When Diet And Exercise Aren’t Enough Welcome to this segment of weight loss bootcamp. The majority of people visiting this site will benefit from a combination of exercise and diet which are described on other pages in this site. I will discuss weight loss medications in this segment as there is a subset of people who may benefit from these medications. These patients are normally morbidly obese. Morbid obesity is described as being 100 pounds over the ideal body weight or having a BMI of 40 or more or having a BMI of 35 or more in the face of obesity related health problems like hypertension or diabetes mellitus. The BMI is calculated by multiplying the person’s weight in pounds times 0.45. The person’s height is measured in inches and multiplied by 0.025. The answer obtained from the multiplication using the person’s height is then squared (multiplied by itself). The person’s weight in pounds answer is then divided by the person’s height squared and the BMI is obtained. A good BMI is considered to be from 19 to 25.
Some of these morbidly obese or super morbidly obese patients cannot exercise due to painful joints secondary to their body weight or they have other problems like asthma. In these cases using appetite suppressants is not unreasonable.
Appetite suppressants have been in the physician’s regimen for a long time. The most common is dexedrine which is dextroamphetamine. As the name implies, this medication is an amphetamine. Dexedrine is effective in diminishing appetite, but there is a potential problem with habituation. Therefore, most physicians will not use this drug long term. It is, however, quite effective in causing short term weight loss. The longer the drug is used, the less effective it will become in suppressing appetite which often leads to increased dosing and increased risk of habituation.
Appetite suppressant drugs got a bad reputation in the 1990s when physicians were using `fenfluramine and phentermine in combination. Most of you may remember this drug combination being called fen/phen. Fenfluramine is a serotonin releasing agent while phentermine releases norepinephrine, dopamine, and serotonin. All of these naturally occurring molecules in our bodies interact with the hypothalamic appetite center. The fen/phen was quite effective in producing weight loss, but there were a number of people on these drugs who developed mitral regurgitation which is a defective heart valve. Some of them required surgery to replace the mitral valve. As a consequence, fenfluramine was pulled from the market by the Food and Drug Administration in the 1990s. Phentermine is still available in the US, and many physicians are still using the medication for appetite suppression.
Weight loss medications have become more sophisticated over the past few years. One of the current medications used is qysemia which is a combination of phentermine and topiramate. This medication causes a decreased desire to eat between meals and produces a feeling of fullness which makes it ideal for weight loss. The exact mechanism of long term weight suppression, however, is unknown. Normally, the medication is taken along with a dietary plan to decrease the caloric intake by 500 calories a day.
Another relatively new medication is belviq, (lorcasering HCl). Belviq releases serotonin which causes the person to feel full. The medication is taken twice a day. Although belviq is not a stimulant, there is the possibility of habituation. Belviq has worked well with a lot of people, and is a popular medication with weight control physicians.
A recent newcomer to the weight loss scene is contrave, (naltrexone HCl/bupropion HCl). This medication is believed to work on two areas of the brain to relieve hunger. This medication also works quite well to suppress appetite.
There are other drugs which have been used “off label” to suppress appetite. Off label means that the drug was not intended for weight suppression, but one of the side effects of the medication is weight loss. Therefore, it is up to the physician’s discretion to decide whether or not he wishes to use the medication for weight loss. Some of the reasons for going off label may include cheaper prices than the mainstream weight loss medications or physician familiarity and comfort using the off label medications. Some of these include adderall (amphetamine and dextroamphetamine) which was originally formulated for ADHD, topamax (topiramate) which was developed for treatment of seizures and migraine headaches, and wellbutrin (bupropion HCl) an antidepressant. Interestingly, one of the newest drugs approved for ADHD, vyvanse (lisdexamfetamine dimesylate) has an explicit warning on the label that the medication is not to be used for weight loss.
I hope you enjoyed this quick overview of the weight loss preparations currently available. Again, these medications are used in those people who absolutely need to lose weight due to their morbid obesity and are not able to lose that weight by either diet and/or exercise. These medications are only available by prescription. There are also nonprescription medications which you can buy over the counter like garcinia and forskolin. By the way, I do not recommend garcinia or forskolin due to their potential side effects. If you have any questions or comments, please feel free to contact me, Pablo, at email@example.com.