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To Swallow or to Cut, that is the Question
By Shaun J. Melarvie
We are surrounded by products and procedures promising an easier way
You are the targets of the promises of an easier way, but for the mere cost of…
You want to know if there is an easier way
You’ll know what works, what doesn’t, does it matter, and if it’s worth it
You will be given the information, unbiased and unequivocally
Prescription diet pills are divided into two broad classes
Appetite Suppressants Fat Blockers
I’m full
A pill will only impact your weight if:
I’m full
The only valid studies are randomized and controlled
Control Group Study Group
REAL ONEFAKE ONE ?
? ?
Appetite suppressants act on the brain to cause satiety
CatecholaminesEpinephrineNorepinephrineDopamine
Sibutramine=MeridiaDiethylpropion=TenuatePhentermine=Adipex-P, Fastin, Anoxine-AM
Increased heart rate
HypertensionInsomnia
Sibutramine is FDA approved for long-term use
• 29 Randomized Controlled Trials
• 929 Patients in 3 of the trials
• Ave. of 9.46 pound wt. loss more than placebo
• Time course of at least one year
Phentermine is FDA approved for short-term use
• 108 Patients in a RCT
• 5.8 pound weight loss
more than the control group
• Time course of nine months
There are continually new drugs in the pipeline
Rimonabant=Zimulti
Tesofensine
Fat blockers inhibit the enzyme—lipase--that digests fat
30%
FlatulenceOily stool
Loose stoolFloating stool
UrgencyIncontinence
Orilstat is FDA approved for long-term use
30% of 30% of 1800 calories=160 calories
•28 RCT•602 patients in 11 trials•5.94 pound weight loss
more than control group
•Time course of at least one yr.
Orlistat is “Alli”
?15% of fat blocked?30% of fat blocked
Prescription diet medications can be expensive
$60-$2160 per year
For the expense, is it worth it?
$20/moor
$240/yr
Controlled Caloric Intake ExerciseDiet Pill
6-10 lbs. more than control group
There are many classes of OTC dietary supplements
Chitosan Ephedra sinicaGarcina camogiaHydroxyCitricAcid
Yohimbe
Plantago
Guar gum
Green tea
Chromium
“unlikely to cause weight loss”
“not likely to reduce total body weight”
“limited evidence to support claim”
“without conclusive evidence”
“unlikely to cause weight loss”
“may cause health problems similar to ephedra”
“heart attacks, stroke and even death”
“likely unsafe and should be avoided”
“unlikely to cause weight loss”
Many OTC diet aids are a concoction of several drugs
ChromiumGreen teaBitter orange10% synephrine
ChromiumGlucomannanGreen treeHoodia
HoodiaAdvantra-Z (ephedra-like)
YohimbineCaffiene (200mg)Synephrine
A survey of 402 products contained over 4,000 separate ingredients
• From December 2006 “Journal of the American Diet Association
• 73 Retail outlets
• Mean no. of ingredients per product=10+/-9
Green teaEphedra
Chromium
Just because a drug is OTC does not mean it is safe
Fen-phen“Redux”
Corti Therm
Green TeaCaffeineBitter OrangeGuarana (contains caffeine)HoodiaChromium
POW
Some stand alone OTC diet aids have been studied scientifically
Fullbar &Aquafull
We did a weight-loss
study with Fullbar that
was 3 months
long. On average,
95% of the people in
the study lost weight,
with the average
weight loss being 11
pounds. We want you
to have the same kind
of success and
recommend using
Fullbar over the same
period of time to get the
benefits experienced
by the people in our
study.
Congugated Linoleic Acid (CLA) may reduce fat mass marginally
Great stuff! Hmmm…don’tFeel much different
Green Tea extract may slightly raise the metabolic rate
Diet Induced Thermogenesis (DIT)•most with protein•least with fat
7-keto is a metabolite of the steroidal hormone DHEA
7-ketoGreen teaCaffeineHoodia
7-ketoGreen teaCaffeine
Hoodia is a rare cactus
P-57
Is scientifically proven in rats
P57 is broken down by the liver
P-57
This better be worth it!
Pfizer relinquished rights to P57 in 2002
Most media marketing efforts are misleading at best
“Through years of study and breakthroughs in modern science we’ve discovered the key to long term weight loss success. And you can only find this compound inside of NUPHEDRAGEN, weight loss solution”
“Each bottle of NUPHEDRAGEN retails for $97.00 USD. However, through our limited time special offer, you can buy it today for greatly discounted prices, depending on the quantity you order”
“Lose up to 14 pounds in only 7 days or Your Money Back Guaranteed”“On this exclusive special offer…for $19.99 (seven day supply)“Buy 5 Get 1 Free”“Buy 6 Get 3 Free”“Do not take two weeks in a row”
Eat all you want and still lose weight
“AKÄVAR®-20/50 literally causes excess fat to be pulled from bulging parts of your body!”
“Eat all you want & still lose weight...”
“Clinical trial shows success” Yerba mateGuaranaDamiana
60 capsule supply$39.99
20day Supply
Help rid you body of unhealthy toxins
30g
40g
There are three basic types of Bariatric surgery
Candidates for bariatric surgery are morbidly obese
Restrictive procedures include the LAGB and the VBG
The purely malabsorptive procedures are not commonly done
The Roux-en-Y Gastric Bypass (RYGB) is restrictive and malabsorptive
Bariatric surgery carries a significant risk of morbidity and mortality
Morbidity = Complications and illness
Mortality = Death
Obesity surgery accounts for 2 billion dollars, annually, for hospital costs alone
The results of bariatric surgery are proven and significant, but…
4047 Patients10 year follow-up
2037 in medically treated (control) group2010 in surgically treated group
No weight change in medically treated groupIn surgically treated group
RYGB: wt. loss 25%VBG: wt. loss 16%GB: wt. loss 14%
Deaths in surgically treated group: 101Deaths in medically treated group: 129
400 PoundsWt. loss of 25%= 100 Pound wt. loss
400-100 = 300 Pounds
Laparoscopic Adjustable Band
There are old people
and There are obese people
but, There are no old, obese people
Some bariatric surgery works better than others.
Bariatric surgery does not negate the need to diet
?
Bariatric surgery requires an emotional and financial investment
Mortality
Morbidity
$$$
$$$$$$
$$$
MorbidlyObese
Overweight orLess Obese
Commitment
Motivation
Empowerment
Inspiration
Effort
Obese orOverweight
HealthyWeight
DespairHopelessness
Powerless
HappinessPeace
Enlightenment
Poor HealthEarly Death
Good HealthNormal Lifespan
What Works?
Poor choices
RecidivismMortality
Morbidity
HappinessPeace
Enlightenment
BMR Down-regulation
Counteract: DIT, Exercise, not skipping meals or snacks
Lose weight 30 lbs. at a time
For example: 250 lbs to 150 lbs
The down-regulation is proportionate to the caloric restriction: so,
250
•Goal wt.=220
•2420 cal/day
220
•Goal wt.=190
•2090 cal/day
190
•Goal wt.=150
•1650 cal/day
2 week stability for up-regulation
2 week stability for up-regulation