Is draining your meals from your abdomen a form of bulimia?

[birchswing]

When I first read about this, it struck me as medicalized bulimia. But apparently there is data showing it's successful and doesn't lead to eating disorders. But the question I have is whether the treatment itself is an eating disorder:

http://aspirebariatrics.com

It's approved for use in Europe and the company is seeking FDA clearance.

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[Ceke2002]

When I first read about this, it struck me as medicalized bulimia. But apparently there is data showing it's successful and doesn't lead to eating disorders. But the question I have is whether the treatment itself is an eating disorder:

http://aspirebariatrics.com

It's approved for use in Europe and the company is seeking FDA clearance.

It's not that unknown for eating disorder patients being fed via gastric tubing (tube inserted into the stomach through a small abdominal incision) to use the tube itself as a method of purging by aspirating food back out of the stomach, so I think the only difference I can really see with that and what you've linked to is the person's intent and/or underlying pathology. The rather large, glaring problem I can see with it though is that people aren't going necessarily going to be learning healthier eating patterns (yeah it says that's the 'goal', but how many people, bulimic or not, will end up just going 'oh who cares, I can chow down on those extra 3 Big Macs today, I'll just suck some of it back out again) and purging in any form can be habit forming/become a compulsive behaviour.

Edited to add: I'm just reading through their 'What to expect' section, they might as well have titled it 'Engaging in bulimic behaviours 101', or even 'So you're on your way to bulimia, now what?' Seriously, medicalised bulimia is actually a good term for this thing. Yikes!

 

[Crayola227]

I wonder if the key is that it makes it difficult to have a really good binge followed by a really good purge. Seems like the addictive nature of bulimia depends on that cycle, so I'm not sure this opens up pursuing that sort of excess. If one was really going to binge and purge, would this really be the inspiration or the way to do it?

Maybe if you were already bulimic or prone to bulimia. If you were already bulimic would you reach for this device? Don't know you would. If you were doing this for weight loss, would you start eating more because you were going to draw out 1/3? I dunno. Fascinating question.

Of course, I'm sure the study group was very carefully recruited to avoid that outcome.

I see now you are more on the side of patient curiosity.

I would say that most invasive/surgical even minimally invasive weight loss procedures are only done when someone's obesity is at a certain severity and less invasive, safer, and overall good for you measures like a healthy diet and healthy exercise, as well as some other non-surgical interventions (like certain prescriptions) have failed. And treatment of obesity should of course include psychological evaluation and treatment from the outset.

So I think based on definition of bulimia this would not qualify, and I'm not sure that candidates for this procedure would then develop bulimia from doing this. Bulimia is not just about a desire to control weight, it is an addiction to binging and purging activities. Often there is a relationship to weight and that is how the compulsion begins, with body dysmorphia or a distorted perception or hatred of one's body image, but bulimics come in all shapes and sizes, and engage in purging/binging without any effect on weight. Some bulimics will lose weight, stay the same weight, or even gain weight. Most of them find that they become addicted to the binging and purging, and that weight is no longer the motivating factor if that was indeed how it started.

Treating bulimia requires not only addressing body image but also the compulsion.

So I wouldn't say this would be medicalized bulimia (no doctor would try to sell that in a bottle), but whether or not this would be used by or lead to an eating disorder, is anyone's guess.

 

[Crayola227]

It's not that unknown for eating disorder patients being fed via gastric tubing (tube inserted into the stomach through a small abdominal incision) to use the tube itself as a method of purging by aspirating food back out of the stomach, so I think the only difference I can really see with that and what you've linked to is the person's intent and/or underlying pathology. The rather large, glaring problem I can see with it though is that people aren't going necessarily going to be learning healthier eating patterns (yeah it says that's the 'goal', but how many people, bulimic or not, will end up just going 'oh who cares, I can chow down on those extra 3 Big Macs today, I'll just suck some of it back out again) and purging in any form can be habit forming/become a compulsive behaviour.

Although I will say that's been a critique of gastric bypass.

I mean, of course you're going to try to get patients to eat healthier even with this sort of thing, and ironically while bypass patients lose weight some develop various deficiencies because a full calorie **** diet may make you fat, it often has enough nutrients, 1/3 the amount of calories shot diet may be 1/3 the iron etc you needed.

At some point the sheer poundage of a patient is what has to be addressed, through any means necessary.

 

[Ceke2002]

I wonder if the key is that it makes it difficult to have a really good binge followed by a really good purge. Seems like the addictive nature of bulimia depends on that cycle, so I'm not sure this opens up pursuing that sort of excess.

This is a very good point, often the 'release' of purging is more in the act of actually vomiting rather than simply removing food from the body. I can still see aspiration as a method of purging becoming compulsive though. Just for some context to my comments as well - I'm recovering (mostly recovered, in partial remission at least) from long term anorexia nervosa, but I have also experienced bulimia/purging anorexia in my eating disorder history as well (so I definitely get what you're saying about the addiction of bulimia relying on that perception of having a 'good binge'/'good purge' type experience or perception, and I also personally found bulimia it feel far more like an addiction compared with restricting type anorexia). Sorry, I'm probably not explaining things very well right now (slight case of brain melt from being unwell the past few days).

