to no control of my own. However my weight loss surgery peers who are still intact aren’t fairing much better then I am, due to using starvation as a mechanism for weight loss when talking about long term weight loss and health. Add that on a severely restricted caloric intake, moderate to intense exercise regimens are encouraged fairly early on, and metabolically you have a recipe for disaster not just from a weight loss point of view but a health point of view, as by the time most people have weight loss surgery, they’ve done everything they possibly can to lose weight. It’s most definately not the easy way out, it is however the fastest way to lose weight, ever. It stops becoming about health as you aren’t seeing patients thanking and praising their surgeons from their sea of fat and the surgeons get a God complex even though they know it’s a crap shoot.

    I know you know this. I know this. And sadly I don’t know how someone could go to medical school and NOT know this. Bariatric surgery has been performed for at least almost 40 years, now. They will NEVER come up with surgical cure to rid people of their fat suits, that cannot possibly cause further health risk but due to metabolic damage, even if someone DOES go into any weight loss surgical procedure for the sole purpose if they have diabetes,pulmonary hypertension and high cholestrol and not risk all the co-morbidities that are now traditional of being a weight loss surgery patient, regardless of the skill of the surgeon. I had a technically perfect performed gastric bypass. It was how my body responded to my digestive system being surgically altered, not that I had a shoddy surgery. But that I had weight loss surgery, period. This is something the most gifted surgeon knows if they’ve been doing bariatric surgery long enough is the fact that the body will respond unkindly to it being tampered with in such a way, so fundamentally.

    I’m trying to summon the energy, however I just don’t have it because still of poor health of asking these doctors who encourage any surgical treatment to rid people of adipose a couple of things. First off what are they and how are they treating their patients who have diabetes, pulmonary hypertension and high cholestrol and sleep apnea who are thin who won’t conform to a healthy lifestyle as there are millions of them as well.

    If that’s the case, we might as well become a society is what I want to say to doctors and card people on what they are allowed to buy to eat based upon what health conditions they have, regardless of weight. Because the truth is, chances are regardless of the surgical procedure and whether or not it’s intact, it’s highly unlikely and very rare that people will keep all or most of their weight off and be in great health. I’ve seen a few. But they are in the rare minority.

    I don’t think and it’s not personal as I’m glad you did the interview, that I’ve seen almost anything that made me so mad, other then fact that bariatric surgeons also have a habit of doing more then one patient at a time. Unfortunately, this didn’t happen in my case during my gastric bypass, however my surgeon had the NERVE to do this during my reversal (he unbanded a lap band patient in the middle of my surgery). In my nationally ranked overall hospital and “Center for Excellence” in Obesity Surgery certified facility, a huge hospital with a huge surgical wings, they were dumb enough as this particular patient while not opting to be revised, had slippage of her band and just elected as she was given a choice (I wasn’t and I wouldn’t have) to be revised to another surgery. However in “easier” unbandings patients are usually same day surgeries. She had a cardiac history so they kept her overnight. My surgery was from 8:45 to 2:15. I know this because I don’t respond well to anesthesia and was concious being both rolled in and out of surgery as well as it’s documented my time in the O.R. Her surgery was at 12:30. By my surgeon and they were FUCKING stupid enough to put us in the same hospital room in a huge hospital like that.

    The arrogance and stupidity of that I still can’t get over…. Oh and the fact that even though I still faint, puke my guts out, I’m considered of normal anatomy now. It’s ok he will no longer treat me, I have such bad MD PTSD that I went from numerous hospitalizations from 2004 to 2010 inpatient. Then I still had and gotten such bad treatment with the 1/2 dozen E.R. visits in 2011 as well as medical procedures such as endoscopies. I had 2 dr visits in 2012. One urgent care because I started to black out and sprained my arm, and the other a physical I HAD to go to, to get meds, from my long term PCP who I trust but still get at this point, such bad anxiety and panic attacks, I can’t even see her. I’m running of time though as I’m not getting any better. I’m getting worse as far as my health is concerned. And please, no one should do what I do, I’m understandbly not being rational as not seeking medical treatment feeling as poorly as I do and no one should risk their health like I am….

    Really we have to start demanding a comprehensive study on how damaging and how it’s killing people to stigmatize obesity. No one health condition is exclusive of it, you know this, I just don’t have the means even though I have the story as well as millions of other people do to some degree to justify it versus coming up with surgical procedures and devices to eradicate obesity…..

    • January 24, 2013 1:26 am

      Yikes, part of the rant above was sponsored by the fact I’m having an enormous amount of trouble eating today and low blood sugar will not let me sleep as well as severe uncontrollable pain. One thing I said wrong that even though I proofed is that wls patients AREN’T thanking their surgeons for their better health if they had diabetes,pulmonary hypertension and high cholestrol they are being thanked for not being fat anymore. I’m shutting up now. If I see anything else as I’m not easy to read, I’ll clarify when I’m thinking a little more clearer.
      I just do want to reiterate, I apppreciate the interview and the blog, Shannon, I just found Dr. Klein, repugnant…

      • The Real Cie permalink
        January 25, 2013 12:21 am

        I say you go on with your bad self, Lisa! I find your rants inspiring. :-)

  12. Tara permalink
    January 24, 2013 6:35 pm

    I’m in a mia support group and most of us purge so that we can eat again. It’s like a Roman orgy. The stomach acids can wreck your teeth so you have to rinse. None of us are thin though.

    If I didn’t purge I’d weight a tonne.

    • The Real Cie permalink
      January 25, 2013 12:22 am

      Tara, I feel for you. I’ve been where you are. No judgment, just wishing you the very best. <3

    • January 27, 2013 2:12 pm

      Tara, thank you for sharing and I also feel for you and your pain. You’ve probably been told before, but I did want to mention it – bingeing is a response to purging and not the other way round. The only way to stop the bingeing is to stop the purging. It simply wont work in reverse. If you’re not already seeking help, please please do so. And I also wish you nothing but the very best. Good luck. :)

    • January 30, 2013 1:58 pm

      I’m sorry to show my ignorance, but what is mia?

  13. Nyssa permalink
    January 28, 2013 2:55 pm

    This is simply put, a disgusting invention. It’s becoming so painfully common that doctors now endorse ED’s :(

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