Podcasts about orlistat

Listen in as Joseph Kim, MD, MPH, MBA; Manish Shah, MD; Martha Grugel, MA, discuss how they manage the prior authorization process for antiobesity agents to improve the quality of their care delivery, including:The information to collect during patient visitsThe available resources to help you submit prior authorizationsThe supporting documents that are often necessary to accompany prior authorizationsHow to address denials and appealsWhen to access manufacturer-based or foundation-based financial assistancePresentersJoseph Kim, MD, MPH, MBAPresidentQ Synthesis, LLCNewtown, PennsylvaniaManish Shah, MDClinical Associate Faculty MS1 PreceptorUniversity of Florida College of MedicineGainesville, FloridaMartha Grugel, MAMedical AssistantWesley Chapel, FloridaLink to full program: https://bit.ly/45P0v8z

Este es un debate fundamental en el ámbito de la nutrición, la medicina y la salud pública. Vamos por partes:1. ¿Obesidad o Enfermedad Crónica Basada en la Adiposidad (ABCD)? La AACE propone el término ABCD (Adiposity-Based Chronic Disease) para enfatizar que la obesidad es más que una acumulación de grasa: se trata de una condición crónica con múltiples factores subyacentes, incluyendo genética, metabolismo, entorno y comportamiento. Este cambio terminológico busca evitar la reducción de la obesidad a una simple cuestión de peso y destacar su impacto en la salud. 2. ¿Es la obesidad una enfermedad o un factor de riesgo? La evidencia más sólida que apoya la obesidad como enfermedad incluye:Su carácter crónico y multifactorial, con componentes metabólicos, genéticos y hormonales.Su asociación con inflamación crónica y resistencia a la insulina, que pueden generar otras patologías como diabetes tipo 2, enfermedades cardiovasculares y algunos tipos de cáncer.Su inclusión en 2013 por la American Medical Association (AMA) como enfermedad para mejorar su abordaje médico y evitar la simplificación de "come menos y muévete más".Por otro lado, hay quienes la consideran un factor de riesgo más que una enfermedad per se, argumentando que:No todas las personas con obesidad tienen complicaciones metabólicas (el concepto de "metabólicamente saludable").La obesidad no siempre causa enfermedad directamente, sino que es un factor predisponente.La clasificación como enfermedad puede medicalizar en exceso y reforzar la dependencia de tratamientos farmacológicos o quirúrgicos.3. Impacto de la clasificación de la obesidadPacientes: Considerarla una enfermedad puede reducir la culpa y el estigma, promoviendo un enfoque más médico y menos moralista. Sin embargo, puede también reforzar la idea de que la única solución es médica o farmacológica.Políticas públicas: Puede favorecer la financiación de tratamientos, programas de prevención y acceso a profesionales de salud.Investigación: Mayor inversión en estudios sobre su fisiopatología, tratamientos y prevención.Percepción pública: Puede reducir el estigma de la obesidad como un "fallo personal", pero también puede reforzar la dependencia de tratamientos médicos en lugar de abordar causas estructurales (alimentación, sedentarismo, desigualdades sociales).4. ¿Comparte el enfoque tradicional factores de riesgo con los TCA? Sí. La visión pesocentrista y la cultura de la dieta pueden fomentar conductas alimentarias desordenadas y contribuir al desarrollo de trastornos de la conducta alimentaria (TCA).Se ha observado que adolescentes con sobrepeso u obesidad tienen mayor riesgo de desarrollar TCA debido a la presión social y médica por perder peso.Reforzar la idea de que la obesidad es una "enfermedad a erradicar" puede llevar a restricciones extremas y a ciclos de pérdida y ganancia de peso (efecto rebote).Enfoques no pesocentristas, como el HAES (Health At Every Size), buscan evitar este problema.5. Cirugía bariátrica y fármacos: ¿solución o parche?Cirugía bariátrica: Puede ser eficaz en algunos casos, pero no está exenta de riesgos ni complicaciones metabólicas y psicológicas. Además, sin un cambio en el entorno y el comportamiento alimentario, puede no ser sostenible a largo plazo.Fármacos (Orlistat, Ozempic, etc.): Su auge responde a la necesidad de nuevas estrategias de tratamiento. Sin embargo, pueden generar dependencia, efectos secundarios y refuerzan la medicalización de la obesidad sin atacar sus causas estructurales.6. ¿Existe el estigma de peso? Sí, y está ampliamente documentado. Se manifiesta en:Discriminación en el ámbito laboral y sanitario (menos oportunidades laborales, peor trato en consultas médicas).Internalización del estigma, lo que puede llevar a peor salud mental y mayor riesgo de TCA.Mayor probabilidad de recibir recomendaciones de pérdida de peso sin evaluar otros aspectos de salud.7. Impacto de movimientos como Body Positive, HAES, Body NeutralitySocial: Visibilizan la diversidad corporal y desafían los estándares de belleza normativos.Político: Impulsan cambios en normativas contra la discriminación por peso.Sanitario: Desafían el enfoque pesocentrista, promoviendo la salud independientemente del peso.Sin embargo, algunos críticos argumentan que pueden trivializar los riesgos de la obesidad y desincentivar el tratamiento en casos donde hay problemas metabólicos reales. Conclusión La obesidad es un fenómeno complejo que no puede reducirse a peso corporal ni a una única categoría (enfermedad vs. factor de riesgo). Su abordaje debe ser integral, basado en evidencia, no estigmatizante y centrado en la salud más allá del peso.4oConviértete en un seguidor de este podcast: https://www.spreaker.com/podcast/comiendo-con-maria-nutricion--2497272/support.

Send a Text Message. Please include your name and email so we can answer you! Please note, this does not subscribe you to our email list, it's just to answer if you have a questions for us. In today's episode, we're expanding on last week's biohacking mindset chat and taking a closer look at extra prescription medications for weight management. (If you missed it, give it a listen now for the full context!) We'll discuss how these options might fit into your current plan, why you might consider adding them, and how tailoring your approach can really make a difference. Join me as I break down how medications like Contrave, Qsymia, and metformin can fit into a personalized approach to weight management. Remember, this episode aims to provide information to help you better understand your options and have more informed conversations with your healthcare provider—it is NOT personalized medical advice. Tune in now to explore more avenues on your weight management journey!ReferencesLast week's episode (Ep. 105): Optimizing Your Toolbox: Biohacking with Anti-Obesity MedsTo learn more about specific weight loss percentages, check out this episode here: Anti-Obesity Medications: Part 2 Audio Stamps00:30 - A quick reminder to listen to Part 1, Optimizing Your Toolbox: Biohacking with Anti-Obesity Meds, before diving into this episode.01:00 -  Dr. Rentea shares some updates, including an upcoming YouTube channel and a paid podcast launching in March with exclusive content and community access.05:33 - Today's episode explores alternative medications that can help if GLP-1s aren't an option or aren't working as expected.09:02 - Qsymia (Phentermine + Topamax) can help with hunger, but side effects make it hard for most to tolerate.11:20 - Contrave can help with intense cravings and snacking when dietary changes aren't enough. 13:20 - Orlistat causes minimal weight loss with unpleasant side effects and is rarely prescribed or covered.14:48 - Metformin aids insulin resistance and supports weight loss without causing low blood sugar.16:35 - There are more weight loss options beyond GLP-1s, and your provider should be able to explain why certain medications may or may not be right for you.Quotes“Always know, if one thing doesn't work, there is always more that can be done if you're really seeing a skilled weight management expert.”“Everyone's physiology is different. We're talking about how to make your physiology work for you.”“If someone is a hyporesponder and they continue to struggle despite dietary changes and exercise and all the things we're doing, I do find that for some people metformin can be that magic continuation that they need.”“If you have significant insulin resistance, which is usually the case when you have a really hard time releasing weight, I find that metformin can be incredibly helpful as an add on.” “Remember the name of the game is wAll of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast. If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Obesity has become a pressing issue in the United States, with a significant increase in its prevalence over the past few decades. This episode explores the factors contributing to weight gain, genetics that may predispose individuals to obesity, and the environment in which we live., highlighting the control we each have over our weight and the potential to modulate genetic influences. We also discuss the impact of obesity on various medical conditions such as heart disease, stroke, hypertension, and diabetes. Obesity needs to be understood as a chronic and relapsing medical condition, rather than solely a cosmetic concern. Listen in to learn more: Plenity; a supplement that expands in the stomach to creates a sensation of fullness Cell Press, a similar supplement with celluose, to help control portion size Calcium Pyruvate, a substance that enhances the conversion of food into energy Orlistat, an over-the-counter medication to block fat absorption Hormonal control of weight using Semaglutide and Tirzepatide The role of the hypothalamus in eating and hunger The role of the mesolimbic reward system in controlling cravings Contrave, a prescription medication working in the brain to reset hunger controls Qsymia, a prescription medication working in the brain with the hunger and craving centers Bariatric surgery as an option Gain insight to understand obesity's medical complexities to explore various interventions, empowering you to make an informed choice for healthier living and weight management. Key moments in this episode are: 00:26 Definition of obesity 00:38 Calculating your BMI 01:06 Rates of obesity in the USA 01:27 Factors related to rise in obesity 03:11 When to begin treating our weight 04:07 Does insurance cover weight loss options? 05:32 Understanding Plenity 06:40 Describing Cell Press 07:08 Calcium Pyruvate supplement 07:40 Orlistat as a fat-blocker 08:20 Hormonal treatment for weight with semaglutide and tirzepatide 11:44 Hypothalamus' role in weight control 12:13 Mesolimbic reward system's role in weight control 13:58 Contrave for weight loss and control of cravings 15:22 Using Qsymia to control hunger and cravings 16:29 Phentermine as an appetite suppressant 17:56 Bariatric surgery for weight loss Learn more about weight loss options, including Semaglutide and Tirzepatide, here: https://www.foundationsfl.com/weight-loss Follow us! Instagram @foundationskristinjacksonmd Website https://www.foundationsfl.com/ FB facebook.com/advancedurogynecology Loved this episode? Share with a friend.

Beginning with a discussion on the evolution of these medications, Dr. Bikman emphasizes their significance in combating obesity-related health issues. He proceeds to analyze the mechanisms of popular weight loss drugs, such as Orlistat, Phentermine, and the combination of Phentermine with Topiramate, elucidating how each functions to aid weight loss.While highlighting the benefits, Dr. Bikman doesn't shy away from detailing the potential side effects, ensuring a comprehensive understanding for the audience. Moreover, he shares an intriguing scientific fact regarding lactate's role in fat metabolism, adding depth to the discussion. Throughout, Dr. Bikman maintains a balance between scientific evidence and personal insight, fostering an engaging and informative session.In discussing liraglutide's mechanism of action, Dr. Bikman reveals its role as a GLP-1 receptor agonist, mimicking the actions of the incretin GLP-1. He then previews next week's class dedicated to incretins and their use in weight loss drugs, including medications like wegovy and ozempic.Liraglutide primarily promotes weight loss by reducing gastric emptying, leading to prolonged feelings of fullness and decreased appetite. Additionally, it inhibits glucagon, lowering blood glucose levels and subsequently increasing metabolic rate and fat burning. Dr. Bikman notes common side effects such as gastrointestinal discomfort and hints at potential risks of thyroid tumors associated with GLP-1 agonists.Ben transitions to discussing semaglutide, another GLP-1 receptor agonist, and its similar effects on weight loss and side effects, including the possibility of ileus. He also touches on metformin's off-label use for weight loss, its mechanisms involving AMPK activation and ATP inhibition, and its potential interference with exercise-induced mitochondrial benefits.Learn more at: Insulin IQ Hosted on Acast. See acast.com/privacy for more information.

Join us as we unpack the world of more weight loss products, focusing on the likes of Wegovy and Orlistat. From the science behind these medications to real-life success stories, we delve into the effectiveness, potential side effects, and the broader impact on individuals striving for healthier lives. Get ready for a candid discussion that separates the facts from the myths, providing valuable insights for anyone considering these weight loss aids in their journey towards wellnessThe content provided in this podcast is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The hosts provide medical advice, and any health-related discussions for general informational purposes. If you have a medical emergency, call your doctor, call 111 or 999 immediately."

Orlistat 奥利司他phentermine-topiramate苯妥英钠-托吡酯naltrexone-bupropion (Contrave)纳曲酮-安非他酮liraglutide利拉鲁肽semaglutide司美格鲁肽setmelanotide (IMCIVREE)长黑素

Dr. Borger invited Dr. Ude to join us today to talk about the world of weight loss medications. Dr. Ude is a family medicine practitioner at Apple Valley Family Medicine and an expert in the treatment of obesity. Listen as they discuss a hot, trending topic - weight loss medications - including Metformin, Orlistat, Plenity, Contrave, Ozempic, Mounjaro, Saxenda and Wegovy.   The content provided in this episode is for educational and informational purposes only and is not intended to provide medical advice. Always consult with a qualified and licensed physician or other medical care provider.    Quick Links:    Family Medicine Website: https://www.applevalleyfamilymed.com/    The Weekly Dose with Dr. Ude Podcast: https://www.buzzsprout.com/2104965   The Weekly Dose YouTube Channel: https://www.youtube.com/channel/UClzXeRVUwfRXtbeYw_qh8ZQ/about   Dr. Ude on Instagram:  https://www.instagram.com/applevalley_dr.ude/  

