A famous twenty-first-century example of someone having their jaw wired shut – or, to use the medical term, undergoing maxillomandibular fixation – is Kanye West, who actually wrote and recorded his debut single, the Chaka Khan-sampling ‘Through the Wire’, while his jaw was wired shut after a face-shattering car accident in 2002.

I drink a Boost for breakfast, an Ensure for dessert
Somebody ordered pancakes, I just sip the sizzurp
That right there could drive a sane man berserk

In late June of this year, maxillomandibular fixation entered popular discourse once again when the University of Otago tweeted a perky little promotion for ‘a world-first weight-loss device to help fight the global obesity epidemic: an intra-oral device that restricts a person to a liquid diet’.

Otago and UK researchers have developed a world-first weight-loss device to help fight the global obesity epidemic: an intra-oral device that restricts a person to a liquid diet. Read more: https://t.co/eLhXwipiqs pic.twitter.com/Of6v3uvVbX

— University of Otago (@otago) June 28, 2021

In answering a question no one had ever asked (except perhaps the Insane Clown Posse), the accompanying press release described ‘DentalSlim’ as using ‘magnetic devices with unique custom-manufactured locking bolts’ which ‘allows the wearer to open their mouths only about 2mm’. A variant of the more old-fashioned jaw-wiring techniques used during the twentieth century, these magnets are visible externally, while the mouth cavity photos shown in the study look as though device would be very uncomfortable – an impression confirmed by the recorded reactions of the seven women who took part in the trial.

The University of Otago’s tweet was quickly ratioed on a global scale, because although fatphobia is structurally marbled through our society – like the intramuscular fat on a Kobe beef steak – no one in the thin world wants to think that openly torturing fat people is something decent people would do in a medical setting. As for fat people, they already knew that dehumanisation and cruelty are regular features of their interactions with medical professionals. Obesity researchers in particular work within a research paradigm that focuses on weight to the exclusion of all else, so alternative approaches – research that focuses on health at all sizes, for example – are often outside of their perception. 

Rushing to control the damage, the university issued a follow-up statement claiming that the DentalSlim was only to be used by people temporarily while they prepared themselves for bariatric surgery. In doing so, they patently misrepresented the study conducted by Paul Brunton and his five co-authors, which described the device as an alternative strategy which may ‘obviate surgery’ or be a ‘realistic, attractive and economic alternative to surgical procedures’ and could be used in the ‘short, medium or long term, either continuously or intermittently’  [emphasis added].

The very positive trial report in the British Dental Journal, which is published by Nature (interestingly, as of August 3 2021, editorial action is pending over the article’s ‘undisclosed conflicts of interests and discrepancies between the reported study and the clinical trial record’) glosses over some significant issues you might consider if, for example, you were a medical professional who wants to treat fat people like human beings with dignity.

The first is that none of the women involved had any other health problems because they were not allowed to take part if they had ‘major co-occurring health conditions‘ such as diabetes or sleep apnoea, or took oral medications that were not liquid. The problematising of the very existence of healthy fat bodies – or, as Margret Westwater-Hobbs put it in her 2010 study of weight loss surgery in New Zealand, the ‘medicalisation of women’s weight’ – is something we don’t have time to unpack here, but someone who dabbles in ethics might find it uncomfortable.

The second is that, if these women did not have major health problems but expressed issues with their own self-esteem and volunteered to have their jaws magnetically shut for two weeks, there would be some broader meta-research questions that might need to be asked, such as: were they in an appropriate emotional state for this trial? Did they have enough agency, and did they truly give informed consent?

The ethics approval form for the study, obtained through an Official Information Act request, contains some worryingly oblivious statements on Brunton’s part. Inexplicably, he states that there were ‘no risks of stigmatisation of individuals or population groups’ in the trial, but then goes on to argue that Māori and Pasifika groups ‘will particularly benefit from this approach’ as it will be more affordable. Asserting with a straight face that poor brown people openly wearing these torturing devices – while richer white people get more expensive and less obviously torturing bariatric surgery – will be both non-stigmatising and a net benefit to society requires a truly mindboggling level of obtuseness. And, as it turns out, none of the participants in the trial were Māori or Pasifika (or men).

The seven white women with a mean age of thirty-six who did take part in the trial were put on 1200-calorie per day liquid diets, a regimen known to cause side effects such as malnutrition, headaches, dizziness, cramps, thinning hair and digestive issues. They reported a number of problems with the device: it was uncomfortable, sometimes severely, and they felt embarrassed and self-conscious. The list of tolerability issues didn’t end there, and the women noted increases in severity as time went on: trouble pronouncing words; taste changes; poor oral hygiene; struggling to relax. They stated that they could ‘not enjoy social events such as family dinners’ and that life in general had become ‘less satisfying’ to them. They tolerated the device well (women are, of course, used to tolerating uncomfortable medical procedures) and were pleased to have lost weight (some felt the experiment was a kickstart for further dieting), but they still felt embarrassed in public about their weight even after the devices were removed, and none of their quality of life indicators changed significantly from those listed beforehand.

