Maintenance: Crutch or Cure?

"I would get up to probably 350 pounds and get mad at myself, go on a diet, do some sort of crash diet. Three different times in m life, I've lost 125 pounds, but never had the ability or the will power or the gumption to keep it off. And this last time, I let myself go. It got too far out of hand."
"This device [aspiration therapy: reverse feeding tube] has absolutely saved my life."
"When I first looked into it [aspiration therapy] and thought about it, I thought that it was gross. I can clean deer, clean turkeys, clean fish, I'm fine. But somebody vomits -- I get sick. I thought, 'OK, I'm going to be puking out this tube'."
"I truly believe that this device has at a minimum prolonged my life but probably saved it. People can look at it as cheating -- I honestly don't care what they think. It's my health, my life, and I'm a healthier person today because of this device."
Eric Wilcoxon, insurance agent, Van Buren, Missouri

Photo: courtesy Eric Wilcoxin

"All I ask is that there's a way to take off the pounds without exercising or changing what I eat or how much I eat."
"Other than that, I am willing to do anything. Well, anything has finally arrived. And it's called AspireAssist."
"Machine-assisted abdominal vomiting."
Stephen Colbert, Colbert Report 

"Evolution provides solutions to past problems, so all of our evolved biology, our successful adaptations, are through challenges our ancestors faced in the past."
"But evolution obviously does not anticipate. Things change, environments change ... and humans, we can change our environment to a much greater extent than other species can ... But guess what? We cannot change our biology."
"We have now completely separated exertion from feeding. In the old days, if you didn't work hard, you didn't get food ... now, I can pick up my smartphone and have food delivered to me."
"We have a predisposition to do things that lower energy expenditure, but there's nothing really to tell me to lower my energy intake. Evolution is going to try to put a floor under you, not a ceiling. It's going to say, 'Don't drop below this'. [The body defends more against losing weight than against gaining weight]." 
"We won't know how successful it [AspireAssist] really is for another twenty years. It sounds like a perfect engineer's, surgeon's solution to the problem."
"This is part of what human beings are -- we have not only the ability to change our environment but also external adaptations that we can stick on ourselves."
Mike Power, animal scientist, Nutrition Lab, Smithsonian Conservation Biology Institute

And that's what Eric Wilcoxon did, agreeing to take part in a pilot study at Barnes-Jewish Hospital in St.Louis looking for recruits to participate in a pilot study of "aspiration therapy" when his physician, Dr. Steven Edmundowicz recommended that he consider joining, as a perfect candidate. His doctor left him with the advice to study the issue, and after researching it, to get back to him. What he discovered is that aspiration therapy meant a small tube would be inserted into his abdomen, connected to a "skin port" that would act as would a tap on a wine barrel -- only it would be affixed to the exterior of his stomach.

He had, in the past, tried a variety of lifestyle change methods and diets in a bid to lose weight. When dieting and exercise failed he considered, then dropped the idea of lap-band surgery, as too costly a possible solution to his problem. And his problem was immense; a large man at 6-foot-3, when his weight soared to 410 pounds at age 41, he foresaw the real possibility that he wouldn't live long enough to see his own children get on with life, when they reached his age. For him, it was death beckoning, sooner rather than later.

The therapy involved a water pump attaching at the valve, enabling a user to siphon off as much as 30 percent of their last meal into the toilet before it undergoes digestion, converting to calories. Known as well as a "reverse feeding tube", the device's commercial label is AspireAssist. Critics, like Steven Colbert, spoke of aspiration therapy as "medically assisted bulimia". That in itself failed to trouble Wilcoxon who was increasingly of the opinion that his enormous weight was a situation desperate enough to call for assistance from what might seem to others, as extreme measures.

He underwent the required surgery finding it of a short time duration, throughout which he felt no overt discomfort. The therapy requires that he masticate the food he consumes endlessly, chewing and chewing to ensure that food particles become sufficiently small to fit through the tube; consequently he eats less than he was accustomed to, and uses the device once or twice daily. He lives as though the tube is simply yet another natural appendage to be ignored when not in use. He swims, hunts and fishes on weekends, engages in action play with his children. And has lost 160 pounds.

His experience has been reflected by other pilot study subjects. Over the course of a year, people using the device along with lifestyle therapy have lost on average 18.6 percent of body weight while those in the control group exposed only to lifestyle therapy had lost in comparison 5.9 percent of their body weight. A larger, follow-up study resulted in similar findings, with few side effects being reported. Researchers were satisfied that therapy and pump users hadn't taken to consuming more food to make up for lost calories, nor did any develop eating disorders.

The U.S. Food and Drug Administration had granted its approval for use of the device in 2016 and shortly afterward it became generally available despite that the Academy for Eating Disorders would not recommend it, and the British Medical Journal spurned the device which requires patients to be mindful about eating; the device is reversible, and designed to be removed once the patient feels comfortable, along with the fact that it is up to the patient to decide when, following meals, and whether to use the device or not.

A century and a half ago, before mechanization altered the way people worked, on average a working man burned between 3,000 and 4,500 calories daily, while women used between 2,750 and 3,500 calories. In contrast, the average calories a woman living a sedentary lifestyle expends today is roughly 1,620 a day at the very time that access to densely caloric food has mounted, where the average meal served in a restaurant is four times more plentiful than in the 1950s, according to the Centers for Disease Control and Prevention, even as the number of calories consumed n North America increased by 20 to 15 percent since the 1970s.

A 2003 study discovered a third of physicians agreed as health professionals that overweight patients were "lazy","sloppy" and "weak-willed", coinciding with findings from a 2016 University of Chicago survey that 75 percent of respondents felt overweight people are simply too lazy to take proper care of themselves. At the onset of the 20th Century, sufficient calories for significant portions of a population were hard to find; food production and a lowering of cost has made more food of high caloric value available to more people than ever before.

Research has identified over 400 genes to be implicated in weight gain - epigenetics economics, biology, environment, stress are all involved. Food consumption is often regulated by emotion, reward and pleasure-seeking in what has been termed scientifically as "hedonic obesity". The larger public looks on that category of food intake as gluttony.  "Because much of this interactive neural processing is outside awareness, cognitive restraint in a world of plenty is made difficult", concluded researchers from Louisiana State University in a 2017 paper.

Eric Wilcoxin considers his flirtation previously with weight-reducing therapies and diets to have been spectacularly unsuccessful, whereas his determined effort to lose weight through the use of the AspireAssist device plus therapy has proven itself more than satisfactorily, giving him another chance at a normal lifestyle, and subduing his concerns about deteriorating health setting in, leading to an early death. After five years of use and dependence on the device, he has no intention whatever of removing it. He feels comfortable with the small port installed in his stomach for the rest of his life.

Gif from Aspire Bariatrics video