Medical Treatment Of Obesity Research Articles

Roux-en-Y Gastric Bypass for Morbid Obesity

Obesity among adults has increased 60% since 1991, and 25% of children are overweight or obese. Direct and indirect costs of obesity represent almost 17% of total health care costs. People who are morbidly obese are far more likely to develop diabetes, hypertension, sleep apnea, osteoarthritis, and some forms of cancer, as well as depression and anxiety disorders than people who are not obese. Medical treatment of obesity only has long-term success rates of approximately 5%. Studies have validated that bariatric surgery, on the other hand, has greater success rates for weight loss maintenance. Of current surgical options, Roux-en-Y gastric bypass offers the best results:complications ratio and is seen as the "gold standard" in bariatric surgery.

Complementary and alternative therapies for obesity

Obesity is a serious medical disorder because it can cause a myriad of health problems, such as heart disease, hypertension, and adult-onset diabetes. While conventional medical treatment for obesity has limitations, there is enormous public enthusiasm for complementary and alternative treatments of obesity. This article reviews currently commonly used complementary and alternative therapies for obesity, such as medicinal herbs, nutritional supplements and acupuncture. Beneficial effects and possible adverse effects associated with these treatment are discussed.

Modern Medical Management of Obesity: The Role of Pharmaceutical Intervention

The medical model of obesity treatment—combining diet, exercise, and behavior modification with antiobesity agents—suffered a setback when fenfluramine and dexfenfluramine were withdrawn from the market because of an association between these medications and valvular regurgitation. The Food and Drug Administration has recently approved sibutramine (Meridia), a norepinephrine and serotonin reuptake inhibitor that was originally developed as an antidepressant, but which has also been shown to reduce weight. In a 1-year placebo-controlled trial, 65% of patients receiving 15 mg sibutramine daily lost more than 5% of their body weight, compared with 29% of patients receiving a placebo; 39% of patients in the sibutramine group lost more than 10% of their body weight, compared with 8% of patients in the placebo group. Health benefits observed in patients receiving sibutramine include reductions in levels of triglycerides, uric acid, total cholesterol, and low-density lipoprotein (LDL) cholesterol and an increase in high-density lipoprotein (HDL) cholesterol levels. Another antiobesity drug currently under review by the Food and Drug Administration is orlistat (Xenical), a pancreatic lipase inhibitor that reduces the absorption of dietary fat by approximately 30%, thus reducing energy intake. In a 1-year placebo-controlled trial, 55% of patients receiving orlistat lost more than 5% of their body weight, and 25% lost more than 10% of their body weight, compared with 33% and 15%, respectively, of patients in the placebo group. In addition, orlistat slowed the rate of weight regain in the second year of treatment. Health benefits demonstrated in clinical trials of orlistat include reduced LDL cholesterol levels and increased levels of HDL cholesterol, reduced blood pressure and fasting insulin levels, improved oral glucose tolerance test outcomes, and improved glycemic control in obese patients with diabetes. The future of the pharmacologic treatment of obesity is promising. Many new antiobesity agents are in the early stages of development, and our understanding of the body's weight-regulating mechanisms is advancing steadily. Human trials of recombinant leptin are underway. Other promising compounds include those that block the Neuropeptide Y5 and Y1 (NY5, NY1) and Melanocortin-4 (MC4) receptors, stimulate uncoupling proteins, and unbind corticotrophin-releasing factor from its binding protein. As better medical treatments for obesity become available, the focus in dietary prescription may shift away from reducing energy intake toward healthier eating for disease prevention. At present, a comprehensive approach, which, in some patients, may include medical therapy as an adjunct, is necessary to treat obesity effectively. J Am Diet Assoc. 1998;98(suppl 2):S23–S26.

