Obesity - part 3 The Aggressive Approach

This third part of the Obesity series centers around the aggressive approaches to treating the problem. One of the most common methods is the very low calorie diet, or VLCD.

VLCD's are characterized by a very severe restriction of caloric intake. Some will keep the dieter to 800 to 1000 calories daily, depending on whether one follows the AMA (American Medical Association) guidelines, or those of the American Diatetic Association (ADA). The Very Low Calorie Diet can be more effective than the usual Low Calorie (LCD) sort in the short term, with rapid weight losses being reported early on in the diet. Such loss was concomitant with a reduction of the comorbidities of obesity and health risks.

When Behavior Modification was included with the VLCD, many of the patients tested and studied had weight losses of as much as 40 pounds in 20 weeks, and tended to improve their weight maintenance. Unfortunately, most on the VLCD program also tended to regain to their original weight within 5 years - results similar to patients on simple Low Calorie Diets. Other, more unfortunate, effects of the VLCD were negative effects such as hair loss, weakness, fatigue, and binge-eating behavior.

Pharmacotherapy (treatment with drugs) may be useful for patients with high comorbidities and those who have failed to respond to traditional methods of weight reduction. Intervention with drugs is indicated for patients with a Body Mass Index (BMI) of 30 or more, or those with a BMI of 27 and concurrent risk factors or comorbid disorders. Drug agents for treatment of obesity can cause weight loss by suppressing appetite, increasing energy burn, reducing absorption of nutrients, or any combination of actions.

Presently in use as appetite suppressants are, phenylpropanolomine, phentermine, diethylpropion and mazindol. These drugs will suppress the appetite but have less potential for abuse than do the amphetamines. The two most effective anorectics, dexfenfluramine and fenfluramine (phen- fen) were lifted from the American market when it was found that they were associated with development of valvular disorders in the heart and pulmonary hypertension.

Meridia (Sibutramine) also acts as a anorectic agent and is effective in causing weight loss in a dose-dependent manner. Unfortunately, the medication has the potential to raise one's blood pressure and pulse rate and requires careful monitoring.

Xenical (Orlistat) see my article 18 may, 1999, works by inhibiting gastric and pancreatic lipase, preventing the absorption of free fatty acids and monoglycerides. By acting in this manner, Orlistat can create weight loss and maintenance. The drug also tends to improve lipid (fat) profiles, improve glycemic control and lower systolic blood pressure. The major factors that render this drug suspect is its high cost per pound of loss, and lack of data on long term maintenance.

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