Can you guarantee weight loss?

We can only guarantee that we will help you keep the weight off if you purchase a program to achieve a BMI of 25. This is consistent with the research results published in "Thin fo Life" of a group of 1800 patients lost at least 30 pounds and kept it off for 10 years.

What is involved in a comprehensive program to keep the weight off?

The average weight loss across studies for medical behavioral intervention is 8.4 kg. If long-term contact is maintained the patients maintain, on average, about two-thirds of their initial weight loss 9 to 10 months after treatment termination. If some form of maintenance program with sustained contact is implemented, this means monthly contact to support and motivate the patient to continue to exercise. 70% of patients, when exercising, maintain weight loss. Only 30% who do not continue to exercise succeed in maintaining weight loss. If an individual gains more than 5 pounds, they need counseling or a return to active treatment to insure long-term weight loss.

My doctor thinks drugs are a "crutch" and that I don't have enough will power. What should I tell him?

Progress has been hindered by the perception that obesity is a disorder of willpower, and the belief that drugs are not an appropriate treatment approach since they must be taken indefinitely. Interest in pharmacological approaches has increased due to the recognition that obesity is a chronic disease, which cannot be cured, but can be managed. This is similar to the results of other chronic diseases such as diabetes and hypertension treatment.

Does Prozac work for weight loss?

It has been evaluated in several clinical trials by Dr. John Foreyt of Baylor College of Medicine, although it is not approved by the FDA for the treatment of obesity. Fluoxetine treatment produces significant initial weight losses up to 24 weeks. After 6 months, when combined with phentermine, Prozac may produce continued weight loss. It is important to be aware that not all anti-depressants are useful in weight loss. For more information, read Dr. Michael Anchors' book "Safer than Phen-Fen?", or contact Dr. Borrell at (713)850-0023.

The combination of fluoxetine and Prozac has been used to enhance dietary restraint and reduce hunger in daytime, while the addition of dexfenfluramine at dinner might effectively control binging. Fluoxetine-dexfenfluramine combination lost significantly more weight than patients who received fluoxetine (13.4 plus/minus 6.3 kg vs. 6.2 plus/minus 2.8 kg, respectively). This combination is more effective at producing short-term weight loss than either fluoxetine or dexfenfluramine alone. The addition of dexfenfluramine appeared to prevent weight gain during active treatment reported in previous fluoxetine studies.

What's new in behavioral and motivation applications?

A greater emphasis must be placed on regular physical activity in weight management programs, as both an intervention and a treatment outcome, since 70% who exercise or participate in a structured exercise program maintain weight loss. It is an important predictor of weight maintenance. Further, it was found that moderately and highly-fit men, irrespective of BMI, experienced significantly lower age-adjusted risk for all-cause mortality compared to sedentary or low fit men.

Moderate-intensity, home-based exercise programs have been shown to improve functional capacity and adherence, particularly when combined with brief instruction and regular telephone contacts. Long-term adherence rates for home-based programs can be greater than for group-based exercise, and they can provide superior weight losses if there is professional contact and monitoring and enhancement of motivation.

What can you tell me about the medicine that is supposed to be better than Phen-Fen?

Meridia, a noradrenergic and serotonin reuptake inhibitor that has both satiating and thermogenic effects, produced weight losses of 4.7-7.6 kg in several clinical trials. Doses of 10 and 15 mg per day produced weight losses that were 3-5 kg better than placebo and tended to plateau by 24 weeks.

What is being researched in weight loss?

Leptin is a protein that may inhibit Neuropeptide Y (NPY) gene expression and appears to increase satiety and energy expenditure. Defects in the ob gene are rare in humans. A lack of the ob protein is probably not a primary cause of human obesity, but the possibility that obese individuals are insensitive to endogenous leptin production. Human leptin clinical trials are currently underway.

Brain & Gut Peptides - important for potential drug development in the areas of peptide agonists and antagonists. Studies have found elevated levels of beta-endorphin (an opiate peptide that stimulates feeding) in obese individuals. Opiate peptide antagonists are now being investigated for application to obesity and binge eating. For example, naloxone, an opiate blocker, has been shown to supress desire for and consumption of sweet, high-fat foods in both obese and normal-weight binge eating women, but not in non-bingers.

