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Orlistat studies:
A clinically meaningful reduction in body weight and the maintenance of this weight loss is achievable with orlistat treatment
and dietary restriction over a period of 18 months. This weight loss resulted in an improvement in risk factors for coronary
heart disease.
Orlistat appears to have anti-diabetic and anti-atherogenic properties and may help prevent metabolic syndrome in the overweight
people.
Sibutramine plus orlistat studies:
Sibutramine and sibutramine in combination with orlistat seemed to be equally effective in terms of weight reduction compared
to orlistat monotherapy. In our study pharmacotherapy showed significant better results in the short-term management of obesity
than dietary regimens alone.
HCG (Human Chorionic Gonadotropin) shots have NOT been shown to be any better than placebo. (Note: do not confuse
this with HGH, which stands for human growth hormone). Here are 4 studies showing HCG shots have no effect on weight loss:
Here's an article I wrote for Lake Mary Life magazine, March 2005:
Dispelling Myths About Prescription Obesity Medications
"Honey, did you take your blood pressure pill today? Did you take your diabetes medication too? How about your
obesity pill?"
In the last issue of Lake Mary Life, Dr. Lawus-Scurry beautifully illustrated the epidemic of 97 million adults in the
United States being overweight or obese. Let's take a look at the myths that contribute to why only a small fraction of them
take prescription medicines that are FDA approved for long-term use to treat obesity.
Myth #1: Obesity is a lifestyle problem; therefore, medications are not necessary.
Lifestyle changes alone do not solve the problem for all patients with obesity. Obesity is now recognized as a legitimate
metabolic disease with both a physiologic and genetic basis. Individual differences in physiology impact body weight and
may affect how much weight is gained or lost under specific lifestyle conditions. Although diet and exercise alone could
effectively control medical conditions such as diabetes, hypertension, and high cholesterol, physicians rarely insist that
lifestyle change be the only treatment used for long-term control of these conditions. Doctors know that long-term lifestyle
changes, while possible for some, do not occur in the majority of patients; therefore, medications are routinely prescribed
as additional treatment. Thus, the role and rationale for the use of medications to treat obesity are very similar to those
in other chronic diseases requiring adjunctive drug therapy when diet and physical activity have not been successful.
Myth #2: Taking weight-loss medications is too risky.
All medications involve some degree of risk, including some you may be taking right now. There are also health risks
to being obese, and these risks increase in proportion to the degree of obesity. This is the reason why evidence-based guidelines
for obesity treatment established by the National Heart, Lung, and Blood Institute (NHLBI) recommend that weight-loss medications
be considered in patients with a BMI of 30 or greater (for an average 5'5" woman that would be 180 pounds; for an average
6'0" man that would be 220 pounds). The medications currently approved for long-term use, taken by over 15 million people
worldwide, work by a different mechanism of action than the two medications (fenfluramine and Redux) that were taken off the
market in 1997.
Myth #3: Weight-loss medications do not produce enough weight loss to make them a useful treatment option.
The ultimate goal in obesity management is long-term weight loss. After short-term weight loss, physiologic processes
in the body make regaining weight much more likely. These processes include a drop in metabolic rate, an increase in appetite,
and a strengthening in preference for high-calorie foods. Weight-loss medications are a tool to help combat these physiologic
and behavioral pressures over the long term. Two medications, sibutramine (Meridia) and orlistat (Xenical), are FDA approved
for long-term use and can make it easier for patients to adhere to lifestyle changes for longer periods.
Meridia works by increasing metabolism and decreasing appetite, while Xenical blocks the absorption of one-third of dietary
fat consumed. At 2 years in the Sibutramine Trial of Obesity Reduction and Maintenance (STORM), 46% of obese patients were
maintaining a 10% or higher reduction from their baseline weight, compared with 21% of patients receiving placebo. Both groups
were on the same diet and exercise programs. In an 18 month trial, patients on a reasonable diet who took Xenical lost an
average of 14.3 pounds, compared to 6.6 pounds lost by those who didn't take Xenical. These are just averages -- individual
differences can be more profound. The results of most all trials involving Meridia and Xenical also show greater improvements
in waist size, fasting blood sugar, and LDL (bad) cholesterol levels.
Phentermine (Adipex-P), one-half of the infamous "phen-fen" combination, is an effective weight -loss medication
but is not approved for long-term use. Human Chorionic Gonadotropin (HCG) shots have not been shown to be any more effective
than placebo in properly controlled studies.
The role of weight-loss medications is to maximize the number of patients who are succeeding at maintaining a medically
significant weight reduction on a long-term basis. The benefits from weight-loss medications disappear when the treatment
is discontinued, just as they would if diabetes, hypertension, and hyperlipidemia medications were discontinued. Weight-loss
medications work best when combined with a specific plan to alter lifestyle behaviors, such as reducing intake and increasing
physical activity. Obesity medications should be prescribed as an adjunct to, not a substitute for, lifestyle change.
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