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James G Beckerman, M.D.  
Male
Portland, OR

Specialties: Cardiology

Interests: Weight Loss, lifestyle changes, healthy diet
Author of The Flex Diet (January 2011)
Providence Heart and Vascular Institute
(503) 216-0900
Portland, OR
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Would you take an obesity drug if it were safe, effective, and...available?

Nov 08, 2010 - 31 comments
Tags:

Obesity

,

obesity drugs



Another drug bites the dust. In the past few weeks, we have seen sibutramine (Meridia) pulled from the shelves due to an increased risk of heart attacks, and now lorcaserin (Lorqess) has failed to pass muster with the FDA because of concerns about cancer. Many years and millions of research dollars later, our only remaining pharmaceutical arm in the fight against obesity is orlistat (Xenical), with the convenient side effects of bloating, stomach upset, and the need to have a public restroom app on your iPhone in case of emergencies.  So what’s a health care system to do?

On one hand, you might argue that Big Pharma has failed us in the obesity space.  So should they throw in the towel? The drugs work poorly, have gross side effects, and increase our health risks in other ways. Some say, why don’t we save the millions of dollars spent on drug research and instead invest them in education, legislation, and regulations that will help us eat better and exercise more? Put the money towards the health costs of the uninsured. Or, use it to fund research in diabetes, heart disease, or any of the other countless complications of obesity.

But is it too early to admit defeat?  If we had done the same for cholesterol medications or diabetes medications, or even smoking patches and pills, we’d be paying for it in countless ways.  So is there something unique about developing medications for obesity?  Obesity is considered by many to be purely a “lifestyle” disease, and some are biased against the obese as a result.  Given that we already have proven treatments (eat less and exercise more), some argue that we are wasting our time by investing heavily in a pharmaceutical solution.

As a physician who believes strongly in the power of personal choice to influence one’s health outcomes, I tend to favor an investment in healthy lifestyles.  But in all fairness to the other side of the debate, one can also argue that prevention hasn’t worked out so well either.  Despite the fact that we have effective treatments, we are not very effective in their prescription or compliance.  For example, aggressive lifestyle modification can lower heart disease risk as effectively as cholesterol medication for many people — but the fact of the matter is, some people would rather take a pill.  Obesity has skyrocketed despite our efforts at communication.  So, it looks like the health care system has failed as well.  Could our failure as health care providers actually position obesity drug research and development as the most important pharmaceutical goal of the decade?

Where do you think we should put our resources?  Do you accept the recent obesity drug hurdles in stride and want the pharmaceutical companies to take on the challenge to develop more anti-obesity medications?  Or do you think we should concentrate our efforts on non-pharmaceutical interventions?  Would you take an obesity drug if it were safe, effective, and available? I’d love to hear what you think!

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by margypops, Nov 09, 2010
No I certainly wouldnt... I have taken the drugs dished out plus all the side effects ,I know folks who take so many pills and some interact with each other..But my guess is many will want to take it, and who can blame the obese for wanting some help, by the way there should be no regulations about what we eat or what we give our children to eat , government should not be interfering so much.This is an interesting thread , however and 'food for thought .....

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by samsmom46, Nov 09, 2010
I most certainly would take the drug, i've done a study for a pill and lost 52 lbs in a year, in that time my blood pressure went to normal, my cholesterol went down to a healthy level, my liver function improved and i felt better. there were minor side effects that eating right took care of.
if it were affordable for people to eat right all the time we would not have such a large marjority. Carbs are the least expensive and filling and they are cheap, plus health care is so expensive any more who can afford to go to the doctor
i would join a gym if i could afford that also.
why cant the health plans include gym memberships for all to get healthy?
i tend to break things when i walk or run so my work out regiment tends to get halted before it even begins.
i agree with margypops when she says government should not be interfering and the fools who vote for it have no clue that is how communism starts. if you think it is bad for you or your children dont buy it.

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by ginbud, Nov 09, 2010
As a younger Doctor I assume that you are as caught up in prescribing drugs vs. working one on one with your patients as it use to be years ago. I would hate to see another drug hit the market which essentially hooks another patient for life on some medication.  I'm fed up with being handed a medication or script every-time I go to the Doctors.  There are few drugs on the market that don't have serious side effects which people are blind to as well as Doctors. Too many drugs are fast tracked by the FDA and are sold without proper clinical research or precaution used by Doctors. I took Fen-fen and some other drug as a means to lose weight years ago. Why didn't anyone know that it would cause damage to the heart while they handed out those scripts?  Today, I've reached my 23rd month of self detoxing off Oxycontin.  This was no easy feat and I was never told that I was essentially getting hooked on a prescribed heroin. Why are Doctors willing to put people on drugs without giving their patients fair warning or what can happen to them in the long run. Would you be willing to give out a drug that a big Pharm. Company tells you it will help your patients lose weight, yet you really don't know how it is effecting your patients body and mind?  If so, just give them Ritilan and don't bother telling a patient what they are going to get hooked on. 90% of obese patients are in a bad way because they are over eating, eating fatty and unhealthy foods, and won't extersize.  So why do you think a pill can help them with there issue in the long run? The new drugs are dangerous and poorly tested clinically.  Ethically, I think Doctors should stop handing out scripts to do the job they were trained to do.

