So, the tubie parent community is fighting a two-front war!
I was going to take a break from special needs blogging, but when it’s timely, it’s timely.
To catch you up on the lingo,”tubies” are what some parents of tube-fed kids call their kids. One of my kids is a tubie.
So first, a doctor named Oliver Di Pietro, who frankly sounds like a bit of a schmuck, has come up with a way to make money off people desperate to lose weight. He inserts a nasogastric tube (NG tube) in their nose (a tube that threads through the nose into the stomach) and gives them an 800 calorie ketogenic diet for 20 days. Some tubie parents are outraged by this, and call it unethical. They claim it is unethical because it is using a medical device for non-medically necessary purposes. Here’s a petition. (For the record, my kid had an NG tube at birth, and now has a G tube, which is surgically inserted and just goes straight into his stomach.)
Of course I think this is really ridiculous. Can’t they just go on a liquid diet or something? If they have to do anything so drastic at all. Why take the risks and stigma that come with an NG tube? But I’m not entirely sure it’s clearly unethical. Plastic surgery uses medical devices for cosmetic purposes. You use a scalpel, etc. for plastic surgery. And I don’t see plastic surgery as necessarily unethical. It may be unethical because it’s an 800 calorie a day diet, but not necessarily because it’s using a medical device for cosmetic device. If anything is unethical about it, it’s that he’s using his position as doctor (perhaps) to put an imprimatur of medicine on it, to make a riskier version of the Slim-fast diet appear legit.
And then, on the other front, we have Kathie Lee and Hoda (this is a show I’ve never watched) basically going “ewwwwww” for two minutes at the idea of an NG tube (5:15-7:15 here). I’m guessing they’d be even more grossed out when I change my kids G tube. I’m full-throatedly with the other tubie parents here. Come on, really? Are they not aware this is a medical device used for other purposes? That other people really do have to carry a bag around and worry about it falling out? It’s like Mean Girl TV. Even if it was done in ignorance, they ought to apologize.
*sigh*
Thanks, Dr. Di Pietro, for the handy reminder of how many assholes there are in my profession. Is what he does unethical? If you put a premium on patient autonomy, I suppose not. But it certainly adds a patina of medical legitimacy to what is an obviously dangerous and extreme starvation diet.
I sincerely doubt the Pietro is giving his patients even the bare minimum counseling required by something like gastric surgery. I might not mind it if I suspected he was being truthful about the consequences as best we know them — “Most of you will gain more weight later because of this.”
I’m not sure if it was clear that to the degree he prescribed a dangerous diet, and abused his medical authority, he is unethical. But not because, as the tubie parents have it, that he used a medical device.
Is it obviously dangerous? My understanding is that the safety of very low-calorie diets in overweight patients is fairly well established, even for periods much longer than twenty days. A quick scan of the PubMed results for “VLCD” shows several studies in the past year alone in which patients went on 800-calorie diets for twelve weeks or more, with only salutary effects noted.
I think there is a notable difference between people who are seeking medical treatment for obesity, and women who are essentially already at a healthy weight who are trying to shed a few extra pounds to fit into their “perfect” wedding dress.
I think the number “800” probably makes it sound much worse than it is.
A few years back, I needed to lose weight after quitting smoking. I had gained 30 in about five months.
It took me another five months to get it off. I reduced my calorie intake to 80 – 90% of normal intake (it takes around 2740 calories/day to sustain my body weight). And an awful lot of exercise.
What I’m getting at is that, depending on the needs of the child, if the normal intake is in the range of 900 – 1000 calories/day, then 800 isn’t so bad.
That said, I believe it’s clear that teaching responsible eating habits would be a much better option.
But then, I also think that it’s better for parents to teach their children to drink responsibly rather than leaving that up to the frat houses.
The tube diet provides 800 calories a day for a grown woman, not a child. That’s very low for any adult, especially for a relatively young, healthy person who’s out and about. Even the crash diets in women’s magazines provide about 1200-1600 calories per day.
What galls me about the NG tube diet is that it’s probably based on pseudoscience. (More than most diets, even.) The doctor claims that dieters are better off with the tube as opposed to a liquid diet because the tube delivers nutrition continuously and therefore staves off hunger. I suspect this is nonsense.
Question for the tubie parents: If you were to give your kid half as much food as usual, s/he’d get hungry, right?
Did he claim that? Jesus. I thought it was something about not being tempted to use our mouth. Let me stress, then, that he didn’t act unethically by using a medical device for non-medical reasons, but he managed to find lots of other lovely ways to be a complete ass.
Well, I never tried feeding my kid half his calories. 🙂 He used to be on continuous slow drip feeds for night with small boluses during the day. When we switched to all daytime boluses, he probably woke up hungrier in the morning, but I doubt he was any overall hungrier. Also, we’ve managed to shift from very slow feeds (two hours for each of four meals) to much faster feeds (half hour per meal). So he went from eating 8 hours a day to 2 hours with same number of calories. No hunger differences that I could perceive.
I found that claim in a .pdf of a online pamphlet the diet. If I had to pick just a few unethical aspects of this doctor’s behavior out of the general morass of sleaze, I’d say he’s unethical because he’s a quack and because the risk of the NG tube for cosmetic weight loss vastly exceed the likely benefits.
A Canadian obesity medicine doc who blogs at Weighty Matters explained the risks of NG tubes in a recent post. Obviously, if you need one to survive, it’s well worth the slightly increased risk of infection or pneumonia or injuries to the delicate tissues. It’s much less clear that it’s ethical to subject someone to the risks of an NG tube for purely cosmetic reason when there’s no reason to believe a tube is more effective than, say, a less invasive supervised liquid diet.
The important thing is to avoid eating an overall healthy, balanced diet and staying active.
And to remember that your self-worth should be inversely proportional to your dress size.
Crazy talk.
Hi there,
Several tubie mom and dad are usually furious with this, and give us a call that underhanded. They will declare it truly is underhanded as it is by using a health-related unit regarding non-medically essential functions. Here’s any case. (For the particular report, our|healthcare professional|personal|my own, personal|search terms|my own , personal|medical professional|published|health care provider|my business|all of my|of my|excellent|my own personal|keyword phrases|a|offered|economical|day-to-day|web page} youngster got a great NG conduit at birth, and after this includes a H conduit, which can be surgically put also to should go straight to his or her tummy. )
Thanks,
Morkar