We Can Do Better

Last week, some of you likely read about AspireAssist, the new weight loss surgery device that allows people to purge a third of their meals through an external pump that dumps some of the stomach’s content into the toilet.

We were horrified by the news, but unfortunately, not at all surprised. We’ve long viewed the traditional weight paradigm as one that prescribes for fat bodies the very behaviors we diagnose as eating disordered in thin ones: weigh yourself daily, track your food and calories, chew gum when you are hungry, exercise obsessively, etc. And now weight loss surgeons have the option to promote medically assisted bulimia.

The unethical treatment of fat people has reached a new low. Eating disorders are life-threatening conditions and obesity is not a disease. Many pursuing weight loss surgery may already struggle with an eating disorder, and a focus on weight loss is contraindicated for people with eating disorders. More patients likely struggle with disordered eating after participating in dieting culture for so long. We’ve long been perplexed by the requirement that bariatric surgery candidates have to prove they’ve had multiple previous unsuccessful weight loss attempts when there is no data to support the diets and programs they’ve tried for years. It seems strange that in order to be eligible for surgery, people have to prove that they’ve participated repeatedly in an industry that has a 95% failure rate. If we critically evaluate the data, we wouldn’t expect anything but weight gain (Mann et al., 2007) and yet we make people participate in the industry to prove something?

What they are proving is the harm that has been done to them. Pre-surgical assessments often fail to recognize the presence of a dieting mind, a kind of mechanistic thinking that is externally directed and focused on this calories in versus out equation that we’ve all been sold. The dynamics of weight regulation are far more complicated than this. When “lifestyle changes” are rooted in this dieting mindset, they are not going to be sustainable. Weight loss surgery does little to help people heal this disordered way of thinking, and more often just cements it in place.

The medical community can and should do better. There is so much we can do to support a person’s health and well-being without ever focusing on weight change.