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by margypops, Nov 09, 2010
well said ginbud

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by Mom2four85, Nov 10, 2010
I don't understand how any weight loss pill can be "safe" with the side effects most have - Orlistat included - there has to be some consequence of how the drug works for it to give you loose stools and bm's anytime you eat a certain% of fat - dehydration would be a concern of mine and that may lead to more pvc's or imbalances in electrolytes.

I have acutally taken Phentermine to lose weight; one time I had no problem worked like a charm but as soon as I came off of it, even though I kept up with my food choices and exercise, I gained weight back.  I tried it again almost 2 years later and it made me sick to my stomach and what I think to be the start of my crazy pvc's/VT's - the dr switched me and I still had crazy pvc's after a couple of weeks, so I quit taking them. (ekg said I was fine)

What's the solution? yes, self control and moderation is important, but there's still the other side of the coin - what about those of us who don't overeat or who can't exercise due to physical problems, or have genetic problems; or problems from meds that made us gain weight.  I have squeeky clean arteries and great blood levels but my heart's electrical system went "whacky" and my LV function and cardiomyopathy they believe went into HF.  My dr's have told me I need to lose weight, but if portion control and eating healthy isn't working and I can't exercise (NCS/OI also)  what's the solution to help?

What about less invasive procedures such as LapBand surgery ...I know there's a new one out but I forgot the name of it.  

Why not legislate the insurance industry to cover expenses like these procedures.  The money they spend for these procedures will lesson their costs later - because a patient CAN"T eat past a certain point, say a cup or two or they pay a price of getting physically ill from the food.  Alot of these procedures have had great results and many have gone off meds to treat what ails them.

What about nutritional counseling? Insurance pays for drug/alcohol/sex related addictions, why not food addictions?

I would never personally take another pill for weight loss, but I would look into a procedure if it were covered by my insurance, as well as follow up care and nutritional counseling.

That's just my personal opinion =)

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by sk123, Nov 10, 2010
ginbud - I think you're missing the point where Dr. Beckerman says he prefers to invest in a healthy lifestyle rather than drugs.

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by vicki595, Nov 10, 2010
Yes,I would take a drug that was proven safe and effective. But,that's just me. I'm not obese and that's a whole other issue!  Heavy,obese folks have a horrible time of it. Results are slow and they need some fast weight loss to get them going! It's mental,physical, and extremely emotional to diet when you need to lose 150 pounds. But,you know this...

I believe in all interventions and lifestyle changes. I believe in emotional suppot. I believe in drugs if they work!  You know,as well as I, that the fat business is big money.  If a drug is going to create a hardship to pay for it;that's not good.

In my opinion,obesity is not just a lifestyle a person chooses. It's a disease that ends in death.  The focus has to get from money making to helping people be well. In the long run,money will be saved.  The thing is,it's hard to be compliant when it comes to food. Food is a big issue with all of us.  So how do you beat that bad boy down?  Drugs,intervention,
support and more...I would think big pharma would want to look at new drugs for weight loss. ( Gee,I've got all these thoughts and they seem to be coming out jumbled... )

Anyway,I've been reading quite a bit about Dr. Simeon's "HCG  and VERY LOW CALORIE DIET".  It's coming back into favor AGAIN and it's been hard to find any good studies as to risks,side effects,etc...I do think 500 calories a day is scary but apparently folks are utilizing this diet. I guess because that's all there is...

Thanks for posting this~

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by ginbud, Nov 11, 2010
I'm not missing any points. I can see where our "insurance" has led us and the Doctors treating us towards pills,pills and more pills. It the cheap way to deal with all the ailments out there, and it's much faster for the Doctors. This Doctor is headed in the same direction. Don't forget that he began with a question asking, "Would you take..."

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by James G Beckerman, M.D.Blank, Nov 11, 2010
Great comments!

