Wednesday, March 30, 2016

Diet, Exercise and Drugs for Weight Loss

When most people are faced with the need to lose weight, they usually turn first to diet and exercise. But after a while, most people either don't lose much weight, or they regain the weight they did lose. However, the addition of obesity drugs to a weight loss program may enable a person to lose and maintain the weight loss -- at least enough of the weight loss to improve health.

Many experts suggest that a 5% weight loss can improve an overweight or obese person's health. The CDC states that "no matter what your weight loss goal is, even a modest weight loss, such as 5 to 10 percent of your total body weight, is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars." Similarly, Weight Watchers indicates that "for most people 5% is enough to lower the risk of developing type II diabetes." Weight Watchers also suggests that the 5% weight loss could "lower [a person's] blood pressure."

Still, most people will regain the weight even after a modest 5% weight loss. But obesity drugs can offer hope to people who have trouble maintaining weight loss. Drugs on the market that fight obesity may help people who satisfy the drug usage guidelines. The drugs include Qsymia, Contrave, Saxenda, and Belviq. In clinical trials, these drugs enabled many subjects to lose 5% of their body weight, and maintain the weight loss for at least a year.

Thus, there is a good chance that anyone of these drugs, when used in conjunction with a good diet and exercise program, will benefit overweight and obese persons who want to lose and maintain at least 5% of their weight loss.

Now in general, to satisfy the obesity drug usage guidelines mentioned above, a person's BMI must be 30 or above with no comorbidity or 27 or above with one or more comorbidities. Indeed, as WEBMD puts it, "Doctors usually prescribe [these drugs] only if [a person's] BMI is 30 or higher, or if it's at least 27 and [the person has] a condition that may be related to [the person's] weight, like type 2 diabetes or high blood pressure."

At any rate, for those persons needing to lose weight and maintain the weight loss, drugs plus exercise and diet might be an important combination.

Wednesday, March 23, 2016

Endoscopic Sleeve Gastroplasty

Bariatric surgery is an effective weight loss approach. Non-surgical weight loss approaches, such as pharmacotherapy, diet, exercise and lifestyle modification are often less effective than weight loss surgery. However, weight loss surgery has more associated complications than non-surgical methods. And less than 2% of the people who qualify for the surgery get the surgery. Fortunately, experts are exploring endoscopic surgical options that may reduce complications, and possibly make additional weight loss surgical options available to more candidates. One of these options is endoscopic sleeve gastroplasty (ESG).

Endoscopic procedures are done via the gastrointestinal tract using a flexible endoscope. Usually there are no surgical incisions associated with endoscopic procedures.
ESG is a form of bariatric surgery. Bariatric surgical approaches are restrictive, malabsorptive, or a combination of these approaches. For instance, the adjustable lap band is restrictive because it restricts the amount of food that pass through the band into the stomach. And gastric bypass surgery is both restrictive and malabsorptive. It is restrictive since it shrinks the size of the stomach, reducing the amount of food a person needs to eat to feel full. Gastric bypass surgery is also malabsorptive, because the surgery reroutes the small intestine in a way to cause food to bypass parts of the small intestine, allowing fewer calories (and nutrients) to be digested.

ESG is a restrictive form of bariatric surgery since the minimally invasive surgery reduces the amount of food the stomach can hold. The surgery can be an effective weight loss approach. Researchers at the Mayo Clinic in Rochester, Minnesota concluded that "ESG delays gastric emptying, induces early satiation, and significantly reduces body weight. ESG could be an alternative to bariatric surgery for selected patients with obesity." Another study indicated that "Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique."

Other examples of endoscopic weight loss procedures include the endobarrier and the gastric balloon. The endobarrier is a liner that is placed, endoscopically, in a portion of the small intestine. The device is designed to limit food digestion in a way that mimics gastric bypass surgery.

The gastric balloon is another endoscopic weight loss procedure. The device is first placed into the stomach endoscopically. The balloon is then filled with liquid or air. When the balloon is filled, a person's stomach feels full with less food. This can enable a person to eat less and lose weight. 
The recent FDA approval of two versions of the gastric balloon -- one manufactured by Apollo Endosurgery, Inc. and the other manufactured by  ReShape -- shows how far endoscopic procedures have come. As other endoscopic procedures, like ESG, are developed, tested, and proven effective, weight loss options will be enhanced. 

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