Australasian Science: Australia's authority on science since 1938

A Modern Vomitorium

By Michael Cook

A portable stomach pump has been developed so that morbidly obese people can continue to gorge themselves and still lose weight.

Some morsels of ancient history are unforgettable. One of these is the vomitorium, a well-known feature of Roman banquets that has become an emblem of the decadence of life under the emperors.

But I was wrong. The “well-known” vomitorium never existed. There was gluttony, of course – gobs of it – and it is described in emetic detail by some of the classical authors. But there were no rooms where satiated guests could disgorge their flamingo tongues and return for a serving of peacock brains (a menu mentioned in the Life of Vitellius by Suetonius).

However, what the Romans failed to have invented, the Americans have. A company called Aspire has developed a portable stomach pump attached to a stomach peg so that morbidly obese people can stay at the table and still lose weight. After a meal they just remove some of the partially digested contents.

“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.”

While the US Food and Drug Administration has not approved the device, so it is not available commercially in the US, it is already available in some places in Europe.

If your response to AspireAssist is “Yuk!” you are in good company. Most reports have been critical. “This is an enabling device, not a helping device,” said obesity expert Keith Ayoobof the Albert Einstein College of Medicine in New York. “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.”

But a portable stomach pump is only the most dramatic of a range of questionable slimming techniques. Another, bariatric surgery – reducing the size of the stomach so that the patient feels full after small portions – has become a staple of weight-loss remedies.

It has even been performed on children. Not long ago Saudi doctors performed bariatric surgery on a morbidly obese 2-year-old who was suffering from sleep apnoea and was developing bowed legs from carrying too much weight.

His doctors reported in the International Journal of Surgery Case Reports that the surgery had been “safe and effective”, but the author of a commentary 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.”

Whatever solutions are proposed, they will probably be controversial. Obesity is being described as one of the most serious public health challenges of the 21st century, so desperation will give rise to even more outlandish solutions.

I’m not sure that we will find an ethical approach quickly. On the one hand, the answer is surely more complex than glib advice to push yourself away from the table. On the other hand, there’s something very disturbing about staying there with a stomach pump attached.

The obesity epidemic is an example of one of the central challenges of bioethics. In the 21st century technology is often used as a substitute for human agency. It’s easier to take anti-depressives than it is to cope with life’s problems. It’s easier to hand teenagers contraceptives than it is to ask them to abstain from sex. Biomedical technology is so useful – and so seductive – that it seems an essential part of life in a developed economy.

But solutions to the obesity epidemic that dismiss will-power as impossible – as AspireAssist does — could end up leading people to an infra-human existence that makes them victims of commercial exploitation. Autonomously controlling our temperaments is an essential part of being human.

If we need expensive technology to lead a happy and fulfilled life, can we really say that we are happy?

Michael Cook is editor of the online bioethics newsletter BioEdge.