Just to clarify, I personally have never prescribed a weight loss medication, and would much prefer to invest in strategies that will help people live healthier lives.  But it's important to recognize that we live in a world where pharmaceuticals have undoubtedly saved lives, particularly with respect to heart disease prevention.  If there were a "magic bullet" for obesity, I can't help but think that many people might approach the issue a little differently.

Thanks for joining the conversation!

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by Jaquta, Nov 11, 2010
If an anti-obesity drug were safe, effective and accessible I think that I would consider it (if I were overweight or perceived myself to be overweight).  I don't think that any medication is ever risk free though?  I don't trust that pharmaceutical facts are not distorted or misrepresented.  I don't believe that a lot of the research is transparent.

Based on my own experiences I would like to see resources put into education.  Education regarding nutrition, exercise, healthy lifestyles, etc.  I think psychotherapy for some individuals is also extremely important.  I think that unless we understand what causes us to emotionally eat that we will continue to have issues with repeated failed weight loss attempts.

I think early intervention is important.  I think it is easier to change many behaviors in childhood vs adulthood.

I think that there needs to be a range of different interventions based around individual needs.  While I favor the least invasive methods (such as diet and exercise) I don't think that I would be prepared to rule out the usefulness of other methods (such as some diet pills and surgery) at this time.  Obesity has so many implications.

I personally would like to see a lot more weight loss programs that are affordable and accessible.  I would also like to see some of these programs offer more emotional support.  People should be identified before dropping out of a program.  Sometimes sitting down one-on-one with someone can be helpful.

I don't think eating healthy is necessarily as expensive as people believe it to be.
On one of our news items last week they did a survey on the cost of eating 5+ (2 fruit/ 3 vegetables) a day for two adults and two children.  Despite many people not eating that amount when viewing the quantity in a supermarket trolley they believed it to be too little.  The price for the fruit and vegetables was also relatively low.  It worked out at less than $10 per person per week.

I have also seen several of Jamie Oliver's Food Revolution programs on TV recently.  The rubbish US schools dish up to their kids is unbelievable.  Seriously!  Who feeds their kids pizza and fries for breakfast and lunch.  It was absolutely shocking to see that and also the attitude of the parents and staff.
Also, it seemed a little strange to mandate foods when the servings sizes were absolutely ridiculous.

I think we're the third, or maybe fourth, fattest country behind the States so we have our own issues too.

I think the availability of drugs would have the potential to absolve us of responsibility for the poor decisions we make.

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by pleth1, Nov 13, 2010
Just a few comments really.

Concerning Ginbud's comment against medical practitioners please re-read what Dr. Beckerman put forward.  Thank you for all these wonderful pharmaceuticals that we are able to lead much more productive lives.  There is also no doubt that our unhealthy life choices have also lead to detrimental consequences.  However, there are conditions in which no amount of forethought could prevent the ailment.  Diabetes Mellitus Type-1, Hashimoto's Thyroiditis, arrhythmia's, osteoporosis, most bacterial infections (it is essentially impossible to never get infected at least at one point in your life no matter what one may do), rheumatoid arthritis, osteoarthritis and the list goes on.  Regardless of health choices, eating choices, exercise, vitamins (I also have my abhorrent issue with people taking prodigious amounts of vitamins, a healthy diet will suffice.  Vitamins have been blown way out of proportion by the media as a panacea of some kind, the same is true with anti-oxidants) etcera.

I also find it strange that many people are completely unwilling to take any kind of medication due to various reasons including that they are unnatural  or that they are poisonous.  Regarding the vehemently hated (by myself and others) natural argument please keep in mind the following.  Most medications have a natural precursor.  Good examples are Aspirin (plant extract from willowbark and spiraea, one requires approximately 1.5Kg of willowbark to get 30mg of ASA).  There is also digoxin (foxglove), a great majority of antibiotics, thrombolytic drugs (clot busting) etcera.  Also of note, is not most plant derived poisons natural as well as snakes etc natural.  What I am trying to point out is that just because something is natural does not mean it is any less harmful.  Another aspect to remember, most plants produce toxins to defend themselves (remember plants cannot lash out at their attackers nor get up and walk away, thus they use chemical warfare to win).  Thus a piece of broccoli (which I happen to enjoy) has many toxins within, but they are very low in concentration. Concerning the poison comment, everything that we are surrounded with may be detrimental to life it is simply the dose that determines what can kill us.  Do not misunderstand me, there is certainly a multitude of medications out there that are quite dangerous however it is called "risk-benefit" which allows us to prescribe such medications.  This is why some medications such as sibutramine have been removed amongst many others.  At least the pharmaceutical companies have some kind of over watch of course a quote from the Roman poet Juvenal comes to mind; Quis custodiet ipsos custodes? (Who will guard the guards themselves?).  That it may be flawed is certainly correct but that only means that it can also be improved upon.