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it. I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.A few things before we dive in. First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn't want to trickle information/commentary out over days and weeks in case it might be helpful to someone now. Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back. Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I'll also use an asterisk in “ob*sity” for the reasons I explain in the post footer. Ok, big breath and let's get into this.In later newsletters, I'll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”No, it's really not. And it's this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don't have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don't have any of those health conditions and some kids/people who are thin do have them. It's especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.)The myth of “non-stigmatizing ob*sity care” Like so much of these guidelines, this idea and much of the verbiage around it mirrors that of the weight loss industry. In this case, it's attempt to co-opt the language of anti-weight-stigma in order to promote (and profit from) weight loss (there's a guide to telling the difference between true anti-stigma work and diet industry propaganda here!) In truth, there is no such thing as non-stigmatizing care for ob*sity, because the concept of ob*sity is rooted in size and the treatment is changing size (the word was made up to pathologize larger bodies, based on a latin root that literally means to eat until fat so…less science than stereotype there.) There is no shame in having a disease, it's just that existing while fat isn't one. The concept of “ob*sity” as a “disease” pathologizes someone's body size. The concept of ob*sity says that your body itself is wrong, and requires intensive therapy and/or risky drugs and surgeries so that it can be/look right. There is no way to say that without engaging in weight stigma.If someone claims that the treatment is actually about health and not size, then it's not “ob*sity” treatment since both the criteria for the “disease” and the measure of successful “treatment” of ob*sity are based on body size. If the treatment is about health and not size, then the treatment and measures of success should be about actual metabolic health, not body size (which would be ethical, evidence-based, weight-neutral care.)The idea that “It is important to recognize that treatment of ob*sity is integral to the treatment of its comorbidities and overw*ight or ob*sity and comorbidities should be treated concurrently”Again, I think this is demonstrably untrue. Any health issues that are considered “comorbidities” of being higher-weight are also health issues that thin people get, which means that they have independent treatments. We could skip body size manipulation attempts entirely and still treat any health issues that a higher-weight child/adolescent has.The dubious claim that “ob*sity treatment” is compatible with eating disorders preventionI wrote a specific piece about this here. Weight loss as a “solution” to weight stigmaThis is unconscionable. Regardless of what someone believes about weight and health, the message that children (as young as 2!) should solve stigma by undertaking intensive and dangerous interventions that risk quality of life moves beyond inappropriate to disgusting, especially when one is perpetuating weight stigma, as these guidelines (and the weight loss industry talking points that are repeated herein) do.There is so much more to unpack here, but I want to move into a discussion of the recommendations themselves.For this, I will start where I left off on the conflict of interest piece. Which is to say, almost all of the authors of these guidelines are firmly entrenched in the body-size-as-disease paradigm. They have pinned their careers to it. None of the authors are coming from a weight-neutral paradigm.  In fact, in the research evaluation methodology section, they explain that they excluded studies that looked at impacting health, rather than weight. In their own words:The primary aim of the intervention studies had to be examination of an ob*sity prevention (intended for children of any weight status) or treatment (intended for children with overw*ight or ob*sity) intervention. The primary intended outcome had to be ob*sity, broadly defined, and not an ob*sity comorbidity.Note that by “ob*sity comorbidity” they mean a health condition that happens to children of all sizes.I don't know if it was intentional, or just a myopic focus on body size manipulation as a supposed healthcare intervention, but the option to focus on health rather than size was specifically excluded by a group of authors whose careers on based on focusing on size.There are three main areas of their recommendation that I'll talk about today - Intensive Health Behavior and Lifestyle Treatment, Weight Loss Drugs, and Weight Loss Surgeries.RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)This is recommended starting as young as age two. That's right, they are recommending intensive interventions to kids in diapers (and they think that they should look into how to “diagnose” kids who are even younger, yikes!) What these guidelines subtly admit is that these interventions don't actually work. They include this (long-time weight loss industry) talking point “a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”The translation to this is that they have absolutely no idea how to make higher-weight people of any age thin long-term. They are aware (and if not they are negligent) that a century of data shows that the vast majority of people will lose weight short-term and gain it back long-term. What they seem to be trying to do here is rebrand yo-yo dieting (aka weight-cycling) as a successful intervention. If there is a prize for moving the goalpost and declaring victory, they are in the running.Don't just take my word for it, they created a graphic as part of Figure 1 to show it:Pro tip: When they say “relapsing remitting” they mean “yo-yo dieting". I know why the weight loss industry loves this idea - it's how they've built a business that creates exponential growth with a product that doesn't work. What I don't understand is how this group of authors can possibly justify this ethically. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies) so setting people up for weight cycling starting as toddlers does not, to me, have the ring of sound science or ethical, evidence-based medicine.Let's dig into the evidence they are using to support this:The guidelines claim that “IHBLT is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. It involves visits of sufficient frequency and intensity to facilitate sustained healthier eating and physical activity habits.” The study they cite to back this up (Grossman et al; 2017, Screening for ob*sity in children and adolescents: US Preventive Services Task Force recommendation statement) says “Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months.”They also include a chart of seven randomized controlled trials (RCTs) from 2005-2017. The combined study population of all seven studies was just 1,153 kids. The largest study (with 549 participants) and the only study to include children from ages 2 to 5 had a duration of 12 months and showed a BMI change of 0.42 that year, and was only “effective” (if you consider a .42 change in a year “effective”) in kids ages 4-8 years old. There was only one study that followed up for more than 12 months, and from 12 months to 24 months, the BMI change decreased (from 3.3 to 2.8,) consistent with the weight regain pattern that we would expect.This will be a running theme in these guidelines - short-term studies will be used to justify life-long recommendations, and weight regain is ignored. In general, sometimes this is based on the idea that if a weight loss intervention works short-term, then it will continue to work forever, other times it's based on the idea that weight cycling is an ethical, evidence-based healthcare intervention. Again, the data on both the long-term failure of weight loss and the danger of weight cycling does not support this.They make a point to mention that IHBLT “involves interaction with pediatricians and other PHCPs who are trained in lifestyle-related fields and requires significantly more time and resources than are typically allocated to routine well-child care.” At this point I'll note that many of the authors of the guidelines run clinics or have practices that provide exactly this type of care.Their criteria for the studies was, I'll just call it lax: “Over a 3-12 month period: The criteria for the evidence review required a weight-specific outcome at least 3 months after the intervention started.” Obviously, this is a very short-term requirement and, again, excludes studies that looked at actual health instead of just body size.Here again they tell on themselvesTreatments with duration longer than 12 months are likely to have additional and sustained treatment benefit. There is limited evidence, however, to evaluate the durability of effectiveness and the ability of long-term treatments to retain family engagement.Note that the idea that longer duration treatment is “likely” to have additional and sustained treatment benefit is not remotely an evidence-based statement, and I would argue that it is biased and should not be included here. Also, they seem to be setting the stage for blaming families for the entirely predictable and almost always inevitable weight regain.Under “referral strategies” they get real about how little weight loss we're actually talking about:Pediatricians and other Primary Healthcare Providers (PHCP's) are encouraged to help to set reasonable expectations for these [BMI-based] outcomes among families, as there is a significant heterogeneity to treatment response and there is currently no evidence to predict how individual children will respond. Many children will not experience BMI improvement, particularly if their participation falls below the treatment threshold.”As described in the Health Behavior and Lifestyle Treatment section, those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline.So they are recommending an “intensive,” time-consuming, expensive intervention to kids starting as young as age 2 with no prognostics as to which kids might be “successful,” the stated result of which is that “many” (their word) of them won't experience any change in the primary outcome, those who do will see a very small change.They do mention the supposed actual health benefits of these interventions, but fail to mention that the health benefits may have nothing to do with the very small change in size. That's because often when health changes and weight changes (at least temporarily) follow behavior change, those who are invested in the weight loss paradigm (financially, clinically, or both) are quick to credit the weight change, rather than the behavior change, for the health change. Here again, the evidence does not support this. It's very possible that these same health improvements could be achieved with absolutely no focus or attention paid to weight, which would provide more benefits and less risks (including the risks associated with both weight stigma and weight cycling.) It could also allow the children (some, remember, still in diapers) to create healthy relationships with food and movement, rather than seeing choices around food and movement as punishment for their size or a way to manipulate it.As they move into specific recommendations, they start with:Despite the lack of evidence for specific strategies on weight outcomes many of these strategies have clear health benefits and were components in RCTs of intensive behavioral intervention. Many strategies are endorsed by major professional or public health organizations. Therefore, pediatricians and other PHCPs can appropriately encourage families to adopt these strategies. To me this sounds a lot like throwing the concept of “evidence-based” right out the window. None of this means “these strategies are likely to lead to long-term weight loss,” but I'll bet that won't be what is conveyed to the patients and families upon whom these “strategies” are foisted. Before we move on to their recommendations around diet drugs, here is some research to contextualize these recommendations:Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass indexNone of the behaviors being used by adolescents for weight-control purposes predicted weight lossOf greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain [Note: This is not to say that there is anything wrong with higher-weight, but that there is something wrong with a supposed healthcare intervention that has significant risks, almost never works, and has the opposite of the intended effect up to 66% of the time.] Raffoul and Williams, 2021, Integrating Health at Every Size principles into adolescent careCurrent weight-focused interventions have not demonstrated any lasting impact on overall adolescent healthBEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-ob*sity StrategiesGovernment-sanctioned anti-ob*sity campaigns* increase the vulnerability of those at risk of developing an eating disorder* exacerbate eating disorder symptoms in those already diagnosed with an eating disorder* show little success at reducing ob*sityStrategies including changes to menus and food labels, information around ‘healthy/unhealthy' foods, and school-based weight management programs all pose a risk.Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiativesOb*sity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weightThey were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the interventionFiona Willer, Phd, AdvAPD, FHEA, MAICD, Non-Executive Board Director at Dietitians AustraliaQuoted from: health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app“Dieting to a weight goal was found to be related to poorer dietary quality, poorer mental health and poorer quality of life when compared with people who were health conscious but not weight conscious”Ok. Moving on.RECOMMENDATION: Use of Pharmacotherapy (aka Weight Loss Drugs)Their consensus recommendation is that pediatricians and other PCHPs “may offer children ages 8 through 11 years of age with ob*sity weight loss pharmacotherapy, according to medication indications, risks, and benefits as an adjunct to health behavior and lifestyle treatment.”They admit that “For children younger than 12 years, there is insufficient evidence to provide a Key Action Statement (KAS) for use of pharmacotherapy for the sole indication of ob*sity,” but then go on to suggest that if kids 8-11 also have other health conditions, somehow weight loss drugs (which are not indicated for the treatment of the actual health conditions they have) “may be indicated.”Their KAS is that “pediatricians and other PHCPs should offer adolescents 12 y and older with ob*sity weight loss pharmacotherapy, according to medication indications, risks and benefits as and adjunct  to health behavior and lifestyle treatment.”The studies that were actually included in the evidence review predominantly studied metformin (alone and in combination with other drugs,) which is not approved for weight loss, orlistat, exenatide, and one study that looked at phentermine, mixed carotenoids, topiramate, ephedrine, and recombinant human growth hormone.Even though the studies for other drugs did not exist at the time of the evidence review, they made the choice to include them anyway. (This includes Wegovy, the drug that Novo Nordisk, a donor to the AAP, has promised their shareholders will be a blockbuster and that announced its approval in children as young as 12 just days prior to the publication of the guidelines.) Let's look at the efficacy of the drugs they are recommending:MetforminAdverse effects include bloating, nausea, flatulence, and diarrhea and lactic acidosis which they characterize as “serious but very rare.” The guidelines describe the evidence of metformin for weight loss in pediatric populations as “conflicting” They evaluated 16 studies, about two-thirds of which showed a “modest BMI reduction” and one-third showed “no benefit.” Also, this drug is not approved for weight loss. They recommend that due to the “modest and inconsistent effectiveness, metformin may be considered as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) and when other indications for use of metformin are present.”Orlistat:This drug is currently approved for ages 12 and up. Orlistat is sold under the name alli by GlaxoSmithKline and as Xenical by Genentech (both GlaxoSmithKline and Genentech are donors to the AAP.) The guidelines point out that the side effects (including fecal urgency, flatulence and oily stool) “greatly limit tolerability” but do say that “Orlistat is FDA approved for long-term treatment of ob*sity in children 12 years and older.” They cite two studies from 2005. One (Behzat et al., Addition of orlistat to conventional treatment in adolescents with severe ob*sity) started with 22 adolescents, 7 of whom dropped out within the first month due to drug side effects. The remaining 15 subjects were followed for 5-15 months with an average of 11.7 months of follow up. Those 15 patients lost 6.27 +/- 5.4 kg within the study time.The other (Chanoine JP et al, 2005, Effect of orlistat on weight and body composition in ob*se adolescents) was a one-year study with 357 adolescents (age 12-15) in the Orlistat group. They lost weight initially but the weight loss stopped at week 12 and by the end of the study the weight of those in the Orlistat group had increased by .53kg.Glucagon-like peptide-1 receptor agonistsThese are drugs that are type 2 diabetes medications that were found to have a side effect of weight loss. In some cases they have been rebranded specifically for weight loss and, in others, are prescribed off-label.ExenatideThis drug is currently approved in kids ages 10 to 17 years of age. The guidelines point out that a small weight loss was shown in two small studies but with “significant adverse effects.”LiraglutideThe study they cite for liraglutide (Kelly et al, Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with ob*sity.) was a 56 week study with a 26-week follow-up period. Participants lost weight initially, but after 42 weeks began to regain weight (though they were still on the drug) at 56 weeks weight gain became more rapid and at the end of the 26-week follow up they were nearing baseline. The guidelines