Medication News
Weight Loss

General information about weight loss and weight loss products
The current weight loss industry
What are the risks of being overweight?
What questions should I ask if I’m considering participating in a diet program?
What drives the hunger response?
Do prescription weight loss medications work?
Are dietary supplements safe and useful for weight loss?
Does ephedra work safely?
Starch or Carb Blockers: the myth debunked
What are some of the questionable weight loss products?
Sensible weight maintenance tips you should follow

The current weight loss industry
Looking for a quick and easy way to lose weight? You're not alone. You may be one of 50 million Americans who will go on a diet this year. And while some will succeed in taking the weight off, very few—about five percent—will manage to keep it off in the long run. One reason for the low success rate is that many people look for quick and easy solutions to their weight problems. They find it hard to believe in this age of medical miracles that an effortless weight-loss method doesn't exist. So they succumb to quick fix claims like "Eat All You Want and Still Lose Weight!" They invest their hopes and their money on pills, potions and programs that hold the promise of a slimmer, happier future.

The weight-loss business is a booming industry. Americans spend an estimated $30 billion a year on all types of diet programs and products, including diet foods and drinks. Trying to sort out all of the competing claims—often misleading or unproven—can be confusing and costly.

All dietitians say that weight loss pills are not magic solutions to weight control. In order to lose weight successfully, without regain, you must combine weight loss medications with a sensible diet and exercise program. In fact, if you check the literature accompanying most weight loss supplements, it often states that effective weight loss is not possible by taking the weight loss pills by themselves.

What are the risks of being overweight?
An estimated 97 million adults in the United States are overweight, a condition that raises the risk of high blood pressure, high cholesterol, heart disease, stroke, gallstones and diabetes. A variety of effective options exist for the management of these patients, including dietary therapy approaches such as low-calorie, low-carbs, and low-fat diets, altering physical activity patterns, pharmacotherapy, and combinations of these techniques.

Being obese can have serious health consequences, and losing weight can help reduce these risks. Here are some points to keep in mind:

• Any claims that you can lose weight effortlessly are false. The only proven way to lose weight is either to reduce the number of calories you eat or to increase the number of calories you burn off through exercise.
• Very low-calorie diets are not without risk and should be pursued only under medical supervision. Unsupervised very low-calorie diets can deprive you of important nutrients and are potentially dangerous.
• Fad diets rarely have any permanent effect. Sudden and radical changes in your eating patterns are difficult to sustain over time. In addition, so-called "crash" diets often send dieters into a cycle of quick weight loss, followed by a "rebound" weight gain once normal eating resumes.

Losing weight safely and keeping it off requires long-term changes in daily eating and exercise habits. Many experts recommend a goal of losing about a pound a week. A modest reduction of 500 calories per day will achieve this goal, since a total reduction of 3,500 calories is required to lose a pound of fat.

What questions should I ask if I’m considering participating in a diet program?
Approximately eight million Americans each year enroll in some kind of structured weight-loss program involving liquid diets, special diet regimens or medical supervision. Before you join such a program, you should know that according to published studies, relatively few participants succeed in keeping off weight long-term. Before you sign up with a diet program, you might ask these questions:

• What are the health risks?
• What data can you show me that prove your program actually works?
• Do customers keep off the weight after they leave the diet program?
• What are the costs for membership, weekly fees, food, supplements, maintenance, and counseling?
• Do you have a maintenance program?
• What kind of professional supervision is provided?
• What are the program's requirements?
• Are there special menus or foods, counseling visits, or exercise plans?

Wellness centers and exercise programs including Weight WatchersÒ are available at most of the Health Alliance Hospitals.

What drives the hunger response?
Obesity research has shown when it comes to appetite, certain hormones play a role in signaling the brain when it's time to eat. Understanding how these mechanisms interact is the key to diet medications. Ghrelin, a hormone secreted by the stomach, triggers appetite in humans and is considered a powerful appetite stimulant. This hormone’s levels have been shown to rise shortly before meals and decrease shortly afterward. The rise in ghrelin caused by dieting and several other forms of weight loss is part of the body's normal adaptive response that triggers a survival mechanism to keep our weight constant. A second hormone is called gastric inhibitory polypeptide. The intestine secretes this hormone after a high-fat meal. Cholecystokinin and somatostatin hormones are normally released after eating and trigger feelings of fullness. Leptin, another hormone, is secreted by fat cells and acts on the brain to decrease food intake and increase metabolism. Obese people are thought to be resistant to leptin.

Different serum levels of these hormones and differences in receptor sensitivity alter the way each individual responds to the stimulus for food.

Do prescription weight loss medications work?
Prescription weight loss medications are effective when combined with diet and exercise, as part of a medically supervised weight loss program. The most currently available prescription weight loss medications are approved by the FDA for short-term use only, meaning a few weeks or months. Meridia® and Xenical® are the only weight-loss medications approved for longer-term use in significantly obese patients, although their safety and effectiveness have not been established for use beyond one year.