 

[Crayola227]

**** @Ceke2002 you're right, I sorta skimmed it and thought "I get it", but then when I read your post edit I read more closely.

"So I wouldn't say this would be medicalized bulimia (no doctor would try to sell that in a bottle)"

 

[Ceke2002]

**** @Ceke2002 you're right, I sorta skimmed it and thought "I get it", but then when I read your post edit I read more closely.

"So I wouldn't say this would be medicalized bulimia (no doctor would try to sell that in a bottle)"

Admittedly that is probably my own bias coming into play, just having been bulimic myself (and recovered from that side of things at least, thankfully), having close friends who are still struggling with bulimia or purging anorexia, and also being involved in the eating disorders support community online, reading through some of the stuff on that site seriously made me think of how I've seen friends progress from early stages of bulimia to full blown addiction, or the type of language and 'feeling' to posts you might see on the online eating disorder communities themselves (the good, the bad and the ugly ones). I can't really put my finger on it exactly, but reading it as a patient who's in treatment for an eating disorder and who engages with a support community for people with shared issues experiences, there's just something about the whole thing that's kind of raising my hackles a bit (or at least has me side eyeing the ideas behind the concept pretty hard). But again, I will fully admit that is my own bias coming into play here as well.

 

[Crayola227]

Ah yeah @Ceke2002 I get what you're saying, makes total sense.

This would "medicalize" it in the sense that putting a tube in sort of forces there to be some extent of medical supervision. Patients could definitely get into all the sorts of trouble that purging does, except maybe less esophageal rupture, enamel erosion, mouth/throat etc. Still bone loss, metabolic alkalosis, cardiac arrythmia, etc etc.

It wicked to say that bulimia lets you have your cake and purge it too in comparison to eating restriction. Hours of forced fasting during training has taught me that there is an odd sort of energy/head change from adrenaline from not eating, but there's that crash. Vomiting feels really gross (I've never done it by choice) but has a different sort of endorphin-feeling high. It's the sort of catharsis you get from a really big cry even though it leaves your face hurting. God I hope some hsSDNer doesn't read this and think "wow ways to get a natural high from doctors"

DISCLAIMER: Kids, it's OK to cry. If your stomach really wants you to vomit that's OK, if you are crying or vomiting too much please seek medical advice.

 

[Crayola227]

Ah yes @Ceke2002, I get what you mean, you're not too sensitive, when you said what you did and I re-skimmed the article "wait for it wait for it" and I knew it as soon as I saw it what you meant.

In med school my friend told me about those websites and it was just, wow.

Glad to hear you're recovering.

 

[Crayola227]

Ah **** too I wasn't meaning to be glib talking about all this, although yeah, docs are on here all the time being glib, me included.

 

[Ceke2002]

Ah yes @Ceke2002, I get what you mean, you're not too sensitive, when you said what you did and I re-skimmed the article "wait for it wait for it" and I knew it as soon as I saw it what you meant.

In med school my friend told me about those websites and it was just, wow.

Glad to hear you're recovering.

Thank you, I'm still a bit of work in progress but getting there (or determined to at least). To cut a long story short I'm pretty much weight and nutrition restored, just still working through some of the psychological stuff and continuing to strengthen myself against the possibility of relapse (or learning to recognise a relapse when it is happening and to get things restabilised sooner rather than later). We have a saying in the eating disorder recovery community - "recovery is a journey, not a destination". And yeah there are some really bad sites out there, but there are also some really good ones too. Interestingly enough it's not just the so called 'Pro Eating Disorder' sites that are bad either, there are actually a few recovery based sites that focus on the idea of recovery to the point that it almost becomes as perfectionistic/control/compulsion focused as the eating disorder itself. Anyway, I'm getting off topic, but just in regards to what you said in your other post, yes there can definitely be a sort of catharsis, or the perception of carthasis at work with the act of purging - it's almost like a more literal form of 'purging' your emotions and feeling that sense of release/relief. Just speaking for myself personally as well, when it comes to food restriction I do get a 'high' off it, not a cathartic high, but there's definitely a mental/emotional change that takes place that is exceedingly pleasant for me (a sense of feeling relaxed, more centred, kind of euphoric and blissful in a way). Of course the fact that experiencing that has come at the price of having done permanent physical damage to my body means it's totally not worth it, but there is definitely an altered state of consciousness type thing going on when I, and I have to say a lot of other anorexic patients I've spoken to as well, engage in a restrictive intake of food.

 

[Ceke2002]

Ah **** too I wasn't meaning to be glib talking about all this, although yeah, docs are on here all the time being glib, me included.

