What In The World?

The FDA has just approved, yet another stellar device for weight loss, called AspireAssist.  AspireAssist is, you guessed it, an endoscopic and reversible procedure. I don’t think they are calling it weight loss surgery without the surgery, yet. I am sure, however, that the description will surface at some point. The procedure is being advertised as very safe. Indeed, it is much safer than those “invasive and irreversible surgeries like gastric sleeve and bypass”. According to the company website, the one year complication rate of gastric sleeve surgery is 24% compared to 3.6% for AspireAssist. It is also very effective with 37% loss of excess weight during the first year after implantation according to information I read on the company website www.aspirebariatrics.com. The device will bridge the huge treatment gap that currently exists between medical and surgical management of obesity.

As usual, AspireAssist is described as the next best thing since sliced bread. A drainage tube is endoscopically placed into the stomach and through the skin under light sedation. Following each meal, patients connect an aspiration pump to the device to aspirate ingested food preventing calorie absorption. Patients are instructed to chew their food very well in order not to clog the tube/pump. Interestingly, the device is described as a tool that will help patients develop healthy eating habits, make good food choices and eat smaller portions!! How can patients develop healthy eating habits by overeating then pumping their stomach empty through AspireAssist is left to your imagination? The device developers further claim that after a year or two, patients can potentially remove the device and maintain the weight loss. Really?

Once again, we painfully witness the introduction of a new weight loss procedure to the US market that makes absolutely no sense. And once again the FDA approves it. Yes we are facing an obesity epidemic and yes surgery is invasive and expensive. (It is very safe, however, and not associated with a 24% complication rate). These facts, however, don’t justify the use of techniques and approaches that contradict knowledge about obesity and weight loss, we have acquired over the past 40 years. Calorie restriction by itself is not a reliable solution for permanent weight loss in obese patients. Let me repeat this statement: ” Calorie restriction by itself is not a reliable solution for permanent weight loss in obese patients”. This concept has been CLEARLY established. We are morally and ethically obligated to support and defend the advancement of science in the fight against disease to improve human condition. Is AspireAssist a scientific discovery and does it improve human condition? I don’t think so. Any weight loss procedure that does not address the underlying obesity pathophysiology is by definition not a weight loss procedure. Call it anything else except weight loss procedure and please do not compare it to gastric bypass and gastric sleeve surgery. This is wrong.

The field of metabolic surgery is currently going through the dark ages of innovation and development. Greedy investors and capitalists are taking advantage of the current obesity epidemic to make fast and short-term gains. We call on the American College of Surgeons and American Medical Association (I am excluding the American Society of Bariatric and Metabolic Surgery on purpose) to halt this phenomenon and focus our resources on genuine scientific endeavors that will help us fight the epidemic of the century.

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