Most available anti-obesity drugs are appetite-suppressant medications. Tenuate®, Adipex® and Meridia® diet pills are designed to affect neurotransmitters in the brain, thus decreasing appetite cravings. Tenuate® and Adipex® are both highly addictive. In clinical studies, Adipex® produced significantly more weight loss than Tenuate® after 12 weeks (18 pounds versus 13 pounds). Most patients adhered to a low calorie diet during the studies. Side effects were similar in each group, with the main side effects of each agent being drowsiness, dry mouth, and constipation. However, Adipex® may produce increases in blood pressure and rapid heart beat, and should not be used in patients with high blood pressure or heart disease. Tenuate® is a preferred weight loss agent in these patients.

Meridia® works by raising levels of certain brain chemicals, including serotonin, dopamine and norepinephrine, in order to reduce appetite. In clinical studies, approximately 60 percent of patients who lose at least four pounds during the first four weeks of Meridia® will lose at least 5 percent of baseline body weight by the end of six months to one year. In Meridia® treated patients, decreases have occurred in concentrations of triglycerides and “bad” LDL cholesterol, while “good” HDL cholesterol has increased. Side effects are similar to Tenuate® and Adipex®.

Another type of prescription weight loss drug is a fat absorption inhibitor. Xenical® is the only example of this type of treatment approved for use in the United States. Xenical® works by blocking about 30 percent of dietary fat from being absorbed; however, gastrointestinal side effects, including diarrhea, abdominal pain and flatulence, often limit its use. In clinical studies, Xenical® groups lost significantly more weight than the placebo group with the average losses being 9 percent. In comparison with other agents, Meridia® is more effective than Xenical® in weight loss.

Are dietary supplements safe and useful for weight loss?
In addition to prescription weight loss drugs, there are a growing number of weight loss or diet supplements that are sold over the counter to assist weight control. Over-the-counter supplements are much less effective. The FDA does not regulate these weight loss pills in the same way as prescription drugs. Instead, the makers of the diet supplements are responsible for ensuring the safety and effectiveness of their weight loss pills. In addition, they are responsible for disclosing all side effects and health problems of the weight loss pills. Lack of FDA regulation of diet supplements and lack of medical supervision probably account for the poor weight loss results with herbal products.

Does ephedra work safely?
Weight loss pills that contain herbal or natural sounding ingredients are not always safe. Mounting concerns regarding the risks presented by ephedra (ephedrine, ma huang) prompted the FDA to propose a ban on dietary supplements containing the drug. The rule will state that supplements containing ephedra introduce an unreasonable risk of illness or injury. This comes after a review of all the available evidence about the risks and benefits of ephedra, including its actions, safety, effectiveness and adverse event reports. Products containing ephedrine extracts have, according to the FDA, caused hundreds of illnesses, including heart attacks, seizures and strokes. They are amphetamine-like compounds with powerful and potentially lethal stimulant effects on the central nervous system and the heart.

Starch or Carb Blockers: the myth “Debunked”?
Supplements sold as "starch blockers" or "carb blockers" are really starch-enzyme blockers; they inhibit the body's production of the starch-digesting enzyme, alpha-amylase. With decreased amounts of alpha-amylase, the body is less able to break down starches and carbohydrates into sugar for further digestion.

Scientists have been aware of various alpha-amylase inhibitors for decades, but up until recent studies, these products have not been shown to stop the absorption of starch calories. A number of factors may have explained why: there was not enough alpha-amylase-blocking activity from these products; they did not work well in the body; they contained endogenous alpha-amylase in sufficient quantity; or another enzyme, glucoamylase, was able to take over when alpha-amylase is inhibited. In clinical studies, tests demonstrated that starch blockers did not block the digestion of starch in the body or reduce overall body weight. Nevertheless, most of these alpha-amylase inhibitors have been shown to work successfully in a test tube.

What are some of the questionable weight loss products?
Some dieters attach their hopes on pills that promise to "burn," "block,” or otherwise eliminate fat from the system. Some pills may help control the appetite, but they can have serious side effects. Other pills are entirely worthless. The FDA has banned 111 ingredients once found in over-the-counter diet products. None of these substances, which include alcohol and caffeine, have proved effective in weight-loss or appetite suppression.
Beware of the following products that have claims as weight-loss miracles:

• Diet patches, which are worn on the skin, have not been proven to be safe or effective.
• "Fat blockers" claim to physically absorb fat and mechanically interfere with the fat a person eats.
• "Starch blockers" promise to block or impede starch digestion. Not only is the claim unproven, but also users have complained of nausea, vomiting, diarrhea, and stomach pains.
• Some bulk producers or fillers, such as fiber-based products, may absorb liquid and swell in the stomach, thereby reducing hunger. Some fillers can even prove harmful, causing obstructions in the intestines, stomach or esophagus.

Sensible weight maintenance tips you should follow
Losing weight may not be effortless, but it doesn't have to be complicated. To achieve long-term results, it's best to avoid quick-fix schemes and complex regimens. Focus instead on making modest changes to your life's daily routine. A balanced, healthy diet and sensible, regular exercise are the keys to maintaining your ideal weight. Although nutrition is constantly evolving, here are some general guidelines for losing weight:

• Consult with your doctor, a dietician or other qualified health professional to determine your ideal healthy body weight.
• Eat smaller portions and choose from a variety of foods.
• Load up on foods naturally high in fiber: Fruits, vegetables, legumes and whole grains.
• Limit portions of foods high in fat: dairy products like cheese, butter, whole milk, red meat, cakes and pastries.
• Exercise at least three times a week.