Podcasts about phentermine

A dysfunctional relationship eventually becomes a dysfunctional marriage.  There was domestic violence and the victim minimised the danger they were in.The perpetrator snapped.Not only their spouse was killed, they took the lives of two people they had never met.Was it the medicine, was it alcohol or was it an accident?...This week we discuss:  Murder, Samoa, Phentermine, Vehicular Manslaughter, UxoricideSources:https://www.idahonews.com/news/local/alofa-time-pleads-guilty-to-vehicular-manslaughter-in-fatal-boise-crashhttps://www.nbcnews.com/id/wbna13512139https://www.idoc.idaho.gov/content/prisons/resident-client-search/details/84492https://www.legacy.com/us/obituaries/idahostatesman/name/theresa-time-obituary?id=13627786https://murderpedia.org/male.T/t/time-alofa.htmhttps://www.findagrave.com/memorial/14639886/samantha-n-murphyhttps://www.findagrave.com/memorial/14638743/jaelynne-clara-grimeshttps://www.youtube.com/watch?v=bVb3wR4-BEISupport the showPatreon https://www.patreon.com/MMoMEmail: murdermeonmondaypodcast@gmail.com Twitter: https://twitter.com/MMonMonday Instagram: https://www.instagram.com/murdermeonmondaypodcast/ Theme Tune is published under license from: Tribe of Noise – Awkward Mystery https://prosearch.tribeofnoise.com/artists/show/29267/32277

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog In general, I spend my time defending women and the fact that our problems and sexual physiology is ignored, by the governmental powers and physician organizations in the US, so I try to do my part to bring information to women about their hormones and the aging process. Today I am changing my focus to men and the way men's normal sexual function is considered a “normal” and rarely discussed outside the men's locker room and or porn sites. So here goes…The fact is that men's sexuality isn't just the act of sex, but men spend a lot of their sexual energy on fantasies and just thinking about having sex.  Men's ability to have an orgasm is not just a wham- bam—thank you…well you know the phrase…and there are many physiologic factors that must work, in the background to bring a man from thinking about sex or desire, to an orgasm. Sadly, in the current environment couples don't talk about sex….they don't tell their partner what makes them excited or even what they want…. because none of us can read minds, too many of us don't get what we want when it comes to sex. With lack of communication between partners, leads couples to trial and error without a map.  Neither sex knows how the other sex “works”.  I decided to describe the normal series of what men go through on their way to orgasm to educate them and their partners.  In addition, the process is not always the same in each person and as men age the time between the first sexual thought to completion gets longer and longer…sometimes these detours include episodes of losing an erection, sometimes getting it back and sometimes not which leads to frustration of both partners. In youth when a man's free testosterone is high and his arteries are free of plaque, between puberty and age 35, erections may occur often, and they last a long time if the man is stimulated for a long period of time. At this point sex is automatic and easy to complete to orgasm and ejaculation. As time goes on, free Testosterone starts to decrease with age, as does the diameter of a man's arteries…blood flow doesn't rush to the pelvis to create an erection like it did in youth. The things that lower free testosterone.  What happens with age that cause erections and ejaculation to be less and less automatic and easy? T and free T drops after age 35 in most men and becomes critical by age 55, even in healthy men. Ejaculate decreases due to lowering of free T Vasectomies decrease the volume of ejaculate by 1/3 Stress causes free T to decrease. Hypertension causes arteries to contract and deliver less blood to the pelvis for an erection. High blood sugar and diabetes destroys the arteries in the pelvis making blood have a more difficult time getting to the penis. Stress causes Cortisol to rise and free T decreases, Obesity increases the estrogens in men and that decreases free T by binding it with sex hormone protein and inactivating it. Any medication the constricts blood vessels (ADD medicine, Phentermine, speed, etc) decreases blood flow to the pelvis. Some medications that lower blood pressure lower It in the pelvis too low so that men are impotent (e.g. Lisinopril). For men who don't know all these medical, aging changes that happen to most men, these changes cause fear and anxiety which of course makes it worse.  Men who have this issue (most men) are even reticent to talk to me about it and they haven't talked to their spouse either. So here is what I tell them:  You are aging like everyone else, and that fact can't be changed, however, your lifestyle and your medical health, or poor health is affecting your orgasms and your ability to have sex.  These factors CAN be changed.  You can change your BP medicine to one that doesn't impair erections.  You can get your diabetes or obesity under control, and you can improve your erections.  However, to get it all back you will need testosterone replacement if your free T is under 129 ng/dl. The safest way to accomplish this is with my practice BioBalance® Health…we do it better and know all the tricks to making you healthy productive and potent! What is in the ejaculate? mature sperm are mixed with whitish, protein-rich fluids with prostaglandins are produced by the prostate. These fluids nourish and support the sperm so they can live after ejaculation for a limited time to fertilize an egg.  This mixture of fluid and sperm, known as semen, and is what is moves through the urethra in the form of ejaculate. Sensory stimulation travels from the skin to the brain and stimulates dopamine and endorphins which are neurotransmitters that make a man fee happily ecstatic during and after an ejaculation.  These neurotransmitters also stimulate the Hypothalamus to make oxytocin, a bonding hormone that binds couples together. Many nerves, vessels and the brain are involved in a successful sexual encounter. The culmination of a sexual encounter is complex and involves the whole body. I find it interesting that the “medical view” of orgasm is still divided into 4 different steps when, if you are a male (or even a female who has had sex with a male) the divisions seem very arbitrary and is ALWAYS connected to ejaculation. It is a fact that men and women can have sexual intercourse and orgasm without ejaculation. The following is how the practice of medicine describes the male sexual act.   In contrast I have educated my patients by comparing sex to a on the fact that men can have orgasms which occur in the brain when endorphins flood the neurons, even without ejaculation.  So I will discuss, the male sexual experience to them, not with the “4 easy steps of male sexual response”, but as a “process” of achieving orgasm in men.  It is more like a recipe, that requires each ingredient to be added in order, but sometimes you can stop in the middle and start again.  It is not always a straight line from sexual desire to orgasm. In general, all men need testosterone to have sexual desire, and sexual desire to have sex, however both men and women can be physically or visually stimulated to be aroused without true sexual desire. If the man has a long history of having sex often, then the habit of having a sexual response can be achieved without enough testosterone, however the erection will not necessarily last long enough.   Continued physical stimulation can bypass desire, and therefore testosterone, and a man can be stimulated into having an erection of sorts and into having an orgasm with or without ejaculate An erection requires testosterone to become fully erect, however there is a “work around” now and men without testosterone can have an erection with Viagra, Cialis pills, or prostaglandin injections into the penis itself. Men can also have a penile implant placed so they can have sex without testosterone or Viagra/Cialis. However, let's talk about sex with testosterone in men who have good pelvic blood flow who don't require medication to become erect. The second necessary ingredient after testosterone is stimulation, which can be with touch, visual stimulation, auditory stimulation or even imagination that causes a man to be stimulated. The sexual response to any of these stimulations send messages through the nerves from the brain to the pelvis that dilates his veins and arteries. This sends blood to the penis from the arteries and blocks the veins from draining the blood out.  This creates an erection. Testosterone's role is to cause the arteries to dilate by stimulating the production of nitric oxide from the arterial walls. Remember the stimulation? The ongoing stimulation (mental, visual, auditory or imaginary) keeps the erection hard with vascular dilation. At this point stimulation can be changed or paused and other stimulation can prolong this part of the process.  Holding the base of the penis can keep it hard, or any tight encircling toy can keep the erection from proceeding to orgasm for some time or the erection can go away without continued stimulation. The third step is the preparation for orgasm which can last from as long as 30 minutes and as short as 2 minutes. A clear “pre-ejaculate” is produced that lubricates the penis for intercourse, and if ejaculation is to take place there is a “loading of semen” that takes place from the seminal vesicles readying the man for ejaculation.  At this point the penis contracts the muscles quickly in rapid repeating emissions that shoot the semen out of the urethra. This is the orgasm and ejaculation that occur together, which is typical of normal youthful ejaculation.  As men get older the force at which they ejaculate decreases. After ejaculation/orgasm the brain is flooded in endorphins, the feel-good neurotransmitters, that make a human feel happy and satisfied.  This is solely the result of the orgasm after a sexual encounter. The feeling of ejaculation does relieve pelvic pressure but is not needed to experience orgasm in most men. Medical science has been able supply an assist for desire (testosterone) and erectile function (vasodilation and release of nitric oxide but they have not discovered the “pill” to make ejaculations occur or to improve their volume.  It is important for an aging man to accept that orgasm doesn't require ejaculation since we don't have an answer to recreating the youthful ejaculation.  Besides age, vasectomy can also limit ejaculation.  dehydration, vasoconstrictors, anti-hypertensive drugs and diuretics can limit the volume of the ejaculate as well. After the “process of sexual orgasm” the penis loses tumescence, blood leaves the pelvis and overall relaxation occurs throughout the body. Then a period of time must pass before another erection can occur.  Over time some “twice a day men” can turn into once every week…..this can be changed by practicing…..having sex more often. The sexual response in both men and women is more like a symphony with several movements, than a recipe, but it is definitely not a series of steps that is followed in every human in every circumstance. It is the job of the physician to help patients both understand and live with any variations in the sexual process.  Much of what I do is act as a teacher to my patients who need to understand their own bodies and any dysfunctions thereof.  Understanding becomes treatment over time.