Fluoxetine is a safer alternative to fenfluramine in the medical treatment of obesity

Fluoxetine is a safer alternative to fenfluramine in the medical treatment of obesity

Fluoxetine Is a Safer Alternative to Fenfluramine in the Medical Treatment of Obesity

T combination of phentermine and fenfluramine hydrochloride is widely used for the treatment of exogenous obesity even though there has been only 1 full published study.¹The therapy is cheap, highly successful, and well tolerated. Nevertheless, experience in Europe suggests that there is a grave risk of primary pulmonary hypertension (PPH) from fenfluramine, whether dispensed as the racemic mixture or the pure D-isomer.²Even though the risk for PPH is small, the mortality is high, the results of treatment are uncertain, and there is no proven screening method. I have treated 557 patients with a variation of the "phen-fen" combination, in which fenfluramine was replaced with fluoxetine hydrochloride. The chemical structure of fluoxetine is similar to that of fenfluramine; both drugs are serotonin-promoting agents, and fluoxetine acts on the cerebral appestat as well as fenfluramine. My patients have lost 3645 kg in 2 years. Only 7 patients failed

Physiologic approaches to the control of obesity.

Morbid obesity is a major health problem in this country and throughout the world. In addition to its social stigma (in the western world), obesity exacerbates several disease states such as diabetes, hypertension, cardiac disease and restrictive lung disease. When effective medical treatment of obesity becomes available, it will depend in part upon understanding the physiologic factors that control satiety. This review summarizes the information available on brain and gut control mechanisms of satiety. Brain nuclei located in the lateral hypothalamus, ventromedial hypothalamus, and other paraventricular areas are the sites of action for potent neuropeptides, such as cholecystokinin (CCK) and neuropeptide Y, that appear to regulate feeding. Exogenous CCK has been used clinically to decrease meal size in obese patients. The sites of the satiety cascade that are most often manipulated are the gastric and intestinal phases. Physiologic gastric distension is a potent inhibitor of feeding, whereas the intermeal interval may be regulated by intestinal signals released by food in the gut. Jejunal-ileal bypass has fallen from favor and has been replaced by gastric restrictive procedures that create a small proximal gastric pouch that empties into the small bowel (gastric bypass) or the distal stomach (gastroplasty). These operations rely partially on their ability to produce gastric distension in the proximal gastric pouch at an early stage during a meal. Thus, failure results if the pouch compensates by distending or if the stoma widens with subsequent loss of slow emptying. Improved medical and surgical treatment will be designed to intervene at specific sites of the satiety cascade as knowledge of the physiologic control mechanisms of satiety increases.

Long-term efficacy of medical treatments of obesity.

Obesity is a chronic, usually life-long condition. Therefore, the success of any treatment should be measured by the long-term weight loss. More patients lose weight than maintain the weight loss after the active phase of therapy has ended. Conservative approaches like dietary restrictions or behavior modification techniques have been only modestly successful in weight maintenance. Both are, therefore, suitable for patients with milder degrees of obesity. Anorexicants seem to have specific but limited use in the treatment of obesity. Fasting and protein sparing modified fast are indicated for patients with a high degree of obesity, i.e. for those who are at least 30% or 25 kg or more over their ideal body weight. Both these procedures have definite risks. Rapid weight loss is induced by fasting but long-term follow-ups showed gradual regain of weight loss. Combinations of various techniques such as behavior modification, exercise, proper nutritional instruction and protein-sparing modified fast seem to have the best chance for long-term success.

The medical treatment of obesity

The medical treatment of obesity

The Medical Treatment of Obesity

Obesity is one of the most common disorders in industrialized society. Thirty-two percent of American men and 40% of American women between the ages of 40 and 49 years are at least 20% above ideal body weight. 1 In a recent study using a national probability sample, 4.9% of men and 7.2% of women aged 20 to 74 years were severely obese, representing 37% and 57% above ideal weight in all age groups of men and women, respectively. 2 For over 100 years, the estimated degree of obesity has been increasing in the United States, 3 without any recent signs of abating. There is little question that obesity is an important risk factor for premature mortality and that correction of overweight is probably the most important hygenic measure (aside from avoidance of cigarettes) available for the control of cardiovascular disease. 4 It appears that, in the absence of hypertension, hyperlipidemia,

The medical treatment of obesity

The medical treatment of obesity

Surgery for morbid obesity: indications, complications, alternatives.

