Friday, November 30, 2012

Childhood Obesity Can Lead to Adult Health Problems

Childhood obesity is currently receiving a great deal of attention. While obesity in childhood can cause social and health problems during childhood, including ostracism and type ll diabetes, childhood obesity can lead to serious health problems during adulthood. In fact, Obese children are ‘more likely to have heart attack or stroke in adulthood...'

To address childhood obesity, much attention is being given to methods that can motivate children to follow a healthy diet and increase physical activity. However, focusing on the obese child’s family may be the best way to induce a child to engage in activities that lead to a healthy weight.

Indeed “A new study shows that when parents model a healthy lifestyle, that lifestyle is more effective than just talking to teens when it comes to obesity topics…” And an Institute of Medicine study shows that with the right home environment, a child’s defensiveness, associated with being overweight, can be lessened. This lessening of defensiveness combined with family  support and encouragement can greatly increase the child's likelihood of achieving a healthier lifestyle.

Bariatric surgery is sometimes mentioned as an option for dealing with childhood obesity. However, changing the home environment, including lifestyle modifications, to address childhood obesity is a lot less traumatic than bariatric surgery. Further, while bariatric surgery has often proven to be the most effective approach to weight loss, addressing childhood obesity with lifestyle modifications is usually a safer approach to childhood obesity than surgery.

Some forms of bariatric surgery, such as gastric bypass surgery, make changes to the internal workings of the body that are virtually irreversible. And these changes could have undesirable consequences in adulthood. Further, certain endocrinologists believe that various forms of weight loss surgery can cause bone loss which could be a problem for a child since a child’s body is not fully developed. So again, non surgical actions seem to be the most appropriate approach to childhood obesity.

By taking actions to address obesity while a child is young, weight loss providers might be even more successful at helping a child maintain a healthy weight. Appropriate action will likely lead to better health in adulthood. And the earlier some action is taken, the better. In fact, “Weight-loss programs can help even very young children slim down, and it appears that acting early may improve the odds of success…”

At any rate, knowing that changes to a  family’s lifestyle can improve a child’s health during childhood and adulthood should give families the motivation to make modifications in the home. And knowing that a family’s lifestyle change can improve a child’s health should give health care providers more ammunition to use in counseling parents who have overweight or obese children.

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Saturday, November 17, 2012

A Look at Qsymia

The FDA has approved several obesity drugs over the past sixty years. Some of the drugs were approved for short term use, and some were approved for use long term. Some of these drugs were found to have serious side effects, and taken off the market. Two new drugs, Belviq and Qsymia, were approved by the FDA in 2012. While Belviq is expected to be available in 2013, Qsymia is currently on the market. Although Qsymia received a good deal of attention leading up to its FDA approval, market results, so far, have been disappointing.

Qsymia is a combination of two existing FDA approved drugs. Those drugs are Topiramate and Phentermine. Topiramate, originally produced by Johnson and Johnson, was approved by the FDA in 1996. Topiramate is mostly used to treat seizures. Topiramate is sold under the brand name, Topamax, by New Jersey based Ortho McNeil Neurologics.

Phentermine  was approved in 1959 as a short term (a few weeks or a few months) treatment for obesity. Phentermine is sold by Medeva Pharmaceuticals under the brand name Ionamin®, and by Gates Pharmaceuticals, under the brand name Adipex-P®. Both Topiramate and Phentermine are also sold in generic forms.

Phentermine has an interesting history. It was part of the infamous obesity combination drug Fen-Phen. The “Fen” in the combination is Fenfluramine. Fenfluramine was approved by the FDA for short term use as an obesity drug in 1973. It was manufactured by American Home Products, now known as Wyeth. While Fen-Phen led to  average weight loss as high as ten percent, the drug also had associated side effects. Fenfluramine was found to cause hypertension and heart valve problems. Fenfluramine was taken off the market in 1997 at the urging of the FDA. Phentermine remained on the market.

As stated above, Qsymia is also a combination obesity drug. And while Qysmia has led to respectable weight loss of “at least five percent … body weight” the FDA has placed restrictions on the drug’s use. Qysmia is not recommended for persons with glaucoma, hyperthyroidism, recent heart disease or stroke.

Even though there are restrictions placed on Qysmia, in the opinion of some, the drug was off to a good start when first released. “Vivus Inc. (VVUS)’s obesity drug Qsymia was covered by health insurers more often than anticipated in its first week on the market, which may help drive sales.”

However, it is felt now that the drug is losing its momentum.  VIVUS recently indicated that "it was concerned by the lack of coverage of Qsymia by insurers, as just 20% of patients are getting reimbursed for the medicine." This may mean that most insurers are not sure that Qsymia's benefits outweigh its risks.

While both Qsymia and Belviq received a lot of attention from those interested in weight loss drugs, Qsymia arguably received the most attention. And while the drug probably won't go the way of Fen-Phen, market results to date are somewhat disappointing. However, these results will likely improve, if the weight loss benefits of the drug are found to outweigh its risks.

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