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Send us a Text Message.Unlock the complex world of obesity and discover the transformative role of GLP-1 medications. Hear from the esteemed Dr. Raghid as she breaks down why obesity is labeled a chronic illness and the various factors contributing to its prevalence. From genetic predispositions to environmental influences and lifestyle habits, understand why tackling obesity goes beyond the simplistic advice of "eating less and moving more." Dr. Raghid's holistic approach addresses everything from stress and sleep to home life and physical activity, providing a comprehensive guide for those struggling with weight management.Ever wondered how medications like Wagovy and Ozampic could revolutionize weight loss? Learn about the anti-inflammatory benefits of GLP-1 medications, not just for shedding pounds but also for managing conditions like IBS and rheumatoid arthritis. Dr. Raghid sheds light on the long-term safety and potential side effects of these treatments, emphasizing the importance of personalized care plans. We'll also explore alternative weight loss medications such as Phentermine and Contrave, discussing the need for extended consultation times to ensure thorough patient understanding and care.Finally, bust the myths surrounding weight loss medications and gain a fresh perspective on weight management. Dr. Raghid stresses the importance of a supportive and respectful approach, highlighting the significance of addressing the root causes of weight gain. Understand the connection between physical well-being and mental health, and how beginning a conversation about health can set you on the right path. With practical advice and heartfelt encouragement, this episode is a must-listen for anyone interested in taking the first step towards better health. Check out the show notes for more information and resources to connect with Dr. Raghid.Dr. Raghid's Practice: WiseCareIG: WiseCare Thank you for listening. Please subscribe to this podcast and share with a friend. If you would like to know more about my services, please message at fueledbyleo@gmail.comMy YouTube Channel https://www.youtube.com/channel/UC0SqBP44jMNYSzlcJjOKJdg

Episode 30 of The Pound of Cure Weight Loss Podcast is titled, GLP-1 Supplement Scams.   In our In the News segment, we cover an article in Today titled, Poppi Prebiotic Soda Brand Faces Class-Action Lawsuit Over Gut Health Claims. Poppi is a brand of soda marketed as a prebiotic and this lawsuit is questioning the validity of the claim.   In our Patient Story segment, we talk to Graham who had a highest weight of 311 pounds. He opted for the gastric bypass and we included GLP-1 medications along the way. He is now comfortable sitting at 168 pounds. Not only did he embrace the medical treatments we offered but he also embraced strength training as another tool to help maintain that weight loss. His story is very poignant for anyone interested in sustainable weight loss.   In our Nutrition segment, we dive into another product review. Biocare is a supplement being marketed to GLP-1 users offering to, “Scientifically Help Reduce Side Effects, Preserve Lean Muscle Mass & Provide Essential Nutrition.” Does it work? Tune in to find out!  Anytime a new FAD diet emerges, the food, beverage, and service companies scramble to create products to fit the new trend. And, over the past year or so, we've seen this happen in the GLP-1 space. So, in our Economics of Obesity segment, we dive further into the growing market of GLP-1 supplements and services.   Finally, we answer 3 of our listeners questions including, our thoughts on Phentermine, when to start taking your vitamins post-op, and how to navigate the GLP-1 shortages. 

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.

In this episode of My Thyroid Health, we learn if Phentermine has any contraindications with your thyroid condition. What you will learn: What is phentermine? How does it help with weight loss? Side effects and precautions for patients with hypothyroidism How to achieve healthy weight loss with a thyroid condition ⁠Check out our blog and read the full article here.⁠ About Paloma Health: ⁠⁠⁠Paloma Health⁠⁠⁠ is an online medical practice focused exclusively on treating hypothyroidism. From online visits with your provider to easy prescription management and lab orders, we create personalized treatment plans for you.  ⁠⁠⁠Become a member⁠⁠⁠, or try our at-home test kit and experience a whole new level of hypothyroid care. Use code PODCAST to save $30 at checkout. Disclaimer: The $30 discount is only valid for first-time Paloma Health members and test kit users. Coupon must be entered at the time of checkout. 

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.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog That is a strong statement, however I am confident in saying that belly fat can put you at risk for Alzheimer's disease, because it is a fact supported by medical research. These studies reveal that obesity, especially abdominal obesity (Beer belly, Gut, “Dunlap's disease”…..), increases the onset and rate of Alzheimer's dementia! Another reason to change your lifestyle to benefit your longevity. Abdominal obesity can come from fat accumulation right underneath your skin (the fat you can pinch between 2 fingers) OR the fat that grows inside your abdomen like an apron draped over the intestines. It is called “visceral fat”, and this type of fat is what places you in the crosshairs for several diseases of aging including Alzheimer's Disease, heart disease, stroke, diabetes, and rapid aging.  A large belly is more common in men, but it is still a risk for women if they develop an apple shaped body. Below is a picture of visceral fat, and a diagram of what it looks like in an artist's sketch of a normal weight person. When the yellow fat doubles and triples in thickness the abdomen pushes out to look like a “beer belly”.   Visceral fat extends from your stomach over the transverse colon and your small intestines like an apron.  This fat pad thickens with alcohol abuse (beer belly), high carbohydrate diet, overeating, junk food, under exercise and creates a large pad of fat that secretes inflammatory cells.  The resulting inflammation is the vehicle that damages your brain leading to Alzheimer's disease and damages your arteries leading to heart disease and stroke. In my office we use INBODY machines that measure your Visceral fat, BMI, and percent body fat.  Normal visceral fat is below #10 on our machine, BMI less than or equal to 25, and fat % for men < 19% and for women < 26%. The Research: A recent study correlated the size of patient's belly (visceral belly fat), and obesity with the amount of amyloid plaque (the cause of Alzheimer's disease) in their brain. This was measured by MRI in the study subjects' brains.  The age of the patients studied was between 40-60. The study found that the amount of visceral fat (fat inside your abdomen) is directly correlated with the amount of amyloid plaque and inflammation in the brain!  That causes Alzheimer's Disease. If that doesn't motivate you to lose your belly fat, then you are making a choice to eventually suffer from Alzheimer's disease, a heart attack, a stroke or arthritis.  If you are thinking that you will just wait for “something to happen”, then not making a decision to change your lifestyle is making a decision to take on illness in the future. We have new medications to help you lose that belly fat and they really work. You should ask your doctor to help you and if they don't understand the importance of arriving at ideal weight then look for a different doctor who will help you. Even with medication you will have to put in the work and self-control to turn down unhealthy foods when others are being unhealthy.  You will also have to add daily exercise to your schedule if you really want to avoid Alzheimer's Disease, heart attack, stroke and early death. The possible meds and habits that can help you lose your “belly”: ·     Limit calories and or carbohydrates ·     Increase daily exercise ·     Diet pills (amphetamines that older patients usually can't take) ·     Xenical (Orlistat)-Side effect is fatty diarrhea ·     Qsymia (topiramate/Phentermine) can increase BP ·     Contrave for craving (naltrexone/bupropion) can decrease sex-drive ·     Semelanotide (Imcivree-new), darkens the skin, expensive ·     Metformin ER an oral, effective medication to treat insulin resistance, and promote weight-loss ·     Victoza and Saxenda injections are diabetic treatments, that can cause GI reflux, however they work well for patients who have Type II Diabetes who need to lose weight. Even though many patients lost weight with these medications, many could not tolerate the drugs listed above because of the side effects.  These side effects limited our ability to help all patients lose weight…until now! Now, for the first time we have an effective way to help most people lose their dangerous visceral (belly fat). If you have a big belly you are at high risk for inflammatory diseases like Alzheimer's dementia, obesity, heart disease, diabetes, cancer and stroke. The new weight loss drug's generic name is Semaglutide, and has been marketed under several names: Wegovy, Ozempic, and Rybelsus. A second generic drug that is in the same family of drugs is called Tirzepetide, includes Mounjaro (for diabetics) and Zepbound (for weight loss). All of these drug's work for weight loss, pre-diabetes and Type 2 Diabetes.  Most insurance companies do not cover weight loss and they require a precertification for you to get the medication covered by insurance.  This precertification process is time consuming for the doctor and her staff, which costs the doctor an increase in her overhead to employ a nurse to provide this service for the patient. In general people with a BMI under 30 will not be covered for Semaglutide or Tirzapeptide, however if their BMI is over 30, there is a chance insurance will pay for one of these drugs for a period of time. The market price at the pharmacy is between $900/$1200 per month if you pay out of pocket to your pharmacy. Because of this fact and because we have so many patients whose pellets are not paid for by insurance, we provide access to the generic form of these drugs through a compounding pharmacy. The cost is a fraction of the normal out of pocket cost, about $560 for 3 months supply. In this way we have been able to treat many people who cannot afford to pay the exorbitant going rate for this medication. Because it is costly for a patient to receive the medication no matter how they are able to get it, It is very important for weight loss patients to be compliant and follow a low carbohydrate diet, exercise daily and to refrain from alcohol consumption while they are taking weight loss medications.  We require our patients who request these drugs to be seen at least every 2 months by one of our NPs or our weight loss specialist to help them get the best results possible. These drugs work for weight loss and diabetes by multitasking.  The ways the medication actually works are listed below: Semaglutide and Terzapeptide, ·      decrease hunger between meals   ·     you feel full faster than normal so you eat less ·     decrease sugar and alcohol-craving ·     decrease the release of sugar from the liver when you are fasting, which turns into fat ·     Prevent hypoglycemia which causes hunger and fat gain ·     Makes patients more insulin sensitive. Obesity is not just a lifestyle problem; it is a disease that should be treated with medicine PLUS lifestyle changes. These drug actions take place in the brain, stomach hormones, pancreas and liver, as well as in all the cells in your body. At Bio Balance Health® have years of experience in treating patients with bio-identical testosterone pellets and we have observed that weight loss plus testosterone pellets for patients over 40 allows patients to lose fat without losing muscle. Now we add these weight loss medications to T pellets, and we have the perfect combo for safe weight-loss (really fat loss). The biggest worry for patients is that they may not be able to get off this drug after they achieve ideal weight.  I have found that the longer you have been overweight and the more overweight you are, the higher the risk of needing maintenance medications to maintain your ideal weight. We try to wean our patients off injectable meds by switching them to Metformin ER, a drug that insurance will pay for. With these effective meds we finally, we have an effective preventive treatment to add to our testosterone and estradiol pellets for those people who view Alzheimer's as their worst nightmare, and for those patients who are worried about heart disease, diabetes and stroke  we can prevent the diseases that can ruin our “golden years”.   KCM Research: People with large amounts of visceral fat as they age may have higher risk of Alzheimer's disease. NBC News (11/20, Carroll) reports, “People who have large amounts of” visceral fat “as they age may be at higher risk of developing Alzheimer's disease, a new study suggests.” The findings were presented at the Radiological Society of North America's annual meeting. HealthDay (11/20, Thompson) reports that investigators “compared brain scans of 54 people between the ages of 40 and 60 with their levels of belly fat, BMI, obesity and insulin resistance.” The investigators “found that people who had more visceral fat compared with fat found just under their skin tended to have higher amyloid levels in the precuneus cortex.” The “relationship was worse in men than in women, and higher visceral fat measurements also were related to increased inflammation in the brain.”