Morbid obesity (100 pounds over ideal body weight) carries with it numerous medical complications and increased mortality which can be improved by weight loss. Medical treatment of obesity is usually not successful, and jejunoileal bypass surgery often produces considerable chronic morbidity which seriously compromises its benefits. Gastric bypass is equally effective and avoids the most severe long-term complications of jejunoileal bypass, but has a higher operative morbidity. Gastric plication will perhaps offer the least operative and chronic morbidity, though few long-term statistics are as yet available.

An index for assessing weight change in children: weight/height ratios.

Weight and height data from two studies were recomputed, and original data were computed using a Weight Index formula that accounts for the interaction of actual weight/height changes in growing children and compares this ratio with that of normed weight/height ratios for equal-aged children. Recomputing the data of one study showed that the Weight Index is a more sensitive procedure for assessing long-term behavioral treatment of obesity for girls than weight alone. Recomputing the data of a second study showed that the Weight Index formula is consistent for boys and girls and is a more sensitive procedure for assessing long-term effects of a variety of medical treatments for obesity than the Ponderal Index or weight alone. Computation of the data for 17 "normal" children in a preschool class showed a zero Weight Index score before and after a six-month interval elapsed without treatment. The procedure may be useful in assessing ponderosity or anorexia over intervals of six months or more with growing children or difference between actual and normed weight over shorter intervals.

Medical treatment of obesity.

Conference Abstract| September 01 1973 Medical Treatment of Obesity J. F. Munro J. F. Munro 1Eastern General and Eadenhall Hospitals, Edinburgh Search for other works by this author on: This Site PubMed Google Scholar Clin Sci Mol Med (1973) 45 (3): 11P. https://doi.org/10.1042/cs045011P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation J. F. Munro; Medical Treatment of Obesity. Clin Sci Mol Med 1 September 1973; 45 (3): 11P. doi: https://doi.org/10.1042/cs045011P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1973 The Biochemical Society and the Medical Research Society1973 Article PDF first page preview Close Modal You do not currently have access to this content.

Obesity in diabetes: a study of therapy with anorexigenic drugs.

