It helped Carola lose almost 100lb, but is this bizarre weight loss op a step too far? Expert describes the device as ‘bulimia by surgery’
- After each meal, Carola Karlsson disposes of a third of what she's eaten
- But the 43-year old does not have bulimia, she uses the new AspireAssist
- This surgically fitted device drains food directly from wearers' stomachs
- However, is 'disposing of calories' the healthiest way to lose weight?
Three times a day, after each meal, Carola Karlsson takes herself off to the nearest bathroom to dispose of a third of what she has just eaten to control her weight.
To all intents, Carola is making herself sick.
But the crucial difference between this 43-year-old nursery nurse and someone with bulimia is that Carola ‘purges’ a specific amount via a surgically fitted medical device that drains food directly out of her stomach.
Carola, who is 5ft 4in, weighed 19st before she had the device fitted two years ago. Within nine months, she had lost an astonishing 8st.
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Three times a day, after each meal, Carola Karlsson takes herself off to the nearest bathroom to dispose of a third of what she has just eaten to control her weight
‘I’ve been trying to lose weight all my adult life,’ says Carola, who is single. ‘But dieting hasn’t ever worked for me. I find food is too much of a pleasure.
‘This system means I can still enjoy my food without having to deprive myself. A third of my calories come straight back out again.’
AspireAssist, as the weight-loss system is known, works basically in the opposite way to the feeding tubes given to people who can’t eat normally — instead of pumping nutrition into a patient’s body, it is used to drain food out before the body has a chance to digest it.
To have it fitted, patients undergo a 15-minute procedure under sedation and a local anaesthetic.
First, the surgeon creates a stoma — an opening on the front of the abdomen that gives access to the stomach.
A tube is then inserted via the stoma into the top part of the stomach (there is a valve connected to the other end of the tube to keep it sealed until it’s needed).
Then, 20 minutes after eating — when food has passed into the stomach, but before the calories have been absorbed — the patient attaches an external tube to the valve.
The other end of this tube is attached, via a small hand-held device, to a plastic bag that you fill with tap water.
Squeezing the bag forces the water up the tube and into the stomach, where it flushes out the contents. These then pass out through another tube and into the loo.
The draining process takes between five and ten minutes and, because of the way the tube is positioned inside the stomach, the process automatically stops once the top third of the stomach contents has been flushed out.
While patients such as Carola (who was fitted with the device in a trial in Sweden, where she lives) are reportedly delighted with the results, not all British experts are convinced
So that it can’t be overused, the device keeps track of the number of times the drain tube is connected to the stoma and it automatically stops working after 115 cycles, which equates to around six weeks’ use.
Patients must then request a replacement part for the device from the clinic treating them.
The system, which was developed in the U.S., is being launched in the UK next month.
But while patients such as Carola (who was fitted with the device in a trial in Sweden, where she lives) are reportedly delighted with the results, not all British experts are convinced.
AspireAssist has been approved by U.S. regulator the Food and Drug Administration (FDA) and has passed EU safety regulations.
But as Shaw Somers, a leading bariatric (weight-loss) surgeon based at Portsmouth Hospitals NHS Trust, puts it: ‘FDA approval doesn’t mean this surgery is a great idea. It just means it’s safe to use.
‘You’re creating a system where someone sucks out what they have just eaten from their stomach —which, by then, is just like sucking out sick — and throws it away. It might be safe, but is it right?’
Mr Somers, a former secretary of the British Obesity and Metabolic Surgery Society’s Council, adds: ‘Just because it’s safe doesn’t make me want to go ahead and do it.
A tube is then inserted via an opening in the abdomen into the top part of the stomach. There is a valve connected to the other end of the tube to keep it sealed until it’s needed
‘For starters, you have to create a stoma, which is a big deal and not without potential problems.
‘A stoma means making a hole in the stomach and sticking one bit of the stomach on to the abdominal wall, which will create internal scar tissue.
‘Later on in life, if you need an operation on your stomach, your surgeon is going to find that whole area stuck like concrete.’
Tam Fry, of the National Obesity Forum, is even more forthright, describing AspireAssist as ‘bulimia by surgery’.
‘It’s a gizmo that shifts any kind of responsibility away from the individual.
The manufacturer is saying: “Eat what you like because, afterwards, you can turn a tap and out it will come”.
This encourages the very worst kind of control of eating — to purge — and I find that unspeakably awful.’
Carola admits that some of her friends were extremely worried when she told them she was going to have the device fitted.
‘They used the word “bulimia” — and they also asked why I couldn’t just eat less and exercise more to lose weight, instead of doing something so extreme.’
But Carola insists that, for her, it has never been that simple.
‘I started gaining weight when I was 15 and lost interest in exercise. My weight crept up and up.