I also find it interesting that many people are willing to do a great many things given out by "homeopaths" and yet are skeptical of things that have been scrutinized and overseen.  Please note, corruption is rampant in the medical community including pharmaceuticals however do you really believe that the homeopath is not looking for business him/herself.  I think it is important that a physician can explain why he/she is handing out the medication and what it does; its mechanism of action.  How many naturopaths can do that?  Please do not say it realigns our energies.  I want a real answer because anyone off the street can come to you and offer fecal matter and say "it will help you out with your arthritis because it is not only natural but realigns your yin and yang".

In the end it is clear that a healthy lifestyle is essential for a healthy quality of life.  Nonetheless, medications are an essential tool in this aspect which when required should be looked at.  Clearly avoid the medication when not required and it is my belief that this is typically the case amongst physicians with obvious exceptions.  One of the problems faced by physicians is the fact that many patients come into the consult hoping to leave with some kind of prescription and when none is handed out they feel "jipped" as one patient once put it.  This is especially true under a private practice setting in which the patient feels as if they have given out a certain amount of money and all they receive is "advice" such as drink lots of fluids, lots of bed rest and the like.  Clearly these patients do not understand the aspect of virology or other diseases in which medications are not required or first line therapy.

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by ggreg, Nov 14, 2010
Dr. Beckerman,
I couldn't have said it better, Pleth.  I am in my 60s and never thought I'd need to take a medicine to get weight off.  Yes, Doctor, I would take medication to get my weight down.  I thought amphetamines were still available?  Here I was, next time I see my doc, going to ask for those... I just need them for a couple months, long enough to get the bulk of me off and clean up my house.  Then I can go back to resting, which I prefer to because I am disabled and in pain from breaking my back in three places in a car accident.  

I was on a bad medication around five years ago, I blew up from normal 115 to 185 last time I weighed.  It is causing new problems for me, heart rate up, pressure up, doesn't help my wrecked-up back, and so on.  I am a typical person who has minor rises and falls in weight, but nothing like this last one!  And since vigorous exercise is not something I can do anymore, only some light aerobic and stretching stuff, that weight is not gonna come off, even with a good food programme.  So, I had planned when I saw my doc in the spring, to finally ask for a weight-loss medicine... not the over-the-counter heavily advertised junk on TV, but what I recall people using years ago, amphetamines.  I am fully aware of the abuse potential, but I am very good with the opiates I take now.

So, yes, where do I sign up?  Ha!  And are amphetimines still around?  A couple months of those, and I'd be good.  Plus once I made a dent in it, who knows, might be easier for me to do a little walking to at least keep things on an even keel.  As it is, I will never make it to 70 unless something is available to help me.
GG  

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by darrellinfocus, Nov 15, 2010
Lots of judgmental people, here. Let he/she who has perfect lifestyle control and no genetic predispositions cast the first stone.

I have never had a doctor who didn't start off his/her advice about these kinds of problems by suggesting lifestyle changes, and where I could get some help with them. I have never seen an insurance agency who wants to pay for another drug for me the rest of my life. Why would they? I have had at least one enlightened insurer who paid for my fitness club membership. What do you think would motivate doctors or insurers to not want you to take the safest, least costly route to health?

In truth, we believe what we want to believe about these things, selectively pay attention to those 'facts' we *can* believe that support our case, and if a contradictory fact shows up, we look for reasons to not believe them. We can always find one.

If I have tried as hard as I can, am still unable to master the change that is needed to protect my health, and there is a safe, effective drug that will help me out, there is no reason I shouldn't take it. This is about health, not about morality.

DI

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by Jaquta, Nov 15, 2010
Should that mean that because no one is perfect that one should not have an opinion?  
I suspect many health strategies are in place today because people have been unwell and lessons have been learned.  Advances come about through discussions (not through people hiding in glass houses).

Prescribing a med at times can absolve others of taking social responsibility.  A pill can also be much cheaper than other, at times more appropriate, interventions.

"Safest," I think, can be subjective.

I'm sure you're right but that doesn't mean that we can't be open to change or an alternate opinion just because we aren't in this moment.  I'm sure denial is a defense mechanism many of us have used.

For me I think that health is more holistic.

