Friday, December 28, 2018

How Does Exercise Help Us Manage Weight

There was a 2015 New York Time magazine article that argued that exercise alone is not a good way to lose weight. The author implied that a well-chosen diet was a lot more effective for losing weight than exercise. Indeed, what you eat counts more than your physical activity when trying to get rid of excess body fat. Still, exercise is important in weight loss and weight management. For example, exercise affects some of our genes and some of our hormones.

Exercise can change the way our genes function. For instance, according to one study, exercise can reduce the effects of a gene called the "fat gene." Specifically, the gene called the “fat mass obesity associated” or FTO gene has been shown to heighten the risk of obesity. This gene was documented in 2007. But a recent study concluded that exercise “can reduce the weight-gaining effects of the  ... FTO gene, by about 30%."

And based on another study, exercise causes an increase in a hormone that boosts the metabolism. This boost in metabolism can help manage weight. The hormone is called FGF21. According to the study, the hormone "boosts the process of the body converting food into energy, helping the body burn more calories even while resting – thus helping in weight loss."

The study also gave us information that was quite interesting. The investigators found that the production of FGF21 from cardio training was three times larger than it was from strength training. Thus, to raise the metabolic rate -- at least with respect to FGF21 -- cardio training appears to be more effective than strength training.

So, we know that exercise is beneficial to our health, including weight management. Exercise affects our hormones and genes. Exercise can lessen the effects of excess weight on our health. Therefore, obesity medicine specialists should counsel their patients on the benefits of exercise with or without associated weight loss.

Sunday, December 23, 2018

Belviq May Give Weight Loss Drugs a Boost

In general, there are three approaches to weight loss and weight management. These approaches are lifestyle modification (including diet and exercise), weight loss surgery, and antiobesity drugs. While each approach can be successful, each one of these approaches has associated problems. Changes in lifestyle are hard for individuals to adhere to for a long period of time. Weight loss surgery can give rise to serious complications. And antiobesity drugs have often produced disappointing weight loss results and severe side effects. But one drug, Belviq, is showing positive results.

Over the past several years, four antiobesity drugs have gained FDA approval and become available for the treatment of obesity. These drugs are Qsymia (phentermine/topiramate), produced by Vivus, Belviq (lorcaserin) produced by Arena, Contrave (bupropion/naltrexone), produced by Orexigen and Saxenda (liraglutide), produced by Novo Nordisk. These drugs give providers new tools to fight obesity. But the drugs have not had the impact that some desired.

However, one of the antiobesity drugs, Belviq, may change that. For example, according to one study, Belviq did not increase the participants' risk of major cardiovascular events compared to the placebo group.  Cardiovascular problems have been a concern since the days of the antiobesity drug, fen/phen (fenfluramine/phentermine), which was taken off the market in 1997.

Also, "Weight loss of at least 5% occurred in 38.7% of those assigned [Belviq] vs. 17.4% of those assigned placebo." Further, the "Researchers observed small but significant improvements in in BP, heart rate, triglyceride levels and HbA1c during the course of the study ..."

Therefore, the study may motivate providers to prescribe Belviq for weight loss. One stumbling block is the cost of the drug, which is $280.00 per month, retail. But if the cost-benefit ratio can be justified by payers, and if commercial insurers start to reimburse providers for the drug, the drug will likely see an increase in use.
 
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