Thursday, June 25, 2015

Diet and Exercise Can Lead to Long Term Weight Loss

For long-term results, nonsurgical approaches to weight loss are generally less effective than surgical approaches. Bariatric surgery is more or less the gold standard in the minds of some people when it comes to weight loss. Still, studies show that some diets and adherence to exercise can lead to long-term weight loss, and to better health.

Recent studies have shown that some commercial  weight loss programs are effective programs. According to U.S. News & World Report, Weight watchers and Jenny Craig programs "had the best evidence that dieters could lose meaningful amounts of weight and keep it off for at least a year."

And in another investigation, U.S. News & World Report  concluded that the DASH diet (dietary approaches to stop hypertension diet), was a good diet for "preventing diabetes and heart disease."  So diet can be an effective weight loss method for a relative long period of time, and diet can improve metabolic health.

Exercise can also be helpful in weight loss and beneficial to metabolic health. One doctor, affiliated the 'Biggest Loser' TV show, suggested that "exercising for four hours a day and following a strict diet can yield the same results as weight loss surgery." And another study indicated that "normalization of metabolic control can be achieved after low intensity exercise in individuals with IGT [impaired glucose tolerance]."  Therefore, combining a good diet with exercise could be a worthwhile approach.

While bariatric surgery is considered by some to be the best way to lose weight and maintain the weight loss, diet and exercise, under the right circumstances, might be a winning combination for weight loss and weight maintenance. So, depending on the patient's inclinations and the patient's BMI, a weight loss provider may appropriately advise diet and exercise, even if the patient is eligible for weight loss surgery. Further, diet and exercise will likely be less costly and less traumatic than surgery for the patient.

Friday, June 19, 2015

Using Obesity Drugs in Combination with Bariatric Surgery

Over the past three years, new obesity drugs have gained FDA approval and become available for the treatment of obesity. These drugs are Qsymia, produced by Vivus, Belviq, produced by Arena, Contrave, produced by Orexigen and Saxenda (liraglutide), produced by Novo Nordisk. These drugs give bariatric service providers new tools to fight obesity. Bariatric surgery, including gastric bypass surgery, sleeve gastrectomy and the lap band, is another tool that bariatric service providers use. Now, some providers are wondering if obesity drugs and bariatric surgery can be combined to deliver optimum weight loss and weight loss maintenance.

Although not much research has yet been devoted to combining bariatric surgery with obesity drugs, the approach is a natural progression in obesity treatment. One expert indicated that "While surgery can provide tremendous benefit, we are realizing that medications may add to this benefit. Many insurers require preoperative weight-loss, and medications may aid in this effort." Further, as the expert suggests, "In addition to utilizing medications preoperatively, there may be a use for obesity medications after surgery."

One small study has shown that  weight gain after bariatric surgery was "significantly reduced after treatment with liraglutide." The investigators concluded that liraglutide may be a treatment for those persons who don't lose much weight or those who regain the weight after weight loss surgery.

One of the most popular obesity drugs is phentermine. It was approved for short term use by the FDA in 1959. Phentermine was part of the Fen-Phen obesity drug taken off the market in the 1990s because of severe side effects. Although phentermine is only FDA approved for short term use, obesity medicine specialists prescribe the drug off-label for long term weight loss -- with good results. And some physicians have suggested that phentermine should be considered for those patients who don't experience good weight loss after bariatric surgery.  

We generally view pharmacotherapy as a weight loss tool to be used in conjunction with diet and exercise. But it makes sense to consider the surgery-obesity-drug combination. This consideration could grow the obesity treatment options.

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