characterize this as “A recent randomized controlled trial found liraglutide (daily injection) more effective than placebo in weight loss at 1 year among patients 12 years and older with ob*sity who did not respond to lifestyle treatment.” They do not make it clear that participants experienced near total weight regain (see graphic below.) In addition to the near total lack of weight loss (and remember that it's pretty likely that subjects continued to regain weight after the tracking stopped at 82 weeks,) side effects included nausea and vomiting, and among patients with a family history of multiple endocrine neoplasia, a slightly increased risk of medullary thyroid cancer. Liraglutide is sold as Victoza and Saxenda by Novo Nordisk. This study was a clinical trial funded by Novo Nordisk, multiple study authors work for, are employees of, take payments from and/or own stock in Novo Nordisk (see disclosures below) and Novo Nordisk provides funding directly to the American Academy of Pediatrics, and has paid thousands of dollars to authors of these guidelines.Just for funsies I checked the disclosures: Dr. Kelly reports receiving donated drugs from AstraZeneca and travel support from Novo Nordisk and serving as an unpaid consultant for Novo Nordisk, Orexigen Therapeutics, VIVUS, and WW (formerly Weight Watchers); Dr. Auerbach, being employed by and owning stock in Novo Nordisk; Dr. Barrientos-Perez, receiving advisory-board fees from Novo Nordisk; Dr. Gies, receiving advisory-board fees from Novo Nordisk; Dr. Hale, being employed by and owning stock in Novo Nordisk; Dr. Marcus, receiving consulting fees from Itrim and owning stock in Health Support Sweden; Dr. Mastrandrea, receiving grant support from AstraZeneca and Sanofi US and grant support and fees for serving on a writing group from Novo Nordisk; Ms. Prabhu, being employed by and owning stock in Novo Nordisk; and Dr. Arslanian, receiving fees for serving on a data monitoring committee from AstraZeneca, fees for serving on a data and safety monitoring board from Boehringer Ingelheim, grant support, paid to University of Pittsburgh, and advisory-board fees from Eli Lilly and Novo Nordisk, and consulting fees from Rhythm Pharmaceuticals. Melanocortin 4 receptor (MC4R) agonistsThese are specialty drugs that are only FDA approved for patients 6 years and older with proopiomelanocortin deficiency, proprotein subtilisin or kexin type 1 deficiency and leptin receptor deficiency confirmed by genetic testing. They site a small, uncontrolled study in which patients experience weight loss of 12-25% over 1 year. PhenterminePhentermine is a controlled substance chemically similar to amphetamine which carries a risk of dependence as well as side effects including elevated blood pressure, dizziness, and tremor. These are FDA approved for a 3-month course of therapy for adolescents 16 or older. I'm not clear what good could come out of giving a teenager a drug with these kinds of risk for 3 months?TopiramateThis is a drug that is used to treat seizures and migraines that happens to have a side effect of making people not want to eat through what the guidelines admit are “largely unknown mechanisms.” These drugs cause cognitive slowing and can cause embryo malformation. It's approved for children 2 years and older with epilepsy and 6 and older for headaches and I cannot for the life of me imagine how it could possibly be ethical to cause cognitive slowing in a child (who is going to school!) in order to disrupt their bodies hunger signals.Phentermine/TopiramateYou read that right, those last two drugs with the dangerous, quality-of-life impacting side effects? The guidelines discuss the option of prescribing them together. To children. This is based on a 56-week study (Kelly et al, 2022, Phentermine/topiramate for the treatment of adolescent ob*sity.) In the study, 54 subjects were given a mild dose, 15 of them dropped out. 113 were given the “top dose” 44 of them dropped out. As we've seen in other studies, weight loss had leveled off and begun to rise slightly by week 56 and there is no reason to believe it wouldn't go back up, but we'll never know because they didn't do any more follow-up. By the way, like most of the other studies, these subjects were also undergoing a “lifestyle modification program.” Also, like the other drugs, I think it's important to note that this was FDA-approved for “chronic treatment” based on the results of a study that only lasted 56 weeks. That is a common situation with weight loss drugs.Finally, the guidelines don't mention that side effects of this drug include increased heart rate, suicidal behavior and ideation, slowing of linear growth, acute myopia, secondary angle closure glaucoma, visual problems; mood and sleep disorders; cognitive impairment; metabolic acidosis; and decrease in renal function.  As I was looking this up, I noticed that the lead author of this study is the same lead author of the liraglutide study. Phentermine/Topiramate is sold under the brand name Qysmia by Vivus. I had to do some digging to get to the disclosures on this one and what do you know, Dr. Kelly has received grant consideration and consults for Vivus. In fact, with the exception of Megan Oberle, every author of this study either receives funding from/consults for Vivus, or is an employee of Vivus. Megan Oberle lists no conflicts of interest in this 2022 study but, interestingly, in a 2019 study (It is Time to Consider Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth) the disclosure states “MO serves as site PI [principal investigator] for study through Vivus Pharmaceuticals” so we know they're not strangers. LisdexamfetamineThis is a stimulant that is approved for kids 6 and older who have ADHD, in those 18 and up for Binge Eating Disorder, and while it is sometimes prescribed off-label for higher-weight kids, the guidelines note that “no evidence available at the time of this review to demonstrate safety or efficacy for the indication of ob*sity in children.”Summing up, there are significant risks of side effects (some life threatending) and not a drug among them has shown anything approaching long-term efficacy. Let's look at the last of the recommendations.RECOMMENDATION: Weight Loss SurgeryThis is the last bit I'll write about today. This section beginsIt is widely accepted that the most severe forms of pediatric ob*sity (ie, class 2 ob*sity; BMI ≥ 35 kg/m2, or 120% of the 95th percentile for age and sex, whichever is lower) represent an “epidemic within an epidemic.”Remember, for a moment, that this phrasing is from authors who swear up and down that they are working to end weight stigma. One wonders what they would have written if they were trying to stigmatize higher-weight children. (Just fyi, if anyone is confused, you can't usefear-mongering language, describing a group of people simply existing in the world at a higher-weight as an “epidemic” without stigmatizing them.)The KAS here (for me the most horrifying of those offered,) isPediatricians and other PHCPs should offer referral for adolescents 13y and older with severe ob*sity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers. [I'll note here that at least one of the authors of these guidelines runs just such a facility.]Before we get too far into this, let's be clear about what these surgeries do. They take a child's perfectly functioning digestive system, and put it into a (typically irreversible) disease state forcing, restriction and/or malabsorption (for an explanation of the various surgeries, check out this post.) If this state happens to a child because of disease or accident, it is considered a tragedy. If the child is higher-weight, it is considered, at least by the authors of these guidelines, healthcare.They make the claim “Large contemporary and well-designed prospective observational studies have compared adolescent cohorts undergoing bariatric surgical treatment versus intensive ob*sity treatment or nonsurgical controls. These studies suggest that weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families”To support this, they cite a single study. The study (Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study) included 81 subjects who underwent Roux-en-Y gastric bypass.The average weight loss was 36·8 kg over five years, but 11% of those who had the surgery lost less than 10% of their body weight.A full 25%  had to have additional abdominal surgery for complications from the original surgery or rapid weight loss and 72% showed some type of nutritional deficiency. And that's just in five years. Remember that the damage done to the digestive system is permanent. They are recommending this as young as 13, so a five year follow-up only gets these kids to 18. Then what?By the look of their own graph, what comes next may well be more weight gain, since the surgery survivors' weight loss leveled off after year one and started to steadily climb after year two. There's also the impact of those nutrient deficiencies. They also claim that these surgeries lead to a “durable reduction of BMI.” Let's take a look at the studies they cite to prove that.Inge et al., 2018 Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Ob*se AdolescentsThis study lasted two years. It looked at data from 30 adolescents who had weight loss surgery. They averaged 29% weight loss over 2 years and 23% of the subjects had to have a second surgery during those two years.Göthberg et al., 2014, Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid ob*sity--surgical aspects and clinical outcomeThis study just rehashes information from the Olbers study above.O'Brien et al. Laparoscopic adjustable gastric banding in severely ob*se adolescents: a randomized trialThis study is about gastric banding and I'm not sure why they included it because in the paragraph above it they point out that these surgeries are “approved by the FDA only for patients 18 years and older, have declined in use in both adults and youth because of worse long-term effects as well as higher-than expected complication rates” (they cite 18 studies to back up this particular claim.)Olbers et al., 2012 Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity: results from a Swedish Nationwide Study (AMOS)These are just the two-year outcomes from the five-year Olbers study aboveOlbers et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study.This is the exact same 5-year Olbers study from above, just given a different citation number.Ryder et al., 2018 Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe ob*sityThis study included 50 subjects who had Roux-en-Y gastric bypass and had a follow-up at year one and another follow-up sometime between years 5 and 12. They were then divided into “regainers” and “maintainers” though by their criteria, “maintainer” subjects could regain, they just couldn't regain more than 20% of the weight they lost prior to their follow-up. Though the study is called “Factors associated with long-term weight-loss maintenance” they were not able to identify any factors that were predictors of “regaining” or “maintaining.” You'll note in the graph below that weight was still trending upward when they stopped following up.So let's recap: They cite 7 studies to back up their recommendation of referrals for these surgeries for kids ages 13 and up. Four of the seven are the same study. One is a study for a surgery that they themselves have said is declining in use, so I'm excluding it. Combined, the rest of the studies followed a grand total of 161 people. The longest follow-up is “5+ years” and the studies consistently showed weight regain that was trending up when follow-up ended, as well as high rates of additional surgery and nutrient deficiencies. This, to me, doesn't come close to justifying a blanket recommendation that every kid 13 and older whose BMI ≥ 120% of the 95th percentile for age and sex be referred for evaluation for weight loss surgery.And when it comes to their criteria for these surgeries, they predicate risk on size. Those with “class 2 ob*sity” are required to have “clinically significant disease” which doesn't make the surgery ethical but, in comparison; children with “class 3 ob*sity” simply have to exist in the world to meet the criteria to have their digestive system put into a permanent disease state. One thing they do point out is that recent data showing multiple micronutrient deficiencies following metabolic and bariatric surgery serve to highlight the need for routine and long-term monitoring. Here we see a serious issue with giving this surgery to adolescents. First of all, they are rarely in control of their access to food. If their parents don't buy them what they need, if a parent loses their job and can no longer afford the supplements they require, if they experience hunger and/or homelessness… there are so many things that could impact a 13-year-old's ability to eat in the very specific ways they need to after the surgery for the rest of their life. Also, these surgeries are going to change the ways that these kids eat - at every school lunch, birthday party, family holiday. Anytime food is served, it is going to become clear that they are different, and if they aren't in charge of preparing the food, there is no guarantee that they will be able to get what they need. And that's if they want to do that. Let's not forget, these are humans who are/will be exploring their independence, including through rebellion, they are humans whose prefrontal cortex is not fully developed, meaning that they can literally lack the ability to fully recognize the consequences of their choices. (Of course, given that we only have five years of follow-up data, I would argue that their doctors and surgical teams also lack the ability to fully recognize the consequences of their choices.)The authors end the section with a fairly shameless plug for insurance coverage of these surgeries. This is another long-time goal of the weight loss industry that has made its way into these guidelines.I think this is a good time for a reminder that thin kids get the same health issues for which higher-weight kids are referred to these surgeries and thin kids are NOT asked to take the risks of these surgeries or to have their digestive systems permanently altered. They just get the ethical, evidence-based treatment for the health issue they actually have. Also, remember that the authors' research methodology specifically excluded research about weight-neutral intervention to see if any health benefits that the surgeries might create could be achieved without the significant (and, from a long-term perspective, largely unknown) risks of these surgeries, and perhaps be more lasting?But there is more to this in terms of informed consent. There are many of the same issues that we see with adults (which I wrote about here). With kids, there is another layer. In the state of California, for example, it is illegal to give a tattoo to someone under the age of 18, even with parental permission. But an eighth grader can make the decision to have their digestive system permanently altered, impacting their life and quality of life in myriad ways, many of which are unknown, and with no prognostics? Given all of this, is informed consent even possible for these kids? I would argue that it is not.Even worse, how many kids' parents, in some combination of weight stigma, concern for their child, and acquiescence to a doctor who may be pressuring them, will make this decision for their child?While I'm sure that there are adolescents who had the surgery and are happy with their outcome, I'm equally sure that there are adolescents who had terrible outcomes and would give anything to not have had the surgery (I know because I hear from them). And I know that the research can't tell us why anyone has the outcome they have. When you combine that with the total lack of long-term follow-up (I'm completely unwilling to consider 5 years “long term” for a lifelong intervention,) I think what we have here are, at best, experimental procedures, not procedures that should receive the kind of blanket recommendations that these guidelines provide for kids as young as 13.Ok, there's a lot more to discuss in these guidelines but I will save that for another newsletter. I hope that the outcry against these guidelines is loud, sustained, and successful in getting them rescinded. Kids deserve far better than this.Finally, I just want to give a quick shout-out to my paid subscribers (I know not everyone can/wants to have a paid subscription and that's totally fine - absolutely no shame at all if you are reading this for free as a subscriber or randomly!) those who are able to pay are allowed me to spend HOURS this week going through these guidelines and creating Thursday's post and this post, I'm just super grateful for the support.I'll be posting additional deep-dives into the research they cite and I'll keep a list here:“New insights about how to make an intervention in children and adolescents with metabolic syndrome” Pérez et al.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today is a very exciting day on the podcast because we have our first guest, Dr. Angela Fitch. She is an internal medicine and pediatric obesity medicine physician and president of the Obesity Medicine Association. She's the former co-director of the Mass General Weight Center in Boston and now she is the Chief Medical Officer for Known Well a new in-person and virtual primary care and obesity clinic that will launch soon in Boston and across the country. In this episode, we will be talking about something that both Dr. Fitch and I are really passionate about, anti-obesity medications that help with weight loss. We will discuss why we think they are important, what kinds are out there and what they do, and why diet and exercise aren't always enough. I hope this information helps you.Points of interest...Why do we need medications? [2:08]Sympathomimetic amines, a class of medications like Phentermine [6:51]Phentermine Topiramate combination [14:32]Naltrexone Bupropion combo [17:39]GLP-1 agonists injections [20:34]Keeping an eye on nutrition when using medications [28:20]Plenity [32:29]Orlistat [35:11]Medications that are not technically anti-obesity medications [37:25]Accepting long-term use [39:18]Resources & People MentionedDr. Angela FitchConnect With Dr. FrancavillaThe Dr. Francavilla Show My linktreeFollow on TwitterFollow on FacebookFollow on InstagramSubscribe to The Dr. Francavilla Show onApple Podcasts, Spotify, Amazon Music, iHeartRadio, StitcherGoogle Podcasts, Pandora

