Outline

• What Is Obesity?
• Health Complications of Obesity
• Medical Treatment of Obesity

I. What Is Obesity?

Obesity is not simply a matter of being "overweight" or more than 10% above your ideal weight. If you are a man and your waist size is more than 45 inches, or if you are a woman and your waist size is more than 35 inches, you are probably obese.

Obesity, which affects about 32 million American adults aged 25-74, is defined as weight more than 20% above ideal weight or a Body Mass Index ( height related to weight) of more than 30.

A person is Overweight if 10%, and Obese if 20% above his/her ideal weight.

Essentially, obesity is a disease of overeating and under-exercising. Taking in more calories than one "burns off" will always result in weight gain. It takes about 3500 calories to lose a pound or to gain a pound. There is no other cause. Even genetic obesity, which is caused by Leptin excess (Leptin is the "fat gene"), is not a major cause of obesity. Eating too much — eating more than the amount of energy you expend daily, is the primary cause of obesity.

II. Health Complications of Obesity

Obesity is a major factor for a number of serious disorders including heart disease, hypertension and Adult Onset Diabetes Mellitus (AODM). AODM is present in about 11 million persons in the United States, and causes or contributes to over 130,000 deaths each year. Diabetes is a leading cause of loss of sensation in the limbs or neuropathy, peripheral vascular disease, renal failure, and blindness.

Nutritional factors have also been linked to osteoporosis, constipation, diverticular disease, and dental disease. An estimated 1.3 million osteoporosis-related fractures occur each year in the United States. Hip fractures in particular are associated with significant pain and disability, decreased functional independence, and high mortality; there is a 15-20% reduction in expected survival in the first year following a hip fracture. Frequent constipation is a complaint of over 3.5 million Americans, and intestinal diverticular disease is reported by nearly 1.5 million people. These are all food related problems.

III. Medical Treatment of Obesity

Food-related problems have been successfully treated with nutritional therapy ("diets" or "eating plans") in combination with exercise, and occasionally with prescription appetite suppressants. Medications such as Selective Serotonin Reuptake Inhibitors (SSRI's) (e.g., Prozac , Desyrel, Norpramine, Pondomin, and Wellbutrin ) have been used. If you are interested in the research, the studies are available on our website.

Drug treatment of obesity has taken a downward trend due to the problems and side effects of fenfluramine, (the other drug in Phen-fen or Fen-phen) can be life threatening. Fenfluramine (sold as Redux®) have both been voluntarily removed from the market by the manufacturer. Fenfluramine is now only used with extremely obese or morbidly obese people.

The appetite loss medications only provide a safe adjunct to any program of nutritional modification and daily exercise for permanent weight loss. Many people can lose weight without drugs.

Appetite suppressants are only effective for temporary use ( three to six months). Medications such as Adipex or Phentermine, Sanorex, Fastin, Tenuate, Prelu-2 and Melfiat only work while they are being used and have no long-lasting effects. For more information please contact our Wellness MD on the Web!

At the Monterey Preventive Medicine Clinic , our nutritional counselors can help to tailor individual programs for obesity treatment by using the The Monterey Diet™ for a quick jump start.

It takes a real committment on the part of an individual who decides they want to change their body from "fat to slim". It is a joint venture and requires total lifestyle change. Lifestyle change is not easy for most. Perhaps that is why Obesity is the number one disease in America and diet books make the best seller list monthly and are the number one best sellers.

In comparison to placebo, desipramine or norpramine reduced weekly bingeing and weekly vomiting. The anti-bulimic benefits appear as early as week one. The modest incidence of adverse effects observed with fluoxetine or Prozac® and the low discontinuation rate as a result suggests that fluoxetine may offer some advantage over earlier antidepressants in the treatment of obesity and bulimia nervosa.

Wellbutrin® /Zyban®, recently approved for smoking cessation also works for weight loss!

Bupropion, sold under the names Wellbutrin® and Zyban® has been available for over 10 years as an antidepressant which causes norepinephrine stimulation. Norepinephrine is used by the brain to modulate eating behavior as well as addictive behavior and depression .

In a multicenter controlled trial (Horne et al 1988), the treatment of bulemia with Bupropion compared to placebo showed favorable results. The actual risk of seizure activity is minimal (less than 1%) and this side effect should not deter someone from using this medication.

Bupropion is now available as a "safe drug for smoking cessation." Smoking cigarettes is a behaviorally motivated addiction. Many people get true satisfaction from handling the cigarette and putting it into their mouth. Many smokers actually have appetite suppression with their nicotine intake, using nicotine instead of food. These people find it very difficult to give up smoking without gaining large amounts of weight since they substitute high caloric foods for the associated hand to mouth behavior.

The use of Zyban helps reduce the cravings for sweets as well as cigarettes. This medication is very useful for obese patients who cannot stop eating sweets. Many obese people are depressed and receive temporary stimulation and good feelings from eating sweets. Sweets are traditionally given to the "good kids" as a reward, as a "desert" and as a special treat. Many people have lifelong associations with positive feelings after eating sweets. Unfortunately, some obese people are not able to control the amount of sweets they consume, and keep needing that "high" good feeling.

At the Monterey Preventive Medicine Clinic , Dr. Kryger uses pharmacotherapy or medication as well as diets like DrK's Life Long Weight Maintenance Plan plan to help patients with their weight loss . You can order the Practical Guide To Permanent Weight Loss from our Wellness MD product line to give you the tools to control your own weight — for life!!

For more information consult the doctor at Wellness MD on the Web.