Mounjaro, Wegovy, Ozempic, Phentermine, Metformin, Diethylproprion are helping cause massive amounts of weight loss, reverse diabetes, and help reverse ageing! Cardiologist and weight loss doctor discusses strategies and tells stories of patients that have lost over 130 pounds and avoided gastric bypass. https://dralo.net/links

Weight loss and obesity medicine expert, Dr. Alo, discusses the most recent data on weight loss medications and how to use them properly. Phentermine, Ozempic, Diethylproprion, Wegovy, Semaglutide, Victoza, Saxenda, and more! https://dralo.net/links

In this Ask Me Anything podcast episode, I address various listeners' questions. Topics include the risks of pursuing overly aggressive and unsustainable diets, the consideration of collagen protein in daily intake (noting its incompleteness), the potential dangers associated with diet pills like Phentermine, metabolism, and the impact of extremely low body fat on menstrual health. The episode underscores the significance of prioritizing balanced, sustainable approaches to diet and health, always seeking expert guidance when needed.   Enter our 500th episode giveaway. 5 Winners will receive a free supplement from Legion  –https://keynutrition.com/500th-episode-giveaway/   Work with a Key Nutrition fitness and nutrition coach – Schedule a free consultation or go to our website www.keynutrition.com to learn more.   Get on the waitlist for the next round of The Next Level Experience. Visit our website www.mynextlevelexperience.com to learn more.   Submit your questions to be featured on our Q&A episodes.   Order from Cured Nutrition and get 10% off your order by using discount code: Brad   Order from Legion Supplements and get 20% off your first order by using discount code: keynutrition   Connect with us on Instagram Host Brad Jensen – @thesoberbodybuilder Key Nutrition – @keynutrition

Christina & Marissa sit down with Austin Stout, founder of Integrated Muscle & Health, and coach of coaches! (0:00) - Intro (1:04) - Austin's Story (7:08) - History Lesson (16:05) - How Are These Drugs Prescribed? (25:30) - Phentermine (30:52) - Epigenetics (42:40) - All Good Intentions (47:18) - Where Do We Go From Here? Want to reach out to Austin?  Instagram: @austinst8 Follow us on Instagram: @barbelllifestylepocast Hosted by: @marissaroyfitness & @christilynnfit

When you think of an addict, most of us visualize a homeless person or someone in a crack house, not a housewife, a wealthy exec, or successful CEO. Our guest today, software developer and business owner, Dave Ford, had never smoked a cigarette or taken illegal drugs growing up. But when his wife suggested he see a doctor for ADHD (attention-deficit/hyperactivity disorder), he NEVER suspected that he'd be spending the next 10 years as a raging addict to Adderall. Adderall is a stimulant medication of mixed amphetamine salts that contains two active drugs: amphetamine and dextroamphetamine.  Dave's doctor never mentioned that Adderall has the potential to be addictive and potentially habit-forming. In Dave's case, it was. According to Dave, ‘No one ever told me that the really dangerous shit doesn't come from the drug dealer. It comes from your family doctor.' In March 2023, the U.S. CDC reported an unprecedented spike in stimulant prescriptions between 2020 and 2021; the sharpest increase happening in women between the ages of 20 and 49 during the pandemic.   KEY TAKEAWAYS 1.    Some of the ways the Adderall addiction wrecked Dave's life, relationships, and livelihood. 2.    Dave's message for doctors who prescribe drugs like Phentermine and Adderall. 3.    Signs can parents, spouses, friends, or co-workers can look for to determine if a loved one may be suffering from an Adderall addiction. 4.    What the term Dopesick means. 5.    Dave's rock bottom moment and detoxification experience. 6.    The biggest misconceptions when it comes to prescription pill addiction. 7.    Advice on where someone can begin to seek help and get on the road to recovery. Free help is available. If high-priced, luxury recovery centers are not an option or you don't have insurance, look for a local 12-step program or reach out to your local church. Mariner's Church offers services at marinerschurch.org/care-recovery/ with locations throughout southern California. We'll have the links in the show notes at https://ronandlisa.com/podcasts/86-adderall-alert-from-prescription-to-addiction/ DISCLAIMER: The contents of this site are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  

How do you say phentermine?  In this episode, I break phentermine down into syllables and explain which syllable has the emphasis.  The source of my information in the USP Dictionary Online.   I am not compensated for mentioning the USP Dictionary, and I have their permission to share written pronunciations in my podcast show notes and YouTube videos.  Thank you USP Legal Dept! The purpose of my pronunciation episodes is to provide the intended pronunciations of drug names from reliable sources so that you feel more confident saying them and less frustrated learning them. Phentermine = FEN ter meen Phentermine has 3 syllables. **Emphasize the first syllable (Phen = FEN). FEN, like Fenway Park, home of the Boston Red Socks professional baseball team.   Ter, like the “TER” in sisTER. Meen, as in someone is being rude or mean to you. If you know someone who needs to learn how to say phentermine, please share this episode with them.  Thank you for listening to episode 236 of The Pharmacist's Voice ® Podcast! Read the FULL show notes on https://www.thepharmacistsvoice.com/podcast.  Look for episode 236. Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out.   Apple Podcasts   https://apple.co/42yqXOG  Google Podcasts  https://bit.ly/3J19bws  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt Links from this episode USP Dictionary Online (aka USAN)   USP Dictionary's (USAN) pronunciation guide (Source:  American Medical Association's  website Webster's Dictionary https://www.merriam-webster.com  The Pharmacist's Voice ® Podcast episode 228, pronunciation series episode 18 (ezetimibe) The Pharmacist's Voice ® Podcast episode 219, pronunciation series episode 17 (semaglutide) The Pharmacist's Voice ® Podcast episode 215, pronunciation series episode 16 (mifepristone and misoprostol) The Pharmacist's Voice ® Podcast episode 211, pronunciation series episode 15 (Humira®) The Pharmacist's Voice ® Podcast episode 202, pronunciation series episode 14 (SMZ-TMP) The Pharmacist's Voice ® Podcast episode 198, pronunciation series episode 13 (carisoprodol) The Pharmacist's Voice ® Podcast episode 194, pronunciation series episode 12 (tianeptine) The Pharmacist's Voice ® Podcast episode 188, pronunciation series episode 11 (insulin icodec)  The Pharmacist's Voice ® Podcast episode 184, pronunciation series episode 10 (phenytoin and isotretinoin) The Pharmacist's Voice ® Podcast episode 180, pronunciation series episode 9 Apretude® (cabotegravir) The Pharmacist's Voice ® Podcast episode 177, pronunciation series episode 8 (metoprolol)  The Pharmacist's Voice ® Podcast episode 164, pronunciation series episode 7 (levetiracetam) The Pharmacist's Voice ® Podcast episode 159, pronunciation series episode 6 (talimogene laherparepvec or T-VEC)  The Pharmacist's Voice ® Podcast episode 155, pronunciation series episode 5 Trulicity® (dulaglutide)  The Pharmacist's Voice ® Podcast episode 148, pronunciation series episode 4 Besponsa® (inotuzumab ozogamicin) The Pharmacist's Voice ® Podcast episode 142, pronunciation series episode 3 Zolmitriptan and Zokinvy The Pharmacist's Voice ® Podcast episode 138, pronunciation series episode 2 Molnupiravir and Taltz The Pharmacist's Voice ® Podcast episode 134, pronunciation series episode 1 Eszopiclone and Qulipta 

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In this episode, we'll discuss the dangers of pharmaceutical and medical weight loss practices that are plaguing our society.

Optavia has been popping up in conversation a lot lately, and so I knew it was something I needed to address. But is the Optavia diet really worth it? And does it work? You'll have to listen to find out. But also, I'm just going to let you know now, this is not a clean episode. As in, I found it really hard to go through this information without getting SUPER heated about all of the nonsense that companies like Optavia are spewing. In this episode, I go DEEP into: - what the Optavia diet consists of - the ridiculousness of Optavia snack choices - why you should never trust an Optavia coach - why not all research is GOOD research - why it's never a good idea to put a teenager on a diet ... and more! Show Notes: Get yourself some Organifi Red Juice with code IPW to save 20% at checkout! The Probiotic Advisor Optavia Diet Review Migrating Motor Complex - an overview Effects of a Meal Replacement System Alone or in Combination with Phentermine on Weight Loss and Food Cravings The Optavia Program: Calories, Coaches, and Chik'n Nutrition and Hydration Requirements In Children and Adults Drive for thinness in adolescents predicts greater adult BMI in the Growth and Health Study cohort over 20 years Cumulative Encouragement to Diet From Adolescence to Adulthood: Longitudinal Associations With Health, Psychosocial Well-Being, and Romantic Relationships Get my Core-Gi Workout Program with the exclusive listener discount by going to bit.ly/core-gi15 Schedule a 1:1 Discovery Call You can learn more about me by following on IG @imperfectlypaigewellness or by checking out my blog, freebies, and offers on my website: https://imperfectlypaigewellness.com Please share with #PaigeTalksWellness to help get the word out about the show - and join the Imperfect Health Fam over on Facebook.

