More than one-third of Americans are obese – putting themselves at risk for heart disease, stroke, type-two diabetes, and certain cancers. When diet and exercise don’t work, many turn to surgery. But now—there’s a new therapy that may work just as well for some.
Kari Adams has been overweight most of her life. At her highest – she weighed 220 pounds.
“I have tried Weight Watchers. I have tried South Beach. I have tried Atkins,” Adams told Ivanhoe.
But nothing worked. So, Adams enrolled in a clinical trial to test a new and very radical weight loss method. It’s called aspiration therapy.
“If we can put food into the stomach, can we also take food out of the stomach?” Shelby Sullivan, MD, Assistant Professor of Medicine, Division of Gastroenterology, Washington University in St. Louis, told Ivanhoe.
Patients first have a skin port placed in their abdomen. After a meal, they connect a tube to the port – and into the stomach. When they turn on the valve, water is infused, and food travels from the stomach to the outside of the body.
“The food just, is emptied out into the toilet,” Dr. Sullivan said.
The device allows users to remove 30 percent of the food from the stomach before its absorbed. In a clinical trial, patients lost an average of 46 pounds during the first year using the therapy.
Adams went from 220 pounds to 145 pounds – after five years of aspiration therapy. And, she’s more active than ever!
“The main thing is, I’ve started running, and I did two half marathons so far,” Adams explained
Now, nothing holds her back.
Patients have to aspirate about 20 minutes after a meal, and the process takes about 20 minutes – so they do have to plan ahead. Doctors also monitor patient’s nutrient intake and can provide them with special supplements if needed.
BACKGROUND: About 35 percent of adults in the United States are considered obese, according to the CDC. Obesity can cause heart disease, stroke, type 2 diabetes, and certain types of cancer. Obesity costs the U.S. $147 billion a year. In fact, the medical costs for obese people are $1,500 higher than those who are not obese. African Americans have the highest rates of obesity, at about 49 percent, and Hispanics have the next highest rate at about 40 percent. A person is considered obese if their weight is 20 percent or more above normal weight, or if their body mass index (BMI) is above 30. BMI is calculated based on your weight and height. (www.cdc.gov)
CAUSES: Gender and genetics can lead to obesity, and so can environmental factors, physical activity, illness or medication. Lifestyle changes, medications, and sometimes surgery are options for treating obesity. Doctors are divided about calling obesity a disease or not, despite it being perhaps the greatest public health issue facing Americans. Labelling it as a disease is seen by some as a way of absolving personal responsibility from the condition. While others think labelling it a disease could lead to a different, more holistic, and more serious way of thinking about obesity. (Source: www.webmd.com)
NEW TECHNOLOGY: Aspiration therapy is now being tested to treat obesity. It’s one of the more radical approaches. It reduces calories stored in the body. To make this happen, a tube is placed in the stomach. The tube is connected to a poker size chip skin port outside of the abdomen; 20 minutes after a meal the patient empties a portion of the stomach contents into a toilet by connecting the handheld device to the skin port. The process takes 5 to 10 minutes. The “emptying” or aspiration process removes a third of the food so the body still receives calories it needs to function. In a U.S. clinical trial patients lost about 46 pounds in the first year. Critics say the pump can get clogged because it can't break up foods like cauliflower, steak, pretzels, and Chinese food. Dehydration, stomach irritation, and electrolyte deprivation are also a concern. (Source: Washington University in St. Louis)
FOR MORE INFORMATION, PLEASE CONTACT:
Shelby Sullivan, MD
Assistant Professor of Medicine
Division of Gastroenterology
Washington University in St. Louis
Shelby Sullivan, M.D., Assistant Professor in the Department of Medicine and gastroenterologist at Washington University in St. Louis, talks about a new weight loss option called Aspiration therapy.
What is aspiration therapy?
Dr. Sullivan: Aspiration therapy is a therapy that uses technology that we’ve been using in gastroenterology for years, called the percutaneous endoscopic gastrostomy tube (PEG), which allows us to feed people directly into the stomach. Aspiration therapy takes this one step further and instead of putting food into the stomach, we take food out of the stomach.
Why do you put those feeding tubes in?
Dr. Sullivan: For a variety of reasons, we may need to feed people through their stomach, for example people who have either had cancer can’t swallow or had a stroke and their swallowing mechanism isn’t working anymore may need feeding tubes.. The modified feeding tube we use in aspiration therapy is called an A-tube. We place the A-tube just like we place a feeding tube and we use this tube to aspirate food out of the stomach after somebody’s eaten. We only aspirate about 30% of the calories at any given meal, but this gives someone a tool that helps them to regulate the amount of food that they’re taking in at the level of their stomach.
How can you control 30% of the food that they’ve eaten?
Dr. Sullivan: It’s not a matter of controlling it. We’ve done some pretty sophisticated testing to figure out how many calories somebody can aspirate if they do a complete aspiration after a meal and it’s about 30% of their calories if they’re aspirating 20 minutes after a meal. If they wait longer than that, they’re going to aspirate fewer calories. If they aspirate before that, we’re not sure if they will aspirate more or fewer calories because the stomach does have to do some work to break those food particles up small enough for them to actually fit through the tube.
So how does it work? How do you do it?
Dr. Sullivan: It works very easily. There is the portion of the device that is left in. That’s the A-Tube™ and the Skin-Port™ is placed on that. There is a portion that is removed every time you aspirate and that’s called the Companion™. After connecting the Companion™ to the Skin-Port™ we infuse fluid from a reservoir that’s attached to the Companion™ and then turn the one-way valve so then fluid and food run out and into the toilet.
How does the person get enough nutrients and everything that they need before it’s aspirated?
Dr. Sullivan: In general, the amount of calories that people are not aspirating is enough to get all of their nutrients. Having said that, we monitor everyone for nutrient deficiencies.
What have you seen so far in trials?
Dr. Sullivan: In the first year participants had about an 18.6% weight loss in the aspiration therapy group compared to around 5% weight loss in the control group and at two years, that weight was maintained.
Does the aspiration tube and everything stay in the patient for two years or is it removed?
Dr. Sullivan: It stays in. This therapy is meant to be a long term, if not lifelong therapy. If you remove the tube, you not only remove the ability to aspirate some of those calories, but you also remove all of the lifestyle changes that had to be made in order to get good aspiration... In order for people to adequately aspirate their food, they have to chew their food really, really well, slow down their meal times, and drink a lot of water with each meal. These are all things that we tell people to do in order to lose weight, but it’s very difficult to do. This device forces people into doing that because if they don’t, food will get stuck in the tube.
This is kind of like a way to lose weight without any sacrifice involved really?
Dr. Sullivan: There definitely are sacrifices involved. In order for this therapy to be effective people still have to make lifestyle changes and make healthier food choices.
Is there a restriction on how overweight you have to be to get this?
Dr. Sullivan: Right now this is not approved by the FDA, and we’re doing a multicenter trial which is called the Pathway trial to determine the safety and effectiveness of this treatment in a wide range of patients. To get into this trial, you have to have a BMI between 35 and 55 kg/m2. That’s about 30 to 150 pounds overweight depending on how tall you are. And, if you’re in that range, we’d love to be able to talk to you if this is something that you are interested in.