‘I joined Weight Watchers — I’d lose quite a bit, then I’d always end up putting it back on and would have to start again. So I thought: “What’s the point?” ’
Her weight reached 19 st in her early 30s.
By the time she applied to be part of the AspireAssist trial, her weight was making her ill. ‘I had no energy, my joints were hurting and I was getting problems with my knees. Being so big was making me unhappy.
‘My doctor offered me a gastric bypass, but I said no because that would have massively reduced how much food I could eat for the rest of my life.
Carola (far right), who is 5ft 4in, weighed 19st before she had the device fitted two years ago
‘I knew I was eating far too much — double portions at lunch and dinner almost every day.
'But I didn’t want to do something that would remove the pleasure eating gives me and mean I could only eat tiny amounts.
‘I also knew I had to do something, because my quality of life was being seriously affected.’
But to have a device fitted that would require her to force out food from her stomach within 20 minutes of eating — didn’t that seem frighteningly extreme?
Carola says not. ‘I look after several children with severe health problems who have to be tube-fed, which is done with the same kind of device, only the other way round. So I was already familiar with how it would work.’
She admits the system is not pleasant to use.
‘It doesn’t hurt, but it isn’t exactly fun,’ she says.
Carola says she did not find the AspireAssist frighteningly extreme, but that she understood well how it would work
‘And it can be inconvenient when you’re out for a meal with friends and you need to go off and find a toilet before your body has time to absorb all the calories you’ve just eaten.
‘But the results make it more than worth it.’
The fact is that the AspireAssist system does work.
A clinical trial, funded by the manufacturer, showed that 111 obese patients lost an average of 12.1 per cent of their body weight after one year, compared with 3.6 per cent in a control group who were only given advice on lifestyle changes.
However, there are concerns that this approach does not address patients’ eating behaviours.
Deanne Jade, founder of the Surrey-based National Centre for Eating Disorders and a clinical psychologist, says she worries about the psychological damage a device such as this might cause to someone already suffering from a bad relationship with food.
‘Tube-feeding is a necessity for those who have become so ill it is the only way to keep them alive,’ she says.
‘Now, we have that same life-saving procedure being done in reverse to take food out of the body — I think that’s awful.’
Kathy Crothall, CEO of Aspire Bariatrics, the company behind the technology, who admits that take-up among UK surgeons has been slow so far, suggests such concerns are misplaced.
‘This device could not be more different from bulimia,’ she told Good Health.
‘AspireAssist is associated with mindful, slow eating — it forces a person to chew their food very well, which promotes a significant improvement in eating behaviour. Bulimia is associated with mindless and very rapid eating.’
Even so, the procedure is not without its risks, including abdominal discomfort or pain, irritation, hardening or inflammation of the skin around the site where the tube is placed, leakage, bleeding and possible infection around the site.
(Carola developed an infection around the stoma soon after her operation, requiring a course of penicillin for ten days.)
‘I hit my target of 11st after nine months, then I started using it after just two meals a day,’ she explains, and adds that the idea is to then see if her weight stays stable
All these complications have the potential to necessitate removal of the device, after which there is the risk of a persistent fistula, an abnormal passageway between the stomach and the abdominal wall.
The procedure — which costs around £7,000 in the U.S. (it is not clear what it will cost here) — is fully reversible, and the apparatus can be removed during a ten-minute outpatient procedure under sedation.
But, according to Kathy Crothall, very few patients have opted to have it taken out. Carola certainly has no plans to have hers removed.
‘I hit my target of 11st after nine months, then I started using it after just two meals a day,’ she explains.
‘The idea is that you then see if your weight stays stable and, if it does, you go down to using it once a day, before stopping altogether.
‘If you don’t gain weight, you can then start thinking about getting it removed, and the hole will just heal up.
‘But I put 6 kg (13 lb) back on over the summer — I think because I enjoyed eating too much ice cream and too many treats. So I’m back using it after every meal again.’
Carola insists that AspireAssist has made her cut back on the amount of food she eats, and has taught her to distract herself if she is in danger of eating for comfort
Yet she insists that AspireAssist has helped improve her eating habits — she says she has cut back on the amount she eats, and has learned to distract herself if she is in danger of eating for comfort.
‘I accept that some people will think this is a bad thing — but for me, the surgery has been life-changing.
‘Admittedly, I worry about what will happen when I next want to be intimate with someone. But this is a part of me now, so I would hope they will accept it as that.
‘The main thing is that I have more energy, my aches and pains have gone and I feel that I have done something really positive.
‘My life is better now: without the surgery, I think it would only have got worse.
‘In many ways, I feel this device has saved me. I have absolutely no regrets.’
In the UK, AspireAssist will be available only privately, to patients with a Body Mass Index (BMI) of between 35 and 55.
For more information, visit aspirebariatrics.com
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