Episode 127: Obesity Update and Uterine CancerSaakshi presents some updates on the treatment of obesity in pediatric patients. Wendy explains a recent study connecting hair iron to uterine cancer. Updates on obesity management in pediatric patients.Written by Saakshi Dulani, MS3, Western University College of Osteopathic Medicine of the Pacific. Edited by Hector Arreaza, MD.Background information:The American Academy of Pediatrics has released new guidelines on obesity management in pediatric patients. This is the first update regarding childhood obesity in 15 years. According to the CDC, the rates of childhood obesity have tripled since the 1980s, and as of now, 1 in every 5 children suffers from obesity in the United States. It is important to recognize obesity is a chronic, multifaceted disease that comes with its own set of complications, such as type 2 diabetes mellitus, high blood pressure, asthma, sleep apnea, heart disease, and various mental and psychosocial health issues. The first-line treatment used to be comprised of behavioral health and lifestyle counseling, however, now, 1st line treatment for pediatric patients includes medications and surgery in addition to the previously suggested counseling. This is because research has shown that diet and level of physical activity are not the only factors that determine weight but also include genes, hormones, and metabolism. Similar to many other chronic diseases, the sooner the treatment is started, the better. There has been no benefit shown in waiting for adulthood to treat obesity. Who qualifies for which treatments?As a reminder, in the pediatric population, we use the BMI percentiles instead of the absolute number for BMI. Overweight is defined as BMI between 85-95th for patients of the same gender and age. Obesity is defined as being above the 95th percentile.Four drugs are now approved for obesity treatment in adolescents starting at age 12, which are Saxenda® (liraglutide), Qsymia® (phentermine-topiramate), Wegovy® (semaglutide), and Xenical® or Alli® (orlistat). Phentermine as monotherapy has been approved for teens aged 16 and older. Another drug called Imcivree® has been approved for children 6 and older affected by Bardet-Biedl syndrome. The problem with medications is that they are not available to everyone due to the cost, and there are many shortages occurring due to the high demand for these drugs. Surgical options:This is a MAJOR change in the recommendations for obesity treatment in children.  The new guidelines recommend discussing SURGERY with patients that are 13 years old and have severe obesity. It has been shown that bariatric surgery provides lasting results but also that it can reverse health issues such as type 2 diabetes mellitus and hypertension. It is exciting that more research is being done to provide us with more evidence regarding the treatment of obesity in children. Obesity treatment is challenging, even more so in children. So, we encourage all listeners to review the new guidelines about the use of medications and surgery to treat obesity in children and put them to practice if appropriate for your patients.____________________________You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program 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.____________________________Hair products and uterine cancer.Written by Wendy Collins, MS3, Ross University School of Medicine. Edited by Hector Arreaza, MD.What is the sister study? The Sister Study is a nationwide effort in the US conducted by the National Institute of Environmental Health Sciences, which includes over 50,000 sisters of women who have had breast cancer. This study aims to find environmental and genetic causes of breast cancer. The women in this study were breast cancer free and lived in the United States, including Puerto Rico. They were enrolled from 2003-2009 and were followed up until September 2019. If the sister study is made up of 50,000 women, why does this study only use about 30,000 of those women? Excluded women include those who withdrew from the study (n = 3), who self-reported a diagnosis of uterine cancer before enrollment (n = 380), had an uncertain uterine cancer history (n = 10), had an unclear timing of diagnosis relative to enrollment (n = 59), had a hysterectomy before enrollment (n = 15,585), who did not answer any hair product use questions (n = 736), and who did not contribute any follow-up time (n = 164), resulting in 33,947 eligible women. How was it done?The authors reviewed medical records and questionnaires about hair care within the past 12 months and compared women who developed uterine cancer with those who did not for about 10 years between 2003-2009. Of this sample, only 378 women developed uterine cancer. Further investigation needs to be done to make worthwhile associations between hair straighter use and the incidence of uterine cancer. This study drew 2 primary conclusions:Hair products are not associated with uterine cancer: No associations were found between hair product usage and the incidence of uterine cancer. This was investigated because it's thought that synthetic estrogenic compounds, such as endocrine-disrupting chemicals, could contribute to uterine cancer risk because of their ability to alter hormonal actions. This is something that has been linked to breast and ovarian cancers in the past, so it made sense to consider the same for uterine cancers.Using a straightening iron is positively associated with uterine cancer: Ever vs. never use of a straightening iron in the previous 12 months was associated with a hazard ratio of 1.80 with 95% confidence interval 1.12 to 2.88. The association was stronger when comparing frequent use (>4 times in the past 12 months) vs never use was associated with a hazard ratio of 2.55, 95% confidence interval 1.146 to 4.45.This was investigated because it is thought that heating processes such as flat ironing or blow drying could release or thermally decompose chemicals from the products. This can lead to potential higher exposures to hazardous chemicals through inhalation or percutaneous absorption of chemicals, which is higher in the scalp compared to other areas. While this hypothesis makes sense and supports the results, there are many confounding variables, including physical activity. Women with higher physical activity tend to have decreased sex steroid hormones and less chronic inflammation, reducing their risk of uterine cancer.Hair products are not associated with uterine cancer, and straightening iron is positively associated with uterine cancer, but further research is needed.The incidence of uterine cancer in the past 20 years has significantly increased. Investigating reasons for why this might be could lead to the discovery of potential targets for intervention. However, I am personally unconvinced by this study, and I fully intend to continue to use hair products, my blow dryer, my curling iron, my crimper, and yes even my straightener for the foreseeable future until further research is done.__________________________Conclusion: Now we conclude episode 127 “Obesity Update and Uterine Cancer.” We learned from Saakshi that the American Academy of Pediatrics now recommends discussion of pharmacologic and surgical treatments for pediatric obesity; then Wendy explained that some association between hair iron and uterine cancer was found but further research is needed. This week we thank Hector Arreaza, Saakshi Dulani, and Wendy Collins. Audio edition by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Chang CJ, O'Brien KM, Keil AP, Gaston SA, Jackson CL, Sandler DP, White AJ. Use of Straighteners and Other Hair Products and Incident Uterine Cancer. J Natl Cancer Inst. 2022 Oct 17:djac165. doi: 10.1093/jnci/djac165. Epub ahead of print. PMID: 36245087. https://pubmed.ncbi.nlm.nih.gov/36245087/American Academy of Pediatrics Issues Its First Comprehensive Guideline on Evaluating, Treating Children and Adolescents With Obesity, American Academy of Pediatrics, AAP.org, published on January, 9, 2023, available at: https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/Gumbrecht, Jamie and Jacqueline Howard, Updated childhood obesity treatment guidelines include medications, surgery for some young people, January 11, 2023. CNN.com, available at: https://www.cnn.com/2023/01/09/health/childhood-obesity-treatment-guidelines-wellness/index.htmlSullivan, Kaitlin, New guidelines for treating childhood obesity include medications and surgery for first time, January 9, 2023. NBCnews.com, available at: https://www.nbcnews.com/health/kids-health/new-guidelines-treating-childhood-obesity-include-medications-surgery-rcna64651Royalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

Are you considering plastic surgery? Join us on this episode of the podcast as we delve into the ins and outs of plastic surgery and discuss how to best maintain the results. We'll be joined by Brittany, who will share her own personal journey and tips for success.Tune in to the latest episode of the podcast to hear the guests discuss their own journeys with plastic surgery, the dangers of getting too much done, and the importance of having realistic expectations and a supportive system before going through with the procedure. Plus, discover how to find a reputable plastic surgeon.Do you need help finding the right surgeon for you? CLICK HERE In this episode we cover:[00:02:30] You can only ✂ cut what you can pinch: Change your habits after surgery[00:05:00] Introduction: Brittney[00:07:56] Feed

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

In this podcast episode, I break down the pharmacology, adverse effects, pharmacokinetics, and drug interactions of phentermine. Phentermine has some CNS stimulant activity so adverse effects like insomnia, hypertension, and tachycardia are possible. Pay attention to drugs that can oppose the effects of phentermine and cause weight gain such as mirtazapine and sulfonylureas. Phentermine is a controlled substance so the risk of addiction and dependence is possible.

Weekly Trash 08-18-22Personal trash I'm throwing a partyyyyyMerch is almost done waiting on shirts to get here! Phentermine update  My high school ex “John Doe” texted me

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/.  

What are the different medical procedures and meds for weight loss? which ones should you stay away from?!

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

In this episode we talk about a weight loss pill called phentermine and my side effects. We also dive into a few of the differences between a ozempic and phentermine. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Drs. Karl and Spencer discuss the weight loss effects of phentermine, Qsymia (phentermine/topiramate), and Contrave (bupropion/naltrexone). Learn: How each of these medicines work. How effective each medicine is. Who shouldn't take these medicines. Go to JoinSequence.com for Dr. Spencer's telemedicine program

In this second episode we talk about supercharging your supplements to get that summer beach body. We discussed the four main pillars of attaining that body. Diet. Exercise. Rest and recovery. Supplementation. https://hhwpalmbeach.com/ MOTS-C supercharges every cell in the body 10-12 weeks twice per year 5 Amino 1Q blocks the enzyme that creates fat Semaglutide manipulates insulin levels, burns fat, blocks appetite Phentermine Stimulant that blocks appetite and burns calories rapidly ECA a more milde version of Phentermine mention Safetyman for 5% off your 1st order.

How does Phentermine vs Topiramate vs Qsymia compare for weight loss? What are the differences and similarities? Here's how these three drugs compare in terms of side effects, cost, dosing, and how you can use them effectively!

