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  • Jan4

    How Losing Weight Helps Your Heart. Are You Actually Overweight?

    Posted in: High Cholesterol, Hypertension, Obesity and Weight Loss, Wellness and Health

    The first big JAMA study of the new year (Happy New Year!) implied that you can be overweight or barely obese, and not die early because of it.

    In between the lines: yes….in that population. Why?

    Because they get medical care right away!. Because they get sicker sooner! Because their pre-diabetes, hypertension and high cholesterol gets screened for and picked up and treated!   And because being sick–like with cancer, immune disease, and heart disease–can make you less fat, because you feel sick!

    Plus, looked at internationally (as this study did), people of lower weight were often malnourished and sickly, and in some cases, starving.

    So much for “spinning the data.”

    Here is what you need to know about who is actually overweight, and why weight loss treats heart disease.

    74% of men and 68% of women in the U.S are overweight or obese, and the rest of the world is rapidly catching up.  Most men and women don’t know where they fall. You can measure your body mass index (BMI), measure your kid’s BMI, or just look below: for both men and women:

    If you’re 5-foot-10-inches, normal is 132 -167 pounds; an overweight is 172- 202 pounds, obese is 209- 236 pounds; severely obese starts at 243; morbidly obese starts at 278.

    If you’re 5-foot-5-inches, normal 114-144; overweight 150-174; obese is 180-204; severely obese starts at 210; morbidly obese starts at 240.

    Weight loss helps your heart because it lowers your blood pressure and your blood lipids including triglycerides and LDL cholesterol; it helps you metabolize sugar more efficiently; it improves insulin sensitivity; and it reduces inflammation. And inflammation probably causes heart disease.

    Not to mention makes it easier for the heart to pump blood where it needs to go!

    No one said it was easy to lose weight and keep it off: crappy, cheap, alluring high-calorie low-nutrient foods are everywhere. Produce is not as cheap or accessible as highly processed food. People often don’t have sit down meals, and motivation is a very weak leg on which to stand.  What you need is a plan, accountability, self-monitoring and the right foods for you.

     

     

  • Jul18

    Diet Drug Redux: How Will Qsymia and Belviq Change Practice?

    Posted in: Common Conditions, Obesity and Weight Loss, Wellness and Health

    With the newly FDA-approved Qsymia available in the 4th quarter at earliest, and Belviq probably the same or later, it’s too early to know what doctors will do.

    But nearly a generation has passed since 1997 when one too many docs recoiled in fear, having prescribed the off-label phen-fen to young women, some of whom later developed heart valve problems. Interestingly, docs don’t take prescription weight loss drugs themselves.

    Then the obesity rate was 33% in women, and  27% in men (versus 35% today for both).  Hmmm. There’s something there, about that difference between men and women.

    And since memory is short and the art is long, and medicine is more competitive than ever, and patients more well-informed than ever, docs will prescribe them and that will be an opportunity gained–for waist measurement. My favorite measuring tape is cloth and hard to find: I use it in my own clinic: look for it here.

    Financial companies are delighted: pharma is one of 4 industries in Merrill’s Globesity Index, estimated to prosper in the coming 25-50 year global crackdown on obesity.  The other 3: sportswear, nutrition and diet industries.

    Dieters should be cautious. Not because these drugs don’t work: they seem to, like Meridia and Orlistat before them (Alli is still on the market OTC).  But because too many physicians have not been trained in how to push the right buttons for their patients who want to lose weight and keep it off.

    A simple “lose some weight” or “eat less and exercise more” or “eat less sugar and fat” are not enough.  But they are all many physicians have been schooled in, and doctors themselves could set a better example.

    Even educated commentators writing in prestigious journals make the inane mistake of saying “fizzy drinks and chips are fine in moderation.” No, they’re not. Not if you’re trying to lose weight.

    Instead, what is on the horizon are excellent devices and programs that allow dieters to do it themselves, without pharmaceuticals, like the Fitbit Ultra, which I recommend to patients and the Withings Scale, which I also recommend.

    There are some cases in which medicine is responsible for overweight: many antidepressants, steroids, even insulin.  Yet the cure is in the kitchen, and with the right foods, and a smart approach–one that embraces and uses social technology and mobile health–will allow DIY answers.

     

  • Jun28

    Should You Take the New Diet Pill in the New Health Care?

    Posted in: Drug Food Safety, Obesity and Weight Loss, Wellness and Health

    Amid the hub-bub of the week, with the Supreme Court affirmed Affordable Care Act health care law upheld, and with one JAMA study showing that 21 people on 3 different diets for 4 weeks each burn calories differently (no real surprise here: the lowest carb diet had the highest energy burn, the second lowest was second, and the highest carb, well, was bad for metabolic syndrome), other news–that the first prescription medication for obesity in 13 years has been approved–slipped under the radar.