What diet should you follow to get the BEST results from orlistat (Xenical / Alli)? Let's see why simply following a “low-fat” diet is not always a good idea, and find out which diets are most effective with orlistat.

That is a radical statement! Being well is something we all want. We follow the latest diet trends. We take the recommended supplements. We become "fat phobic," telling ourselves we are not "good enough" if we are overweight. Debra Benfield, founder and owner of Body in Mind Nutrition, told me that there is an ageist diet/wellness culture that leads to a lack of body respect in the Pro-Aging movement. Deb wants to blaze a path into elderhood without the scales! Topics covered: Internal biases around eating, diet, weight and fitness, specifically focused on women over 50 We have learned that in order to be loved, be worthy or be of value, we must be thin, This belief leads to disordered eating, feeling badly about ourselves.  Intuitive eating - eat when you are hungry, stop when you are full. Stay out of your head, stop counting calories, stop tracking,  We can feel overwhelmed by so many different diets and even may have forgotten how to eat a healthy diet. Research shows that it is not obesity that causes heart disease, diabetes or other diseases, it is actually the behaviors or genetics or trauma. You can be fat and fit.  Being thin does not equal healthy. Episode Takeaways: 1. Wrap your head around the idea that all bodies are worthy 2. These suggestions can help you age with vitality and protect you from disordered eating Move your body so it feels like play Be socially connected Manage your stress Use intuitive eating Thanks so much for listening. Subscribe on Apple Podcast, Stitcher , Google Podcast. or Spotify Follow up on Facebook and Instagram How to reach us You can email me with questions or comments at wendy@heyboomer.biz Join the Hey, Boomer Walk to End Alzheimer's Team at act.alz.org/go/HeyBoomer  – Wendy Green is a Certified Life Coach, working with people going through the sometimes uncomfortable life transition from full-time work to “what's next.” Find out more about Wendy's 6-week “What's Next Transition” Coaching workshop – You can find Debra Benfield at debrabenfield.com  - On Instagram at @agingbodyliberation - or email her at deb@debrabenfield.com Books mentioned in the show The Beauty Myth: How Images of Beauty Are Used Against Women The Body is Not an Apology: The Power of Radical Self-Love Intuitive Eating: A Revolutionary Anti-Diet Approach How to Raise an Intuitive Eater: Raising the Next Generation with Food and Body Confidence Show transcript Toxicity of the Wellness Culture.m4a Hello. Welcome to the Hey Boomer Show, which is live each Monday on Facebook, LinkedIn and YouTube and then available the next day on your favorite podcast app. My name is Wendy Green and I am your host for Hey Boomer. And Hey, Boomer is for those of us who believe we are never too old to set another goal or dream, a new dream. It is for lifelong learners who have found meaning and are finding meaning and purpose in their lives and are living their best lives into this new chapter. We at hey boomer are on a push to grow our hey boomer Walk to end Alzheimer's team and what I would like to do is welcome our newest walk member, Kathy McAfee. She joined our Greenville, South Carolina, team. We also have Melanie Whitlock, who is out in Clearlake, California. And you can join her team, her hey, boomer team or Bernadette Wagner. She's having a team out in Hagerstown, Maryland. Everybody who joins the team is going to get a cute, hey, boomer hat that you can wear for the walk and you can wear afterwards with great pride because you are a boomer. So join our team, any of these teams by going to act.ALZ.org/goto/HeyBoomer and if you don't want to walk with us or you feel like you can't, you can still go ahead and contribute so that we can find a cure and end this disease and meanwhile help people that are still going through the disease. I also wanted to mention the What's Next Group Coaching program. This program helps answer the question Who am I now? Who do I want to be? Will I ever feel useful and productive in society again? And what is my value to my family, my community, my society now that I am no longer fully employed or following my career path? At the end of the six week program, you will have a six month plan and possibly a 12 month plan, and the next cohort begins on September the 20th. And let me show you how you can reach out. You can go to Calendly/heyboomer/20min and we can set up a free 20 minute consultation. Find out where you're at, where you want to be. See if this makes sense to you or you don't have to talk to me if you don't want to. You can just check out the program at HeyBoomer.biz/Coaching and learn all about it. It really can be a program that can move you into your next chapter with great comfort and ease. So let's get to what we're talking about today. And I've been struggling with this topic a little bit, the toxicity of the wellness culture. I mean, I mostly try to eat healthy. I take supplements. I exercise some most of the time. No, probably not as much as I should. And I have to admit, I am a fair weather walker and hiker when it is cold and rainy. I am not the one that's out there, but I do get uncomfortable when the scale says I've gained a few pounds and all of these beliefs about weight and fitness and behaviors. These all are reinforced by my family and by the media. You know, we all hear comments like, oh, she's really put on some weight or, well, wouldn't she be pretty if she just lost some weight? Advertisements and TV shows portray happy, slender people and not so happy larger people. And if they're heavy older people, the images can be even more demeaning. So preparing for this show has shown me how much I've bought into these ideas that fat is bad and skinny is good. Did you know that we as a society spend over $35 billion on diet products annually? It is a lucrative industry. And diet culture is that collective set of social expectations telling us that there's one way to be. And one way to look. And one way to eat. So that we are a better person. And we're a more worthy person if our bodies are in that mold that we all hear about. So today we're going to dissect what it is meant by the wellness culture, how it can be toxic and how it affects us as we age. And I really want you to join in and ask questions, because a lot of this is learning for me, and I'm sure it's learning for you. So feel free to join us. And let me bring on our expert today. Her name is Deborah Benfield. Hi, Deb. Wendy. Hey, everybody. So Deborah invites you to join her on the intersection of pro aging and body liberation on her newest website. DebraBenfield.com. From her experience, she understands how aging creates vulnerability to the ageist, diet, wellness, culture, and how frustrating it is to find a profound lack of body respect in the pro aging movement. And I had to check with her on that quote because I was like, Wait, pro, aging? Aren't we, like all about accepting where we are? Well, you're going to hear about some of how it's not accepting. Deb is a registered dietitian nutritionist with over 35 years of experience in that field. She's also a registered yoga teacher. She is the founder and owner of Body and Mind Nutrition, a group practice of registered dietitians and nutritionists. And like I said, the founder of her newest site, which is more focused on the aging, she'll tell us more about that. Deborah Benfield She's passionate about preventing and treating disordered eating and eating disorders and supporting you in feeling more comfortable and confident in your relationship with food, eating and your body. So, Deb. Tell me how you got into this field in the first place and then kind of what your journey has been to move more into the aging space. Well, I first want to thank you. I really appreciate your openness to this conversation, because I know it's kind of tricky and surprising to think about how the pro aging movement may have some problems with how we look at bodies. And I think that may be more true for women's bodies. I also want to say that my pronouns are she, her, hers. And I want to talk just a minute about my vocabulary. I you'll hear me say obesity right now as a word that I will not be saying any further. I believe that the way we talk about bodies further stigmatizes pathologizing as bodies that are fat and fat, in my worldview is a descriptor just like you have red hair. Wendy I believe that it's just a descriptor of who you are. I have brown eyes, so it's a description of me. So fat in my worldview is not pejorative. It's a description. So you'll hear me say a fat and not the ugly words. And I'll talk a lot more about that later, too. So I got into this because I really like talking to people as whole human beings. So when I started my career, I pretty quickly started referring clients to therapists to talk about issues outside of what was going on in their eating and their relationship with their bodies. And I happened to develop a relationship with a therapist. That was amazing. Her name is Joan Wilkins, and she was my supervisor, and her specialty was eating disorders. So I, very early in my career, started developing this curiosity and interest in learning more. And it's just kind of become what I do. And I'm very passionate about the work. It's very rewarding to watch and work with a woman who starts to become more powerful in her life and doesn't kind of give her power away by wanting to shrink herself. So I hope that's all well. And so, you know, we talked about the early time we're getting into the eating disorders, but now you're moving into how it's affecting us as we age. So what brought your interest there? Well, I will be 64 in December. And when I turned 60, I also became a grandmother for the first time. Oh, congratulations. Thank you. So something happened in my head where I just wanted to do more research on what we know to be true about how to support aging with vitality and being who I am and understanding what I understand about diet and wellness culture. I was absolutely shocked by how the anti-aging messages hit me hard and fast that I had to get through what I consider to be a bunch of bullshit. I didn't ask you if I can say those kinds of words on your show. Of course, again, this is an adult show. But it just felt like I had to wade through a lot of things that I knew were not based in science and I knew were very adjust and what I consider to be phobic. So I quickly saw that I had to dig a little deeper and I really couldn't find what I was looking for. So I realized that I had to I wanted to create what I think people are needing, what I needed to start with. And it's been it's been fascinating to me to really look at how you can support aging with vitality without getting pulled into all of the you must lose weight. Yeah. So I want to talk about those biases and I want to talk about internal biases because those certainly do hold us back. I mean, and we have more control over those than we do some of the external biases we hear from the media. So in my world, I talk about living an engaged, meaningful life and getting over that internal bias of I'm too old, I don't have the energy anymore. I don't learn as quickly. And shifting that message. In your world, it's more about eating and diet and weight and fitness. And so what are some of the messages that you hear that are internal biases and how do we address those? Yeah, I think that it's I really love that we're kind of focused on a particular group of people right now because coming of age, when we all came of age, I went back and looked at the timeline of how women's bodies were portrayed in the media. The forties and fifties, women's curvy and voluptuous bodies were heralded as the ideal, the beauty ideal. And as a matter of fact, there are there is evidence of, like ads for weight gain products. Really? Yes. I'll show you. There are like you can't be too skinny in the forties and fifties. That's not appealing. Now, of course, all of this marketed to women. Right. And then guess what happened in the sixties? Twiggy, twiggy. Twiggy entered our lexicon and the diet industry took hold and just blew up. And women quickly believed they had to be like Twiggy and which, in my opinion, is unachievable and ridiculously thin and likely fragile. And if you pursue that kind of ideal, you have to diet. I mean, that's what happened is the women believed that in order to be beautiful, in order to be valued, in order to have worth, they must diet. So I don't know if you watched Mad Men. I watch some of that, yeah. I think the character Betty Draper is an amazing character to talk about when it comes to this, because that show took place when all of this happened and it's set in that time period. They did a great job of showing what happened, especially with women in that time. And she joined Weight Watchers and that was the classic choice. And they show her in several shows going back into the kitchen and sneaking her food and actually bingeing the foods that she was deprived of. So it's really interesting to look at how in the sixties. The dive industry took hold because women felt to be worthy, to be loved, to be valued, they must be thin. And I really feel like that's where it really shifted in a in a big way. And also what you're describing about the money that was to be made based on that. And there are a lot of people that believe that it's not surprising that that's also when the women's movement was taking place and that perhaps there was kind of this interesting way to get women to be disempowered. If they're really focused on dieting, they won't have as much of a voice. They will have as much power. So Naomi Wolf's book, The Beauty Myth, is a wonderful book to read if you want to dig into that concept. Interesting. She's not the only one that believes that, but that book is very powerful. And what's interesting, Deborah, is that if that started in the sixties, here we are. What. 60 years later and it's still going on. I mean, you know, I can look in my in my cabinet, you know, I have the whole body diet. I have, you know, diet for a small planet. I have South Beach diet. I have like all these books because I'm like, oh, gosh, you know, I've got to lose a little weight. And every trend changes. You know, it's like, Whoa, och, don't eat carbs. Well, now you should eat carbs. Don't eat fruit. Well, now you should eat fruit. You know, it's like count calories don't count calories. And it's so confusing and no wonder it creates disordered eating. I don't know about eating disorders, so maybe you can differentiate that for me because I don't understand that. Yeah, we're definitely going to talk about that. I don't know if you want to jump into that now, but I think we're we need to talk. I know it's way outside the scope of the show to get to details about eating disorders, but I think it is helpful to look at what is normal and what is disordered and what is an actual diagnosable eating disorder. Yeah. Do you want to do that now? Well, first of all, Angela says, what was the name of that book you mentioned? It is titled The Beauty Myth. The Beauty Myth. And the author is Naomi Woolf was written quite a while ago, but it's exceptional when it when you look into the principle that we're talking about. So yeah, we can go one of two ways. Why don't you describe the difference right now? And then we'll talk a little bit more about the dieting and intuitive eating. How about that? Okay. So perhaps I feel that eating occurs on a continuum and most of us kind of travel up and down that continuum, hopefully not too far toward disordered eating, but normal eating is. Easy. Normal eating is messy. It's eating when you're hungry. When your body says it's time to eat. And stopping. When you're full and. Even a variety of foods that satisfy you. So that you can actually notice when you're satisfied and full. It is not being in your head, counting and calculating and tracking at all. It is only listening to your body and therefore not struggling with feeling guilty or even ashamed of what you're doing. So there's no reaction in your emotional life and there's no space taken up in your head. You're very simply easily eating when you're hungry. Stop it when you're satisfied. And disordered. Disordered eating is likely getting much more in your head with it. And much more rule based, much more tracking, and therefore more reaction. More in your head following rules, and therefore feeling like you're being bad if you've eaten something that you've decided is bad. And eating disorders are. We have many we have anorexia nervosa. We have bulimia nervosa. We have binge eating disorder. We have arfid, which is a new diagnosis, relatively new ARFID stands for If I Get All This right, avoidant restrictive food intake disorder. And it's really about having a negative experience like choking or vomiting, that's created an anxiety about eating or a sensory issue where there are many foods that you feel like you can't eat, that you can only eat a shorter list of foods. And there's also something called Orlistat, which is basically a group of disorders that don't fit into any other boxes. So it's like a catchall phrase, but there is a disorder to the point of some debilitation in your lifestyle, so we can break each of these down. There's a lot to talk about with you. I know this is where I get hung up, because when you describe normal eating, just eat what you want, when you want until you're full. I mean, I think I had mentioned this to you once, you know, like if I had a plate of chocolate chip cookies here, which is my go to dessert and I have a refrigerator with carrots, celery and lettuce, I'm going for the chocolate chip cookies every time. You know, it tastes good. It's easier than putting together a salad. How is that normal eating? Of course, I'm probably going to beat myself up about it and say, Why did you do that? You know that's not good for you. Yeah. Yeah. Well, I do want to say you mentioned before that, you know, there was this diet and that diet and sometimes they contradict each other. I do want to say that. Probably every single client that I work with comes to me with that particular feeling of overwhelm by all the different kinds of diets that have they've heard about feeling kind of lost and like, Which way do I go? Because they're so contradictory. Also really noticing that they feel kind of like they have forgotten how to eat. Like, actually, like I forgot eat. I've lost my way because of all the diets that they've been on. And they may not have a full blown eating disorder, but they are feeling all of those things. They're trying to find their way back. So the way that we find your way back is by trying to get out of your heads and starting to realize that your body carries innate wisdom that your body actually knows. When you need to be nourished and what even what foods would nourish you and when you've got enough. Now there's a look on your face that is to look at people's faces. It's like, I can't believe that could possibly be true. But if you think about if you've been around a baby, you know that a baby cries a very distinct I'm hungry cry. It's very distinct. And babies pull away when they've had enough, when they're satisfied. We know that if children are allowed to eat with the structure of family meals, with some security around the fact that there will be food and those variety provided without a lot of food rules, without a lot of judgment, without pressure, that over time they will eat a variety of foods and their bodies will go where their bodies are genetically dictated to go. And sadly, nobody really allows that to happen. I think it's more and more true because parents are being taught that this is the way to sorry, actually raise competent eaters to prevent children from getting eating disorders. Because eating disorders are very much on the increase right now, and we're all born with that capacity. It's the culture, the cultural messages, the diets, the millions, billions of dollars that market, those diets that make us no longer trust ourselves. Yeah, I think you're right about parents today. I know when I was raising my kids again, I went through all these different diets, tofu and vegetarian, and then know we're having roast beef and whatever. And, you know, my daughter and this is where. You know, was it because I was putting the pressure on or not? But I mean, she didn't want to eat what I was cooking. And I was like, this is healthy food. You need. To be eating. This. And she does not do that to her kids. And I mean, and we got into some battles over food, you know, which is unfortunate. And Martha makes the point that even when we were young moms, I mean, we had our babies on a schedule, you know, every 3 hours you need to eat at. And so we were raised with that belief that there is a right way and a wrong way to eat. How do we undo that? Well, you know, boy, I don't even know which way to go with this. There's of talk about when I was a mom. Young mom. I was well, I was already a dietician, so I was reading certain things. And the reading that I was I mean, there were folks that were telling young moms to follow the baby. Baby led weaning there. There was that phenomenon that we should say up away. And I don't know if you want to get into all this, but Ellen Satter is the woman's name who wrote all of those books. Those books were available in the eighties and they're still available. There's also a new book called Intuitive Eating for Kids. So it's like parenting with intuitive eating. So this can be prevented or we can develop a little bit more resilience in our children when they hit all the diet messages, when they get to school or when they go to grandmother's house. Because I think that's what you're describing. I don't know. I've heard so many clients talk about that rub in the family around what people say to the children about how they're eating. If you if you think as the grandmother that there are certain rules or that you have concerns about the size of your grandchildren's bodies, you know, you can get all into like, well, should you really do you really need that or like, don't you? Should you eat your vegetables before you get your cookies? All the things you clean your plate or not clean your plate, all those things are not helpful. The children actually can be trusted to feed themselves well if we stay out away again. Very hard for people to believe. But the more you follow this intuitive eating way of feeding yourself and your family, the more you'll prevent disordered eating and eating disorders. So that's why I'm talking about it. And we haven't gotten into aging bodies yet. That's a whole nother. Yeah. And I think I think June raises a good question here. You know, eating because we're hungry or are we eating because we're angry or bored or lonely or tired or. Yeah, so discerning that you can't discern that if you're not slowing down and paying attention if you the principles of intuitive eating. We're way into this really fast. Yeah, let's. Go. The principles of intuitive eating. Start with ditching diet mentality. You have to get rid of the good bad list in your head first so that you can. Really listen to your body. If you're still in your head with what? I shouldn't have this or I should have that. It's very hard to get the discernment to give yourself space for this discernment. So to slow down and eat as mindfully as you can. I know we're all really distracted and moving really fast, so it's not that easy to slow down and notice your body. I mean, I'm a yoga teacher, and the reason I'm a yoga teacher is because I think you have to have embodiment practices where you kind of ground yourself like perhaps if you say grace or if you try to have gratitude for the food in front of you to also notice your body. And I do this because this is what I do. I put my hands on my heart and my belly to notice my own body's hunger first. And the principles of intuitive eating are to dismantle diet culture in your head, to notice your hunger sensation, to eat foods that are satisfying. And we can talk more about that so that you can stop when you're full and emotional eating as the question that's in front of us. That's very real. Emotional eating is normal human behavior. Nobody likes to hear that either. Is actually that's very normal. And can you develop some skills that help you manage your emotions in other ways as well so that you have choices like, I know I'm really angry, so I need to like. Go punch the pillows for a walk or call a friend or write in a journal, or just sit and let yourself feel. Let yourself ride the. Wave of anger because it does pass. All right. So that's a lot. That's a lot. Not easy. I mean, you started by saying, yeah, yeah, okay, good. There's a distinction because I'm going to say you started by saying normal eating is simple, but it's not easy to be mindful to slow yourself down, you know, to be out in a group or to feel frustrated and not want to just go grab a chocolate bar or something. So let's talk about aging, right? So, so easy for me to see how the anti aging movement is displaying perfect bodies and get rid of the wrinkles and all of that. And they're trying to sell something just like the diet industry. But talk to me about how the pro aging industry is not respecting the way we look. Well, what I am noticing on social media especially, is a lot of thin white bodies. So. My the person who taught me the most about all of these issues in our culture is Sonya Renee Taylor. She wrote a book called The Body is Not an Apology. The Body Is Not An Apology. And she talks about how we live in a culture that has a body hierarchy, the default body that's at the top that everybody knows without knowing is thin. Young, male, heterosexual, cisgendered, able bodied, white. Probably neuro normative, you know, all of those things, that kind of body people that live with that kind of body have power and easily belong in our culture. If you are. Anything other than that. And you may have one or more things that are not in that description. You're more in the margins, therefore more marginalized. We marginalize people based on their bodies. And the more marginalized you are, the more marginalized your identity is, the more your risk of wanting to be thin. Because the feeling is, well, I can at least be thin if I am a woman, I can at least be fat. Then if I'm old, I can at least be thin. If I am disabled, I can at least be that great black or brown. I'm can be thin because it brings you into feeling like you may belong. You may have more of a sense of power. In our culture. You're not quite as invisible either. Right. So there's increased pressure and increased pressure to be thin as you age. And if you have any other marginalized identity, it's even more so. In fact, I noticed in the most recent AARP magazine talk about they're all about pro aging right there. One of their articles was How to Stay Thin If You're a Chef. It's like I would not even have noticed that, Deb, if I hadn't been talking to you. But, yeah, it's like. There's a lot of pressure. There is a lot of pressure. A lot of there's a lot of pressure. But now I'm going to be devil's advocate. But we hear that if you are overweight, it's hard on your heart. You are at risk for diabetes. It's harder on your joints and it's not healthy. So how do you how do you deal with that image that we have, that belief that we've been told from the medical world and for years, I mean, even with COVID, oh, you're more at risk if you're overweight. You know, I have so many references for what I'm about to say. It's this is not my opinion. This is I try not to say anything. That's my opinion because I am an old fashioned scientist. I really like to read and learn and speak with an expert, you know, kind of. Status and through that lens. So what I'm going to say is I can send you lots of like links to articles and podcasts, etc.. So all of the resource that talks about. I'm going to say that medical term obesity causes hypertension, heart disease, diabetes, even COVID, and not that it caused COVID. We can talk about that in just a minute. But all of that research is correlational. And not causal. We have no causal research that shows that being a certain way causes a disease process. What we have is certain activity patterns, certain particular dietary patterns. Definitely genetics. Definitely stress. There are many things that we actually do have research on that causes those diseases. And people assume people have assumed because of correlation that's correlated, but it's actually the behavior. I have worked with many folks that are fat, that have high levels of fitness, that have perfect labs. I've worked with very thin folks that are not at all fit and have high cholesterol, diabetes, hypertension. You cannot tell by looking at somebody that they're healthy. Being thin does not equal healthy. Losing weight does not equal healthy. As a matter of fact, what we also know is that yo-yoing weight cycling actually does cause hypertension and other aspects of heart disease. So we also know that 95% of people who go on diets regain the weight plus. So dieting is not a solution. So if I understand you right. What you're saying is that. Being fat does not cause. Hypertension does not cause diabetes. It's the lifestyle around that that's causing those illnesses. It's the particular kinds of behaviors. And it may be genetic. It may be stress and anxiety. We also know that trauma having trauma experiences, especially early in life, is related to certain body sizes and diseases. So it's much more complicated than we are, we assume. We make a lot of assumptions that make it very black and white and simplified. And there's a lot of problems with that because then people who are in fat bodies are stigmatized. They especially are stigmatized in the health care setting so that that kind of stress and we also have research that weight stigma is a stressor that can contribute to disease process. So it's such a mess. Because you're afraid to go to the doctor, because you're going to be embarrassed. And it's how you treat it when you do go to the doctor. There's shame. There's fetching, there's body shame that's experienced. That's very legit. So, yeah, it's very, very messy. It's not. I'm afraid in our culture we see it very simply that losing weight is good. Being thinner is good. Certain foods are superfoods and goods, and it's so much more complicated. Then there's also access. Access to food. I think that we actually believe that there is a moral value to food and a moral value to thinness, that people are better people if they're thinner and that certain foods are good. I mean, if you listen to what people say, I'm being sinful. Yeah, I mean, it gets really convoluted pretty quickly. I still need to learn a lot to shift my beliefs and to think that I'm not going to eat those chocolate chip cookies instead of the. Well, something we should talk about with intuitive eating is that there is a psychological phenomenon called habituation. But if you have something that you're deprived of, of course you want to eat it all. That's a normal reaction to deprivation if you have permission to eat the food consistently. Like if you start to bring chocolate chip cookies in and you eat them, you know you can eat them and you know you can have them whenever you're hungry again. You will start to lose interest in the chocolate chip cookies over time. You habituate to cookies and they have less and less and less power over you. Okay. Well, we're getting towards the end here. I mean, we could probably talk for another couple of hours. There's so much to talk about. I know. But give me a couple of takeaways that those of us who are just learning about this for the first time, what we can do to take this into this next chapter of our lives as we are aging. I think the first thing is to wrap your head around the fact that all bodies are worthy. I mean, we can't. White knuckle and control. Our bodies into a particular size and shape. As a matter of fact, the more you try to do that, the more likely you are to get disordered in your eating. And you could you could end up with an eating disorder. And we didn't really get into that very much today. But it's a real problem with midlife and older women because you do feel like you can't control your body. And the more you like knuckle, the more disordered you become. So trying to. Be a little bit more compassionate with yourself and understanding that all bodies are worthy. Number one. Number two, to try to in my research, what I found is the things that really contribute to aging with vitality and protective of getting disordered in your eating are moving your body so that it feels like play. So just like play, you have some joy in it. Trying to be socially connected, trying to actually manage your stress, which I know is easier said than done. And to eat with an intuitive eating mindset. All of that is protective and supports vital aging. So that's enough take aways. Yeah. Thanks. I'm going to learn more about this intuitive eating because I certainly. It can do the good, bad thing. So if you want to reach out to Deborah, you can email her at Deb at Deborah Benfield. Benfield. You can find her on Instagram at Aging Body Liberation. And check out her new website. In fact, Deb, you have some kind of coaching program that's getting ready to start. Quickly, tell us about that. I'm doing what I've been talking about today. I'm doing intuitive eating through the lens of pro aging. Yeah. It's a it's a. A group coaching cohort that begins the end of September. Okay. All right. I'm sure. We could all. Use some help on understanding that. So her website is Debra. DebraBenfield,Com Thanks. Thank you. Yeah. And let me remind people about our walk to end Alzheimer's. Please join our team at actor ALS dot org slash go to slash. Hey Boomer and check out also at the end of September, September 20th our hey boomer coaching the what's next after your full time career and that's it hey boomer dot biz slash coaching. So my guest for next week. Her name is Melanie Gordon and she's the founder of Do.Love.Walk Collective. And one of the programs Melanie offers through the collective are Ubuntu circles. And I wrote a blog about Ubuntu probably a year ago and it's just fascinates me. So in the Ubuntu circles they address empathy, social isolation, belongingness, compassion and reconciliation. And the groups gather for a weekend retreat or eight weekly sessions or extended experiences. So join me next week to learn more about Melanie Gordon and Ubuntu circles. And I'd like to leave you all with the belief that we can live with passion, live with relevance and live with courage. And remember, we are never too old to set another. Goal.Or dream. A new dream. My name is Wendy Green, and this has been. Hey, Boomer.

