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Weight loss
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Approximately 60% of Americans are overweight. If body weight is 10% over ideal weight, one is overweight; if body weight is 20% over ideal weight, one is obese. Diseases that are associated with obesity are cancer, heart disease, hypercholesteremia, high blood pressure, diabetes, and kidney failure. Public health costs from treating obesity related illness is more than 100 billion dollars a year. There are more than 400,000 deaths a year secondary to obesity. There are many over the counter and prescription remedies available, but few actually work and many are dangerous. The best medicine is proper nutrition and exercise. Weight gain is the result of caloric intake being greater than caloric burning. Instead of temporary diets, it is better to make permanent changes to eating habits. See the chapter on nutrition. Unfortunately, metabolism is greatly controlled by our genes and aging, two things we cannot change. If medication is needed to help with weight loss, I prefer natural remedies.
There are many natural remedies that have been shown to be helpful with weight loss. Adequate intake of water is the most important thing other than a proper diet and exercise for losing weight. Green tea has been shown to increase fat oxidation and energy expenditure. It decreases lipolysis of triglycerides, resulting in reduced fat absorption. The active ingredients in green tea that help with weight loss are epigallocatechin-3-gallate and caffeine. Green tea also has antioxidants, protecting the body from cancer. Chromium is important in helping regulate blood glucose levels. Chromium is part of glucose tolerance factor (GTF) and is necessary to produce insulin. Studies have shown that taking chromium increases weight loss, especially fat weight. Most Americans are deficient in chromium. Chromium lowers triglycerides and probably lowers cholesterol levels. 5-hydroxytryptophan (5-HTP) is another natural remedy that aids in weight loss. 5-HTP increases serotonin levels. Adequate serotonin levels have been shown to decrease appetite, whereas low serotonin levels can cause carbohydrate cravings and binge eating. Tryptophan is either converted to serotonin or 5-HTP, so consuming 5-HTP causes tryptophan to be converted to serotonin. Calcium has also shown to be helpful in weight loss. Calcium decreases fat production and increases the metabolism of fat.
Proper will power is also very important. It is natural for us to crave foods high in fat and sugar. These are comforting foods, which is why we often eat them during times of stress. They cause us to relax by calming the brain. These foods cause the release of dopamine which temporarily counteracts the stress hormone, cortisol. It is imperative to fight these cravings because over time the desire for these foods diminishes. Unfortunately these foods often taste better when they have been avoided, so if one falls off the wagon, it becomes that much harder to get back on.
Prescription and over-the-counter medicines for weight loss are either classified as central-acting appetite suppressants, bulk forming drugs, or fat absorption blocking drugs. The over-the-counter central-acting appetite suppressants either have ephedra, ma huang, and/or caffeine. These drugs are stimulants and can have adverse effects on the cardiovascular system. Ephedra contains ephedrine and pseudoephedrine. Their stimulant effect on the central nervous system can result in decreased appetite. Recently the Food and Drug Administration (FDA) banned ephedra secondary to complications from the drug leading to more than 150 deaths. Ephedra caused sudden death secondary to heart attacks and strokes.
The most popular prescription stimulants are dexafenfluramine (Redux), fenfluramine (Pondimin), phentermine, and sibutramine (Meridia). Redux and Pondimin were banned by the FDA in 1997. Fen-phen, a combination of fenfluramine and phentermine, was found to cause damage to heart valves. Phentermine was not implicated in the damage to the heart so it is still available. Phentermine acts like amphetamine so it is no different than speed. The danger with phentermine and Meridia is they both can raise blood pressure. Meridia inhibits the reuptake of the neurotransmitters, serotonin and norepinepherine. Redux and Pondimin also worked by increasing the same neurotransmitters. Meridia works in a similar fashion as the SSRIs; see the chapter on depression. The risk of these drugs outweighs the possible benefit.
The most commonly used bulk forming drug is methylcellulose. The purpose of the drug is to give a feeling of satiety, so less food is consumed. Side effects can be abdominal distension and flatulence. Xenical is a prescription medicine that blocks an enzyme involved in fat absorption. As a result fat is not digested and fat is excreted in the stool resulting in symptoms of gas and steatorrhea (fat diarrhea). Olestra, a fat substitute, is a fat that cannot be digested and is now found in fat free chips, can give the same symptoms. Diuretics are often abused and they can result in electrolyte imbalances. Laxatives are also commonly used and if abused severe swelling and constipation can result when the medication is stopped.
Recently scientists have discovered a protein, YY3-36, which is produced in the stomach. This particular protein is what gives us a sense of fullness after we eat. It has been shown that obese people make less of this protein than thin people. When people are injected with YY3-36, they have been found to eat 67% fewer calories. As of this publication, YY3-36 suppressants are currently in the research phase and are unavailable to the general public. Leptin is a hormone that partially controls hunger and metabolism. Leptin levels increase as people gain weight causing a decrease in appetite. Leptin levels fall when people start to burn fat, which is why it difficult to keep the weight off after dieting. Researchers are currently evaluating the efficacy of injecting people with leptin after losing weight. Researchers are also studying drugs that destroy blood vessels that supply fat cells, causing the cells to die. These drugs are still in the experimental phase.
Procedures such as bariatric surgery (stomach stapling) and liposuction should be reserved when diet, exercise, and supplements have failed. Liposuction is for cosmetic reasons not for health benefits. Liposuction removes only the superficial fat, not the internal fat that promotes heart disease. Bariatric surgery shrinks the size of the stomach from two quarts to one ounce. Secondary to weight loss there was also a drastic reduction in cholesterol levels, hypertension, and diabetes. Bariatric surgery should never be done for cosmetic reasons because of the high risk of complications associated with the procedure. More than 10% of people have a serious complication such as internal bleeding or blood clots. Malnutrition secondary to rapid weight loss can cause peripheral nerve damage so these patients need to be monitored closely. Over 100,000 people undergo the procedure yearly.
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