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Obesity Fact #8: Obesity Drugs Can Help Some Patients



sharma-obesity-medicationsObesity Fact #8 from the New England Journal of Medicine paper on obesity myths, presumptions and facts, states simply that,

“Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used.”

While it is no secret that the history of obesity medications has been rather disappointing (not to say disastrous), with the few meds available (largely in the US), a relevant proportion of patients do achieve clinically meaningful weight loss, which they can hope to maintain for as long as they stay on these medications.

This need for long-term use is no different for medications than for the use of diets or other interventions – when interventions stop (and this includes reversal of bariatric surgery), weight comes back – no surprise here.

The authors further qualify their statement by adding,

“While we learn how to alter the environment and individual behaviors to prevent obesity, we can offer moderately effective treatment to obese persons.”

I might have worded this slightly differently, because irrespective of whether we manage to change the environment or behaviours to prevent obesity, we will always need to offer effective treatments to obese persons – these have always been and will always be around, no matter how effective our preventions measures.

As I have said before, people struggling with the health impacts of excess weight deserve effective treatments in the same manner that we offer treatments to people with other chronic health conditions – anything less is simply weight-bias and discrimination.

Sadly, the range of effective and safe medications we can use for treating obesity remains limited, which in itself may well in part be a reflection of weight-bias and discrimination – but I’ll save that discussion for another post.

AMS
Edmonton, AB

4 Comments

  1. Sure, drugs can assist people in losing weight. When will we break free from the notion that weight loss is an issue? Weight loss, in the grand scheme of things, is not all that difficult. Most people can do it — with drugs, commercial programs or simply implementing their own creative restriction system. When will we put energy into medically assisting weight maintenance and weight-loss maintenance? That’s where people need help. Leptin replacement may be a good start in the latter, but research stalls as energy is invested in all this irrelevant weight-loss crap.

    I shake my head.

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  2. I agree with DebraSY’s sentiments!

    Formerly obese persons like myself (those of us who eventually deduce that our “morbid obesity” was symptomatic of dysregulated neuroendocrine/metabolic pathways) may encounter a jarring reality after significant reduction of our adipose cell tissue. We discover that our abundant and large adipose cells were providing some compensatory (although inadequate) homeostatic/regulatory functions, which cannot simply be replaced or repaired by changing our behaviors, lifestyles, attitudes, or psychological stress factors.

    In other words, after significant reduction of adipose cell size, when the underlying pathological functions (e.g. neuro/endocrine/metabolic alterations) have not been identified or effectively treated, people may continue to suffer from distressing, chronic and significant symptoms of ongoing pathology: e.g. chronic REAL hunger and/or powerful impulses to eat more (often resulting in regain); or increased severity of long-term symptoms of impairment in cognitive functions, or mood self-regulation, or stress-response regulation.

    Symptomatic improvements (in blood glucose regulation, blood pressure, etc)—accompanying fat reduction and reduced social stigma—may have little or no impact on the underlying pathological/physiological alterations (neuro-endocrine-metabolic impairments that accompanied or originally contributed to increased fat mass) which, in that case, remain as chronic (i.e. unsuccessfully treated) pathological conditions—including when fat cell mass also remains reduced.

    Therefore, I’m beginning to wonder if the perceived negative “health impacts” of “excess weight” may sometimes, more accurately, reflect a discursive (rhetorical) distortion of “pathological processes” and “health” as currently conceptualized. That is, dominant discourses currently construct a reduction in “excess weight” as evidence of reduced pathological (disease) processes or as evidence of a reduction in “health risks”. However, the reduction of “excess weight”—given the current intensity of focus on changes in surface appearances and on overt, easily-measured symptoms (e.g. BP, BG)—may mostly provide an illusion of reduced pathology while it serves to obscure (hide, distract attention from, and/or minimize) the ongoing and underlying pathological (disease) processes.

    In light of the overwhelming failure rate (re: weight loss usually followed by regain), the continuing focus on “excess weight” as the salient pathological condition (or disease) also serves to maintain the social status quo—which perpetuates social inequities and injustice—including, for example, both social privilege (authority, professional status, increased material security) and social stigmatizing of individuals and groups who are not able to conform to socially constructed standards of “normalcy” and “health.”

    Furthermore, if helping some people to lose weight reflects “the same manner” in which health care providers “…offer treatments to people with other chronic health conditions” then I hope it is standard medical practice—at least—to offer additional, effective interventions—that is, to provide relief and to preserve the patient’s quality of life when iatrogenic treatment responses occur, or when treatment efforts fail to effectively diminish suffering.

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  3. There are stages in my depression where if I try to restrict eating carbs and fats I know that I will completely fall apart. When my depression is successfully managed, I can lose weight without “dieting.”

    I wonder when people will figure out that the weight REFLECTS the problem, not IS the problem!

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  4. What drugs are effective? Of course this varies by individual and etiology, but I’d love to see a brief summary of who responds to what. Any have a link or offline source?

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