Other Peptides - Cholecystokinin (CCK) & NPY - there are no known defects in the CCK responses of obese individuals. B-3 antagonists are currently not approved by the FDA for the treatment of obesity.

Are drugs a "magic bullet?

Yes and no. There is the Myth of the magic bullet. The reality is that a comprehensive coordinated medical care program produces superior results and is less costly because of the long-term effectiveness.

Studies of single drugs and drug combinations, usually in conjunction with psychosocial lifestyle modification programs, have shown modest weight loss when compared to lifestyle change and placebo. Phen-Fen had potential and significant adverse effects include depression, neurotoxicity, primary pulmonary hypertension (pph), and the potential for abuse or the development of tolerance. It has been removed from the market.

Is it true that all patients gain back the weight they lose?

No, it depends on the given maintenance program and lifestyle changes made. Poor adherence is common and it is a routine dilemma in the management of many chronic diseases. For example, in weight loss, 85% attrition in 96 weeks, 57% of patients dropped out over 3.5 years, 57% attrition at 1 year, and 30% in 30 days was reported. If attrition can be this high in controlled clinical trials, it is likely to be a greater problem in clinical settings. Attrition appears to be related to motivation that is maintained by intensity of professional contact independent of amount of weight loss necessary. Emotional factors are significant since stress is responsible for 80% of weight gain. To place this risk in perspective, the risk of anphylatic shock or stroke while using oral contraceptives and smoking are 40 per million. Death from an automobile accident is 200 per million.

It is difficult to understand compliance problems. Financial and real life demands are as difficult to assess in research situations. Satisfaction with the result may be a more useful measure. This requires assessment of motivations, expectations, intensity of treatment and severity of problems, not just weight. A clue is available from research which shows that there is a large gap between how much weight patients expect to lose and how much they really lose; they drop out due to disappointment with the treatment. In one of the few studies on this issue, only 9% of the participants achieved their "dream" weight, only 25% made it to their "happy" weight, and 25% reached their "acceptable" weight. 67% achieved only their "disappointed" weight or below. This gap between their weight loss expectations and reality may be an important factor in early treatment withdrawal. Also, research shows that the more severe the weight problem, the more intense treatment needs to be to be effective. The role of the physician and professional is to help individuals to continue to perservere when they reach less than their ideals, appreciated their successes and set realistic goals. This will allow continuing effort as the resources of the individual and the program allow.

Is your program as cost-effective as Weight Watchers?

It depends on your goal. Short-term obesity treatment does not have good outcomes. It is not unreasonable that obese patients should receive long-term, continuous interventions, including extended drug therapy, similar to the treatment of hypertension or diabetes, continued support and therapist contact, and continuous drug therapy. This data provides preliminary evidence that long-term comprehensive obesity treatment could be delivered in a cost effective manner by physicians who see the patient 10-20 minutes at each visit 1-2 times per month.

What is your opinion of surgery?

I founded Comprehensive Weight Management. We treated more than 5000 patients in 15 hospitals. Our research shows that surgical approaches are one of the most successful treatments for obesity if the person is morbidly obese (i.e., with a BMI of 40 or with medical problems and approximately 80 pounds overweight.) It should be considered after failure of medical and behavioral intervention of severe comorbid condition or lack of motivation, support or other psychological factors. Even if surgery is undertaken this does not preclude the use of medication and psychological intervention. This must be available and provided as early as possible for those patients because the patients regain weight which places them at risk for medical conditions related to obesity. The research at Weight Loss for Life shows that 80% of patients are successful and lose 60% of their excess body weight within a year. The literature and research at Weight Loss for Life shows an 80% long-term weight loss for 3-5 years. This compares to Weintraub's classic study with Phen-Fen of only 25% and long-term weight loss of 25 pounds.

Have you published your information in a medical journal?

Yes. If you want copies of the original article, Challenges in Obesity, it is available for:

1. Original Article       $5.00

2. Bibliography           $3.00

Contact Positive Changes for Health & Beauty at (713)850-0023