Episode 106: Weight Loss Meds. Anti-obesity medications are FDA-approved drugs to support your patient's efforts to lose weight. It is important for primary care providers to learn about these medications to continue fighting against obesity in our communities.Introduction: Obesity is a chronic disease.By Hector Arreaza, MD. Obesity has all the characteristics of a chronic disease. Let's use our imagination and think about a patient with hypertension, for example. Let's imagine you are the doctor or Mr. Lee. He is 45 years old and his blood pressure has been persistently high, around 150/100, even after lifestyle modifications. You decide to start chlorthalidone 25 mg and Mr. Lee takes chlorthalidone every day. Four weeks later you see Mr. Lee again and you review his labs with him. He has normal renal function and normal electrolytes. His blood pressure is now 119/75. He is feeling great and reports no side effects to chlorthalidone. Would you stop the medication at this time? Think about it. The most obvious answer is NO, you will not stop chlorthalidone. Today you will listen to a discussion about anti-obesity medications, common indications, contraindications, cautions, and more. We will learn that obesity requires chronic treatment with medications just like any other chronic disease. I hope you enjoy it.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________Weight Loss Meds. By Sapna Patel, MS4; and Danish Khalid, MS$. Ross University School of Medicine. Moderated by Hector Arreaza, MD. S: Hello and welcome back to our nutrition series! If you haven't already listened to our previous episodes, pause this and make sure to give them a listen. We have talked about physical activity, meal plans, and intermittent fasting. Today we are going to talk about the clinical management of obesity, specifically the pharmacotherapy that is used. We will divide these drugs into drugs that reduce food intake primarily acting on the CNS, drugs that reduce fat absorption and medications that are associated with weight gain. D: Can anyone who is considered obese take medications to help them lose weight? Pharmacotherapy should be considered if the patient will be taking the medication in conjunction with the overall weight management program, including changes in eating habits, increased physical activity, and realistic expectations of the medication therapy. Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with BMI >27 kg/m2 who have concomitant obesity related diseases. A: You are going to find doctors who are pretty much against anti-obesity drugs, but that's not my case.  S: Drugs that reduce food intake primarily acting on the CNS: Let's start with Phentermine and other sympathomimetic drugs A: Phentermine has been in the market over 60 years and it is well tolerated by most patients. It is effective, expect 5-8 lbs weight loss a month when taken with dietary changes and increased physical activity. The weight loss happens mostly the first 3-6 months when you take anti-obesity medications. S: One of the longest clinical trials of the drugs in this group lasted 36 weeks and compared placebo treatment to treatment with continuous phentermine and intermittent phentermine. Both the continuous and intermittent phentermine therapy produced more weight loss than placebo. D: Other options are Phentermine and topiramate ER which is known as  “Qsymia”. These drugs combine a catecholamine releaser and anticonvulsant respectively.  Topiramate is currently approved by the USFDA as an anticonvulsant for treatment of epilepsy and for prophylaxis of migraine headaches. Weight loss was seen as an unintentional side effect during clinical trials for epilepsy.The mechanism responsible for this is thought to be mediated through the modulation of GABA receptors, inhibition of carbonic anhydrase and antagonism of glutamate to reduce food intake The common adverse effects include cognitive impairment, paresthesia, and increased risk for kidney stones. Topiramate is also a teratogenic drug, so patients need to be in a good birth control to take it. It causes cleft palate in the fetus.The 2 phase-III trials called EQUIP and CONQUER, both 1 year randomized  placebo-controlled double-blinded clinical trials, 3 different strengths of a once-a day formulation were tested: full strength dose (15 mg of phentermine and 92 mg of topiramate ER), mid-dose (7.5mg of phentermine and 92 mg topiramate ER) and low dose (3.75mg of phentermine and 23 mg of topiramate ER). Subjects  randomized to the full strength dose in EQUIP and CONQUER trials lost an average of 10.9% and 9.8% body weight in 1 year compared to 1.6% and 1.2% loss for placebo subjects respectively. Significant improvement in fasting glucose, insulin, Hemoglobin A1C and lipid profile were seen.Due to the dose dependent side effects of the medications an initial dose of 3.75/23 mg is prescribed daily for the first 14 days then increased to 7.5/23mg daily. These patients should be re-evaluated after 3 months. If 3% weight loss is not achieved by that time, either discontinue or escalate the dose to 15/92mg for 12 weeks. S: Drugs that reduce fat absorption:Orlistat. What is orlistat? Well it's a selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat. The mean weight loss when compared to a placebo was 2.51kg at 6 months and 2.75kg at 12 months. A: It is one of the few anti-obesity medications approved to be used in children 12 years and older. D: GLP-1 Receptor Agonist (-glutide): Semaglutide and Liraglutide - Only two that have been approved for treatment of obesity. A 20-week randomized trial, comparing Liraglutide, placebo, and orlistat, showed that patients assigned to liraglutide lost significantly more weight than those assigned to both. When compared to placebo, those on liraglutide lost a mean weight loss of 2.8 kg. Whereas compared to orlistat lost an average of 5.8kg, however this was on the higher doses of liraglutide. A 56-weeks trial, comparing liraglutide with placebo, showed a mean weight loss was significantly greater in the liraglutide group (8.0 kg vs 2.6 kg). Furthermore, those who initially lost weight with diet and exercise, a greater proportion of those taking liraglutide maintained the weight loss.  Similarly, clinical trials favored semaglutide, with a weight loss greater in the semaglutide group versus placebo. For both, weight loss occurred in patients with and without diabetes. Note: Semaglutide: once a week. Helps induce weight loss. Liraglutide: daily.  A: We dedicated a whole episode on Semaglutide and another whole episode on Tirzepatide. Tirzepatide (dual agonist: GLP-1 and GIP) seems promising for weight loss and it is likely to be approved soon for obesity treatment. So, when do we discontinue anti-obesity medications? We can ask the same question for other chronic diseases: When do we stop medication for hypertension or diabetes? When we have a patient is unable to keep their weight off, we can't see him/her as someone who has lost their motivation to keep their weight off. Really what's happened is that their hormones have changed in a way that is promoting weight gain and it's very hard to lose weight. We should be at the patient's side to fight it off. Conclusion: Now we conclude our episode number 106 “Weight Loss Meds.” Phentermine is the most widely used anti-obesity medication. It is a stimulant, and it is a safe and effective medication for most patients who are fighting obesity. Make sure you learn the contraindication, side effects, and precautions when you prescribe it. Also, learn about other meds that are very effective, including GLP-1 receptor agonists, and your patients will thank you. This week we thank Hector Arreaza, Danish Khalid, and Sapna Patel. Audio by Sheila Toro.Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References: Perreault, L., Apovian, C. (2021). Obesity in adults: Overview of management. Pi-Sunyer,  F.X., Seres, D., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-overview-of-management?search=weight%20loss%20medications&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Perreault, L. (2022). Obesity in adults: Drug therapy. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-drug-therapy?search=weight%20loss%20medications&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Dungan, K., DeSantis, A. (2022) Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Nathan, D.M., & Mulder, J.E. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus?search=glp%201%20receptor%20agonists&source=search_result&selectedTitle=2~97&usage_type=default&display_rank=1 Perreault, L., Bessesen, D. (2022). Obesity in adults: Etiologies and risk factors. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-etiologies-and-risk-factors?search=medication%20associated%20with%20weight%20gain§ionRank=1&usage_type=default&anchor=H1612312650&source=machineLearning&selectedTitle=1~150&display_rank=1#H1612312650. Royalty-free music used for this episode: Salsa Trap by Caslo, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/caslo/caslo-vol-1/salsa-trap/. Space Orbit by Scott Holmes, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.  