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by nsummerof69, Nov 16, 2010
Yes I would take them if needed. I would like my doctor to help me make an educated choice . There are no drugs without side affects but would the + out weight the - ? I would have to make a list even if it was just mentally. I myself am a 41 year old F that has been over wieght for years. I was a slender child and at the age of 12 in one summer without any lifestyle changes went from wearing slims to pretty plus sizes . I have strech marks from the rapid growth I made over that summer , breast, hips, butt , thighs . I went from no bra to a C cup when I went back to school that fall. When I graduated from Highschool I was a size 20/22 in womans clothing . In my adult life I have been up to a size 28/30 weighing in at 350 lbs. way to much for my 5 ft 8.5 frame. I have only really went on a dite 2 times in my life , I eat healthy and most all my weight gain is slow and over time. I now am back in a size 20/22 - I watch everything I eat to stay this size . My blood pressure has always been good, same for blood sugars , and cholesterol . I am healthy in all aspects just over weight. I used a perscription to loose 58 lbs , and when I say "a perscription" I mean one 30 pill supply. I used it in half doses and for 5 day runs or less with breaks of 7 days inbetween. It was the help I needed , emotionaly or physically is still hard to say.  So I do think for non abusers a pill is a good option. I feel for the person with the anger issues over pill and drug addiction. A narcissist , is always the life of the party with but never good to take home for keeps.
Like many people a doctor is not around enought to see our true lifestyle , and I think making a choice in 9 mins baised on charts and bits of personal views of our own lives would be a very hard job. It would be like me as a hair stylist picking out a hair cut or color for somoene over the phone, there is no way a Doctor has enought time to make a fulley educated choice for each and everyone of us. We still have a responsability.

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by Destani214, Nov 16, 2010
I would take it in a heartbeat!

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by Stelaraemo, Nov 16, 2010
I would take it if it were safe enough.  Insulin makes me extremely hungry.  Most of my docs thought it was in my head until I saw a research specialist at a Diabetic Institute.  He told me that in some folk insulin does in fact make them hungry.  I also take coumadin.  Two separate and opposite eating worlds.  I can lose weight without insulin.  So if somebody came up with a drug that takes most of the important stuff into consideration...like diabetics on coumadin who need to lose weight, then I'd be willing to try it.  Can't be worse than what I'm doing now....taking rat poision to thin my blood.  The specialist I see for the blood thinners/PT/INRs won't consider taking me off of it until I lose weight.

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by margypops, Nov 16, 2010
I agree jaquta since when are we not to have opinions of our own , thats what we have voiced here I think Dr Beckerman realised that  ....

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by inkheaven, Nov 17, 2010
I think prevention is worth an ounce of cure...with that said...if we had a stronger support system for prevention...we wouldn't need so much "cure!" So much of our health care is fixing stuff after it is broken rather than keeping it in good working order so it doesn't get broken! I lean towards believing that since the focus in our health care system is not prevention and education - that there must be more money in keeping us sick. The grocery shelves are stocked with cheap processed foods, sugared drinks, meat pumped up with growth hormones, etc. All of which are slowly but surely killing us. If there were money to be made in keeping us healthy - you can bet your boots that there would rarely be a sick person among us! I believe that there are ways to focus on prevention that will keep folks motivated. If health care paid for gym memberships...people may or may not use them...but if payment was guaranteed to be made only if the gym was used a minimum of say, 3 times a week - people may be more inclined to go to the gym...just saying! That is just one example...but I am sure there are many more!

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by starsong4, Nov 17, 2010
Everyone has a right to their own opinions--its when those with certain authority over others enforce those opinions onto the others (Drs over patients; Government over the Public) that it becomes a bit scary.

I'd like to know where ginbud's doctors are at because I can't get my regular doctors to write a scrip for anything! And that goes for dentists too! These days, doctors are so afraid of becoming the new drug dealers that they have gone to the other extreme where writing a perscription is the very last thing they will do. For every doctor who is loose with his/her scrip pad there's at least 2 that seem to have sent their scrip pads to Fort Knox!

And for every case of a lazy person who has eaten & channel-surfed their way into obesity there are several others whose weight problems stem from physical injury, genetics, other illnesses, other medications, aging, or a combination of those, & no amount of dieting, exercising & water drinking will get them back to a heathy weight in time to stop/reverse the secondary problems of obesity from arising.

Instead of wanting BigPharm to develop a NEW anti-obesity drug, I think they should re-evaluate & re-educate certain drugs that have worked well in the past-namely Phentermine-FDA approved since approx 1956.  (Completely safe and Effective-FOR SOME PEOPLE-when taken under Dr supervision, along WITH diet and exercise). Instead-the FDA has a knee-jerk reaction of pulling the medication or administering harsh new rules about how and When to perscribe when a handful of people take an overdose of the medication then go play football in the hot summer sun, have a heart attack & die. And pulling Meridia because of a RISK of increase in heart attack? That's like saying we all shouldn't drive anywhere on Friday and Saturday nights because of an increase in being hit by a drunk driver. And if one fits the bill to be obese enough to have a doctor perscribe Meridia in the 1st place then one is already at an increased risk for heart attack-and diabetes, high blood pressure joint pain, arthritis, etc., ALONG WITH social stigma, ridicule & lack of employment (yes-its true-those of a 'normal' weight are twice as likely to be hired over an equally or even slightly more qualified applicant who is overweight/obese).