In this weekend's short I break down the good & bad of weight-loss drugs. Shownotes are available @ https://zecohealth.com/weightlossdrugs/ Click here to access The Zeco Recommendation Page for all products I recommend for health, fitness & fatloss. https://zecohealth.com/recommendations/

This episode I talk about the drug Phentermine. I also tell you about a condition that I developed this month called Costochondritis. When I tell you I've been down for the month. We'll talk about plans for March. Don't forget March is National Women's Month. Remember you can find me on my social media platforms IG @being_valeriee FB Being Valerie Twitter @valerieASCENDI1 Snapchat @mocha_highness Longwalks @ValeriePetry #wellness #healthandwellness #fitjourney #wellnessjourney #getfit #workouts #podcast #blackgirlpodcasts

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.

Should you try phentermine (aka Adipex-P or Acxion or Fastin or Duromine or Lomaria or Panbesy or Terfamex) 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!

In this episode the crew tackle Phentermine, favorite macro distraction for health, co-workers giving you shit for your food choices, biggest PEDs mistake they each see, morning or afternoon labs for testosterone readings, loading creatine and more. Enjoy! To get info on the Elite Physique University Seminar visit www.elitephysiqueuniversity.com/seminar To email John use john@team-gorman.net or... The post Ep. 65 Q and A appeared first on Elite Physique University.

Episode 66: Meth Abuse. By Ikenna Nwosu, MD, and Hector Arreaza, MD.  Discussion about screening, epidemiology, clinical presentation, diagnosis, and treatment of meth abuse. Association between intranasal corticosteroids and lower risk of COVID-19 complications is mentioned.Introduction: Intranasal corticosteroids associated with better outcomes in COVID-19By Bahar Hamidi, MS3, American University of the Caribbean When I first heard of the news of a pandemic occurring, I never thought it would last more than a couple weeks. Of course, as a medical student the first thing I wanted to know was what bug is causing all this commotion in the news. When I discovered “Coronavirus” my first reaction was a chuckle and blurting out “no way.” Why did I respond this way you may ask? As a student when we studied that coronavirus would cause nothing more than a regular cold, thus a mere pesky virus causing a whole pandemic seemed odd to me at the time. Little did I know almost two years later we are still talking about it! “Don't touch your face before washing your hands.” These are the words that run through my mind anywhere I am nowadays. Why? Well, SARS-CoV-2 spike (S) protein is why. This protein engages ACE2 (angiotensin-converting enzyme 2) as the entry receptor. This virus's receptor is found to be highly expressed in our nasal mucosa. How much of this ACE2 we have interestingly can correlate with your age; lower in children compared with adults. Other things that can affect a person's susceptibility is the level of eosinophils in your body. High absolute eosinophil count showed to have a lower hospitalization risk in a group of individuals with asthma and COVID, but we must keep in mind that the study can be confounded by the use of inhaled corticosteroids (iCS). This was taken into account during a study.The study was done by Ronald Strauss and collaborators, it's titled, Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019, and it was published on The Journal of Allergy and Clinical Immunology: In Practice, September 2021.So how may inhaled corticosteroids prevent significant illness from COVID? The answer is lower expression of ACE2 and its cellular serine protease TMPRSS2. Theoretically, it makes sense because the less entry gates the virus has the less sick someone may possibly get. Therefore, the study hypothesizes that by suppressing receptor expression, intranasal corticosteroid use is protective against complicated outcomes like hospitalizations, admission to ICU and mortality.Interestingly in addition, two types of corticosteroids [ciclesonide (Alvesco®) and mometasone (Asmanex® for asthma and Nasonex for allergic rhinitis)] were discovered to suppress replication of coronavirus. This overall study has pertinent findings for the treatment of this everlasting pandemic and proves there is yet much left to discover and continue to research.This is Rio Bravo qWeek, 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. ___________________________Meth Abuse. By Ikenna Nwosu, MD, and Hector Arreaza, MD IntroductionDrug use is a growing problem with serious consequences to individuals, families, and whole nations. Today we will discuss one of the most common drugs abused by our patients: Methamphetamine. Definition   Methamphetamine (street name chalk, crank, crystal, glass, ice, meth) is a stimulant commonly abused in many parts of the United States. It is a psychostimulant that causes the release and blocks the reuptake of monoamine neurotransmitters, including dopamine, norepinephrine, and serotonin. Methamphetamine is most often smoked or snorted and is less commonly injected or ingested orally.  Arreaza: Phentermine (appetite suppressant) is not meth. Phentermine is less potent because it acts mostly on norepinephrine, very little on dopamine, and minimally on serotonin.  Epidemiology  Amphetamine-type stimulants, which include methamphetamine, are the fastest rising drug of abuse worldwide. An estimated 2.1% of the United States population have been reported to have tried methamphetamine at some time in their lives with its rate of use found to be similar among men and women. Data indicates that methamphetamine is a significant public health problem. Mortality has increased by about 40 percent from 2015 to 2016 and drug overdose deaths involving methamphetamine have tripled since 2011. Arreaza: The mortality is high but also the morbidity. I can imagine how costly it is for health systems to take care of the complications of meth use, from dental work to cardiovascular disease, i.e., heart failure. It is a serious problem in Bakersfield, California. As an interesting fact, meth is the most common drug identified in urine drug screenings, then follows marijuana, cocaine, heroin, and fentanyl. Clinical manifestations  When someone uses meth, they have increased energy and alertness, pupillary dilation, tachycardia, euphoria, decreased need for sleep, grinding teeth, dry mouth, loss of appetite, and other symptoms of sympathetic nervous system activation.  Repeated use causes weight loss, dental decay, chronic adverse mood, and cognitive changes, including irritability, aggression, panic, suspiciousness, and/or paranoia, hallucinations, and memory impairment.  Chronic use also can exacerbate depression and anxiety, and those changes can interfere tremendously in patient care. The risk of suicide is also higher. It can also cause complications in other systems:-Cardiovascular (cardiomyopathy, myocardial infarction, and stroke)-Skin (abscesses, aged appearance, and skin lesions)-Neurologic (confusion, memory loss, slowed learning)-Oral (dental decay or “meth mouth”) Acute intoxicationComplications of severe acute intoxication: hypovolemia, metabolic acidosis, hyperthermia, disseminated intravascular coagulation (DIC), rhabdomyolysis, tachydysrhythmia, hypertension, and seizures.  Methamphetamine as a psychostimulant, has a half-life of 12 hours, so its effects last longer than those of cocaine. It is metabolized by the liver through the cytochrome P2D6 system. After the acute intoxication you can see the opposite: sedation, slurred speech, hypersomnia.  Screening  No specific guidelines regarding screening for methamphetamine use are available.  In 2008, The U.S. Preventive Services Task Force concluded that evidence available at that time was insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.  This guideline was updated in June 2020. The USPSTF now gives a grade of recommendation “B” to screening for unhealthy drug use. How do you screen? By asking questions about unhealthy drug use in all adults older than 18 years old. This recommendation does not include testing biological specimens. Screening should be implemented when diagnosis, effective treatment and care can be offered at your clinic or you can refer to other providers for treatment. The American Academy of Pediatrics, the American Medical Association's Guidelines for Adolescent Preventive Services, and the Bright Futures initiative endorse screening adolescents for illicit substance use. On the other hand, the USPSTF concluded in June 2020 that the current evidence is insufficient to recommend screening for unhealthy drug use in adolescents. So, it gives a grade of recommendation “I”. Remember, “I” does not mean “Do not screen”, “I” means “Insufficient or I don't know”. The American College of Obstetricians and Gynecologists recommends direct questioning of all patients about their use of drugs as part of periodic assessments. Screening for methamphetamine use by history should be considered for pregnant women, teenagers and young adults, persons with criminal histories, men who have sex with men, and persons in high-risk ethnic groups. Diagnostic testing with informed consent can be useful in patients with stimulant-associated symptoms and signs, but this is not screening, this is a diagnostic test. Diagnosis  DSM-5 criteria — A problematic pattern of methamphetamine use leading to clinically significant impairment or distress, as manifested by two or more of the following within a 12-month period:• Methamphetamine is often taken in larger amounts or over a longer period than was intended (patient wants more and more meth)• There is a persistent desire or unsuccessful efforts to cut down or control methamphetamine use (patients want to quit but they can't)• A great deal of time is spent in activities necessary to obtain methamphetamine, use methamphetamine, or recover from its effects (patient spends a long time using meth and recovering)• Craving, or a strong desire or urge to use methamphetamine (patient crave)• Recurrent methamphetamine use resulting in a failure to fulfill major role obligations at work, school, or home• Continued methamphetamine use despite having persistent or recurrent social problems caused or exacerbated by the effects of methamphetamine• Important social, occupational, or recreational activities are given up or reduced because of methamphetamine use• Recurrent methamphetamine use in situations in which it is physically hazardous• Continued methamphetamine use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by methamphetamine Subtypes of severity of methamphetamine use disorder ●Mild: Two to three symptoms●Moderate: Four to five symptoms●Severe: Six or more symptoms Urine drug testMethamphetamine can be detected in urine for approximately 48 hours after use. It can be detected in meconium in newborns,indicating maternal use in the second half of pregnancy. Pseudoephedrine can cause a false positive test result for amphetamines.The amphetamine portion of the "tox screen" is susceptible to both false positive and false negative results and must be interpreted in clinical context.  Drugs of abuse, such as benzphetamine and bupropion (a synthetic cathinone), may give positive results. Medications such as selegiline and nonprescription nasal inhalers (decongestants) containing the active ingredient l-methamphetamine (l-desoxyephedrine) may yield positive results for amphetamine. Phentermine can give a false positive result in Utox for meth or MDMA (ecstasy). If a patient states he/she is taking phentermine, you can order a confirmatory test, which will then show that it was phentermine and not amphetamine or methamphetamine. If you are taking phentermine for weight loss, you should stop taking it a week before the drug test. Treatment of acute intoxicationThe treatment of acute methamphetamine intoxication is largely supportive. -Activated charcoal (after oral ingestion) when there are severe symptoms of intoxication and absorption needs to be reduced-Benzodiazepines may be indicated for seizures or agitation-Antipsychotics may be needed for paranoia or psychosis. -Cooling measures may be required if there is hyperthermia. -If elevated blood pressure is dangerously high, it should be lowered, but there are no data regarding blood pressure goals or which medications to use. -Abuse of multiple substances is possible. Patients may have used a combination of marijuana, alcohol, and cocaine, for example. You should also consider testing for several STIs in meth users since high risk sexual behaviors are possible. Treatment of abuseOutpatient behavioral therapies are the standard treatment for methamphetamine abuse and dependence. Inpatient treatment may be needed in some cases. -Cognitive behavior therapy and contingency management programs are successful in treating cocaine addiction and may be effective in treating methamphetamine addiction as well. -Contingency programs consists of rewarding patients who provide a drug-free urine sample.-The Matrix Model is an individualized outpatient regimen that has been used successfully to treat patients who abuse stimulants. It is based on cognitive principles, incorporating individual, group, and family therapies, as well as drug testing and a 12-step program.  Medications to treat meth abuseThere are no medications approved by the U.S. Food and Drug Administration to treat methamphetamine dependence. Some studies on this topic include:-A Cochrane review showed that fluoxetine (Prozac, 40 mg per day) may have modest benefit in reducing cravings for a short time but does not reduce use of meth, and that imipramine (Tofranil) may improve adherence to therapy in methamphetamine users. -One small RCT showing that bupropion (Wellbutrin) decreased subjective methamphetamine-induced effects and craving in a laboratory setting. -A randomized controlled trial enrolled 60 men who have sex with men; participants had methamphetamine use disorder and were actively using the drug. All the men received weekly counseling plus mirtazapine (Remeron), 30 mg per day, or placebo. Men in the mirtazapine group had decreased methamphetamine use and sexual risk, despite low adherence.In Episode 47, Kafiya Arte mentioned the Accelerated Development of Additive Treatment for Methamphetamine Disorder (ADAPT-2), which assessed the efficacy of combined bupropion and naltrexone for the treatment of meth use disorder. 403 participants were enrolled. The efficacy of extended-release injectable naltrexone (380 mg every 3 weeks) combined with once-daily oral extended-release bupropion (450 mg) was evaluated, as compared to placebo.  Results: 13.6% response rate in the naltrexone-bupropion group and only 2.5% response with placebo. The response rate among participants that received naltrexone and bupropion was low, but it was higher than those who received placebo. Withdrawal-Stimulant withdrawal is less dangerous than withdrawal from alcohol, opioids, or sedatives, but seizures are possible.-Stimulant withdrawal symptoms include depression, somnolence, anxiety, irritability, inability to concentrate, psychomotor slowing, increased appetite, and paranoia. -There are no known effective treatments. -Methamphetamine withdrawal is associated with more severe and prolonged depression than is cocaine withdrawal, so patients with withdrawal should be monitored closely for suicidal ideation. How is methamphetamine made?Most methamphetamine used in the United States comes from small illegal laboratories in Mexico and within the US. It is unexpensive, potent, and highly pure. Pseudoephedrine is a common component used in the production of meth, along with many other dangerous ingredients. These chemicals can cause deadly lab explosions and house fires and they may remain in the air of the houses used as laboratories.   Can you get high if you breath second-hand methamphetamine smoke?Researchers have not proven that people who inhale secondhand methamphetamine smoke get high or have other health consequences but breathing these fumes can cause a positive urine test for methamphetamine. More research is needed in this field. Methamphetamine use is a big problem. Prevention of use is key in fighting this devastating addiction. In patients who are addicted, treatment includes behavioral health strategies. No medications have been approved for treatment of dependence, but we hope new research finds an effective medication to treat it.  Conclusion: Now we conclude our episode number 66 “Meth Abuse.” This topic is very extensive, but Dr Nwosu presented a good summary. Meth will continue to be a significant problem as long as we do not find a cure for this devastating addiction. Remember to screen your patients for drug use by asking direct and simple questions, then offer the addiction services available in your area. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ikenna Nwosu, and Bahar Hamidi. Audio edition: Suraj Amrutia. See you next week! ___________________________  References: Ronald Strauss, Nesreen Jawhari, Amy H. Attaway, Bo Hu, Lara Jehi, Alex Milinovich, Victor E. Ortega, Joe G. Zein, Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019, The Journal of Allergy and Clinical Immunology: In Practice, September 2021, ISSN 2213-2198, https://doi.org/10.1016/j.jaip.2021.08.007. Winslow BT, Voorhees KI, Pehl KA. Methamphetamine abuse. Am Fam Physician. 2007 Oct 15;76(8):1169-74. PMID: 17990840. https://www.aafp.org/afp/2007/1015/p1169.html Klega AE, Keehbauch JT. Stimulant and Designer Drug Use: Primary Care Management. Am Fam Physician. 2018 Jul 15;98(2):85-92. PMID: 30215997. https://www.aafp.org/afp/2018/0715/p85.html Paulus, Martin, Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis, Up ToDate, last updated: July 20, 2021. https://www.uptodate.com/contents/methamphetamine-use-disorder-epidemiology-clinical-manifestations-course-assessment-and-diagnosis?search=methamphetamine%20use%20disorder&source=search_result&selectedTitle=2~128&usage_type=default&display_rank=2 Boyer, Edward W and Steven A Seifert, et. al, Methamphetamine: Acute intoxication, Up To Date, last updated: December 24, 2019. https://www.uptodate.com/contents/methamphetamine-acute-intoxication?search=Methamphetamine:%20Acute%20intoxication&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Methamphetamine, Drug Facts, National Institute on Drug Abuse (NIDA), accessed on July 28. 2021. https://www.drugabuse.gov/publications/drugfacts/methamphetamine.  

