Is AspireAssist Safe?

To the casual observer, AspireAssist therapy may sound a lot like surgically enabled bulimia, the compulsive practice of losing weight by inducing vomiting after a meal by sticking a finger down the throat. It might even remind some sci-fi fans of that drink people in the Hunger Games' capital used to be able to keep on eating after they were already full.

The primary advantage of AspireAssist over other forms bariatric surgery is that it does not reduce the size of the stomach, so it leaves the stomach capable of absorbing vitamin B12 and also of generating hormones such as the endorphins, serotonin, and cholecystokinin, which help control appetite. Also, since the stomach retains its normal size, it is not necessary to eat tiny meals like those required after gastric bypass or lap band surgery.

This makes vomiting and nausea far less of a problem, but AspireAssist is not entirely without risk. Here are the most important safety considerations for using AspireAssist:

• A number of studies suggest that bulimia (a common practice that has the same result as aspiration therapy) is closely correlated to problems with "executive function," the ability to make sound life decisions. Screening recipients of the device for bulimia before surgery would seem to be necessary, but is not mentioned by the promoters of the device.

• The lining of the stomach makes the hormone ghrelin, which helps regulate appetite. The effects of creating a wound in the lining of the stomach on the production of ghrelin are not known.

• The liquid contents of the stomach are easier to the aspirate than solid contents of the stomach. As a result, users of the AspireAssist device are at greater risk for dehydration after their surgeries. Since dehydration presents few early warning signs, users of the aspiration method of weight loss must take care to get enough fluids every day.

• Aspiration therapy can deplete electrolytes, especially potassium. Most users of the device are advised to take potassium supplements.

• The stomach releases acid in response to the amount of food eaten. When food is siphoned off and flushed down the toilet, there may be too much acid in the stomach for the amount of food remaining. That acid can leak up the throat and cause heartburn. Most doctors put their AspireAssist patients on a kind of medication known as a proton pump inhibitor, but this medication interferes with the ability of the stomach to liberate calcium, magnesium, and vitamin B12 from food.

• The Skin-Port where the silicone tube meets the surface of the body is prone to infection. The site has to be kept clean and dry, and users of the device may not be able to go swimming, use a hot tub, or take tub baths.

The makers of the AspireAssist are a little vague in their explanations of how the user of the device would know how to quit the procedure when 30% of stomach contents have been flushed down the toilet. Also, it is easy, if a little disgusting, to imagine situations in which splash from the toilet could result in serious infections of the stomach. These concerns are not addressed by the manufacturer's website or in the medical literature.

The AspireAssist tube can be removed at any time by a simple surgical procedure that only takes 15 minutes and that can be performed on an out-patient basis. For lifestyle considerations (the ability to go swimming, for example) or to prevent infections, many users will opt for removal when they have reached their goal weight.

To maintain goal weight after the device has been removed, requires dieting. And since the reason for using the device is to lose weight without dieting, AspireAssist patients may find themselves quickly gaining all their weight back if they do not learn new eating habits while they lose weight.