- This article is a collaboration between MedPage Today® and The American Heart Association
It’s an entirely new approach to the treatment of disease, said Caroline Apovian, MD, of Boston University, the lead author of a new guideline for treating obesity with medications, published online in the Journal of Clinical Endocrinology and Metabolism
DR. APOVIAN (THE LEAD AUTHOR OF THIS NEW GUIDELINE FOR OBESITY) DISCLOSED FINANCIAL $$$$$$$$$$$ RELATIONSHIPS WITH THE FOLLOWING DRUG AND WEIGHT LOSS SURGERY COMPANIES: AMYLIN, MERCK, JOHNSON AND JOHNSON, ARENA, NUTRISYSTEM, ZAFGEN, SANOFI, OREXIGEN, ENTEROMEDICS, LILLY, ASPIRE BARIATRICS, GI DYNAMICS, PFIZER, METAPROTEOMICS, AND THE ATKINS FOUNDATION. (CONFLICT OF INTEREST?).
The guideline focuses on medical management of obesity, a component not addressed in the 2013 earlier guidelines released by the American Heart Association, the American College of Cardiology, and the Obesity Society, since they were written before many of the new weight-loss drugs were approved. DR. APOVIAN, STEEPED IN FINANCIAL TIES TO THE PHARMACEUTICAL INDUSTRY, MADE SURE TO GET GUIDELINES TO FOCUS ON USING PHARMACEUTICALS TO MANAGE OBESITY.
Those drugs, coupled with extensive lifestyle counseling and clinician visits, are poised to help patients who’ve struggled to lose weight for years by enhancing their ability to make behavioral change, Apovian said. WAIT A MINUTE….PRESCRIBE THE DRUGS AND EXTENSIVE LIFESTYLE COUNSELING AND CLINICIAN VISITS. WHO IS PAYING FOR THIS AND WILL THE MILLIONS OF OBESE INDIVIDUALS PEOPLE ATTEND OVER 16 CLINICIAN VISITS A YEAR, EXERCISE FIVE DAYS A WEEK, AND FOLLOW THE PRESCRIBED DIET (THE DIET MAKES SUCCESS IMPOSSIBLE) AS DR. APOVIAN RECOMMENDS?
That, in turn, should diminish their need for medications to manage other conditions that are tied to obesity, including diabetes, hypertension, and dyslipidemia, she said.
Several obesity experts contacted by MedPage Today said they agreed with the new guidance, that treating overweight and obesity could resolve many of the conditions that commonly occur with it. MEDPAGE DID NOT CONTACT THIS OBESITY EXPERT. I HAVE NO AFFILIATIONS TO PHARMACEUTICAL COMPANIES. I WONDER IF THAT MADE A DIFFERENCE?
Four new obesity drugs have been approved in the last few years: Belviq, Qsymia, Contrave, and Saxenda. Many of these medications work by amplifying the effects of behavioral changes, Apovian said, and they have the greatest effect when they’re reinforced with face-to-face visits — the literature says at least 16 visits per year, a figure that federal insurers reimburse for. SO, THE DRUGS NEED TO BE ADDED TO LIFESTYLE CHANGE, EXERCISE, DIET, AND AT LEAST 16 FACE TO FACE CLINICIAN VISITS PER YEAR.
“Adding the medications to a diet and lifestyle program leads to a greater enhancement of their effects,” she said. “And we recommend that if you’re going to treat weight management patients that you see them frequently.”
Apovian noted that the Endocrine Society still stands by the AHA/ACC/TOS guidelines on weight management, and that the current guidelines simply fill a gap that wasn’t addressed in the 2013 guidance.
The new guidelines are the first to mention specific obesity drugs and give some guidance on how to prescribe them. AND THE NEW GUIDELINES ARE FUNDED BY DRUG COMPANIES
Patients with cardiovascular risk, for instance, should be put on the drugs with the lowest cardiovascular risk, which include orlistat (Alli, Xenical) or lorcaserin (Belviq), Apovian said. THESE DRUGS HAVE BEEN PROVEN INEFFECTIVE AND COME WITH SIDE EFFECTS
Patients should be put on the drugs for a 3-month trial period, starting at the lowest dose and titrating up, the guidelines state. If they don’t lose at least 5% of their body weight in that time, they should be switched to another drug. I WONDER WHY THE FIRST CHOICE WOULD BE TO SWITCH MEDICATIONS. PERHAPS THIS PATIENT IS HAVING DIFFICULTY WITH HIS/HER DIET, EXERCISE, LIFESTYLE, OR IS FAILING TO ATTEND ALL THOSE CLINICIAN VISITS….YET, WITHOUT KNOWING THE SITUATION, THE DIRECTIVE IS TO WRITE ANOTHER PRESCRIPTION FOR ANOTHER DRUG FOR ANOTHER 3 MONTHS.
