Weight loss surgery provokes controversy

Michael Cook
19 October 2013
Reproduced with Permission

Obesity, one of the great health issues of our time, is provoking some controversial treatments by doctors. Here are two recent issues which ought to ring bioethical alarm bells.

Doctors have performed bariatric surgery on a morbidly obese two-year-old in Saudi Arabia - the youngest person ever. The toddler weighted 66 kilograms and had a body mass index of 41 (18 to 25 is normal). He was suffering from sleep apnea and was developing bowed legs from carrying too much weight.

Saudi doctors reported in the International Journal of Surgery Case Reports that the surgery was successful. Within two months the boy lost 15% of his body weight; two years after the 2010 surgery his weight had fallen from 33kg to 24kg and his BMI was 24.

The doctors concluded that the operation was "safe and effective". But the author of a commentary in the same journal damned it as unethical. "One could argue that overfeeding a child by the parents to the point of becoming morbidly obese is a form of neglect or maltreatment, and that the help of child protective services may be justified before considering surgical options in such cases."

The second development comes from the US. Inventors have updated the Roman idea of a vomitorium* to help morbidly obese people lose weight. Their device, AspireAssist, sucks the stomach contents out through a tube so that only about one-third of the calories are absorbed by the body. The US Food and Drug Administration still has not approved the device and it is not available commercially in the US, although it is available in some places in Europe.

"Some people manage to lose weight on a diet, but the kinds of changes you need to make to keep it off are probably not sustainable for many," said a company spokeswoman. "There's a lot to be said for people being in the driver's seat with their own body, with their own health. This allows a patient to do that while under the care of a physician."

Most reports have been critical. "This is an enabling device, not a helping device," said Keith Ayoob, of Albert Einstein College of Medicine in New York City. "It doesn't do anything to make someone change their relationship with food. Once you put this in someone, they're never going to want it taken out."

*This is widely believed, but it appears that vomitoria never existed, even if Roman banquets were on the Gargartuan side.