☎️ Tyson Fury Beat Up in Sparring

Oscar Valdez tested positive for banned substance Phentermine but will fight tonight anyway, COVID continues to KO the fight schedule, and Michael Montero steps into the ring next Thursday, September 16 in Atlanta. BUY THE PPV FOR MIKE'S FIGHT HERE: PPV for my fight: https://wbc.vivetv.network/events/sept-2021/atlanta-corporate-fight-night/

The Boxing Rant podcast returns to discuss the latest cheating scandal coming out of the Reynoso boxing camp, as Oscar Valdez pissed hot for the VADA banned stimulant, Phentermine. Ken and Vin discuss the state of boxing and the apathy they feel for this dysfunctional and fully corrupt sport. Enjoy the rants.Shop the TBR Swag store at https://theboxingrant.myspreadshop.comFollow us on Twitter:@VinceCummings81@KennyKeithJrSupport The Boxing Rant at www.Patreon.com/BoxingRant.Contact:mailbag@theboxingrant.comOriginal music produced by DJ Chrome Bills for The Boxing Rant.Original artwork created by @Fightposium for The Boxing Rant podcast.

 On this segment of "Real Talk", the Ring Gang crew discuss Oscar Valdez failing his drug test yet suffering no disciplinary action 

On this segment of "Real Talk", the Ring Gang crew discuss Oscar Valdez failing his drug test yet suffering no disciplinary action --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/rgradio/message Support this podcast: https://anchor.fm/rgradio/support

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If you are experiencing discomfort, you would sometimes wonder what's wrong with you. It's okay to make changes and learn how to take care of yourself more. After all, you are in charge of your life and your body. Join your hosts Sammi and Bre as they discuss the side effects of phentermine in their bodies and how they handle different situations. They emphasize the ultimate need for confidence in everyone who's going through the same and share their learnings throughout their weight loss journeys—from struggles with binge eating to taking medication to mental health. The first year could be the hardest, but it is also the easiest time to lose weight. Don't be frustrated if you don't lose a lot of pounds because you're just learning what works for you. Sammi and Bre also remind us that comparing ourselves with others doesn't benefit us in any way. We have the rest of our lives with our bodies. We must learn to love it! Learn a lot of valuable insights in this episode so you can embrace who you are!

You're more than just a number. In this episode, Sammi and Bre give the phentermine update you've all been waiting for. They discuss how numbers on your weight mean absolutely nothing when it comes to your mental health. Would you rather be strung out, depressed, and seven pounds lower? Join in the conversation as Sammi and Bre both agree that they'd rather feel alive and happy! Tune in to hear more about weight loss and mental health.

Sammi and Bre sit over ice tea and talk about the harsh truth of phentermine and antidepressant drugs. Bre has been taking phentermine, starting with the lowest dose but it wasn't working. It didn't help her lose weight at all. Instead, it made her feel like she's in a dark place. She can't even talk to her parents about it! Tune in to learn what steps you can take to protect yourself against medications that harm you.

We are all aware that health is wealth. So we make sure we are eating the right food and getting the regular exercise that we need. But while maintaining our health, we also want to feel confident and beautiful from the outside. Sammi and Bre share conversations with their doctors about using Phentermine in their diet for the short term and their eating habits before and after taking it. They both talk about their situations while taking it in conjunction with other medicines. They delve into what symptoms are most common and the effects of this prescription medication on their bodies.

