 A moderately obese person doing moderately intense physical activity, like biking or risk-walking, would burn off approximately 350 calories an hour. But most drinks, snacks, and other processed junk are consumed at a rate of about 70 calories per minute. Therefore it only takes five minutes for someone to wipe out a whole hour of exercise. Enter the Aspirisist Siphon Assembly. It's a percutaneous gastrostomy device, meaning surgeons cut a hole in your stomach. And tunnel a fistula out through your abdominal wall. So after each meal, you can attach a suctioning gadget to the hole and directly drain out your stomach contents. You could gorge on donuts, spew them out through the hole in your stomach, and then gorge again on even more donuts. Have your cake and eat it, too. And three and four times. It's like bulimia without the aftertaste. It seems to be the quintessential American invention, straight from the land that brought you jello salad, spray cheese, and deep-fried Snickers bars. Patients do lose weight, perhaps in part, because the fistula may interfere with the relaxation of the stomach wall during a meal. The process also requires drinking lots of water and for food to be chewed thoroughly, both of which may help with weight loss in other ways, by increasing hydration and slowing eating rate. It also started to make healthier choices to avoid unpleasant appearing gastric aspirate of unhealthy food choices. The tubing is clear, and evidently fried foods look particularly gross as they're pumped out. All patients need to take supplemental potassium since it's sucked out in the stomach juices, otherwise they risk becoming potassium deficient, common complication in true bulimia. But most side effects are just minor, wound complications. Most adverse effects, like abnormal abscesses, are rare. The big selling point is that the siphon device does not alter the anatomy of the gastrointestinal tract. It seems like a low bar, but in today's wild west world of weight loss procedures you can't take anything for granted. Case in point, the duodenal-jejunal bypass liner. Gastric bypass surgery works in part by cutting out part of the small intestine from the flow of food to help prevent the absorption of calories. Instead of major surgery, how about just dropping down a couple feet of plastic tubing to line the intestinal walls? The problem with the endobarrier is that it has to be anchored in the digestive tract. This is accomplished with 10 barbed hooks that cause lacerations, accounting for the majority of the 891 adverse effects reported in 1056 patients. That's nearly 9 out of 10. Severe penetrating trauma resulting in esophageal perforation or liver abscess is thankfully more rare, occurring in only about 1 in 27 patients. Concern has been raised about the palatability of the aspirous stomach pump, but the most cringe-worthy endoscopic procedure I ran across in my research was intestinal resurfacing. Why cover the inside of your intestines with plastic to prevent absorption when you can just thermally ablate the superficial duodenal mucosa? In other words, have your intestinal lining burned off, or rather resurfaced? Surgeons have tried injecting Botox into the stomach walls of obese individuals, hoping it would partially paralyze their gastric muscles, slow stomach emptying, make people feel fuller, longer, and lose weight. It didn't work. Researchers in Sweden tried randomizing people to wear corsets for 12 to 16 hours a day, 7 days a week for 9 months, and it didn't work. You can guess why the study subjects just didn't wear them. The corset was perceived as uncomfortable. Duh! Sanitized tapeworms have evidently been widely advertised as a weight loss remedy since back in the early 1900s. The fact that living tapeworms have been discovered during bariatric surgery operations suggests infesting yourself with parasites may not be particularly effective either. Speaking of disgusting strategies, how about disgust itself? A study entitled Harnessing the Power of Disgust, a randomized trial to reduce high-calorie food appeal through implicit priming, tried using subliminal messages to ruin people's appetite. Immediately before images of healthy foods, researchers showed people happy images, like a group of kittens in a 20-millisecond flash that's too quick to consciously register, but the hope was to plant a positive imprint on the brain. Before images of high-calorie foods like ice cream, though, they instead flashed scenes of a cockroach on a slice of pizza, vomit in an unclean lavatory, a burn wound. Apparently, it worked. Subjects subsequently reported a reduced desire to eat high-calorie foods, though this wasn't tested directly. The researchers conclude subliminal revulsion may be a successful tactic to combat the onslaught of food cues that promote unhealthy eating. The rest of the world look on, bemused by American machinations, penning commentaries like A View from Across the Pond, Don't Let Them Eat Cake. A paper in the journal Obesity Surgery, entitled What Are the Gangs Doing, reviewed the U.S. experience with implantable gastric stimulation inserting electrodes into the muscular layer of the stomach wall. When that didn't work, we tried colon electrical stimulation. Even more shocking were studies like Repetitive Electric Brain Stimulation, reduces food intake in humans. Though placing deep brain electrodes is considered a complication-prone operation, studies have long pondered whether placing an electrode somewhere in the brain could make people eat less. Holes were drilled through the skulls of five obese individuals, and wires were pushed into their brains for electro-stimulatory exploration. Once they poked around and found spots where they were able to elicit convincing hunger responses, they sent enough juice in to fry out electro-coagulatory lesions. It seemed to work in cats and monkeys, but the researchers found that burning holes in people's brains did not produce weight loss in obese humans. Thankfully, as I aim to explain in my book How Not to Diet, Healthy Sustainable Weight Loss is in brain surgery.