Not medical licensed advice . Always consult with your doctor:New Treatments For ObesityBMI: 25-30 : overweight  >30 ObeseWHO 2016 40% are over weight and 13% obese slightly higher in females . This is triple that in 1975UK 2019 House of Commons Library  40% are overweight and 30% obese higher in middle aged and elderly menNHS 2021: Children Obesity has gone up in 12 years from 19% to 25% The Surprising Link Between Chronic Inflammation & Obesity—Plus What You Can Do About ItMay 5th 2021Leptins are hormones produced by adipocytes that communicate with the hypothalamus to reduce eating. If you have too much leptin you become leptin resistant and do not stop eating. High leptin levels are also associated with  chronic inflammation.Conversely losing weight reduces systemic inflammation. REVIEW articleFront. Physiol., 29 January 2020Sec. Clinical and Translational PhysiologyChronic Adipose Tissue Inflammation Linking Obesity to Insulin Resistance and Type 2 DiabetesFrederika ZatteralThe key mediator of inflammation in obesity is the innate immune system cell the macrophage that can account for up to 40% of adipose tissue and it differentiates into a pro-inflammatory M1 macrophage setting up chronic inflammation.Obesity and Inflammation: A Vicious CycleDoes obesity cause inflammation or does inflammation lead to obesity?Jun 25, 2020Jennifer LutzObesity causes chronic inflammation via a chronic immune reaction initiated in the adipose tissue but inflammatory cells can go round the body. In addition gut inflammation may be a result also of the poor diet that led to the obesity.We know that obesity has tripled in the last 50 years such that 40% of the western world are obese. In fact 75% are prediabetic.Cardiovascular disease leading to cardiac disease and strokes, diabetes, cancer, depression, osteoarthritis all feed back and make it more likely you will continue to be obese.Higher adiposity and mental health: causal inference using Mendelian randomization Francesco Casanova,Jessica O'Loughlin,Susan Martin,Robin N Beaumont,Andrew R Wood,Edward R Watkins,Rachel M Freathy,Saskia P Hagenaars,Timothy M Frayling,Hanieh Yaghootkar... Show moreAuthor NotesHuman Molecular Genetics, Volume 30, Issue 24, 15 December 2021, Pages 2371–2382, There is a bidirectional relationship between depression and obesity.Genetic sorting showed that it is obesity per se and not the metabolic unhealthiness due to the obesity such as diabetes that leads to depression.That said diabetes from obesity causes depression although obesity itself causes systemic inflammation which is an independent risk factor for depression and cancer.There are also huge psychosocial effects of obesity on mood.Once-Weekly Semaglutide in Adults with Overweight or ObesityNew England Journal Of Medicine March 2021John P.H. Wilding,Once a week subcutaneous Semaglutide reduced weight by up to 20%Semaglutide is a GLP-1 agonist so suppresses Glucagon and increases insulin hence controlling blood sugar. It also slows gastric emptying  increasing satiety and acts on Receptors in the Arcuate Nucleus in the brain to increase satiety.It is already licensed to treat Type 2 diabetes.It also reduces the risk of cardiovascular complication in Type 2 diabetes and at a cellular level reverses atherogenesis. There is a question on worsening the risk of retinopathy.Other GLP-1 agonists : Liraglutide Setmelanotide.CpdFDA Approved Medication for treating ObesityPhentermine, diethylpropion,benzphetamine, phendimetrazine , Orlistat, Phentermine/topiramate Qsymia, Bupropion/naltrexone, Semaglitide, Liraglutide, setmelanotideCpd Phentermine-topiramate: First combination drug for obesityInt J Applied Med Res 2015Singh et alPhentermine is a centrally acting sympathomimetic that reduces appetite and topiramate enhances GABA ergic transmission reducing Dopamine Response to food.This combination causes up to 10% weight loss maintained in 50% for 2 years.The relationship between early weight loss and weight loss maintenance with naltrexone bupropion therapy.THe Lancet Discovery Science 2022Le Roux et alNaltrexone blocks opiate receptors and bupropion (wellbutrin/zyban) blocks reuptake of dopamine  -reward pathways- .and noradrenaline . Weight loss is maintained at 1 yearBoth medications enhance each other on feeding and satiety

Gewicht verlieren ist ein wesentlicher Teil in der Diabetes-Therapie. Und gleichzeitg eine Sache, die vielen schwer fällt. Immer wieder liest man von Medikamenten, die die Pfunde purzeln lassen sollen. Ist da was dran? Das möchte Host Sabine Pusch in dieser Folge wissen. Dabei betrachtet sie nicht nur Diabetes- und Adipositasmedikamente wie Semaglutid oder Orlistat, sondern hinterfragt auch den Nutzen von Naturheilmitteln. Alle 14 Tage am Freitag erscheint eine neue Folge. Habt Ihr Fragen, Anregungen oder Kritik? Dann schreibt uns gerne an redaktion@gesundheit-hoeren.de Redaktion: Helena Salamun, Anja Kopf; Post-Produktion: Yves Seissler

Drs. Karl and Spencer have guest Dr. Alex Bonnecaze on to discuss Orlistat and Plenity. Learn: - How well these two substances work for weight loss - How they they actually work - Side effects - and whether you should even look into them or not. For Dr. Spencer's online clinic - go to JoinSequence.com

See all the Healthcast at https://www.biobalancehealth.com/healthcast-blog/ During 2021 several new weight loss drugs have been approved by the FDA for weight loss.   The Lancet is a very well-respected medical journal and in December of 2021 they-compared the available medications intended to help people lose fat and become healthy. Today I will discuss the weight loss medications that we use to assist our patients in weight loss and in our next Blog I will review the new, very effective weight loss drugs that have been released, and explain how doctors choose the right weight loss medication for you. At BioBalance Health® we provide medical weight loss treatment utilizing all the common methods of managing food intake, and exercise, and we add medications that are chosen for each patient based on their age, medical conditions and type of trigger that causes overeating.   This is referred to as an individualized medical weight loss program and we have been very effective.   Choosing a treatment program for each patient requires that we order blood lab tests, measure body composition at each visit, and find out a patient's history of weight gain to determine the most effective weight loss drug to prescribe for each patient. We also use blood type diets, which are a type of genetic evaluation that determines the best and worst food for each person.  It has been scientifically discovered that different body types (endomorph, ectomorph or mesomorph) require different forms of exercise and this observation plus blood type, and personality type helps us suggest the most effective type of exercise.  In the future we will be employing genetic testing to determine which medications would be the best for each individual. Today we will discuss the medications available by prescription that can make weight loss, or rather fat loss, possible. Because we are all different it is true that one particular medication, like one particular diet is not effective for all people. The first thing we consider is the medical condition of the patient including other medications that they are on which might interact with weight loss medications, and we don't want to give a patient that would make her blood pressure or other condition worse. After considering the safety of a particular treatment for an individual patient, I consider an individual's problem with food: Does she have anxiety that she soothes by constantly snacking? Does she eat sweets because of a metabolic dysfunction like hypoglycemia, that causes her to be tired when her blood sugar drops and she eats sugar to regain energy, Does she have bad eating habits from never learning how to eat cleanly, or how to cook? Does she always feel hungry even right after she eats which is genetically determined? Does she have a genetically determined inability to feel full? Because there are so many reasons for people to be overweight, many solutions must be found to treat the problem that causes weight gain. The first and most popular weight loss class of medication is appetite suppressants, or amphetamines, are ideal for patients who always feel hungry, who are young, and who don't have hypertension, or heart disease. Amphetamines are the same medication that are used for ADD/ADHD, and both constant hunger and ADD originate from a deficiency of norepinephrine in the brain.  Patients with untreated ADD and weight gain are a perfect match for amphetamine appetite suppression. Amphetamines were the first weight loss medication available for appetite suppression. They were commonly prescribed to women beginning in the 1960s.  These medications were widely used and were very effective, however they were often habit forming and only continued weight loss as long as they were taken. When they were discontinued patients generally gained their weight back. This particular class of medication didn't fail to result in lasting weight loss because of the drug itself, but when given without diet and exercise training, patients could not sustain the weight loss after the drug was stopped.  Today we still use amphetamines for appetite suppression and weight loss, but we combine it with low carbohydrate diets and daily exercise to achieve long lasting weight loss in a select group of patients. The names of these drugs are Phentermine, Dexedrine, and phendimetrazine. In the 1980s a drug called Orlistat® was introduced. This weight-loss medication worked by causing fat that was in a meal to pass through without being digested and absorbed. The fat passes through to the intestines and resulted in fatty stools.  This medication worked by decreasing calories absorbed from fat in the diet.  This was somewhat effective for patients who would not, or could not diet, but who still wanted to lose weight.  This in itself did work for a time in some patients, but was not an effective lifetime plan, because there was no accompanying training on how to eat appropriate amounts of food, and how to incorporate exercise in their diet.  This medication is now over the counter even though it prevents the absorption of fat soluble vitamin like Vitamin D, A, and E. Worse yet Orlistat causes the side effect of fatty diarrhea, fecal incontinence, and terrible gas.  This medication was not a long-lasting answer to obesity because it was not well tolerated and because it didn't cause patients to change their overeating habits so what weight was lost, came back when they were off the medication. The third weight loss medication is a combination of two drugs, Topamax (an anti-seizure medication) plus amphetamines, specifically phentermine. This duo is effective as a long-lasting weight loss answer for patients who are always hungry and can't control their appetite, as well as patients with food addiction, and sleep related eating disorders.  This treatment requires that a patient takes 25-100 mg of Topamax at bedtime and a dose of phentermine in the morning.  Weight loss with this drug combination is effective when it is combined with low carbohydrate diets and daily aerobic exercise.  This weight loss medication can be used long-term, however there are side effects for some patients which makes it intolerable.  Some patients experience dizziness, diarrhea, insomnia, depression, and numbness, that can cause patients to stop taking it, as well as to change to another medication for weight loss.  Many of the patients who have had success with these drugs, can't say enough good things about this combo! Next week we will discuss the new weight loss medications, who they are effective for and their side effects. I hope you join us to discover the new long-term answers to weight gain and obesity.

Welcome to the WellMedic podcast. In this podcast series. I will focus on going through several MRCGP AKT scenarios that will focus on the application of your knowledge. Each episode will cover a clinical topic taken from within the MRCPG curriculum guide. In this AKT podcast episode, we will cover weight loss medication, the weight loss medication in question is Orlistat.  The key is to focus on the application of your knowledge, but also some of the finer details covered within the relevant guidelines. WellMedic.co.uk hosts this MRCGP AKT podcast. WellMedic is a platform that focuses on the wellbeing of doctors across the UK. As a founder of WellMedic, I have developed online courses to help GP trainees PASS the MRCGP AKT.

Why is Orlistat / Alli / Xenical not working for you? Let's take a look at some mistakes people make when taking orlistat or reasons why you might not want to take orlistat.

Should you try Orlistat (aka Xenical or Alli or Thincal) for weight loss? Here's what you can expect, the side effects, and how to most effectively make use of this weight loss drug if you decide to take it!