In this episode, OMA Chief Science Officer, Harold Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC interviews Mahtab Ahmed, MD, FOMA, Dipl. ABOM about a recent article on the safety and effectiveness of longer-term Phentermine use. Topics covered include risks and benefits of prescribing Phentermine longer than 12 weeks, the impact of study results only including low cardiovascular disease risk patients and being a retrospective study, and the role of local regulations in prescribing. In our article review podcasts, we have carefully selected recent articles included in the latest version of the Obesity Medicine Association (OMA) Obesity Algorithm, which is a comprehensive review of obesity medicine that can be found at obesitymedicine.org. We then discuss this new science with obesity experts. To access other resources from the clinical leader in Obesity Medicine, visit: www.obesitymedicine.org. Episode Guests Harold Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC Mahtab Ahmed, MD, FOMA, Dipl. ABOM Resources Mentioned Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort

Episode 8 brings brings Dietitian Dad into the wonderful world of fad diets. Including IF, Keto, Phentermine and HcG. This important episode examines the billion dollar diet industry which is only making us more obese. What should you do for yourself? Listen to find some answers. Also, how much protein can be absorbed in one sitting?

In today's episode of VSG Tea with Sammi and Bre, the ladies give an update on their phentermine journal. Learn what Sammi and Bre have been experiencing these past weeks when it comes to health. Does it really help in losing weight? Does the medication really stop your craving for food? How fast do the results show? Does Topamax really help in your diet? Have all your answers about phentermine and medication answered today. Also, learn how to fix negative and weak mental. Because a weak mental will just make everything else harder than it already is.

Phentermine has always been considered a forbidden word in weight loss, but Sammi and Bre explain why that thinking must now end. Sammi shares her experiences with this medication with her first week of phentermine checkup with Bre. She discusses how it affects her weight gain and loss and its impact on her eating habits. Sammi also talks about how phentermine goes with her other medications and her experiences with its few side effects. Their discussion also sidetracks to plastic surgery, with the two hosts sharing their thoughts and plans about tummy tuck.

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/

For more details on this podcast visit: https://www.journeybeyondweightloss.com/blog/11 Episode 11: Surrounding yourself with support and learning to make good decisions helps you continue on your path to healthy eating. Blog Description: By nature, we learn and adapt to the community that surrounds us. When we change our eating habits, it can feel as if we're abandoning the community we know. Here are some tips to overcome these issues, and still stay connected. Timestamps: 8:45 Conundrum - what if you're trying to eat healthy, and your family is bringing unhealthy foods into the home? 16:30 If you've discovered you are super sensitive to the drug-like effects of sugar and flour products, treat the birthday cake the same way an alcoholic would treat a champagne toast. 22:47 We were born to be members of a tribe for support and survival! Consider joining a community of like minded people. Full transcription of this podcast: https://www.journeybeyondweightloss.com/blog/11

With being a busy entrepreneur, juggling family, and trying to multitask; our health sometimes goes by the waist side. We are running low on time and the only place to catch something to eat is McDonalds. After we eat the fries, we decide it's time to go on a diet. We turn to Slimfast, Jenny Craig, Phentermine, Atkins diet, etc to transform us. For some of us, it works and we are forever slim and healthy. For the rest of us it turns into a constant cycle of yo-yo dieting. What are we doing wrong? Tune in to today's show as I talk to Canadian native Holistic Lifestyle Coach Crystal Chen. She gives us the scoop on to be healthy and the 3 key things that will actually help lose weight that the diet industry never talks about.  You can connect with Crystal on Instagram at www.instagram.com/goddessfitology Check out her Link Tree at www.linktr.ee/Crystalchen Don't forget to subscribe to Your Small Business Podcast. New episodes every Tuesday and Thursday!

Download my free thyroid resources here (including hypothyroid symptoms checklist, the complete list of thyroid lab tests + optimal ranges, foods you should avoid if you have thyroid disease, and more): https://www.restartmed.com/start-here/​ Phentermine is one of the most common weight loss medications prescribed by doctors. But there's one big problem: It doesn't work nearly as well as you might think. Yes, it can help you lose weight but that weight loss is only temporary. In addition, it comes at the cost of damage to your metabolism, a loss in lean muscle mass, and it may also cause some serious side effects. Before you use phentermine for weight loss, you need to watch this video so you can avoid these negative side effects. There are other weight loss medications available which can help with long-term weight loss which do NOT cause these negative side effects. Recommended thyroid supplements to enhance thyroid function: - Supplements that everyone with hypothyroidism needs: https://www.restartmed.com/product/hy​... - Supplement bundle to help reverse Hashimoto's: https://www.restartmed.com/product/ha​... - Supplements for those without a thyroid and for those after RAI: https://www.restartmed.com/product/th​... - Supplements for active hyperthyroidism: https://www.restartmed.com/product/hy​... See ALL of my specialized supplements including protein powders, thyroid supplements, and weight loss products here: https://www.restartmed.com/shop/​ Want more from my blog? I have more than 400+ well researched blog posts on thyroid management, hormone balancing, weight loss, and more. See all blog posts here: https://www.restartmed.com/blog/​ Prefer to listen via podcast? Download all of my podcast episodes here: https://podcasts.apple.com/us/podcast​... I'm Dr. Westin Childs and I focus on thyroid health, hormone balance, and weight loss. I write about thyroid disorders, weight loss, insulin resistance, estrogen/progesterone balance on my blog. I truly believe that hormone balance is the key to managing your weight, your mood and your quality of life which is why I'm so passionate about it. This video is not intended to be used as medical advice. If you have questions about your health please consult your physician or primary care provider. Dr. Westin Childs goes to great lengths to produce high-quality content but this is NOT a substitute for medical care.

How can we stop uncontrollable and unintentional weight gain? What can we do about it, what works and how do we stick to it? Should those with serious weight problems consider bariatric surgery and medication?I recently learned so much about obesity from incredibly informed health psychologist Dr. Dina Goldstein Silverman. After watching her excellent presentation at the 2020 NJPA Conference I asked her if she would be a guest on podcast. We are joined in this conversation by attorney and my husband, Neill W. Clark.Expert guest Dr. Dina Goldstein Silverman is the recipient of the Frank and Mary Ann Dattilio Education Award from the Pennsylvania Psychological Association. She was recently recognized by South Jersey Magazine for the Reader's Choice Award in 2019 and 2017. She is an Assistant Professor of Psychiatry and Psychology at Cooper University Hospital where she teaches evidence-based psychotherapy and provides individual supervision to psychiatry residents, medical students, and post-doctoral and pre-doctoral clinical health psychology residents. If you have found any value from this show, please show your encouragement by buying me a coffee: https://www.buymeacoffee.com/dralexandraEnjoy! Support the show (https://www.buymeacoffee.com/dralexandra)

When losing weight, you've got to stick to the rules and follow the program. But once you get to maintenance, it’s all about finding what works for you over the long term.  People often come to think there's only one way to eat for everybody - that is just simply not true. Now, we do believe that there's never really a place for processed Frankenfood crap. Talking of having Slurpees from a 7-Eleven every day, and having Ding Dongs and Ho Hos every day, there's not a place for that, but other than those foods, there really isn't just one way to eat for every single person. There's just not one right way, and that's how Code Red was born. The program was born because I got heavy and fat. I put on quite a bit of weight even though I was exercising three to five hours a day. When I realized that it was all diet-related, and that exercise had nothing to do with losing weight, I created Code Red as a mixture of many different programs. It is a mixture of Atkins, paleo, Mediterranean, keto - lots of different things. I mixed them all and came up with Code Red, so you're going to see things that they allow on keto, that we don't allow on Code Red. Once you lose your weight on Code Red, we transition you to a maintenance group, and we encourage our rebels to find what works for them because they might be a little different. We're really strict during weight loss, but during maintenance, although we still have our core values and rules in place, we do want you to mess with the formula, just in case you think you are missing something or you think you want to try something else out. You need to have the right plan for you to match your goals and to whatever is going on in your life, right then. For instance, if you are training for a marathon, and you are in our maintenance group, we are going to change your diet a bit. We’re going to help you determine what carbs you need to help fuel you for that marathon. If your goal is to get super shredded and super lean, we're going to keep you on Code Red. I might even put you on a carnivorous diet, I don't know. And so we're really going to adjust you down, but you have to find what works for you.  In the short term, we want you to eat according to Code Red. We want you to stay strict. I want you to stick to the food list. Do not deviate from your custom program plan. You do exactly what I say until every last drop is gone, and then, I switch to playing the long game - What can we do for you long term, that is going to keep this weight off for the rest of your life. Weight loss and maintenance modes are not that different, but there are going to be some shifts. To know more, stay tuned as Cari and I explain to you how one size just does not fit everybody. Key Points of Discussion: He's able to build muscle on veganism; not everybody is that way (6:28) Code Red was born as a mixture of many different programs (6:44) We encourage our rebels to find out what works for them in maintenance mode (7:48) Be wary of too much stress on your body in the fat-burning mode (8:09) We change people's food when they’re on maintenance as per their goal (12:05) What works for me, might not work for Cari (12:05) Different case: She's not exercising. She doesn't have a big calorie demand… (13:12) I don't want you coming to Code Red just for short-term ends (15:48) I don't want to see you add certain foods back in, but there are some foods you can, if it works for you (16:32) What are you eating now and how is that working? (17:25) We have a very strategic protocol to transitioning you into maintenance. And it's only adding one thing at a time (18:27) What is working for you right now may not be what works down the road (20:12) Being a “nutrivore”, meaning picking the best quality you can, of your food, and finding the eating style that works for you (26:38) It’s about accountability, and long-term sustainability (28:01) You can’t take Phentermine every day for the rest of your life and expect it not to hurt your body, but you can do Code Red every day for the rest of your life (28:18) If you clean up your diet, you can find out what is going to work for you (30:05) We only want what you can keep up with for the rest of your life - for you to keep your weight down and still feel good (32:25) ---------------------------------------------  Additional Resources: Get your FREE copy of the On-The-Go Guide for Code Red approved food here: http://bit.ly/on-the-go-guide  You can find out more about Cristy and the topic covered in this episode by checking out her website here.  --------------------------------------------- Lose your first, next, or last 10 pounds with absolutely NO pills, powders, shakes, or exercise required.  Click here to take the 10-pound takedown challenge! Be sure to grab your copy of my book, The Code Red Revolution here.  Connect with Cristy: Facebook Instagram LinkedIn YouTube --------------------------------------------- Subscribe to the podcast on Apple, Spotify Stitcher, YouTube or anywhere else you listen to your podcasts.   If you haven't already, please rate and review the podcast on Apple Podcasts!

