Tuesday, April 17, 2012

Church booked? Check. Flowers? Check. Feeding Tube? Check?

From the WTF files comes a new trend in wedding preparations - the pre-wedding day feeding tube diet.

For those of you who aren't familiar with naso-gastric (NG) feeding tubes, think a small hose, about the diameter of a healthy earthworm, inserted through your nose and then with the help of you swallowing, passed down into your stomach (and by the way, that photo up above is staged.  Insertion is quite uncomfortable). A balloon on the tip is then inflated so it's less likely to come out and it gets taped to your nose.

There are risks of course (it's an invasive procedure after all). Probably the most common risk is incorrect placement into the airway rather than the esophagus. If unnoticed and someone starts to access the tube for feeding there'll be a very real risk of developing an aspiration pneumonia. More remote risks included a perforated esophagus or a pneumothorax.  There are also very real risks to the very-low-calorie-diets these tubes provide the brides to be in that polyuria (peeing a lot) due to ketosis (the body making its own sugars) can lead to hypokalemia (low potassium) which can lead to cardiac arrhythmias (irregular heart rhythms) and even rarely death (yes, death).

NG tubes are medically indicated to aspirate stomach contents for diagnostic or therapeutic reasons, or to provide a route for feedings or administration of medications when swallowing is compromised (strokes, decreased level of consciousness, etc).

Apparently now they're being used to lose weight before the big day.

Now I'm not going to dwell on the women who've decided the NG tube diet is a good idea. I feel badly for them. Both in terms of the desperation they must feel to go through with it, and for their clearly challenged body images which may well be reflections of weight bias or just our screwed up societal ideals of beauty.

I'd like to focus instead on the physicians who are performing this procedure on women who clearly have no medical indication for an NG tube's insertion. I'd argue the physicians involved are in breach of their Hippocratic oaths, as to put patients at unnecessary risk of infections, perforations, and the cardiac risks inherent to very-low-calorie-diets is contrary to the spirit of "do no harm". Now I realize the Hippocratic oath isn't one that's enforceable (or even one that's taken everywhere), but I'd be shocked if these physicians' respective medical Colleges would approve of this inane treatment, and were someone to lodge a complaint I'd consequently be shocked if the College didn't caution said physician on that practice.  And if their Colleges don't have any concerns, I'd be concerned with their Colleges.

There's no doubt in my mind that eventually, if sufficient numbers of women opted to try the NG tube diet, there'll be a serious medical complication, potentially even a death. I sure wouldn't want to be the physician who inserted the NG tube when that happens as I can't imagine it'll take the prosecutor much time to ascertain that the physician's practice didn't meet the standard of care of medicine.

[Here's a link to the NYT's story on same and photo up above from their as well]

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  1. Parallel perspectives, apparently!
    Hopefully your medical insights will make a dent on those considering this process and the senseless medical practitioners will reconsider their practices!


  2. Alexie7:43 am

    The first person to invent a bionic device wired into the brain that zaps the person as soon as they think pleasurable thoughts about food is going to make a lot of money. Or maybe doctors could start wiring patients' jaws shut. I bet that would work a treat, too.

  3. Wow. I'd like to know which doctors are advocating this nonsense. I am appalled.

  4. I could not agree with you more...physicians who do this procedure must be really hard-up for patients and fees. Women who request this weight loss method should be referred to a therapist instead of placing a g-tube in them.

  5. Anonymous9:43 am

    Colleague, not college.

    1. Anonymous4:07 pm

      No mate, certainly here in England, because on the whole doctors are not completely devoid of souls, we have self regulating 'colleges' which assess and maintain standards of academic and ethical/professional behaviour

    2. As do we here in the Commonwealth.

  6. Anonymous10:37 am

    Ummm... I believe you have got your terms confused. The correct term for when we make our own sugar is 'gluconeogenesis'. The term that you have used, 'ketosis', is an indication that there are ketones present in the blood, caused by carbohydrate restriction and the body seeking to find an alternate fuel source. Ketones are produced by the liver at this time and indicate that fat is being burned as a substrate rather than sugar. Of course, this is in no way related to the condition known as Diabetic Ketoacidosis, which may occur in Type 1 Diabetics.
    And yes, I do agree... the NG tube is a stupid way to consider losing weight.

  7. Bobbini11:27 am

    I assume by "College", you're referring to the regulatory body that governs the practice of medicine (here in the U.S. it's called something like the State Board of Medicine). I would suspect that this would be covered by regulation like any other cosmetic procedure--as long as there is informed consent, it's fine with the medical board.

  8. Anonymous12:48 pm

    So once the ketosis is over and the bride goes back to eating normally (I presume she doesn't hold up her feed bag to make a toast at the reception) then the lost weight goes right back on, right?

  9. On a side note, are these brides just going about their daily activities with tubes sticking out of their noses? I'm not sure I'd see the benefit in losing some weight before the big day, if that meant everyone at my wedding would think I was a little crazy.

    Seriously though, losing that much (looks like it could be upwards of twenty pounds) in such a short amount of time doesn't seem like something that any doctor should be advocating. And, I agree with the comment above about being any brides asking for this to be referred to a therapist.

    One last thing I'm wondering. What are the husbands-to-be thinking? If I were a man, I think I might be more than a little terrified.

  10. Mairi Graves RD2:59 pm

    ASPEN(The American Society for Parenteral and Enteral Nutrition) has contacted the NYT's, the Today Show and the Good Morning America Show informing them that ASPEN does not support this practice. I can only hope their effort makes some type of impact.

  11. I would like to know how this keeps her from eating a Big Mac. Does the tube make it physically impossible to eat food? If it doesn't do that then I don't see the point. If these people have the will power to just not eat then why don't they just go on a normal low cal diet? I'm so confused by this!

    1. No, the tube doesn't make it impossible to eat. They would probably only be hooked up for a few hours each day. It provides you with enough nutrition to keep you going, so you don't feel acute hunger, although from what I've learned in clinical nutrition it's not very satiating. If you've ever had oral surgery or anything that puts you on a liquid diet, this would be comparable.

      As for not going on a "normal" diet... it's possible that this is appealing because it's new and trendy. I agree with Dr. Freedhoff, this is appalling and unethical to say the least.

  12. Anonymous4:45 pm

    Clearly....you all don't understand that Ng tubes aren't considered 'invasive' and secondly....risk for aspiration...? What a joke...again...whoever was looking up the risks for this doesn't understand the check points you have to go through in order to place one of these. There's like 5 different checks you have to do....and if you want to be overly cautious....you can check placement with an xray.
    These are routine procedures in many facilities...I have placed a number of them. And if a grown woman can't a decision without being criticized by all of you....what is this world coming to? I'm sure you all aren't perfect at home.... get over yourselves.

    I just googled searched j tubes for a picture for class....and I come across this crap. You are funny.