MEDICATIONS for the TREATMENT of OBESITY

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MEDICATIONS for the TREATMENT of OBESITY

• NASMHPD MEDICAL DIRECTORS
• BEST PRACTICES SYMPOSIUM
• LAURENCE H. MILLER, MD

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Overview

• Obesity is a chronic disease despite the cultural
  conviction that medications are inappropriate for
  obesity management.

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BMI

• Prescription weight lost drugs are approved only
  for those with a body mass index (BMI) of 30 or
  above
• Or
• 27 and above if they have obesity-related
  conditions such as high blood pressure,
  dyslipidemia or type 2 diabetes.
• BMI of 18.5 24.9 is healthy.

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Why Medications?

• Medications are used to establish control and to
  sustain that control.
• Weight loss medications lead to an average weight
  loss of 5-22 pounds more than what you might lose
  with non-drug obesity treatments.

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Parameters of Use

• If a patient does not lose at least 4 pounds over
  4 weeks on a particular medication, then that
  medication is unlikely to help the patient
  achieve significant weight loss.

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Studies

• There are very few studies lasting more than 2
  years evaluating the safety or effectiveness of
  weight loss medications.

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Benefits of Medications

• Maximum weight loss usually occurs within 6
  months of starting medication treatment.
• Weight tends to level off or increase during the
  remainder of treatment.

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Benefits of Medications

• Over the short term, weight loss in obese
  individuals may reduce a number of health risks.

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Potential Risks

• Potential for abuse or dependence since most
  medications except Orlistat are controlled
  substances.
• Development of tolerance
• Side effects might outweigh benefits because
  weight loss medications are used to treat a
  condition that affects millions of people, many
  of whom are basically healthy.

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Support Services

• Patients tend to use support services more
  frequently when they are losing weight and then
  rely entirely on their relationship with their
  physician alone for the continuing use of the
  medication for the maintenance of their weight
  loss.

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Specific Medications

• Appetite Suppressants decrease appetite or
  increase feeling of being full by norepinephrine,
  serotonin and dopamine reuptake inhibition
• Phentermine (Adipex-P)
• Side effects
• Sleeplessness, nervousness, euphoria
• Sibutramine (Meridia)
• Side effects
• increase in blood pressure and heart rate

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Specific Medications

• Diethylpropion (Tenuate)
• Mazindol (Sanorex, Mazanor)
• Phendimetrazine (Bontril)
• Side effects
• increase in blood pressure and heart rate

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Specific Mediations

• Lipase Inhibitors decrease the bodys ability
  to absorb dietary fat by 1/3 by blocking the
  enzyme lipase which breaks down dietary fat. Diet
  must contain less than 30 fat.
• Orlistat (Xenical)
• Side effects
• cramping, discomfort, gas, diarrhea, oily stools

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Bottom Line

• The treatment of obesity should not only include
  medications but also
• diet
• exercise
• support activities