    In other words, there is a small high profile study in a reputable medical journal that shows that the kind of calories you eat matters, that calories are not all alike, and that eliminating ultraprocessed carbs gives you a better chance of idealizing your weight.

    And also, now, there’s a new FDA-approved drug, Belviq, for obesity. And maybe a second one, called Qnexa, shortly.

    Belviq (generic = locarserin) is metabolized by the liver: it acts in the brain to promote satiety by activating the serotonin 2C receptor to increase satiety and taste aversion (so food doesn’t taste good).

    About half of obese people who took the drug for a year lost at least 5% of their body weight, compared to 20% of dieters who took a placebo pill.

    But people have trouble staying on it: 40% dropped off in a year.

    And the drug was turned down in just 2010 because of safety problems (principally psychological and cognitive ones). It can interact with medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclics, lithium, selective serotonin uptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), or antipsychotics.

    It will be available, reportedly, in early 2013.

    Qmexa, on the other hand, is a phentermine (the go-go-go of phen-fen fame) and long-acting topiramate (the anti-seizure drug) combo. Research subjects lost, on average, about 6% of body weight, vs about 2% on control medication, per year.

    Phentermine has been on the market for over 40 years; it is a stimulant, and boosts blood pressure and pulse slightly. Topiramate sometimes causes fatigue, slowed thinking, and impaired memory and concentration. 

    Nevertheless, the FDA wants doctors to have another tool in the tool belt, and with the US Preventive Services Task Force suggesting that all docs should measure BMI, and treat people who measure over 30 kg/m2 (and with Medicare already paying for 22 visits per year for obesity), I think the tide is turning. Doctors are going to become interested in treating obesity again, if they are paid and trained to do so.  And have new drugs. And they will.

    The real questions: are you really better off taking a pill than getting on the right lifestyle program for you? Do you think that the diet and lifestyle programs that are supposed to come with these new drugs will integrate the nutritional science above? Will our new DIY economy spill over into health care, so you do more of this too, or will you become integrated into the health care system, now that nearly everyone will be covered (say, 5 years from now, and excepting Medicaid patients, whose coverage will likely be quite limited)

    Will you be able to say to your doctor…I want your help in losing weight but I don’t want to take drugs? One on one self-monitoring, accountability, individual diet, and tailored fitness programs? Or will you just want the drugs, because they’re new, and your knees hurt, and you’ve tried to stick to diet and exercise, but they’re just not enough? What if you just want the best online programs, rated for weight loss?

    I don’t know, but I can’t wait to find out. Meanwhile, you’d be shocked what simply cutting out ultraprocessed carbs and calories will do to your weight. Here’s a first step.

     

  • Feb15

    How To Recognize If Your Child Is Obese: Results from a Pediatrician’s Office

    Posted in: Child Obesity, High Cholesterol, Obesity and Weight Loss

    Many studies now show parents underestimate their overweight kids’ weight.

    A New York pediatrician’s office shows that barely 10% of parents of overweight kids actually thought their kid was overweight.

    In contrast, fully 60% of parents of normal-weight kids knew that their kid’s weight was normal. Parents of overweight kids were off by an average of 45%tile.

    Parents of normal-weight kids who underestimated are more likely to be concerned about their child’s weight than parents who get it right.

    Parents most likely to make changes are those who knew that they themselves were overweight, had overweight kids over 8 years old, and those who thought their kid had a health problem.

    Obese children have a high risk of diabetes, high cholesterol and metabolic syndrome. These are all disorders thought only to occur in adults–like my patients–until several years ago.

    Bottom line: parents have a hard time discerning when their child is overweight, and it is different for adults than for kids.  For kids, use the BlubberBusters BMI for kids calculator: good, clear explanations and info.

     

  • May11

    Marching Orders for Docs, Hospitals: The White House Child Obesity Report

    Posted in: Wellness and Health

    Today, the White House Task Force on Childhood Obesity has released its recommendations and report. Of course, it needs a roadmap: recommendations without funding or teeth just set the agenda. But for doctors, hospitals and insurers, the assignments are clear.

    *Doctors should
    a. calculate BMI, beginning at age 2
    b. tell parents how to keep kids slim (this is worth a lot, as most MDs are frustrated and feel ineffective)
    c. prescribe, on a Rx pad, healthy active living

    *Insurance should cover assessing, preventing and treating overweight and obese kids.

    *Medical schools, associations and health care systems should train and teach pediatric obesity prevention and treatment.

    How will this work? The NCQA, which monitors quality for health care plans using a tool called HEDIS, will track rates of BMI assessment, nutrition and physical activity counseling. And payment dollars *may* follow. What a big If!

    Childhood obesity increased by 10% between 2003 and 2007. 16.4% of U.S. kids are obese and 31.6% overweight.

    The incentives have been not to write recipes on prescription slips, or prescribe free play. That takes training and time which most health providers don’t have and don’t get paid for.

    But physicians and hospitals are no different than other workers: they do more of what they are paid and trained to do. Let’s move!

     
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