Support the show (http://hotmomzlifestyle.com)

Brandy and Alexis talk Fen-Then, Phentermine and several other anti-obesity medications. Appetite control and upcoming events in March and May. Why is it called "For Fats Sake"? As always, thank you for listening. You can email us at forfatssakepodcast@gmail.com Share your stories, questions or comments.Find us on social media...Twitter @ffspodcast_Instagram @forfatssakepodcastFacebook http://www.facebook.com/forfatssakepodcast

In part 3 of Mason Harder's, The Phentermine & Clenbuterol Sourcebook, available now on amazon.com. You'll discover how you can get phentermine and clenbuterol like results from my favorite fat burning nutraceutical, Anorectant No.10. Anorectant is still legal and over-the-counter as of this writing. Anorectant No.10 is available at www.anorectant.com. Check their site to see if they are running their popular two free bottle promo! Get the complete audio series by going to www.clenbook.com And if you learned anything at all from this episode, please click Like. In this audio, we'll cover: 1. What is Anorectant No.10? (00:01:08) 2. What compounds are in Anorectant No.10? (00:04:20) 3. What results can you expect from Anorectant No.10? (00:09:06) 4. How to use Anorectant No.10 for weight loss and what are the usual Anorectant No.10 weight loss results? (00:10:53) 5. How Anorectant No.10 works and how to cycle it... (00:12:02) 6. Is Anorectant No.10 Legal? And will Anorectant No.10 show up on a drug test? (00:13:36) 7. How to buy Anorectant No.10? Where can I buy Anorectant No.10 online? (00:14:14) Get the complete audio series by going to www.ClenBook.com And if you learned anything at all from this episode, please click Like.

In this episode I reveal everything you need to know about using clenbuterol to burn fat. You'll learn what it is, why it's so coveted by bodybuilders and models, how to use it safely, how to avoid its side effects, and where to get it. You can get the complete audiobook of The Phentermine & Clenbuterol Sourcebook by going to: www.ClenBook.com And if you learned anything at all from this episode, please click Like. In this episode, we'll cover: 1. Dieting prior to industrialization (00:00:55) 2. What is Clenbuterol or Clen? (00:03:13) 3. What clenbuterol results can you expect before and after using clen? (00:07:51) 4. How does clenbuterol work and how to cycle clenbuterol. (00:10:29) 5. What is an effective clenbuterol dosage on a Clen cycle? (00:13:39) 6. How to buy clenbuterol? Where to find clenbuterol for Sale? Where to buy clenbuterol online? (00:15:30) 7. What are clenbuterol's Side Effects? Is clenbuterol safe? What are the clenbuterol side effects on men and clenbuterol for women? (00:20:47) 8. Is Clenbuterol Legal? And will clenbuterol show up on a drug test? (00:25:03) 9. What form does clenbuterol come in? Including Clenbuterol tablets, Liquid Clen, Clenbuterol Peptides, and Clen powder. (00:27:13) 10. What is Clenbuterol Half-Life? (00:31:13) 11. Who's Using clenbuterol? (00:33:17) Get the complete audio series by going to www.ClenBook.com And if you learned anything at all from this episode, please click Like.

In Part 1 of my the Phentermine & Clenbuterol Sourcebook, available now on amazon.com, I reveal everything you need to know about using phentermine to burn fat fast. You'll learn how to use it safely, how to avoid its side effects, and where to get it. Get the complete audio series by going to: www.ClenBook.com And if you learned anything at all from this episode, please click Like. In this episode, we'll cover: 1. Phentermine / Adipex P (Brand Phentermine) (00:00:49) 2. What is Phentermine? (00:01:24) 3. Phentermine for Weight Loss & How does Phentermine Work?(00:03:17) 4. Phentermine Side Effects (00:05:57) 5. Phentermine High & Recreational Drug Use (00:08:31) 6. The Phentermine 37.5 mg Pill (00:09:16) 7. How Long Does Phentermine Stay in Your System? (00:10:58) 8.Phentermine Before and After (00:15:36) 9. Where to Buy Phentermine Online (00:16:17) 10. Over the Counter Phentermine (OTC Phentermine)(00:19:56) 11. Phentermine Prescription from an Online Doctor (00:21:33) 12. Phentermine Coupon (00:22:15) 13. Adipex Reviews, Results, & Side Effects (00:23:56) 14. Phentermine Brands (00:25:19) 15. Which is Better, Phentermine Tablets or Phentermine Capsules? (00:28:06) 16. Do I Need a Prescription for Phentermine? (00:29:37) Get the complete audio series by going to www.ClenBook.com And if you learned anything at all from this episode, please click Like.

INTRODUCTION: YOU'VE BEEN LIED TO... The so-called ‘weight loss experts' love to say, “to lose weight, all you need is a healthy diet and plenty of exercise.” Right? WRONG! Men, when you fail at getting the muscular, shredded physique of a men's fitness competitor or MMA fighter, and ladies, when coming up short on your journey to burn fat fast and have the sexy figure of a Victoria's Secret Angel, a fashion model on the catwalk, the curves of a Kardashian, or a red carpet ready celebrity, the diet industry wants you to think it's your fault. They want you to feel like you did not try hard enough. They want you to believe that you're to blame because you were not strict enough with your diet and you did not spend enough time at the gym. Here's the truth of the matter: It's not your fault that you don't already have the body you want. It's the weight loss industry's fault. In, Mason Harder's, The Phentermine & Clenbuterol Sourcebook, available now on amazon.com, I'll share with you all the most radical weight loss pill secrets that the elite use to achieve physical perfection. Not only can overweight people use my book to burn fat fast and shed major pounds, but this book is also for people who are not overweight and who want to take their bodies and quickly look like the actors and actresses playing superheroes in the movies. Listen to the Introduction chapter of The Phentermine & Clenbuterol Sourcebook now. Learn why this bada$$ book is the exactly what you need to read or listen to if you want to burn fat and burn it fast! Get the complete audio series by going to www.ClenBook.com And if you learned anything at all from this episode, please click Like.

Master the safe and effective use of obesity medications with Endocrinologist, Dr. Karl Nadolsky (co-author of 2016 AACE Obesity guidelines), Director of the Diabetes, Obesity & Metabolic Institute at Walter Reed National Military Medical Center. We get under the hood of each FDA approved obesity medication plus some of our normal hijinks. Check out episode #23 for a more general overview of obesity. Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 03:12 Picks of the week 08:44 Rapid fire questions 13:00 Counsel patients about obesity 14:40 Pathophysiology of obesity 18:00 Case 22:46 Phentermine/topiramate (Qsymia) 26:20 Bupropion/naltrexone (Contrave) 29:18 Liraglutide (Saxenda) 34:32 Orlistat (Alli, Xenical) 37:35 Cost issues 40:18 Lifelong medical therapy for obesity 42:44 Dr. Nadolsky’s take home points 44:45 The Curbsiders recap and discuss their experience with obesity medications 52:28 Outro Tags: assistant, care, doctor, education family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, primary, resident, student, obesity, pharmacotherapy, weight loss, safety, side effects, orlistat, alli, naltrexone, bupropion, contrave, phentermine, topiramate, qsymia, lorcaserin, belviq, FDA

Phentermine was in the news a few years ago but is still being used by doctors to help patients get a handle on weight loss issues when diet and exercise have not proved to be enough. Randy is currently on this medication and he will share his thoughts, how it is affecting him, and any concerns he had going into the program. More discussion on weight loss help in the form of supplementation, meal replacement, or surgery, ensues after that with the underlying question of "when does it become time to seek medical intervention?". What role does it play while training for endurance events? Remember to join the Fat Slow Triathlete blogs and Facebook page. The Blog is at fatslowtriathlete.com and the Facebook page is ENDURANCE FOR EVERYONE.  Find your FST Shirts on Amazon by selecting this link or by searching for Fat Slow Triathlete on the site.  You can also get RACE GEAR at Jakroo by going HERE Use code SHARE15 at TriSports.com for a 15% discount Use code FATSLOWTRI at Generation UCAN for 15% your order  

Dr. Drew addresses the tragic shooting in Orlando before answering listener phone calls about using Phentermine for weight control, what do do with an abusive daughter, and how to handle a possible beer allergy.DrDrew.com

In this podcast, Chip Lavie, MD, joins Todd Whitthorne to discuss Qsymia (formerly dubbed Qnexa), a new weight loss medication approved by the FDA that should be available by the end of this year. Dr. Lavie is triple board certified in internal medicine, cardiovascular diseases, and nuclear cardiology, and is a staff cardiologist at the Ochsner Heart and Vascular Institute in New Orleans and is medical director of cardiac rehabilitation and preventive cardiology at the Ochsner Clinic Foundation. Dr. Lavie's also an active researcher and is the author, or co-author of more than 600 medical publications. As a society we need additional tools to help those who are struggling with weight. Seventy percent of  Americans are overweight or obese, and the number of those who are morbidly obese continues to grow. The new weight loss medication, Qsymia, is a combination of the drugs phentermine and topiramate, and it's estimated that weight loss will be 7- to 10 percent. For most individuals, this amount of weight loss can dramatically improve health values, although the person might well still not be at an ideal weight. Dr. Lavie and Todd discuss the potential impact this new medication may have on the obesity epidemic.