weight loss center

2008-01-02T08:05:00.001-08:00

(This article was first printed in the April 2006 issue of the Harvard Women’s Health Watch. For more information or to order, please go to Diet drugs have gotten a lot of press lately. In January 2006, a federal advisory panel recommended that the FDA make available, over the counter, xenical fat loss a popular prescription weight-loss medication, orlistat (Xenical). The FDA usually takes the panel’s advice, but approval of the orlistat (which would be called Alli) is not a sure thing.

Many question the drug’s effectiveness in a broader setting; others worry about its side effects. Considerable excitement surrounds rimonabant (Acomplia), a type of weight-loss drug that works by blocking the same receptors in the brain that cause the “munchies” in marijuana users. Rimonabant reduces weight, quiets food cravings, and improves cholesterol and other risk factors for heart disease, including waist circumference. We certainly need new weight-loss solutions. Two-thirds of adults in the United States are overweight or obese, many of them unwilling or unable to seek help from the medical system for this problem. New understanding of the complexities of weight regulation may eventually lead to more targeted therapies. In the meantime, weight-loss drugs can help, but they’re not the ultimate solution. The key to long-term weight loss is ravenous hunger.

A clinician may prescribe an appetite-suppressing drug so that an overweight or obese and at risk for several major medical conditions as well as for premature death. Even modest weight loss helps. One study of obese women found that those who intentionally lost any amount of weight experienced a 40%–50% decrease in death from obesity-related cancers and a 30%–40% decline in death from obesity-related cancers and a 30%–40% decline in death from type 2 diabetes. The prescription weight-loss medications on the market as of spring 2006 generally fall into one of three categories: Certain antidepressant drugs are prescribed on a short-term basis because they’ve been found to help some people lose weight.

But their effects are unpredictable, and in some cases they may produce weight gain rather than loss. Clinical guidelines suggest that if an individual hasn’t lost at least a pound a week in the first month on a weight-loss medication, she’s unlikely to benefit from the drug. Also, people who overeat because of stress, bad habits, bad habits, or emotional problems tend to get less out of appetite suppressants than those who overeat because of stress, bad habits, or emotional problems tend to get less out of appetite suppressants than those who overeat because of hunger. For them, psychotherapy or behavioral therapy may be a more appropriate first step. “We don’t know who’s going to respond to these medications,” says Sue Cummings, a registered dietitian and coordinator of clinical programs at the Massachusetts General Hospital Weight Center in Boston. “We may try them, and if there’s no weight loss in one month, or the person reports no difference in appetite, we discontinue them. My preference would be to take a person as far as we can with healthy, sustainable eating habits and exercise, and then, if maintenance is a real problem, offer a medication.” If approved, over-the-counter orlistat will be the first test of broader use of a powerful weight-loss agent.

More side effects may crop up, especially without the oversight of clinicians or the guidance offered by comprehensive weight-loss programs. Yet there’s an urgent need to make more tools available to the increasing number of people who are overweight or obese and at risk for several major medical conditions as well as for premature death. Even modest weight loss can reduce these risks. But as weight loss center most of us know, losing weight can be extremely difficult, and keeping it off even more so. Most people who shed pounds regain them within five years. Little wonder that there’s intense interest in drugs to boost weight-loss efforts. But the reasons for weight problems are complex. Genetic makeup, hormones, brain chemistry, environmental influences, and psychosocial pressures all contribute. No pill can melt away fat or keep off the pounds.

And the drugs being prescribed for weight loss don’t do the job by themselves. But for people whose health is at risk and who are struggling to reduce through diet and exercise, drug therapy may increase the odds of success. Experts agree that weight-loss drugs, which all have side effects, are not for the mildly overweight or those who just want to lose a few pounds to improve their appearance. Over the past few years, researchers have learned a lot about the biological causes of weight disorders. They’ve identified dozens of genes and begun to discover how these genes influence the many systems that affect weight.

Weight-loss drugs can temporarily manipulate these systems. For example, sibutramine (Meridia) and phentermine (Adipex-P, others) suppress appetite, while orlistat reduces fat absorption. Some 100 new drugs are in the testing phase. Weight medications have a history of failure and safety concerns. In the 1950s and 1960s, dieters took amphetamines to quell their appetites and boost their metabolisms — until it was discovered that the pills were addictive weight loss tip and reduce excess body weight caused paranoia. The combination of fenfluramine and phentermine — popularly known as fen-phen — was widely used in the mid-1990s, until it and another drug, dexfenfluramine, were linked to heart valve disease and subsequently withdrawn from the market. (Phentermine alone is still used.) Until sibutramine was approved in 1997 for long-term use in obesity, the FDA had required that most such medications be prescribed for more than three months at a time. Blood pressure should be checked every four weeks. Serotonin/norepinephrine reuptake inhibitor sibutramine (Meridia) Increases levels of norepinephrine and serotonin; reduces food intake. Side effects include insomnia, agitation, nausea, sleepiness, diarrhea or constipation, and problems with libido.

Some people gain weight because they’re in situations such as business travel that can trigger overeating and disrupt the body’s normal cues for hunger and satiety. Balancing the demands enlargement pills of job and family can lead to a reliance on prepared foods, take-out, and restaurant meals, which are usually higher in calories than homemade meals. Others eat in response to stressful or emotionally challenging situations. And many people don’t expend enough calories because they don’t incorporate enough physical activity into their daily lives. Even more disconcerting: Weight loss can result in reduced calorie burning, whether the body is at rest or active. That’s why exercise is so important to weight-loss efforts: Increased muscle mass burns calories more efficiently. Another response to weight loss is effort on many fronts. The National Weight Control Registry (www.nwcr.ws), which tracks people who have maintained a weight loss of at least 30 pounds for one year or more, has found that successful “losers” join support groups, exercise intensively, quick weight loss restrict the amounts and kinds of food they eat, and weigh themselves often. (This article was first printed in the April 2006 issue of the Harvard Women’s Health Watch – the monthly newsletter that focuses on the special health concerns of women, with expert information and advice from the specialists at Harvard Medical School. Read more 12 monthly issues (Print+Electronic) $28.00 12 monthly issues (Print+Electronic) $28.00 12 monthly issues (Electronic Only) $24.00 BACK TO TOP | HOME CONTACT US: Media | Technical Support | Corporate Sales | Licensing © 2000–2007 President and Fellows of Harvard College.