Article1 January 1951OBESITY IN DIABETES: A STUDY OF THERAPY WITH ANOREXIGENIC DRUGSKERMIT E. OSSERMAN, M.D., HENRY DOLGER, M.D., F.A.C.P.KERMIT E. OSSERMAN, M.D.Search for more papers by this author, HENRY DOLGER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-34-1-72 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the treatment of the obese diabetic, management of the obesity is secondary to insulin in the control of diabetes mellitus. Mirsky1considers the obese diabetic as being "decompensated" with a relative or absolute insulin insufficiency. With decreased caloric intake and consequent weight reduction, the patient may be restored to "compensation" and the insufficiency of insulin can equal the reduced metabolic demand. If the diabetic patient remains obese, not only may the control of the diabetes become more and more difficult, but reduction in weight eventually may not be effective in restoring carbohydrate tolerance.2The relative insufficiency of insulin then...Bibliography1. Mirsky IA: Consideration of the etiology of diabetes in man, Proc. Am. Diabetes A. 5: 117, 1945. Google Scholar2. Duncan DG: Diabetes mellitus and obesity, 1935, Lea & Febiger, Philadelphia, p. 79. Google Scholar3. NewburghConn LHJW: A new interpretation of hyperglycemia in obese middle aged persons, J. A. M. A. 112: 7 (Jan. 7) 1939. CrossrefGoogle Scholar4. Handelsman MB: Factors influencing the return of tolerance for glucose in middle-aged obese diabetics, Am. J. M. Sc. 208: 15 (July) 1944. CrossrefGoogle Scholar5. John HJ: Some interesting and obscure problems in diagnosis and treatment of diabetes mellitus, Ohio State M. J. 33: 741 (July) 1937. Google Scholar6. FetterDurkinDuncan FJKCC: Dietary versus insulin treatment of the obese diabetic patients, Am. J. M. Sc. 195: 781 (June) 1938. CrossrefGoogle Scholar7. DanowskiWinkler RSAW: Obesity as clinical problem, Am. J. M. Sc. 208: 622 (Nov.) 1944. CrossrefGoogle Scholar8. Freed CS: Psychic factors in the development and treatment of obesity, J. A. M. A. 133: 369 (Feb.) 1947. CrossrefMedlineGoogle Scholar9. Bruch H: Psychological aspects of obesity, Bull. New York Acad. Med. 24: 73 (Feb.) 1948. MedlineGoogle Scholar10. Richardson HB: Amphetamine sulphate (benzedrine) in the treatment of obesity, New York State J. Med. 46: 998 (May 1) 1947. Google Scholar11. Nicholson WM: Emotional factors in obesity, Am. J. M. Sc. 211: 443 (April) 1946. CrossrefMedlineGoogle Scholar12. WilliamsDaughadayAsperRogersTowery RHWHSPWFBT: Obesity and its treatment with particular reference to the use of anorexigenic compounds, Ann. Int. Med. 29: 510 (Sept.) 1948. LinkGoogle Scholar13. StorzKirk HR: Über eine neue Blutdrucksteigernde Substanz, Deutsch. med. Wchnschr. 63: 393 (March 5) 1937. CrossrefGoogle Scholar14. Rao V: Antagonismo fra insulina e simpamina sulla pressione arteriosa e sulla glicemia, Fra Med. 27: 106 (Feb. 15) 1941. Google Scholar15. DetrickMilikanModernThienes LERSFCH: On the pharmacology of phenylisopropylamine (benzedrine), J. Pharmacol. and Exper. Therap. 60: 56 (May) 1937. Google Scholar16. Dolger H: Clinical evaluation of vascular damage in diabetes mellitus, J. A. M. A. 134: 1289 (Aug. 16) 1947. CrossrefMedlineGoogle Scholar17. AdlersbergMayer DME: Results of prolonged medical treatment of obesity with diet alone, diet and thyroid preparations, and diet and amphetamine, J. Clin. Endocrin. 9: 275 (March) 1949. CrossrefGoogle Scholar18. GastineauRynearson CFEH: Obesity, Ann. Int. Med. 27: 883 (Dec.) 1947. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication December 21, 1948.From the Metabolism Division of The Medical Services of The Mount Sinai Hospital, New York.Aided by a grant from the Smith, Kline and French Laboratories. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDiabetesLiteraturLiteraturEating Away PoundsGewichtsreduktion bei Adipositas durch Di�t, Medikamente und operative VerfahrenANOREXIGENIC DRUGS IN PERSPECTIVEObesity and DiabetesLONG-TERM WEIGHT REDUCTION IN CARDIOVASCULAR DISEASE: EXPERIENCES WITH A HYPOCALORIC FOOD MIXTURE (METRECAL) IN 78 PATIENTSThe Treatment of Obesity in Patients with Cardiovascular DiseaseOBESITY AND DIABETES: A REËVALUATION*S. K. FINEBERG, M.D., F.A.C.P.The treatment of obesity: An analysis of methods, results, and factors which influence successEVALUATION OF APPETITE SUPPRESSANTS*LEO J. CASS, M.D.THE USE OF A FORMULA DIET FOR WEIGHT REDUCTION OF OBESE OUT-PATIENTS*ALVAN R. FEINSTEIN, M.D., VINCENT P. DOLE, M.D., IRVING L. SCHWARTZ, M.D.CLINICALLY USEFUL APPETITE DEPRESSANTSThe anorexigenic effect of sustained-release dexedrine preparationsRelation of Obesity to LongevityDiabetes Mellitus 1 January 1951Volume 34, Issue 1Page: 72-79KeywordsCarbohydratesDiabetes mellitusDrug therapyInsulinMedical servicesObesityOverweightWeight loss Issue Published: 1 January 1951 PDF downloadLoading ...