Category: prevention and fitness

How to lose weight when nothing else has worked.

In helping people lose weight, there is a significant gap that needs to be closed. When diet/exercise fails, we need something less invasive  before resorting to surgery with its significant risks and complications. One option is prescription medication.

This post has been updated July 22, 2021

On this blog we’ve looked at

how lifestyle changes can make losing weight possible and

which weight loss programs work best.

 But what if those do not work? Studies show that any low fat, low carb , or other restricted calorie diet can lower weight, but then weight tends to plateau and may even rise again.

For severely overweight people, especially with a BMI of 30 or more, this means that even if they lose weight, they still have not reached  a healthy weight. For them, some type of weight loss (bariatric) surgery may be considered.

For some, medication is a good option for weight loss.
For some people, medication is an acceptable option for weight loss.

One option is prescription medication. Prescribing drugs for weight loss is not new, and has been an approach used by some retail weight loss clinics, “weight doctors”, for years.

Most of these programs used stimulant type drugs, amphetamines, to decrease appetite. People do lose weight on these because they eat less, but the drugs’ effect tends to diminish with time. They also have high potential for abuse and dependence.

When the non-amphetamine drug Meridia (sibutramine) was released, we thought we had found the solution- an effective drug without the risk and side effects. of amphetamines.  However, once a significant risk of  serious cardiac effects was found, its use was suspended.

Another drug, orlistat,  seemed promising. Known by the brand names of Xenical and Alli, it works in the gut to block the absorption of fat. But patients found the unpleasant side effects of gas, diarrhea and oily stools not worth the benefit.

In past few years  several new drugs have come to the party.

Belviq, lorcaserin, a serotonin agonist with uncertain action on appetite; as of September 2020, this has been withdrawn from the market.

Qysmia, a combination of two drugs- phentermine/topiramate,a stimulant and an antiseizure drug,

Contrave, also a combo -naltrexone, used for alcohol dependence and bupropion, an antidepressant

Saxenda, liraglutide; unique in that it is taken by subcutaneous (SC) injection similar to insulin; it also is used for diabetes under the name Victoza

Wegovy, semaglutide, also a subcutaneous injection, given just once weekly, rather than daily like Saxendra

Please note: none of these drugs are approved for use in pregnancy, and are in fact contraindicated, meaning they are unsafe in pregnancy and probably unsafe while breastfeeding. 

an MRI of the human brain
an MRI of the human brain

These drugs all work in the brain to control appetite and increase satiety, the feeling of fullness. The long term solution to preventing and reversing obesity may lie in finding new ways to control the processes in the brain that control eating behavior. Much of obesity management research is directed to this area. 

Learn more about the use and side effects of these drugs here-

via Diet Pills, Prescription Weight Loss Drugs, Appetite Suppressants.

 

exploring the HEART of health

Dr. Aletha

Health lessons from the Women’s World Cup

I watched the final game of the Women’s World Cup between Japan and the United States.  Tuning in a few minutes late I was stunned to see I  missed the first 2 goals! Believe me, I paid attention the rest of the game and was not disappointed. I admired the skill, talent and energy of both teams and with other Americans cheered the United States team’s victory  clinching the world champion title 5-2.

Besides enjoying the action I was more impressed by  the class and grace demonstrated by both teams as winners and as losers. That is the greatest lesson we can teach children and I hope parents used that as a “teachable moment”.

2015-07-06 08.02.56

I observed the superb fitness level of these and the other participants in the World Cup. Running up and down a field , kicking a ball and outmaneuvering opponents for 90 minutes is exhausting, but they made it look almost easy.  We can’t all be world class athletes  but we can be physically active in some way.

The U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans recommend 

  • moderate-intensive physical activity for 150 minutes or more per week

  • vigorous-intensity activity for at least 75 minutes per week

  • engaging in muscle strengthening activity at least twice per week.

 

Medical studies show that exercise can prevent or improve many chronic health conditions and lack of exercise contributes to many diseases.

  • Physical activity may reduce the risk of cancers of the breast, colon, uterus, prostate and pancreas.

  • Regular exercise may help prevent diabetes and heart disease.

  • Exercise can relieve joint and back pain due to arthritis.

  • Depression is treated with physical activity successfully

 

With proper guidance, anyone can perform some exercise or other physical activity regularly. I stay active with walking, bicycling, ballroom dancing, gardening and have recently tried yoga

 

ballroom dancing
dancing in a competition with my pro instructor

I have more energy and stamina when I am active regularly, and get sluggish if I don’t.

What do you do to stay active, fit and moving? please share and encourage someone else.

More information here

Physical Activity Basics from the CDC