Each patient in the study was assigned a professional dietitian, but half of them left, with two of them citing ethical issues. One emailed to remark that the research did not comply with their ethical obligations as a health professional’ and that the device negatively affected the ‘mental health of the participant, with very little benefit for their physical health’. As researchers scrambled to find another professional dietitian, using an unqualified graduate student was suggested. None of the dietitians’ concerns were reported in the published article or mentioned publicly by Brunton – they were uncovered by journalist Hamish McNeilly.

Further excellent work by Denzel Chung of University of Otago student magazine Critic Te Arohi showed that the university itself, along with two researchers on the team, became shareholders in a company owning the patent for the DentalSlim while the feasibility study was ongoing, and did not report this development to the ethics committee.

Nutrition science and its evil twin, obesity research, are unfortunately rife with these sorts of questionable ethical choices. A review of 200 articles studying different sorts of beverages discovered that the conclusions were likely to be biased based on whether or not the research had received industry funding.

All this suggests that researchers in these fields should be particularly careful about their methods and conclusions and how they treat their subjects. The authors of the Otago study told on themselves and their research area at large with some barely disguised contempt toward one of their participants, who (quite understandably) couldn’t handle starvation rations:

One patient admitted to ‘cheating’, consuming melted chocolate and fizzy drinks. This was not surprising as studies have shown that obese patients usually have an addictive personality and an impulsivity for sugary food, and suffer from binge-eating disorders.

Or perhaps liquid starvation diets are, as Kanye predicted, enough to drive a sane [wo]man berserk?

Having summarised a list of disturbing side effects felt by the subjects and the general lack of improvement in their self-esteem, and moreover having ignored the ethical concerns voiced by professional dietitians – not to mention elephant in the room of societal stigma toward fat people – the authors came to a bizarre conclusion: that, following a two-week study of only seven white women, one of whom left early, nearly everything about the device showed great promise for long-term weight loss in the general population. This, too, is fairly common in the field. To quote eating disorders therapist Jeanne Courtney:

How many weight loss experts does it take to screw in a light bulb? Three. One to stand on the ladder and keep trying to screw a burned out bulb into a socket that doesn’t fit, one to stand under the ladder and tell him he’s doing a great job, and one to write a press release declaring that the three of them have discovered a revolutionary, completely safe and effective new way to screw in light bulbs.

The overwhelmingly negative public response to the magnetic clamping device appeared to take its authors by surprise, with Brunton describing the worldwide feedback as ‘hurtful’. Professor Jim Mann wrote a long, overwrought defence of the device in the Otago Daily Times without mentioning that he was one of organisers of the 2016 feasibility study – an oversight we can only hope was not deliberate. In any case, both academics came across rather like the well-used meme of The Simpsons’ Seymour Skinner: ‘am I out of touch? No, it’s the children who are wrong.’

These problems with obesity research are nothing new. Medical literature about jaw wiring for weight loss peaked in the 1980s and some of the clinical trial write-ups contain some gobsmackingly patronising or callous approaches to their participants. High incidences of pain and gum infection around the wires were common. In 1985, an article in The Australian and New Zealand Journal of Surgery on ‘Jaw wiring in the treatment of morbid obesity’ reported on a study of only ten participants: two dropped out after two weeks and only one managed any significant weight loss without resorting to bariatric surgery. This seems typical of the literature. The vast majority of people regained weight after having the wires removed – probably because crash diets are generally unsuccessful and starvation causes weight regain no matter how little solid food you go back to eating afterwards.

Yet researchers were always trying to shame their patients into thinness. In a 1981 article in The British Medical Journal (referenced approvingly by Brunton in the original 2016 University of Otago research study protocol for Dentalslim), researchers attempted to stop weight regain after the wires were removed from their patients by fastening a nylon cord around their waists to act as a ‘psychological barrier’.

In May of this year, The British Journal of Oral and Maxillofacial Surgery published a study about nutritional interventions for patients undergoing maxillomandibular fixation for a fractured jaw, noting that helping their patients to ingest more and better quality liquid foods allowed them to avoid some of the physical discomfort associated with having their jaws wired shut, kept their weight loss to a minimum, and allowed them to have better ‘quality of life’. A cursory search of Google Scholar reveals that quality-of-life factors for those undergoing jaw wiring following facial fractures are seen as much more worthy of research (more than five times worthier, in fact) than the quality of life of fat people having their jaws wired shut. Discomfort, pain, embarrassment, infection, malnutrition – none of these are covered by medical research to the same extent as they are for jaw fractures.

Many obesity researchers don’t appropriately consider the quality of life or mental wellbeing of their patients as a result of these extreme interventions, which is precisely the problem. In their zeal to solve the ‘obesity epidemic’ by any means necessary, they lose sight of the fact that the fat people in their trials are precisely that – people. And when it comes to making fat people thin, ethical considerations are more easily thrown out the window, because if you use the magic word ‘obesity’ almost anything goes. Desperate fat people – who are, I hasten to add, completely blameless, given the crushing pressure on them to be thin at any cost – volunteer for outlandishly awful studies and procedures, even if they have no other health problems. This is a pseudo-medical intervention on a par with snake oil, not healthcare. There is no end that justifies these means.