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Diet Drugs Work: Why Won't Doctors Prescribe Them?
Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"
i am sorry this is not biochemistry this is made up "science". When ketosis is entered (by depleting ready carbohydrate resources) the body can metabolise fat into ketones (via the liver). The reason this myth persists is because for decades medical researchers couldn't imagine the brain running without glucose, which is a necessary condition of ketosis. Then some bright spark pointed out that the Innuit have been living like that for millenia and (shock horror), it works on western folks too!
Diet and exercise works every time. Guaranteed. There are no exceptions. If you are not exercising , a good chance you will lose some "lean mass". Loss of muscle through maintenance also occurs, so these statements are no helpful.
*however* biology is all about homoeostasis. When you look at your paunch and flabby bits, ask yourself the question "why does biology hang on to them". The body stores excess sugars as fat, as sugars in the blood are toxic. The hormone insulin causes this sequestration of the sugars into fat cells. If you go on a crash diet , the body is happy to burn up the fat. But the cells are still there. Returning to previous over-caloried state just fills the cells up again. Only by a gradual change onto a *lower* calorie diet will you lose the weight "permanently". Think 6 months minimum. Believe it or not 2lbs/week is a pretty good rule of thumb as the body gradually reallocates the cells. If you want to get "cut" that requires some more extreme measures...;-)
Recent research is showing that being overweight and diabetes are connected, although the data stretches back decades. The biggest FUD of the 20th century is the daily calorie limits. If they ever applied it was to a population that was more active, but modern folks spend way too much time on computers(!).
Biology is very complicated but the rules are simple. Everything in moderation....;-)
Cold pressed vegetable oils, avocados, and fish oils are (with a few exceptions) predominantly unsaturated fats. So it sounds like you mostly got the good kind of fat, you simply didn't realize what you were doing.
You're confusing unsaturated fats and partially hydrogenated vegetable oils; partially hydrogenated vegetable oils are really bad for you.
Saturated fat is good for you. It also helps you feel fuller longer. The lies fed to us over the past 30 years about "don't eat saturated fats and eat tons of grains" is why this society is so fat in the first place. There is nothing wrong with a moderated consumption of saturated fat.
Another factor that often gets overlooked in this debate is the role of sugar in our diet. (Here's a written summary of the video.)
Last spring, the convenience stores in my area started stocking fresh fruit, so I switched my habitual breakfast from coffee and a Snickers bar to coffee and a piece of fruit. Around the same time, I saw the video linked above, and started actively avoiding sugar whenever it's convenient. These are the ONLY changes I've made to my lifestyle, but since then I have lost about four inches off my waistline.
Sugar is toxic. Do yourself a favor and avoid it. (Did you know that a 12oz can of coke does as much liver damage as a 12oz can of beer?) And artificial sweeteners are even worse. They mess up your insulin response profile and impede the signals which tell your brain when you've had enough to eat. (If you have a diet coke with dinner, you'll likely eat more food.)
The BBC did a four-part series on the "weight loss industry" earlier this year. It does a pretty good job of exposing the hype and marketing BS behind our current situation. Worth a look.
XML is like violence. If it doesn't solve your problem, you're not using enough of it. --AC
Perhaps doctors don't prescribe them because:
- they don't work very well in the short term and not at all in the long term
- they are expensive
- they have lots of bad side effects:
Qsymia has particular risks for pregnancy, as it can cause birth defects if taken in the first months of pregnancy, even before a woman knows she is pregnant. Women of childbearing age must use effective birth control to keep from becoming pregnant while taking Qsymia.
Qsymia should not be taken by:
Pregnant women
People with glaucoma
People who have been told they have an overactive thyroid
People taking a type of antidepressant called a MAOI
People allergic to phentermine or topiramate
Belviq should not be taken by:
Pregnant or nursing women
People taking drugs linked to valvular heart disease, such as cabergoline (Dostinex)
Belviq should be taken with caution by:
People taking certain medicines for depression; migraine; the common cold; or mood, anxiety, psychotic, or thought disorders
Men with conditions that predispose them to erections lasting more than four hours. These conditions include sickle cell anemia, multiple myeloma, and leukemia
Men with a deformed penis
Qsymia and Belviq each come with a long list of important safety information, but this list is different for each drug.
I don't read your sig. Why are you reading mine?
You might want to review the full research before posting.
> - they don't work very well in the short term and not at all in the long term
Qsymia gives about 10% weight loss beyond "placebo" (which was a diet and exercise program that all treatment arms got.) Weight loss was maintained out to two years, which was the end of the study. Qsymia is a combination of two medications that have been on the market for a long time. Weight loss docs have been prescribing them together for quite a while and I haven't heard any talk about them not working after a certain point. Qsymia just takes two existing meds and makes one pill out of small amounts (if you want to match the Qsymia doses with generics you have to chop tablets as small as an eighth) and uses a time release formula so the side effects (carbonated drinks taste funny and tingling in the fingers are common. I have the change in taste) aren't as bad. There is no research on Qsymia past two years, but there is experience with the components. Belviq is a 5-HT2C receptor agonist, and I'm on a SSRI. I haven't paid much attention to it, but I assume it has data out two years also.
> - they are expensive
True dat. And not covered by a lot of insurance. I buy mine out of pocket. About $170 per month. It's worth it to me.
> - they have lots of bad side effects:
Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.
First, if I, as a 45 year old man, get pregnant on Qsymia it will be news. Much bigger news than a birth defect.
Second, obesity also increases in risk of birth defects.
Third, this is why they have a program to tell people that if you take Qsymia in the first few months of pregnancy there is an increased risk of cleft lip/palate. This is because Qsymia contains topiramate, a medication prescribed about 10,000,000 times a year. Interestingly you can take 400mg a day of topiramate for neurological conditions without a warning, but if you take 23mg a day for weight loss you have to be warned of the risk. Not that there is a bias against obesity or anything...
I think I have posted more in this one topic than in all the rest of the time I have been on slashdot, but this drug has made such a difference in my life.