As for myself: A back injury (treated w/steroid injections) followed by a hysterectomy (problem treated w/hormones 1st) made my 5'3", 145lb frame balloon up to 188lbs. After trying exercises, diets, meal plans, thousands of dollars on equipment, books, foods, programs-for a year and a half-and losing a whopping 7 pounds---I researched phentermine, made appointment with my doctor, fully armed with the facts, and was told to continue to diet, exercise, eat more fruits/veggies and drink more water. Because with my BMI at 31(!), being pre-diabetic (diabetes runs rampant in my Native American family), I wasnt obese ENOUGH for her to perscribe phentermine. I had to be Morbidly obese! --SO - for another 2 years I suffer--And I lose 5 more pounds. I then see another doctor at a medical weight loss spa-running a special on phentermine weight loss program-where I go in monthly for blood pressure & heart rate check and weight loss monitoring. I lose 22 pounds in FOUR MONTHS. I stop taking it for a month and gain back 2 pounds. They cannot prescribe it to me again for another 6 months due to FDA regulations. So I shop around--and 1 month later-I find a more expensive doctor who I see more regularly & who does more in depth analysis of my health monthly, so I may safely lose another 15 pounds. I have kept my weight loss off for 4 months. I believe the Phentermine was the kick in the butt my metabolism needed.

Docs say I'm a phentermine success story = I say its because I DID NOT wait until I was Morbidly obese--with morbid obesity there would be less chance of me keeping weight off AND higher health risks because of higher heart rate, blood pressure and most likely Type II Diabetes. If doctors are waiting for morbid obesity to perscribe these meds, its no wonder the meds are getting a bad rap/poor results.      

So-if you think a weight loss medication might work for you-do ALL the research-talk to your doctor-or a weight loss doctor. Expensive-a little--shop around---but less than surgery.

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by James G Beckerman, M.D.Blank, Nov 17, 2010
Keep the comments coming!  I tend to think that there are two issues:  the first is your opinion of using pharmaceuticals in general, and the second is using pharmaceuticals for a medical condition which is impacted by lifestyle.  I believe that regardless of the many different opinions out there, that it is important to be fair and not to discriminate against any particular group of people when considering various options.  I really appreciate everyone's passion about this issue!

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by ADiJanni, Nov 17, 2010
Very interesting and controversial topic.  I will start out by stating that I am an ICU RN and therefore everyday see the outcome of what excess weight does to people and the effect it has on their lives.  Only recently are we starting to report obesity as one of the contributors to a cause of death.  This means that currently, obesity's mortality rate when looking at statistics is not accurate.  In the next few years it should start to show more of what is actually seen clinically.  I still come across charts however that will list the patient's conditions and not ever say that the patient is overweight - when clearly the patient in the room is 200kg (or 440 pounds).  Conditions listed for cause of hospitalization (I'm using this example because I came across it last week) will be: atrial fibrillation, diabetic ketoacidosis, diabetes mellitus II, coronary artery disease, hypertension, osteoarthritis. The patient will be treated for the listed conditions and then released from the hospital without ever once being counseled on WEIGHT LOSS which, to any medical professional, is clearly the cause for ALL of the listed diagnoses!!  This happens so often it is mind boggling.  In the meantime, at the hospital we have to take classes on how to not offend obese patients. We have to use certain words because others could be taken the wrong way.  No one ever does, but if we do talk to the patients about losing weight we have to be VERY careful - or we could be sued!  Currently, I am 5'2" 125# - do you know how hard it is to move a 440# person when you are my size?  I am sympathetic to the obese individual though because I used to weigh 180#.  I believe this is why I am so passionate about this topic, I have been for years (my first degree is Health and Exercise Science), somewhere there is a major disconnect in this whole obesity epidemic.  