Nah you're okay, I didn't think you were being glib at all. I like hearing a Doctor's take on things, especially when it's not just straight out 'medical' type discussions, but involves expressions of opinions and observations and personal type relational stuff as well - it's all good.

Edited to add: I'm open to questions as well, so feel free if you want to ask anything (either in here, or via message, whatever's preferable - although we probably shouldn't let this thread meander too far off topic, unless of course Birchswing doesn't mind, as the OP).

 

[Ceke2002]

Now that @birchswing has posted about this, I would actually be very interested in hearing how a Psychiatrist/Psychologist/Medical professional in general et al would formulate a response to this product/service from a clinical pathology, and/or risk thereof point of view, if anyone else wants to chime in (...and so maybe the thread I derailed slightly can get back on track as well )

 

[Therapist4Chnge]

When I first read about this, it struck me as medicalized bulimia. But apparently there is data showing it's successful and doesn't lead to eating disorders. But the question I have is whether the treatment itself is an eating disorder:

http://aspirebariatrics.com

It's approved for use in Europe and the company is seeking FDA clearance.

I'm a big believer in data, but data can be shaped/diced/sliced in all sorts of ways that it can't be taken at face value. I have a hard time believing this "treatment" isn't hugely problematic. While it depends on how you conceptualize eating disorders, I think most people can agree that there is a learned behavior aspect to every eating disorder (e.g. "X works better than Y." "If I do X instead of Y, I can avoid more calories). I can't see how this "treatment" doesn't promote and reinforce maladaptive behavior to deal with food intake. I'd hazard a guess that medicalizing it provides the excuse for even more eating disordered behavior. I can see this being the jumping off point for many to learn how to be the best person with an ED they can be…which is tragic.

 

[FlowRate]

If it's a regular occurrence with baseline eating habits, wouldn't it be more akin to medical anorexia? Bulimia implies periods of loss of control (hence the binge before the purge), right?

 

[Ceke2002]

I'm a big believer in data, but data can be shaped/diced/sliced in all sorts of ways that it can't be taken at face value. I have a hard time believing this "treatment" isn't hugely problematic. While it depends on how you conceptualize eating disorders, I think most people can agree that there is a learned behavior aspect to every eating disorder (e.g. "X works better than Y." "If I do X instead of Y, I can avoid more calories). I can't see how this "treatment" doesn't promote and reinforce maladaptive behavior to deal with food intake. I'd hazard a guess that medicalizing it provides the excuse for even more eating disordered behavior. I can see this being the jumping off point for many to learn how to be the best person with an ED they can be…which is tragic.

Agreed. Even before the rise of the internet with the whole 'Pro Anorexia', "Thinspiration' nonsense, it was still easy enough to figure out or learn certain tips and tricks to entrench oneself deeper into the disorder. This so called 'treatment' just adds fuel to an already potentially raging fire.

 

[Ceke2002]

If it's a regular occurrence with baseline eating habits, wouldn't it be more akin to medical anorexia? Bulimia implies periods of loss of control (hence the binge before the purge), right?

True, but if this treatment is meant for morbid obesity then I'd venture a guess that the majority of patients didn't reach a morbidly obese weight by restricting their intake. As I'm sure you're already aware Bulimia can come in many shapes and sizes, and some Bulimics just aren't that good at purging (not that being good at purging is something to strive for mind you). Hence, depending on their calorie intake during a Binge, it's not exactly unheard of to have someone with Bulimia who is in a morbidly obese weight range. So you take someone who is already compulsively bingeing, and you give them an easy outlet to purge through, and in my mind you've got a potential disaster in the making.

 

[FlowRate]

True, but if this treatment is meant for morbid obesity then I'd venture a guess that the majority of patients didn't reach a morbidly obese weight by restricting their intake. As I'm sure you're already aware Bulimia can come in many shapes and sizes, and some Bulimics just aren't that good at purging (not that being good at purging is something to strive for mind you). Hence, depending on their calorie intake during a Binge, it's not exactly unheard of to have someone with Bulimia who is in a morbidly obese weight range. So you take someone who is already compulsively bingeing, and you give them an easy outlet to purge through, and in my mind you've got a potential disaster in the making.

Good point. They're not significantly low weight, so not technically anorexic, and technically all obese people binge, but I don't know that we'd consider everyday baseline eating habits to be "binges" in the same fashion?

 

[Ceke2002]

Good point. They're not significantly low weight, so not technically anorexic, and technically all obese people binge, but I don't know that we'd consider everyday baseline eating habits to be "binges" in the same fashion?

True. I suppose if you're talking about bingeing as part of Bulimia there's far more of a feeling of loss of control or being frantic to get the food into you, as opposed to someone who is just compulsively overeating on a regular basis. I mean someone could eat their way through 8,000 calories or more in a couple of hours and I'd classify that as a binge, whereas the same amount of calories spread out over a day due to a non stop compulsion to eat, I wouldn't necessarily call that a binge, even if the person themselves associated the overeating with a loss of control.