Weight Management Program - Obesity

What is it

Obesity is defined as a body weight greater than 100% over the ideal weight.

An easy way to determine your frame size is to circle one wrist with the middle finger and thumb of your other hand. If the fingers just touch you are medium frame, if they overlap you are a small frame, and if they can't reach you are a large frame.

It Kills

It is a serious medical problem with greatly increased risks of heart attack, stroke, pulmonary embolus, hypertension, diabetes and others.

Its Not Your Fault

It is a chronic disease with a strong genetic component. If one of your parents is obese, your risk are >50% of being obese. If both of your parents are obese, your risk of being obese is greater than 80%.

It is treatable

There are many treatment options now. These consist of three components, diet, exercise, and medication.

Diet

Most important is diet. We recommend a low fat diet, typically 20-30 fat grams a day for women, and 30-40 fat grams a day for men. If you don't want to read labels and count fat gram, there are many prepackaged health food items to choose from.

Exercise

To lose weight, you must do aerobic exercise. Aerobic exercise is continuous exercise that gets your heart rate up. For a healthy heart you should exercise a minimum of one half hour three times a week. To lose weight, the more the better. Examples are walking, jogging, swimming, treadmill, and stair climber machines.

Enter in your weight and how many miles you jog or run then click on the calculate button to see how many calories are consumed.

Isometric exercise helps to tone muscle. Examples of isometric exercise are weight lifting and weight machines.

It takes a lot of exercise to burn off calories. The following table shows the number of calories burned per hour for various activities.

Medication

Research by Dr. Michael Weintraub changed the thinking on diet medication. He tested the combination of phentermine with fenfluramine, commonly known as "phen-fen". He showed that diet medication could be used up to three years with continued and maintained weight loss. Perhaps more importantly, he stressed that obesity is a chronic medical problem like diabetes or high blood pressure, and may require treatment for life. It is not a character defect or moral weakness. Weight Loss Rx

Phentermine (Adipex P, Fastin, Ionamin)

Phentermine is the most effective, safest, least expensive diet medication. On it most of our patient lose five to ten pounds a month. It is taken once a day in the morning, and is time released to suppress your appetite all day long. Side effects are usually minor, including dry mouth, constipation, rapid heart rate, and nervousness. Some people find they have more energy and use this to exercise more. It is not associated with the rare but fatal lung disease of PPH (primary pulmonary hypertension). It can not be taken by patients with heart disease (angina or heart attack), and some kinds of glaucoma. In Dr. Weintraub's research it was as effective as alone as the combination of "phen-fen".

Diethylpropion (Tenuate, Tepanil)

Diethylpropion is similar to phentermine, but tends to have less but similar side effects, and is available in once daily doses of 75 mg, or 25 mg three times a day.

Rimonabant (Accomplia)

Accomplia brand name of generic Rimonabant has been released by Sanofi-Adventis. It is the first drug in a new class of weight loss drugs known as selective CB1 endocannabinoid receptors. It promises to not only to help lose weight, but also to stop smoking and drug addictions. Accomplia has been called the “Anti-Marijuana” because where Marijuana gives people the munchies, Accomplia decreases apetite by blocking instead of stimulating the CB1 receptors.

Topamax (Topiramate)

Topamax brand name of generic Topiramate is used for various medical problems including migraine headaches, seizures, and behavior problems in children. As a side effect it was noticed that people taking the drug lost typically twenty pounds. It is used off label as a weight loss medication. Our patinets report that it makes sweets taste funny and helps with the craving for carbs. One patient said it made Coke taste like acid.

Phendimetrazine (Bontril, Plegine)

Phendimetrazine is similar to phentermine, but is in a stronger strength category.  Some people finds it works better than phentermine, others find it doesn’t work as well.  It is available in once daily doses of 105 mg, or 35 mg three times a day.

 Symlin (pramlindite), Byetta (exenatide) and Victoza (liraglutide)

 Symlin (pramlintide), Byetta (exenatide) and Victoza (liraglutide) are medications used to treat diabetes that cause weight loss.  They work in the brain to decrease hunger, and cause a feeling of prolonged fullness after eating by delaying emptying of the stomach.  They also stabilize glucose levels.  A one month trial is available from the manufacturer.

Qnexa

 Qnexa from Vivus is a combination of phentermine and Topamax in a single pill.  In one study patients lost 37 pounds in 56 weeks.

Loracaserin

 Loracaserin from Arena Pharmaceuticals helps lose weight by creating a feeling of fullness.  In one study patients lost 35 pounds in one year.

 Contrave

 Contrave from Orixigen is a combination of bupropion and Naltrexone.  Bupropion is an antidepressant also used for smoking cessation that is chemically similar to diethylpropion.  Naltrexone is a narcotic antagonist used for the treatment of alcohol addiction.  In one study patients lost 9.3% of their body weight in 1 year.

Orlistat (Xenical)

Orlistat is a fat blocker that keeps up to 30% of dietary fat from being absorbed into the body. Dosage is 120 mg up to 3 times a day taken ˝ hour before meals containing fat. Common side effects include cramping, diarrhea, gas, and uncontrollable oily leakage.

Sibutramine (Meridia)

Sibutramine is an appetite suppressant chemically similar to antidepressants with side effects similar to them, most commonly dry mouth, insomnia, nausea, and headache. Daily doses of 5, 10 and 15 mg are available.

Fenfluramine (Pondamin) withdrawn from market 9/23/97

By itself, fenfluramine is a relatively mild appetite suppressant. It has just the opposite side effects of phentermine. It makes some people sleepy, and can cause diarrhea. By using them together, the side effects of both can be reduced. It has been associated with PPH, and heart valve damage .

Dex-fenfluramine (Redux) withdrawn from market 9/23/97

Dexfenfluramine is a relatively new diet medication. It is the chemical mirror image of fenfluramine, and has similar action and side effects, including the risk of PPH and heart valve damage.

Prescription diet pills are recommended to be used only in people who are dangerously overweight, according to the following chart.

If you fall in the red region, you fall in the dangerously overweight category, and are eligible for prescription diet medication. If you are in the yellow region, you are eligible only if you have hypertension or diabetes. If you are in the green region you are not eligible.