I was reading this article today http://health.usnews.com/health-news/family-health/heart/articles/2010/11/16/gaining-weight-raises-risk-of-heart-disease.html - it talks about the huge risk that excess weight has on the heart.  That article is only about heart risks, but the truth is excess weight is so bad on EVERY system in your body.  The fact is, the most we educate the public, the higher the obesity rates rise.  Recently I read that soon obesity rates will be at 42% of the population.  Often I hear that the "old height/weight charts" are severely outdated and people can't possibly be healthy at that weight.  Number one, that's not true.  Number two, we are SO used to seeing everyone bigger that when we see a "normal" sized person we think they are too skinny!  I'm getting off topic.  I have so much to say on this I could probably write a 50 page paper.  Point is, in my opinion, a drug for obesity would be LESS harmful than the obesity itself.  Even if there are risks, the obese person has so many risks already from the obesity alone - they need to weigh the pros and cons with their physician.  I think the benefits will outweigh the risks though, which you have to assess with any medication.

Obesity is tricky because people are quick to become offended, get their feelings hurt and then they quickly turn defensive.  People will say they have "tried everything" including diets, exercise - but the truth is, if you took that person and put them on a deserted island with only what they absolutely needed for survival - that person would lose weight.  Even if they had a thyroid problem, I hear that a lot, they would lose weight.  The problem though ISN'T the individual.  Remember, I have been overweight myself and am CONSTANTLY fighting to keep my weight down, so I understand - believe me I do.  I think there are several problems that contribute to this epidemic of obesity, but the biggest is one we really can't do a whole lot about and that is the way society has evolved.  First off, our work week.  I believe it is completely unnatural for humans to sit at a desk M-F 8-5 or whatever days they might work.  Confining ourselves to a little cube, office or desk area.  I don't believe that is the way humans are designed to operate.  In my opinion, this leads to depression in many cases and the need to "self medicate" or do something to get away.  This is where I think most people fall, even if they don't realize it.

I like to think about obesity and over-eating like having a drug, alcohol, or smoking problem.  Clearly, drugs, alcohol and smoking are still big problems in our society and they are very hard to overcome.  But, you can stop drinking and at least keep yourself away from environments where alcohol is served - take all the bottles out of your home, etc.  You can stop drugs and not do them anymore because you know if you go back, even for just a little bit, you're hooked again and the process starts all over again.  You can stop smoking and not have another cigarette.  Not trying to make those things sound simple, that's not my point.  The point is, if you are trying to lose weight, you can't walk away from food and "never go back."  It's not even the sweets or fatty things that are really bad for you- it's the EXCESS CALORIES.  You could eat 4,000 calories in apples everyday and guess what - you're going to gain weight.  Similarly, you can eat (depending on your size) 1,800 calories in twinkies every day and LOSE WEIGHT.  What?  Gimmick?  No, it's simple math.  Our body is a machine and it needs a certain amount of fuel to operate.  Bottom line.  Read this article:  http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html

The point I'm trying to make, haphazardly I know, is that eating triggers a satisfaction response from your brain.  Chemicals are released that make you feel good when you eat food.  Very similar, if not the same in some cases, chemicals that are released when a person takes drugs.  It's nature's way of making sure we don't all starve to death.  If we didn't get some satisfaction from eating, then why would we do it?  Then everyone would be nutrient deficient and our species wouldn't survive.  The problem is that now, more than ever before, nutrients are available in such abundance that we can eat all the time!  We have also become such a "right now," "no patience" society that when we eat good for say, a day a two, and don't see any results, we aren't inclined to keep doing it.  We want results now and, let's face it, losing weight and seeing results takes some time.  

Back to the original question.  A drug for obesity?  In this day and age, I think it's our best shot.  If we put more money into obesity education, history shows that the obesity rates are only going to increase.  Is it because people feel bad about themselves, so they eat more?  I'm not for sure but I think that's likely.  Instead of the drug working like drugs in the past have - I think they need to act on the "feel good" neurotransmitters that keep everyone going back for more food.  Similar to an anti-depressant but more specifically geared.  Phentermine and those drugs are okay, but they don't work long term and I don't think they treat the root-cause of this problem.  This epidemic needs something that is going to work.  If we don't do something about this problem, the obesity epidemic is going to bankrupt our country.  The new generation of kids is the first in history that has a shorter life expectancy than their parents because of obesity.  Something has to be done!  

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by margypops, Nov 20, 2010
I like the above post by AD and I agree with what you tell us, but I do forsee that with good food costing a lot more, as inflation takes hold, that many folks will be resorting to cheaper foods which may be high in carbs, protein ie Meat will be impossible to buy its already very expensive as corn is made into ethanol and not fed to cattle . I also think that with this huge emphasis going on about weight including how much a childs body index is on their report card at school, will increase the anxiety kids have about themselves with anorexia climbing. I do not want government control taking over more than it already  has done, but good advertising and teaching of Doctors, nurses like yourself for parents is the best way to go.Drugs will still have side effects but if really over weight folks want to try them it is their freedom and their choice .

