Posts Tagged ‘Obesity’
Gimmee a Pill Part Deux
Is obesity a disease or a condition? If it is a disease, is it chronic or situational? Does obesity raise itself to a problem which requires the might of pharmaceutical research to overcome, or is it a societal problem? What do you do when one third of the United States population is obese? These are some of the questions that the FDA and its committees have been wrestling with lately.
The weight loss industry is a multi billion dollar a year business and as anyone who has read the labels at the health food stores knows, these substances sold as pills are not FDA approved. Their efficacy is also not known or tested, but that doesn’t really matter because if Kim Kardashian said it works, it’s good enough for me. Most of these diet aides contain substances that allegedly increase metabolism like caffeine or guarana which contains twice the amount of caffeine that coffee beans do to provide “the burn”.
At the present time “real” drugs to make people lose weight come in two basic categories. Fat blockers, like the drug orlistat known as Alli and produced by GlaxoSmithKline, is one type. This drug is the equivalent of a movie which goes straight to DVD. This drug went almost straight to over the counter because although it works, it is punitive. The drug works by blocking the absorption of fat in what we eat. It causes a condition much like those individuals who lack pancreatic enzymes and cannot digest food properly. The outcome, if you foul up and eat something you should not, is pretty unpleasant. Be sure to buy extra underwear!
The second class of drugs target serotonin. This was one part of the famous Fen-Phen combo that was pulled by the FDA after reports of valvular pathology appeared far removed from the time frame of study. To make it clear - if a study lasts one year, how do we know what will happen if five years later you are still taking the drug? After taking the drug for many years, some patients developed what clearly was a side effect related to fenfluramine. So many law suits were filed that the company went bankrupt.
Two new drugs have appeared on the horizon, but strike me as lacking what’s needed. The first is a compound called Qnexa which is a combination of phentermine (how original) and topiramate which is an approved drug for seizure prevention and migraine prevention. I do not understand the mechanism of the action, but it appears that this combination allows patients to lose weight. However, it also causes the side effects of and I quote “depression, anxiety, sleep disorders, attention deficit disorders, memory difficulty, language difficulty, increased heart rate and teratogenicity (deformed babies)” to name a few. As Doctor Evil would say “Riiiiiight”.
This drug was not approved at the FDA committee meeting. It is unlikely that it will ever pass the hurdles. Stay tuned for the second drug.
Gimmee a Pill!
When I was a child I had four great-grandparents. Two were from Russia and two were from Poland. My grandparents were actually born in the United States. My last great-grandparent died at the age of 96 when I was 31 and in training after medical school. She was someone I knew as a full person and not just as a grandparent. Interestingly enough she actually came to the United States not once but twice. She returned to Russia because she did not like the conditions in New York City when my maternal grandmother was five years old. She quickly returned to the United States when she got back to Russia.
My great grandmother suffered from congestive heart failure and loved to eat anything salty. Pickles, lox you name it she ate it and then she would call me up and complain she was short of breath. She wanted no part of diet restriction and all she would say was “Gimmee a pill”. Then she would infer that I wasn’t as smart as I should have been because I didn’t have a pill to solve her problem.
We as a population have become much like my great grandmother. Maybe she was on to something. The area of life which comes to mind the fastest is that of weight loss. No one wants to hear or deal with the knowledge base we have. Eat less, actually a great deal less, and get some exercise, actually a great deal of exercise, and guess what? You will lose weight and keep it off. Whoa that’s just not going to cut it. “Gimmee a pill” screams America and what America wants is big Pharma to continue to serve up.
What is a significant weight loss induced by pills? Give up? One would hope it would be 20-30 pounds, or in the case of gastric bypass or the Biggest Loser TV show, at least an entire person worth. You will find out that’s not the case.
