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Tuesday, August 4, 2009

WEIGHT-LOSS DRUGS: PILLS AND SUPPLEMENTS

Weight-loss drugs are intended to enable patients to lose weight more effectively than diet or exercise alone by suppressing appetite, inhibiting the absorption of fat, or in some cases, increasing the metabolism slightly. Maximum weight loss as a direct result of the drugs will generally show results within the first six months. A patient could also lose weight due to the drugs after the first six months, but it will be a moderate weight loss. The length of time during which a person will continue to lose weight as a direct result of the weight-loss drug depends on how long it takes his or her body to adjust to the medication. Despite the efficacy of weight-loss drugs, the likelihood of losing significant weight without also increasing exercise or making dietary changes is unlikely. For this reason, patients should always incorporate at least some form of exercise and dieting as part of their weight-loss plan. Even if a patient’s weight loss has leveled and he or she has reached a target weight, the individual must continue to take the medication to maintain the weight loss; this is controversial because some doctors believe the safety of taking many of these drugs for decades is not yet well known. We know that many weight-loss drugs cannot be taken long term, and therefore the patient must switch to another weight-loss drug, further increase exercise, or adjust his or her diet.




Weight-loss drugs are generally prescribed for people who are obese, not those who are slightly overweight or those looking to get ultra-slim. The most common guideline used to determine who is underweight, normal weight, overweight, or obese, is the body mass index (BMI). The body mass index is a guideline of how appropriate a person’s weight is given his or her height. BMI is a number that represents weight divided by height squared. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) define the weight status categories with BMI ranges for adults in the following table:





To illustrate what these numbers translate to in pounds, the following information demonstrates various BMI categories for a person who is 5’9" tall.



There are two additional subcategories, morbidly obese and super morbidly obese. Morbidly obese represents people with a BMI of 40.0 to 49.9, and super morbidly obese refers to people with a BMI of 50.0 and above.

Assessing weight with BMI also has its critics in the medical community. The problem with BMI to determine a healthy weight is that is does not account for how much muscle a person has. An extremely muscular person may be considered overweight according to BMI but could be healthy and fit. Consider, for example, the basketball player Shaquille O’Neal. At 7’1" and 325 pounds, O’Neal’s BMI is 31.6, which puts him in the "obese" category. Shaquille O’Neal is definitely not obese; he is extremely muscular, and therefore BMI is not a suitable evaluator of his health. A person also could have a normal BMI but be in poor nutritional health. Elderly people who have lost muscle due to inactivity might be considered a normal weight due to their BMI but in fact may have reduced nutritional reserves.



For children and teens (ages 2 through 19), the criterion for overweight is slightly different than for an adult. For children and teens, BMI age- and sex-specific percentiles are used because the amount of body fat changes with age, and the amount of body fat differs between girls and boys. To be considered overweight, a child or teen would be in the ninety-fifth percentile or higher for his or her age based on BMI. Being in the ninety-fifth percentile, for example, means that
the individual’s BMI is greater than 95 percent of the other individuals in the same age category. A child or teen in the eighty-fifth to ninety-fifth percentile is considered at risk for overweight, according to the Centers for Disease Control. The CDC does not provide a definition for obese children and teens, although the term childhood obesity is used in their literature.

In the United States, one-third of all adults are overweight, a statistic that has been consistent since 2002; the percentage of overweight children, however, is on the rise. According to the Mayo Clinic, since the 1980s, the prevalence of overweight children ages 6 to 11 doubled and the number of overweight teens tripled. According to the Centers for Disease Control, approximately 18.8 percent of U.S. children and 17.1 percent of teens are overweight. Being an overweight child or teen greatly increases the chances that he or she will be an overweight adult and therefore be at a greater risk for obesity-related health disorders, such as type 2 diabetes and heart disease.

The U.S. Food and Drug Administration (FDA) is the agency responsible for protecting the public from unsafe drugs; however, the FDA has much more control over prescription drugs than it does over nonprescription drugs and dietary supplements. A dietary supplement is a pill, capsule, powder, or liquid that supplies nutrients such as vitamins or minerals. A multivitamin is an example of a dietary supplement. Taking fish oil to assist with lowering blood cholesterol would be one way that a person might use a dietary supplement. Although the nutrients in supplements are in foods, the FDA does not consider them foods.

Drugs that require a prescription must produce research to show that they are safe and effective before the FDA approves them for sale. Dietary supplements do not have to be approved by the FDA to be sold. Dietary supplements must not, however, be marketed on false or misleading claims. The FDA can only intervene after the product has reached the market and there is evidence that it is dangerous to human health. This lack of regulation has proven to be a danger to the public, as is the case with ephedra, which caused several deaths before the FDA stepped in and banned this supplement.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

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