ResourcesAnderson JW. Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage. Expert Opin Pharmacother. 2007;8(11):1733-1742. doi:10.1517/14656566.8.11.1733Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Hum Reprod Update. 2017;23(6):681-705. doi:10.1093/humupd/dmx027Gorgojo-Martínez JJ, Basagoiti-Carreño B, Sanz-Velasco A, Serrano-Moreno C, Almodóvar-Ruiz F. Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: The XENSOR Study. Int J Clin Pract. 2019;73(11):e13399. doi:10.1111/ijcp.13399Li J, Wang Z, Wei D, et al. Effect of preconceptional orlistat treatment on in-vitro fertilization outcome in overweight/obese women: study protocol for a randomized controlled trial. Trials. 2018;19(1):391. Published 2018 Jul 18. doi:10.1186/s13063-018-2780-7Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Obesity and reproduction: a committee opinion [published online ahead of print, 2021 Sep 25]. Fertil Steril. 2021;S0015-0282(21)01941-5. doi:10.1016/j.fertnstert.2021.08.018Roche Laboratories Inc.. Xenical (orlistat) [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020766s035lbl.pdfRevised January 2019. Accessed October 17, 2021.Wang Z, Zhao J, Ma X, et al. Effect of Orlistat on Live Birth Rate in Overweight or Obese Women Undergoing IVF-ET: A Randomized Clinical Trial. J Clin Endocrinol Metab. 2021;106(9):e3533-e3545. doi:10.1210/clinem/dgab340World Health Organization. Body mass index - BMI. Accessed October 18, 2021. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi

Los complementos dietéticos para perder peso están a la orden del día, es más, cada poco tiempo tenemos un nuevo producto a la venta aún mejor que el anterior, más efectivo y mucho más potente. Pero, ¿son realmente eficaces?Vemos en detalle algunos de ellos, pero hay ciertas características generales que es importante que conozcamos antes. En caso de que se decida tomar un complemento dietético para perder peso, siempre deberá hacerse con ese objetivo, el de complementar. Es decir, no debemos tomar un complemento dietético pensando que va a compensar o arreglar nuestros malos hábitos. Se trata de que ayude, acelere, o potencie los resultados de mi cambio y mejora en la alimentación, el ejercicio físico, el descanso, la gestión del estrés…Vamos a hacer un repaso de ellos para conocerlos y comprobar verdaderamente su eficacia.- chicles reductores hacendado: se trata de unos chicles que debes consumir 2 U al día y que dicen ser reductores. Esto pueden decirlo debido a que contiene enzimas un mineral que interviene en muchísimas funciones entre las cuales se encuentra la de antioxidante y antiinflamatorio pero en ningún caso va a tener este efecto de forma destacada. Además dicen ser probióticos, cuando está cargado de edulcorantes y polialcoholes, que precisamente lo que hacen es alterar la microbiota. Este complemento no es eficaz.- El Chitosan contiene chitina, una fibra que se obtiene del caparazón de algunos crustáceos que, al ingerirla, forma una película en el intestino que impide la absorción de grasas las cuales serán eliminadas como desecho intestinal de forma natural. En este caso si sería efectivo, pero creo que es mejor trabajar la flexibilidad y poder salir, hacer una sobreingesta sin necesidad de ir preocupado y tomarse un complemento para ello.- El glucomanano es una fibra de una planta llamada konjak, que va aportarnos saciedad debido a un gel que se forma al ponerse en contacto con el agua.Este gel va a portarnos saciedad y va ayudarnos a no sentir hambre y por lo tanto a reducir la ingesta calórica. También funciona pero una vez más soy partidaria de llevar una dieta rica en fibra y evitar este complemento.- El té verde, esa infusión tan popular y tan usada sí que tiene propiedades diuréticas y antiinflamatorias y pueden ser compatibles con una alimentación saludable, unos buenos hábitos y utilizarse de forma recurrente como complemento. Diferente es, las cápsulas de concentrado de té, en este caso no sería recomendable su uso recurrente. - La Garcinia cambogia es una pequeña fruta tropical que contiene ácido hidroxicítrico, que se asocia a la inhibición de la enzima ATP que se encarga de iniciar la síntesis de grasas. En ratones ha tenido efectos lipolíticos importantes, en humanos, muy escasos. - La L-carnitina es un compuesto que el organismo produce de manera natural, pero no hay evidencia científica que concluya que pueda ayudar a perder peso.- La cafeína es la sustancia psicoactiva más consumida y son muchos los suplementos quemagrasa que la contienen. De igual modo que ocurría con el de, sí que sería efectiva pero debemos vigilar ya que se puede generar tolerancia para lo cual se recomienda en periodos de abstinencia. - Los diuréticos a base de alcachofa o cualquier drenantes a base de alcachofa es uno de los complementos más utilizados y siempre hago la misma reflexión, ¿por qué tomar un líquido de alcachofa pudiendo comer alcachofas?- Finalmente, hay un medicamento que es Xenical, principio activo Orlistat, que es el único medicamento anti-obesidad que se ha demostrado su efectividad pero tan solo puede utilizarse en personas que padecen obesidad y una vez más como complemento a su trabajo de cambio de hábitos. Además se trata del medicamento de un precio elevado que tiene efectos secundarios como la diarrea.En resumen, podemos ayudarnos de estos complementos, al menos de los que tienen efectividad, pero siempre será mejor trabajar los hábitos, llevar una dieta completa basada en vegetales que nos aporten todos esos antioxidantes y propiedades antiinflamatorias, a la vez que rica en fibra. Complementándola eso sí que nunca falla, con ejercicio físico diario.

Eu fico triste de ver tantos profissionais de saúde que insistem em drogar os seus pacientes em vez de recomendar uma mudança do estilo de vida. Ainda mais com toda a informação já disponível sobre a Low Carb nos meios científicos. E o pior é que a maioria das drogas (bupropiona, sibutramina, etc) causam dependência, tem efeito rebote de compulsão, fazem mal a saúde tendo efeitos colaterais que podem levar até a morte. Outras menos tóxicas podem levar a uma desnutrição. É o caso do Orlistat pro exemplo, que faz a pessoa ter diarréia sempre que come gordura. Fazendo com que ela tenha baixas quantidades das vitaminas lipossolúveis no organismo: Vitamina D (a Vitamina do Milênio), Vitamina E, Vitamina A, etc. A melhor opção é sempre a via da saúde. A droga nunca é a resposta... Comece a Emagrecer Agora Clicando Aqui: https://www.novalowcarb.com Receba dicas de Emagrecimento! - No seu WhatsApp: https://www.novalowcarb.com/grupowhatsapp - No seu Email: https://www.novalowcarb.com/news Siga nossas Redes Sociais para ter acesso a mais conteúdo da dieta! Dicas e Receitas no Youtube: https://www.youtube.com/turisouza No Instagram - Dicas: https://www.instagram.com/drturisouza - Receitas: https://www.instagram.com/novalowcarb No Facebook - Dicas: https://www.facebook.com/drturisouza - Receitas: https://www.facebook.com/novalowcarb Nosso Podcast: https://www.soundcloud.com/dietalowcarb Compartilhe com um amigo que vai gostar de ver isto ;)

In today's episode we delve into the fascinating world of weight-loss medication, appetite suppressing drugs, and obesity treatment with obesity specialist and lipidologist Dr. Spencer Nadolsky 0:00 intro 1:39 - What factors drive obesity? 6:54 - Genetics factors behind obesity 11:25 - Weight loss medication - just how effective are they? 15:26 - GLP-1 analogs: Dulaglutide, Liraglutide, Semaglutide, etc 21:50 - Phentermine 28:51 - Sibutramine 30:51 -Naltrexone/bupropion 38:59 - Lorcaserin, Orlistat, other, less viable drugs 41:06 - Why are these drugs not widely available for everyone? 44:28 - Do people stay on these drugs permanently? 47:07 - Personal trainers and coaches being against these drugs 48:21 - Anything over the counter that's effective? 50:55 - Where can we find you? To apply to the new round of group coaching, you can book a time at: https://calendly.com/abel-csabai/ssd-transformation Or drop me an email to abel.csabai [at] gmail.com Angles 90 grips: https://angles90-the-first-dynamic-training-grip-worldwide.myshopify.com/?rfsn=5301938.a3640b Coupon code for 10% off ABELC10 insta: @ssdabel Find Dr. Nadolsky: insta: @drnadolsky https://renaissanceperiodization.com/team-member/spencer-nadolsky https://drspencer.com/

A question I get a lot is “can you actually have insulin resistance if your test results have come back normal?”.A lot of you have suspected insulin may be driving your PCOS and requested blood work from your doctor, only to find that everything is normal - and they won’t order anything else. So you’re stumped as to what your next step should be and you’ve got all these awful symptoms but you’re not sure why.“What the heck do I do now? I don’t understand what my root cause could be. I feel like I fit all of them…”PCOS is a complicated beast, which is why it’s so important to work with someone who knows about all of the nuances that come with having it.Because I know so many of you are confused about your PCOS and have questions like the one above, I’ve done a Q&A podcast answering some of your questions! I know, it’s a bit late this week because a) you guys had soooo many questions (I’m going to have to do a part 2!) and b) I’ve just moved house! If you know you know, it’s chaotic to say the least.In this podcast, I sit down with my lovely colleague Sophia and we talk through some of your burning questions about PCOS that we got the other week. We talk about everything from the question above to BMR and PCOS, the Pill to Orlistat, endometriosis to stress and ovulation pain.It’s a jam packed episode with lots of great tidbits on not only all the science-y information you know and love from the podcast but also some great actionable tips. So even if you’re not worried about insulin resistance, it’s definitely worth a listen!This episode is for you if:Your tests have come back normal and your doctor won’t order anything elseYou’ve just been pushed to go on the Pill and lose weight for your PCOSYou think you might have endometriosisWeight loss is a goal for youYou keep gaining weight, particularly around your midsectionWeight gain doesn’t seem to stop even when you’re exercising 6 times a week and eating in a severe calorie deficitYou take YasminYour stress levels are high and you want to know how to manage them betterSome things we cover in this episode:EndometriosisStressYour BMR and PCOSCalorie deficits and intense exerciseWhy the calorie equation isn’t the be all end allOrlistatPain, PCOS and ovulationResources and References:“What’s the difference between an ovarian cyst and polycystic ovaries?” Instagram post10: Part 1: Why period pain is not a symptom of PCOS and all things Endometriosis with Dr. Lara Briden11: Part 2: PCOS and Endometriosis with Dr Lara Briden38: The long term effects of not addressing our insulin resistance with Professor Grant Schofield44: Your Guide to Birth Control (Part 1): Hormonal Birth Control45: Your Guide to Birth Control (Part 2): Non-Hormonal Birth ControlMy Book: Getting Pregnant with PCOSLinks to our programs:The PCOS ProtocolEggducated

代餐的效果： 代餐減肥三個月可瘦掉體重的9.6% 比較代餐和低卡飲食，一年後使用代餐的人多瘦2.6公斤 比較代餐和減肥藥的效果，發現代餐的效果和排油的羅氏鮮Orlistat不相上下 代餐的好處： 減肥代餐比自己控制熱量的飲食更有減肥效果 減肥代餐獲得初步成效，可以預見長期減重會成功 代餐可作為長期減肥的方法 代餐成功的要訣： 減肥期一天兩餐、維持期一天一餐 變換口味以維持新鮮感 粒狀減肥代餐比液狀減肥飲料好 避免代餐失敗的重點： 代替正餐，餐間勿食 一份不夠可吃兩份 不能當點心 各位朋友，若您有醫美、減肥、健康相關問題，請直接到「景升診所」官網任一頁面留言，或用下列方法與我們聯絡： 直接撥打24小時專線 +886-931919066 Line id=“Gscline" WeChat id=“Gscline" 哈囉，大家好: 我們有幾個不同的頻道： Grand Health 大健康 （健康加財富、知足就是福）https://goo.gl/6EGLMd Grand Beauty 大醫美 （好好愛自己、就從現在起）https://goo.gl/g1E1rq Grand Touring 大旅遊 （大叔向前跑、永遠沒煩惱）https://goo.gl/7HN4bk 歡迎大家欣賞，喜歡就請按個讚，想獲取最新訊息就按「訂閱」吧！ 我們會提供更多更新的知識和訊息給大家。 感謝以下單位的幫助： ✪景升診所 醫美中心 https://www.gscline.com ✪愛瘦美官網 https://www.isome.com.tw ✪邱醫師醫話園 https://www.okclinic.gscline.com ✪隆乳 https://www.gscline.com/ifatgraft/breast-adsc-htm ✪減肥 https://www.gscline.com/islimcenter-htm/fat-htm ✪自體脂肪隆乳 https://www.gscline.com/ifatgraft/breast-adsc-htm ✪瘦臉 https://www.gscline.com/ilipolysis-htm/fll-face-htm ✪瘦手臂 https://www.gscline.com/ilipolysis-htm/fll-arm-htm ✪瘦小腹 https://www.gscline.com/ilipolysis-htm/fll-abdomen-htm ✪瘦腿 https://www.gscline.com/ilipolysis-htm/fll-leg-htm ✪瘦大腿 https://www.gscline.com/ilipolysis-htm/fll-thigh-htm ✪抽脂 https://www.gscline.com/liposuction-new-technique/fat_liposuction-htm ✪男性女乳 https://www.gscline.com/ihair-htm/fll-gynecomastia-htm ✪狐臭 https://www.gscline.com/ihair-htm/laserhyperhidrosis-htm

Weight loss medications have always been notorious for the dangers associated with amphetamine-related medications. But it's a new day. There are new medications related to SSRIs, the newer/safer antidepressants. There's Contrave, which uses a combination of Wellbutrin and Naltrexone. Naltrexone is used for narcotic or alcohol addiction. Orlistat is another medication that blocks digestion of fats.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's blogsPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

This episode covers orlistat!

Siguiendo con los productos adelgazantes, hoy uno de los reyes, lo puedes conocer como Orliloss o Xenical entre otros nombres, pero todos llevan el mismo principio activo, como medicamento que es, tenemos que saber para quién está indicado y qué debemos avisar al paciente.

Os traigo el resumen de toda la semana, como leéis en el título os explico las diferencias de conceptos y la importancia que tiene, analizo varios productos en base a qué son y qué contienen, hablamos del orlistat como medicamento para perder peso y analizamos como no caer en las trampas del marketing. Espero que os guste! https://amzn.to/2B2nO2J

Can you use thyroid supplements to help with weight loss? The answer is probably not as straightforward as you might think. We will talk about WHY this isn't the right way to think about losing weight if you have thyroid problems but first let's focus on weight loss and thyroid supplements. There are really two groups of people who are interested in using thyroid supplements for weight loss. Those who are overweight but don't have thyroid problems and those who are overweight and DO have thyroid problems. The reason that both groups of people want to use thyroid supplements for weight loss is because they know that the thyroid controls and regulates your metabolism. If you can naturally boost your metabolism then obviously weight loss will be easier. When it comes to weight loss, though, (for all types of people) you want to focus on T3. T3 is king when it comes to weight loss because T3 is THE active thyroid hormone and it contros all of the functions that we think about when we think about the thyroid. T3 is in charge of your metabolism, your thyroid function, your energy levels, your heat production, and your heart rate. If you are interested in weight loss then T3 should be your PRIMARY focus (not other thyroid hormones). And what makes this a problem is that MOST thyroid medications contain ONLY T4 in them. And most people are NOT able to turn that T4 into T3 which causes problems and weight loss resistance. This is why it's so important to optimize your T3! If you have thyroid problems and you want to lose weight here are the supplements you should AVOID: - Gimmicky weight loss supplements or those which are heavily marketed. - Raspberry ketones. - Orlistat. - Garcinia cambogia. - Hydroxycut. These supplements are marketed for weight loss but are not really effective for those with thyroid problems. So what should you use instead? You will want to focus on supplements which target the following areas: - T3 levels (you want supplements which INCREASE T3) levels. - Inflammation (you want supplements which REDUCE inflammation to help with weight loss). - Appetite (you want thyroid supplements which help NORMALIZE your appetite and notice I didn't say suppress it). - Protein powder (protein powders can help balance your appetite and help you build muscle mass). - Supplements which promote T4 to T3 conversion (these help INCREASE T3 levels). - Supplements which LOWER leptin and insulin resistance. Focus on THESE supplements and THESE areas if you have thyroid problems and want to lose weight (see my recommendations below or in the comments section).