Should drugs even be used in what is generally a self induced problem? Obesity is epidemic in this country, and childhood obesity has become a national disaster that will dwarf all health care spending deficits. As you will see in my next blog, approving these drugs is not an easy task, and as most people will remember the diet drug combo known as Phen-Fen was removed from the market only when its serious side effect of heart valve problems became an issue. This has made it even harder to approve these drugs as the heart problems did not become evident for many years after the drugs were marketed. What is “reasonably safe” and is this a problem for which there is a “medical solution”?
I will discuss these issues in my next blog. Until then I’m going for ice cream.
The Opportunity We Lost
Healthy People 2010 was launched in 2000. The aim of this project was to reduce the number of cardiovascular deaths by 20%. This is certainly a worthy project. The results were published in the Bulletin of the World Health Organization in February.
I’m sure you can guess but we didn’t make it. 400,000 deaths in the U.S. from cardiovascular disease are projected to occur this year. I want to put this into perspective. 416,000 servicemen and women died during World War II. Each year, we lose that many people to heart disease. You would think there would be uproar. The only sound I hear is snacking.
What exactly seems to be the problem? We have had a reduction in improved total cholesterol and in lower blood pressure in men. We have also increased physical activity and decreased smoking. However, this is almost totally offset by an increase in obesity and diabetes.
We must rethink the balance of government and personal responsibility. The government does not make us eat more or make us fat. The government can limit the salt in food and demand that soft drinks be removed from schools. We can develop all sorts of medications, but it seems to come down to what will you do for yourself and most of it seems to revolve around how much you eat. Most diabetes is related to simply being overweight. This is a personal responsibly and until we grasp this future progress may not be made.
The most recent National Health and Nutrition Examination Survey found that most Americans are overweight and one-third are obese. Obesity has overtaken smoking as a major health burden in the United States. This is very apparent if you travel anywhere outside the United States and compare average body size. Don’t go to Disney World, it is truly disheartening.
Let’s all pledge to lose 10 or 15 pounds. We went to the moon. We can understand this problem and solve it. It won’t be solved by drugs, it must be solved by education and the simple understanding that we eat too much. Put down the remote and do something.
Metabolic Syndrome: Three Steps Away from Cardiovascular Disease
One of the challenges in the practice of medicine today is the general obesity of the population. In cardiology we share a syndrome with the endocrinologists called the Metabolic Syndrome.
This syndrome is defined by several factors of which at least three are required for diagnosis.
1. Central Obesity which is defined as waist
circumference > 40 inches for male or 36 inches
for female
2. Dyslipidemia Triglycerides >150 mg/dl
3. Dyslipidemia HDL C <40 for male or <50 for female
4. Blood pressure > 130/85
5. Elevated fasting glucose >100 mg/dl or the use
of diabetic medication
One can easily see just how many people fall into this syndrome. The hope is that by identifying those people with it treatment programs can be put into place that will limit the long-term risk. One study published in 2008 looked at over 30,000 men enrolled in an aerobics program from 1979 to 2004. All the individual risks were associated with increased death; both all causes and cardiovascular. The most worrisome aspect was the finding that this was additive. The more risk factors the higher the risk of death.
This syndrome at least doubles the risk of developing cardiovascular disease. Many of these patients go on to develop type 2 diabetes. Additionally, this syndrome is associated with increased levels of C-reactive protein and other proinflammatory cytokines. Although this is not a therapeutic target it does help with treatment choices.
Next: what can be done to help.
About the Institute
Browse by Category
- Acute Coronary Syndrome (14)
- Adult Stem / Cell Treatment (10)
- Angioplasty (4)
- Aortic Aneurysms /Stents / Grafts (13)
- Atherosclerotic Heart Disease (12)
- Atrial Fibrillation (11)
- Cardiac Imaging (4)
- Cardiac Surgery (19)
- Carotid Disease (7)
- Cholesterol (51)
- Chronic Angina (13)
- Clinical trials (3)
- Coronary Artery Disease (34)
- diabetes (15)
- Heart Failure (30)
- High Blood Pressure (22)
- Myocardial Infarction (36)
- Pacemaker / AICDs (9)
- Peripheral Artery Disease (5)