PLEASE NOTE, A 5% WEIGHT LOSS AFTER 3 MONTHS (FOR AN OBESE PERSON) IS INSIGNIFICANT….REMEMBER, THESE PATIENTS HAVE SUPPOSEDLY MADE LIFESTYLE, DIET, EXERCISE CHANGES, SEEN A COUNSELOR AT LEAST 3 TIMES IN 3 MONTHS AND TAKEN A DRUG FOR WEIGHT LOSS. A 300 POUND PATIENT WOULD ONLY NEED TO LOSE 16 POUNDS AFTER 3 MONTHS OF ALL THIS WORK TO BE CONSIDERED A SUCCESS.
“You have to give your best guess as to which drug the patient should go on based on their lifestyle characteristics that make them amenable to that particular drug,” Apovian said. “Unless you have a very clear idea of what drug you think the patient will do best on, it’s going to be trial and error.” JUST PRESCRIBE DRUG AFTER DRUG….WITH FOUR NEW DRUGS, THAT WILL TAKE UP AN ENTIRE YEAR AND $6000.00 FOR THE DRUGS ALONE. THE PATIENT WILL MORE THAN LIKELY END UP MORE OBESE THAN HE/SHE WAS AT THE BEGINNING OF THE YEAR.
The guidelines also offer specifics on dietary recommendations — taking down saturated fats and trans fats for those with lipid problems, lowering salt and going on the DASH diet if they have hypertension — and calling for 150 minutes per week of moderate-intensity exercise. A LOW FAT DIET IS, BY NATURE, HIGH IN CARBOHYDRATE. A HIGH CARBOHYDRATE DIET STIMULATES INSULIN RELEASE. HIGH LEVELS OF INSULIN CAUSE FAT GROWTH ON THE BODY, IN THE LIVER, AND IN THE BLOOD. HIGHER BODY FAT AND CIRCULATING FAT LEADS TO HYPERTENSION, HYPERLIPIDEMIA, OBESITY, TYPE 2 DIABETES, CANCER, ET AL. THIS LOW FAT DIET PRESCRIPTION IS 100% WRONG. I GUESS IF MD’S KEEP RECOMMENDING IT, THERE IS MORE OPPORTUNITY TO PRESCRIBE MORE WEIGHT LOSS DRUGS (NONE OF WHICH WORK).
They also cover how to treat patients who have both obesity and diabetes, urging clinicians to wean patients off diabetes drugs that make them gain weight, such as insulin, sulfonylureas, and thiazolidinediones, and replacing them with drug classes that promote weight loss, including GLP-1 agonists and SGLT2 inhibitors. LOTS OF VERY NEGATIVE SIDE EFFECTS RELATED TO THESE VERY EXPENSIVE NEW CLASSES OF DRUGS FOR DIABETES. WHY NOT RECOMMEND THE CORRECT DIET TO TREAT OBESITY ALONG WITH EXERCISE AND METFORMIN? DONE AND DONE.
The question remains whether insurance will cover these medications, Zonszein said.
“Many insurances do not want to pay for obesity drugs,” he told MedPage Today. “And they’re expensive. They can cost between $4,000 and $6,000 per year.” INSURANCE COMPANIES CHOOSE NOT TO REIMBURSE FOR INEFFECTIVE MEDICATIONS WITH A HIGH LEVEL OF SIDE EFFECTS.
With more clinicians focused on the treatment of obesity as a disease — which is what the American Medical Association called it in 2013 — experts say that could change. GET ALL THE MD’S ON THE BANDWAGON TO PRESCRIBE EXPENSIVE, HIGH RISK, INEFFECTIVE DRUGS TO THEIR OVERWEIGHT PATIENTS! MORE MONEY FOR YOU, MORE MONEY FOR BIG PHARMA. NOTHING FOR YOUR PATIENTS.
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The Metabolism Miracle Cookbook: http://www.amazon.com/The-Metabolism-Miracle-Cookbook-Delicious/dp/0738214256/ref=pd_sim_b_1?ie=UTF8&refRID=0DC5FY8CN1D1YH85YNM
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The Interactive Support Group for Followers of The Metabolism Miracle and The Diabetes Miracle: www.Miracle-Ville.com