An Overview for the General Public Summaries from "Challenges in Obesity" and The Scientific Literature
Accepted for publication to Southern Medical Journal, January 1998
Dr. Leo J. Borrell, M.D., President M.D. Weight Care and The Weight for Life Program

Obesity, which has reached epidemic proportions in the U.S., is associated with greater risks of medical and health hazards including death. The risk of hypertension is almost three times greater in overweight individuals and these risks appear to be evident even in the mildly overweight. In addition, socioeconomic status is affected by and individual's weight, as the overweight population tends to receive lower salaries.

Such medical risks as diabetes, dyslipidemia, hypertension, cancer and cardiovascular disease, are improved by even a small weight loss. A lot of overweight people who smoke are afraid of gaining weight after they stop smoking. 80% of people who successfully stop smoking gain 5-10 pounds. 5% stop smoking on their own and 10% are successful with the patch. At M.D. WeightCare based on university research, we utilize the patch, counseling and medication with results in success rates of 40-60% stop smoking in 6 months.

Progress in treating obesity with drugs has been hindered by the belief that they do not cure the problem and must be taken indefinitely. However, recently the view that obesity should be considered a chronic disease, which can be managed with medication, has gained acceptance. Only the medication has to be controlled in order for it to be considered successful.

Drugs, which have been considered for treatment of obesity, include the following:

Ionamin Resins - Strategic Monotherapy is more effective than phen-fen for 6-9 months. Weintraub's study shows it is more effective with night time binge eating and individuals with mild depression.

Phentermine/Fenfluramine-( Phen/Fen) - is not FDA approved in combination. However it showed 3-5 years longer weight loss. Because of reports of valvular heart problems, it has been withdrawn from the market.

Fluoxetine (Prozac) - is not FDA approved for weight loss, but has shown results of high initial weight loss. Recent studies show it is more effective than fenfluramine.

Sertraline (SSRI) - has shown some benefits.

Ephedrine - Caffeine although theoretically it appears to be beneficial, from practical experience there is not much benefit. The FDA has 38 deaths associated with its use.

Products sold over-the-counter - such as phenprepyline (i.e., Dexatrim), although previously tested and shown as effective by advertisers, has not proven to be reliable by acceptable scientific standards and is not advised for patients with hypertension because of the risk of stroke.

Other Drugs - are soon to be released. Orlistat, a fat blocker, shows only 5% weight loss. Sibutramine (with action like phen/fen) which will be available in 1998 may also be an effective medication.

Surgery is most effective when treating obesity of 80 lbs or more. With an 80% success rate it should be considered in place of other treatments, including medical and behavioral intervention for individuals who have not otherwise been successful and who have a BMI of 44+. In addition to Videoscopic, surgery combined with medication and counseling offers patients a new sense of hope. Medication and Medical-Monitoring has improved short-term and long-term outcomes. Research at the Weight for Life Program shows 80% maintain their weight loss for 5 years.

Studies indicate that weight loss is more likely to be maintained when accompanied by exercise, contact from family, and social support.

Regular physical activity in weight management is important as both an intervention and a treatment. However, its primary benefit is in maintaining weight loss after weight loss has been achieved.

Home based exercise programs, particularly when combined with brief instruction and regular telephone contacts, improve adherence, and when combined with professional contact and monitoring, produce superior results. It is clear that structured programs or those who exercise with partners have more success than those who do it alone. Those who expend 2,000 calories per week with exercise have 90% of long-term weight maintenance after weight loss.

Reducing energy (caloric intake) is the primary form of weight loss. Looking at portion size is more important than counting calories or fat grams.

Studies of single drugs and drug combinations, usually in conjunction with lifestyle changes, have shown modest weight loss. However, potential and adverse effects include depression, and primary pulmonary hypertension. The Mayo Clinic Report, which showed valvular heart disease is only an observational study. Without scientific validity, its relevance is yet to be determined.

Side-effects include diarrhea, dry mouth, sleep disturbance, nervousness, and increased blood pressure which disappears in 2-4 weeks in 95% of the patients. This has been confirmed by clinical research which was conducted on 2000 patients at M. D. Weight Care in Houston, Texas. Dr. Leo J. Borrell is President of Weight for Life Program.

Attrition is a problem because of unrealistic goals related to motivation. A reasonable goal is 8 pounds of weight loss per month. Weigh loss is coordinated with amount of professional contact - (2 pounds per month per visit).

Research indicates that many patients may "drop out" if their expectations in a weight loss program do not match actual results. It appears that the degree of disappointment may have a substantial impact on treatment withdrawal and this is why counseling is important to maintain realistic goals and motivation.

Short-term obesity treatment in the past has not had good outcomes. However, long-term treatment including drug therapy and therapist contact is cost-effective and makes long-term weight management attainable.

Individuals with more weight to lose are just as successful if they are willing to participate in more intensive treatment.

Since weight loss has been shown to minimize the risks associated with obesity, it should be on par with insurance reimbursement for other medical or psychological conditions regarding treatments, which are reimbursable.

The most effective programs should be targeted at obesity prevention for young children and adolescents. The best predictors of weight loss in adolescent and children are parents losing weight.

In conclusion, it is likely that overweight persons will need motivational counseling, medical evaluation, long-term management programs, and extended pharmacotherapy in order to successfully treat their conditions.