Saturday, September 17, 2016

The Importance of Diet and Exercise

The combination of exercise and diet is one of the cornerstones of weight loss, weight maintenance, and overall good health. Diet and exercise have been shown to be beneficial for both children and adults. Indeed, diet and exercise might improve cognitive ability as well as overall health.

One study has shown that exercise and healthy diet can improve a child's cognitive abilities, and prevent obesity. The researchers concluded that "Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children." The researchers also indicated that "Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions."

In another study, the investigators concluded that three months of physical activity could not only improve a child's physical fitness, but physical activity could improve a child's ability to shift his or her attention from one situation to another -- and do it smoothly and quickly. The researchers concluded that physical activity "programs ... improved executive function-related set-shifting performance, as measured by the total number of errors" committed by the obese young adolescents in the study.

Still, it should be noted that if weight loss is the primary goal of an intervention, diet is usually more effective than exercise. In fact, some researchers have concluded that while "Regular physical activity reduces the risk of developing cardiovascular disease, type 2 diabetes, dementia and some cancers by at least 30%, ... physical activity does not promote weight loss."

But exercise is important to our health. And while diet is more effective than exercise for weight loss, the combination of diet and exercise will likely lead to better health. In fact, studies, including the studies referenced above, show the combination's importance. So bariatricians, bariatric surgeons, and other clinicians should always emphasize the value of both diet and exercise.

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Wednesday, September 14, 2016

The Combination Obesity Drug: Orlistat and Resveratrol

Sometimes, combination obesity drugs can be more effective than either of the drugs in the combination. The weight loss drug Qsymia, which is a combination of Phentermine and Topiramate, is more effective for weight loss than either Phentermine or Topiramate used alone. And the recently approved drug Contrave, which is a combination of Naltrexone and Bupropion, is more effective than either Naltrexone or Bupropion. And the combination of Orlistat and Resveratrol might be more effective for weight loss than Resveratrol or Orlistat.

Orlistat is an obesity drug approved in 1999. The drug is available in two forms -- the prescription form, Xenical, and the over the counter form, Alli. Resveratrol is a supplement sold over-the-counter. While Orlistat is FDA approved, as a supplement, Resveratrol is not.

In a randomized study where 161 subjected were selected, with 84 subjects completing the study, it was found that the group using the Orlistat-Resveratrol combination experienced more weight loss than the subjects using either Orlistat or Resveratrol alone.

Now, the Center for Drug Evaluation and Research (CDER), as a division of the United States Food and Drug Administration, reviews drugs for the federal government. CDER "is a consumer watchdog in America's healthcare system. CDER's best-known job is to evaluate new drugs before they can be sold."

In a 2007 draft report, CDER indicated that a combination weight loss drug would have a better chance of approval by the FDA if the weight loss with the combination drug is at least twice that of either one of the individual drugs used alone.

In the Resveratrol-Orlistat study, the combination caused a weight loss of 6.82 kg (5.03553 lbs), while Orlistat caused a weight loss of 6.02 kg (13.27183 lbs) and Resveratrol caused a weight loss of 4.68 kg (10.31763 lbs) as monotherapy. So the combination did not achieve CDER's best case scenario.

But while the Resveratrol-Orlistat combination did not provide double the weight loss of either one of the drugs in the combination, medical weight loss physicians might want to monitor research into this combination. Indeed more research is in order. But if future research shows that the combination is safe and effective, it could become a new tool in the fight against obesity. 

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