A dieta carnívora possui muita proteína, mesmo ela também é capaz de gerar a cetose, mas se sua dieta é predominantemente a base de carboidrato utilizar o Orlistat pode te ajudar a diminuir um pouco a gordura e calorias de sua dieta. . Já na Cetogênica não é tão bom utilizar o Orlistat já que o objetivo é absorver mais gordura e diminuir o carboidrato sendo a gordura parte fundamental da dieta. Se você absorver menos gordura, irá gerar menos cetose e pode perder alguns benefícios da dieta. #DietaCarnivora #DrDiogoSimao #EspacoVolpi #Carboidrato #Orlistat #Gordura #DietaCetogenica

Obesity is of epidemic proportions in the United States and, unfortunately, many physicians are ill-equipped to tackle this disease.  In this episode, we talk with Dr. Timothy Garvey, MD, FACE, one of the world’s leading experts in obesity research.  We asked the American Association of Clinical Endocrinology to recommend an obesity expert and they gave us the best! Got feedback? Email thecurbsiders@gmail.com  Clinical Pearls: Obesity is a DISEASE. Not a lifestyle choice! Obesity is known to be associated with many of the most common preventable diseases and, thus, should be an important component of any treatment program. BMI goals differ between ethnic groups (for example, east Asians developing heart disease with a BMI greater than 23). Weight loss treatment should focus on the disease burden and not on body image. While diet and exercise are independently important, failure to address the underlying sedentary lifestyle will likely prove fruitless.  The American College of Sports Medicine recommends avoiding any sedentary activity greater than 90 minutes at a time and at least 150 minutes of moderate activity weekly. Always ask permission before talking about weight loss; otherwise, you might negatively impact the physician-patient relationship. In order to prevent weight-related complications, aim for approximately 10% weight loss. Weight regain is a REAL problem that should be anticipated (decreased BMR, hormonal implications, and many other issues); weight loss medications help to fight against these pathophysiological mechanisms. Weight loss medications (Orlistat [inhibits fat absorption], Lorcaserine [5HT2C agonist, blunts appetite], Liraglutide [GLP1-RA] at higher dosages [3mg/day], Phentermine/Topiramate [“...most effective…”], Naltrexone/Bupropion) are under-utilized across the board, but before using these medications, the physicians should understand how to use these medications and consider them as part of a weight loss treatment plan that includes lifestyle modifications (i.e. dietary assessment and exercise “prescription”). Liraglutide, Phentermine/Topiramate, and Naltrexone/Bupropion are the most effective medications. If the patient does not lose at least 5% of their weight by three months, stop that specific medication and consider trying another medication. Follow-up with your weight loss patients frequently over the telephone (2 weeks after starting a medication) and in the office (at least monthly). Minimal data supports using weight loss medications in the elderly (>70 years of age) Dr. Garvey’s “Take-Home” Points: Obesity is a DISEASE not a lifestyle choice! Don’t be afraid to use weight loss medications! Weight loss should be a tool to improve HEALTH, not appearance. Disclosures: Dr. Garvey reports several financial disclosures for this talk: Scientific Advisory Board:  Novo Nordisk, Eisai, Janssen, Vivus, Liposcience, Takeda, Astra Zeneca, Alexion, Merck Research Funding (university administered):  Merck, Astra Zeneca, Weight Watchers, Eisai, Sanofi, Pfizer, Novo Nordisk, Lexicon, Elcelyx Stock Ownership (publicly traded):  Eli Lilly, Pfizer, Novartis, Merck, Isis, Bristol-Myers-Squibb, Affymetrix Learning objectives: By the end of this podcast listeners will be able to: Understand the impact obesity has on overall health and disease burden. Identify the weight loss medications and which might be appropriate for your patient(s). Have a general understanding of the impact that each individual treatment modality (lifestyle modification, medications, and surgery) has on weight loss. Links from the show: Dr. Timothy Garvey’s bio (UAB):  https://www.uab.edu/medicine/diabetes/faculty/faculty-bios/111-w-timothy-garvey Dr. Timothy Garvey’s app recommendation, “Lose It,” available from https://www.loseit.com/. Dr. Timothy Garvey’s book recommendation:  “House of God” available https://www.amazon.com/House-God-Samuel-Shem/dp/0425238091/ref=sr_1_1?ie=UTF8&qid=1484443555&sr=8-1&keywords=House+of+God. AACE 2016 Obesity Guidelines:  https://www.aace.com/files/final-appendix.pdf AACE Obesity Treatment Algorithm (highly recommended):  https://www.aace.com/files/guidelines/ObesityAlgorithm.pdf Naltrexone/Bupropion SR for Weight Loss:  Method-of-use study of naltrexone sustained release (SR)/bupropion SR on body weight in individuals with obesity.  Obesity (Silver Spring). 2016 Dec 27. doi: 10.1002/oby.21726. Phentermine/Topiramine for Weight Loss (Review Article):  Combination phentermine and topiramate extended release in the management of obesity.  Expert Opin Pharmacother. 2015 Jun;16(8):1263-74. doi: 10.1517/14656566.2015.1041505.

With thoughts turning to our festively-expanded waistlines, Kit Chapman looks at a poster child in the battle against obesity

Drugs to encourage weight loss have a chequered past, with many of them having been withdrawn from the market due to increased morbidity and mortality. In this podcast Raj Padwal, associate professor of medicine at the University of Alberta, takes us through the remaining therapy Orlistat, and discusses the potential for two new therapies, Phentermine-ER topiramate, and Lorcaserin, which are being licensed in some countries Read the full article: http://www.bmj.com/content/348/bmj.g3526

Fitness expert Janice talks about the ABC’s of Staying Slim with Q, R, S, T, U, V, W, X, Y and Z. Q is for Quinoa which has more hunger-taming protein and fiber and less carbs than most other whole grains. R is for replacements. Researchers found dieters who drank liquid meal replacements lost just as much weight over 52 weeks as those who used the weight-loss drug Orlistat with regular meals. Don’t take pills. S is for stress. A study shows stressed mice gained more than twice as much weight as a group with the same diet, but no stress. The next time you feel stressed, take an exercise class to relax. T is for tea, the fat-busting benefits of green tea include the release of disease-fighting compounds called catechins. U is for user-friendly -- make sure your diet is a plan you can live with. V is for Vinegar which will cause you to eat less over the whole day. W is for weights -- pumping iron allows you to burn calories faster after a strength training session, as opposed to cardio. X is for Xenical -- the prescription fat blocker is green-lighted by the FDA. Y is for Yoga -- yoga causes you to release tension, so you don’t eat so much. Z is for sleep. Get your Z’s because a study finds if you sleep less than 5 hours, you’ll be heavier than other people who sleep for 7 hours

Übergewicht hat in den letzten Jahrzehnten weltweit epidemischen Charakter erreicht. In Europa sind bereits 43% der erwachsenen Bevölkerung übergewichtig und 17% fettleibig. Die Adipositas ist eine multifaktorielle Erkrankung und führt über ein erhöhtes Risiko für Diabetes, Krebs oder Herz-Kreislauferkrankungen bis hin zu einer deutlichen Herabsetzung der Lebenserwartung. Durch das Versagen konventioneller Therapien wie Diät oder Sport, treten medikamentöse Behandlungsmethoden immer mehr in den Vordergrund. Bisher sind zwei Kategorien etabliert, die Appetitzügler und die Lipasehemmer. Zahlreiche Studien erforschen neuerdings Therapiekonzepte zum Angriff an spezifischen Rezeptoren und Veränderungen des Fett- und Energiestoffwechsels auf molekularer Ebene. Diese Arbeit beschäftigte sich mit der Entwicklung neuer Arzneimittel zur Behandlung von Adipositas in verschiedenen Fettsuchtmodellen an Ratten. Alle Studien begannen mit Vorversuchszeiten von 1-2 Wochen zur Stabilisierung des täglichen Körpergewichtzuwachses, der Futter- und der Wasseraufnahme. Die Tiere erhielten in allen Versuchen eine zucker- und fettreiche Diät, deren Zusammensetzung sich an Ernährungsgewohnheiten in westlichen Industrieländern orientierte (Western Diet). Wasser wurde ad libitum bereitgestellt und die Aufnahme täglich bestimmt. Das gleich galt mit Ausnahme von Versuch 1 auch für das Futter. Am letzten Tag der Experimente erfolgten Blutabnahmen an den zuvor nüchtern gesetzten Ratten. Unmittelbar danach wurden die Tiere in einer CO2-Kammer getötet, die Kadaver einzeln in Gefrierbeutel verpackt und anschließend zusammen mit den Blutproben bis zur weiteren Aufarbeitung gruppenweise bei -20 °C eingefroren. Versuch 1: In Versuch 1 wurde an männlichen Wistarratten eine mögliche Wirkungsverstärkung des selektiven CB1-Antagonisten SLV319 in Kombination mit dem Lipasehemmer Orlistat (Xenical®), auf Körpergewichtsentwicklung, Futter- und Wasseraufnahme, Blutwerte und Zusammensetzung der Tierkörper untersucht. Die Tiere wurden über einen Zeitraum von 4 Wochen einmal täglich mit Vehikel 1 (CMC) oder SLV319 (3 oder 10 mg/kg KG) geschlündelt, und zweimal täglich mit Vehikel 2 (Labrasol) oder Orlistat 50 mg/kg KG. Jeweils nach Gabe von entweder Labrasol oder Orlistat erhielten die Ratten für genau 2,5 Stunden Futter ad libitum. Das Körpergewicht der Tiere war in allen Gruppen im Vergleich zur Kontrolle vermindert: Bei Einzelbehandlung mit SLV319-3 um 50%, mit SLV319-10 um 42% und mit Orlistat um 52%, bei der Kombination tendenziell aber nicht signifikant stärker durch SLV319-3+Orlistat um 76% und durch SLV319-10+Orlistat um 59%. Die Futteraufnahme in Relation zum Körpergewicht wurde im Vergleich zur Kontrolle durch die niedrige und die hohe SLV319-Dosis um 8 bzw. 10% vermindert und durch Orlistat um 18% erhöht. In der Kombination erhöhte sich Futteraufnahme ebenfalls um 11% bzw. 13%. Zusätzlich erniedrigte sowohl SLV319 als auch Orlistat die Triglyzeride, NEFA-Level, das freie Cholesterin, und hatte einen positiven Effekt auf die HDL-Werte im Serum. SLV319 erniedrigte die Insulinspiegel und verbesserte die Insulinsensitivität. In der Carcass-Analyse konnte in allen Gruppen der Körpergewichtsverlust überproportional auf eine Verminderung an Körperfett zurückgeführt werden. SLV319 hat somit ein mögliches Potenzial für die Therapie der Fettleibigkeit, die durch Kombination mit Orlistat noch verstärkt werden könnte. Versuch 2: Die vorliegende Studie erforscht die Auswirkungen von SLV335, einem neuen Carboanhydrasehemmer, auf Körpergewicht, Futter-, Wasseraufnahme und Blutwerte bei weiblichen Wistarratten im Vergleich zu Topiramat. Die Tiere wurden über einen Zeitraum von 4 Wochen zweimal täglich mit Vehikel, SLV335 oder Topiramat geschlündelt. Die Tagesdosen von jeweils 30, 60 oder 100 mg/kg KG wurden zu einem Drittel am Morgen und zu zwei Dritteln am Abend verabreicht. Sowohl SLV335 als auch Topiramat erniedrigten signifikant und dosisabhängig das Körpergewicht der Tiere im Vergleich zur Kontrolle: Bei den drei SLV335-Dosen um 18%, 52% und 85%, bei Topiramat um 38%, 40% und 58%. Auch die Futteraufnahme relativ zum Körpergewicht reduzierte sich, aber nur bei SLV335 um 9%, 15% und 23%, bei allen Topiramat-behandelten Ratten um 11-13%. Topiramat und SLV335 führten unabhängig von der Dosis zu einer Steigerung der Wasseraufnahme, die sich aber nur bei Topiramat signifikant von der Kontrolle unterschied. Weder Topiramat noch SLV335 zeigten signifikante Änderungen der Blutwerte, doch erniedrigten sie leicht die Triglyzeride und NEFA-Werte im Serum. Der CA-Inhibitor SLV335 hatte einen stark gewichtsreduzierenden Effekt. Somit könnte die Hemmung spezifischer Carboanhydrasen ein Mechanismus für Gewichtsverlust sein, und SLV335 ein therapeutisches Potenzial in der Behandlung der Adipositas besitzen. Versuch 3: In diesem Versuch wurden zwei CB1-Antagonisten, das bereits im Handel befindliche Rimonabant (Acomplia®) und die Prüfsubstanz SLV330 in ihren Wirkungen auf Köpergewicht, Futter-, Wasseraufnahme und die Blutwerte bei männlichen Wistarratten verglichen. Die Tiere wurden einmal täglich 2 Wochen lang entweder mit CMC-PEG-Vehikel oder mit 3 oder 10 mg/kg KG SLV330 bzw. Rimonabant i.p. gespritzt. Sowohl SLV330 als auch Rimonabant erniedrigten das Körpergewicht der Ratten im Vergleich zu Kontrolle: Bei der niedrigen und hohen Dosis von SLV330 um 25% und 70%, bei Rimonabant um 37 und 60%. Die Futter- und Wasseraufnahme wurde in allen Gruppen ebenfalls dosisabhängig erniedrigt. Beide Substanzen erniedrigten die Triglyzeride, NEFA und freies Cholesterin im Serum. Lediglich die hohe Rimonabantdosis erhöhte das HDL, verbesserte die Insulinsensitivität und erniedrigte die Insulinspiegel im Serum. Diese Ergebnisse zeigen, dass SLV330 durchaus Potenzial für die Therapie der Adipositas besitzt. Intraperitoneal verabreicht zeigt es vergleichbare Ergebnisse zu Rimonabant. Versuch 4: Die dosisabhängige Wirkung von Topiramat auf Körpergewicht, Futter-, Wasseraufnahme, Blutwerte und Zusammensetzung der Tierkörper wurde an männlichen Zucker-Ratten untersucht, die erstmals mit einer fettreichen „Western Diet“ gefüttert wurden. Die Tiere wurden zweimal täglich über einen Zeitraum von 4 Wochen entweder mit CMC-PEG-Vehikel oder Topiramat (30 oder 100 mg/kg KG) geschlündelt. Das Körpergewicht der Tiere verminderte sich je in der niedrigen und hohen Topiramatdosis im Vergleich zur Kontrolle um 10% bzw. 32%. Auch die Futteraufnahme wurde dosisabhängig unterdrückt. Die Wasseraufnahme steigerte sich dagegen bei der niedrigeren Dosis stärker als bei der hohen Dosis. Unabhängig von der Dosis erhöhte Topiramat im Serum die Triglyzeride, NEFA und LDL und wirkte sich negativ auf das HDL aus. Das gesamte und freie Cholesterin erhöhte sich, die Insulinsensitivität wurde nicht verändert. Die geringe Gewichtsreduktion nach der niedrigen Topiramatdosis konnte fast vollständig auf den Fettverlust zurückgeführt werden, wohingegen die hohe Dosis eine gleichmäßige nicht-spezifische Erniedrigung an Fett, Wasser und etwas weniger an Proteinen bewirkte. Die gewichtsreduzierenden Eigenschaften von Topiramat wurden bestätigt. Vor allem die niedrigere Dosierung von 30 mg/kg führt möglicherweise zu metabolischen Veränderungen, welche eine Verminderung des Körperfetts bewirken.