USING MEDICATION TO TREAT OBESITY

Two years ago a very obese Choctaw woman walked into a clinic at a university medical center seeking help with an underactive thyroid and thyroid nodules.  Standing 5 ft. 6 inches tall she weighed in at 368 pounds.  She also had diabetes and high blood pressure.  Her thyroid medication was adjusted and the nodules were found to not be cancerous.   But because she already had the risk factors for heart disease and a premature death, attention was given to her massive weight problem. 

She tried hard to comply with the recommended dietary changes and had cut out the sweetened carbonated drinks.  And although she had also cut back on pastries, bread and rice she continued to snack between meals on fruits, cookies and popcorn.  Her preferred drinks at meal time and snack time were Kool-Aid and sweetened tea.  Additional aggressive efforts at dietary changes, increased physical activity, a formal exercise program, and behavior therapy were implemented but when she returned for follow up she had gained an additional 19 pounds, now weighing in at 387 pounds, with a Body Mass Index (BMI) of 62!

Because of the failure of these treatment attempts, and because she had a strong family history of obesity, diabetes, and heart disease, it was at this point her doctors advised her to have bariatric surgery -- a gastric bypass or similar surgery.  But she adamantly refused.  The only alternative she would accept was medication.  Since none of the 5 FDA-approved drugs for treatment of obesity was approved by her insurance plan, and would be paying out of pocket, she opted for the least expensive at  about $35/month. 

Without doing anything different other than taking the medication she began losing weight the first month.  It was a steady and continuous weight loss.  Her diabetes improved even further, her A1C dropping by 10%.  Her blood pressure, cholesterol, and triglycerides also significantly improved.  At the 7 month mark she had lost about 14% of her initial weight (down to 334) without doing anything other than to take her medication.  Her energy and mood level improved to the point that she was now able to walk 45 minutes on most days.

This case was reported and published by the Department of Endocrinology at the University Medical Center in Jackson, Mississippi in the Journal of the MSMA.  The researchers’ interest was in addressing the obesity problem in our state, a problem for which we’ve continued to rank No. 1 in our country for 5 consecutive years.  The lesson they hoped to teach was there are approved medications, one in particular, that is inexpensive and effective.  In spite of the issues surrounding weight-reduction drugs, they urge the medical community to reconsider its use, overcome its misperceptions, and to look back over a long track record of safety experience with the medication; this, in the interest of utilizing the benefit/risk ratio to help a significant part of our population who carry a certain and dismal prognosis in the long run.  About 1/3 of the U.S. adult population are obese, that is, have BMI’s over 30, and statistically will lose 1-6 years of longevity.  Persons with BMIs over 45 have their lives shortened by up to 13 years.

The demand for a drug treatment of obesity has tempted and motivated scoundrels of all types, medical and non-medical persons, in various “weight loss clinics” to promote and use counterfeit drugs with the same name as approved drugs for the sake of easy profits.  The FDA and others continue to attempt to ferret out these counterfeits.

The proper approach to the treatment of obesity (defined as a BMI over 30) is of course the approach these doctors used:  dietary changes, increased physical activity, lifestyle change, and behavior therapy.  If you have already failed using these measures, AND also have a BMI greater than 30, then you may be a candidate for a medication approach to your obesity.  You can quickly determine your BMI by going to the “RESOURCES” tab above and clicking the “BMI Calculator” link.  Your current medical conditions, existing cardiovascular risk factors, and medications are also factors in any decision to prescribe and take a medication.