The FDA recently approved a new, minimally invasive weight loss device, Aspire Assist. The concept is as follows: a physician endoscopically places a tube through the stomach, which exits the abdomen through the skin. The process is similar to placing a feeding tube. But this is no feeding tube. The idea is to “aspirate,” or drain, partially digested food through the tube, approximately 30 minutes after eating. Food is drained directly into the toilet, using a detachable pump. By dumping up to 1/3 rd of each meal, weight loss occurs.

At first glance, this might seem like a disturbing concept. Certainly a drastic one. Draining stomach contents into the toilet probably doesn’t sound appealing to most people. Others would argue that this is essentially bulimia and allows an individual to continue poor eating habits, even binge eating.

But maybe it’s not such a bad idea. Consider that 160 million Americans are overweight or obese. 30 million have diabetes. All are at risk of hypertension, high cholesterol, heart disease, and stroke. And diet and exercise typically aren’t sustainable, long-term options. Bariatric surgery – whether re-routing, stapling, or cutting internal organs – is an accepted weight loss intervention. But it is maximally invasive and associated with a significant risk of complication.

So let’s revisit this crazy drainage idea. Maybe it’s actually not that crazy. We know that calorie reduction works, but that actually reducing how much we eat is extraordinarily difficult. In other words, if you can’t stop putting the food in, maybe you need to find a way to get it out (before digestion).

The largest study to date compared the Aspire Assist device to intensive lifestyle (diet and exercise) therapy. This was a multi-center, US study. There were 111 people in the Aspire group, and 60 in the lifestyle group. After 1 year, those with the Aspire device lost an average of 35lbs, compared to 10lbs in the lifestyle group. Actual weight loss varied depending on a person’s starting weight, but the average subject in the Aspire group lost 14% of their total body weight. Subjects were closely monitored for signs of eating disorders or excessive aspirating, neither of which occurred. Interestingly, because food needs to be chewed thoroughly to pass through the tube, subjects with the device started to eat differently – they ate slower, chewed their food more, and drank more water. The researchers estimate that this contributed to about 20% of overall weight loss, and could potentially lead to better long-term eating habits.

Overall, these are very compelling numbers. The device clearly works. And risks appear infrequent and minor. So should this technology be embraced? It’s too early to say. This will likely be a niche player at best, but shows promise for the emerging field of non-invasive or minimally invasive obesity treatment. Recognizing the enormous burden of obesity in our country, all options need to be considered. Even the seemingly crazy ones.

Christopher McGowan, MD, MSCR