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by Jaquta, Nov 21, 2010
I too was intrigued by the previous post.
Everything is so PC these days you can't call it what it is.  One of our radio talk-show hosts called our Governor-General fat.  He got considerable flack for his comment.  He is fat though, so why sugar-coat it?  What's wrong with the truth?

I don't necessarily agree with work being the issue though as there are also people in employment who are not over-weight and who make the time for exercise and who lead healthy balanced lives.

I think that food if often used as a defense against negative emotions created by unresolved issues.
(Check out www.shrinkyourself.com for more info on ways to address emotional eating.)  

I think education is still an issue.  Perhaps we need to look at why we aren't getting the results we would like to see? Education is working in some instances, why not others?

Even Dr Beckerman's philosophy of incremental change for weight loss and healthy lifestyle is so different to the all or nothing approach of general dieting.

Many people are already said to be eating too much meat.  You could always import it from NZ.

I had almost forgotten about those term weigh-ins.  They were very degrading and no interventions were ever made.

My doctor says that clinically weight is not an issue unless you are at one extreme or the other.

The two issues as seen by Dr Beckerman.  Generally I am adverse to taking pharmaceuticals (not a cost issue either as my prescription items are government subsidized and come to $3 each).  I also think it makes sense to take medication for medical issues, if needed, until lifestyle changes can be implemented.

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by Sumanadevii, Nov 23, 2010
Take the research money for fat pills and start supplementing our farmers so vegetables and fruits are not so expensive that the average family cannot afford to eat properly.  It is a simple problem with a simple answer.  Make it available to all and see the fat drop.  And  I dislike the holier than thous preaching.  Try feeding a family of six and see what you eat..

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by Marco_61, Mar 02, 2011
There needs to be said about obesity that it can be a physical problem for some, but it seems that it is psycological for many. I will go even further to say, although perhaps many people would disagree, that in most cases it is psycological but it is fueled by a spiritual problem called sinfulness. Gluttony is a sin and many have it. We should eat to live, while many peoplelive to eat. Also it is the problem of not loving oneself enough to take drastic measures to be well. We are not talking about being a narcissist which is the opposite spiritual problem than obesity,in other words the obsession of having a perfect body. We are saying however that we are tolove God with all of our being,that includes our body that He created and gave us, we are all responsible to take the best care of it we can. Also we are to love our neighbor as our self,and that's the other problem as well. Most people do not really know what it really means to love oneself properly. It does not mean to be selfish and to think only about oneself,it means to love others and respect them as we would our own self. However, you see where we are going with this? If you do not know how nor you love yourself how can you respect and take care of yourself properly. That's also why people have a really hard time loving and resepcting others. Now, some will even say, "hey I am obese and God loves me any way even if I am fat". True, but is that the best He really wants for you? One can say then the same things about other more serious sins but does God want you to stay in the condition you are in, whatever that condition is if it is harmful to you and others? In the end people in most things lack self control,and obesity is not a different problem. The Bible tells us that the fruit of the Spirit, one of them is self control and a disciplined mind, but if one is not born again of the Spirit will never have it, for it comes only by the Holy Spirit. So if you still think the problem goes away with a pill, well God bless you, however it's a much more complex issue. The pill will not however get you in the right relationship with God. If someone is interested in knowing how this is possible you can write to me privately, I preached enough here. God bless all of you.

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by Marco_61, Mar 02, 2011
What really disturbs me about many people is that they always re direct their problems upon other people or institutions.It's called victimism of which unfortunately our society is full of. Granted we are all affected somehow by this terrible pshycological trap, even me.

It's the government's fault, it's the fda's fault, it's the insurance companies fault, it's also my grandmother's fault as she cooked with lard instead of olive oil because it costs too much, and so on and so forth. Let me tell you something you who blame being overweight or obese on poverty and not being able to buy good food because they cost too much. Did you ever see an African obese person, I mean African from Africa that lives there? I've been in Africa, been around 5 different nations, did not see obese people,you know why? they're poor and do not eat a lot. So if you think that blaming poverty for the kind of food you eat is an excuse , well, what can I say. We love to always have everybody else to blame, but the poorest American is much richer than any regular African person. Where there is a will there is a way, it's about time we ended all this poor me attitude and responsibilize our selves for the situations we find ourselves into. I will exclude people who really have genetic probles and thyroid issues and are obese because of these reasons, what do you think the precenteage of the obese population are because of these reasons, maybe the good doctor can tell us? I believe it's low. So having excluded these what's the others excuse?

You may think I have a hlier than thou attitude and I respect your opinon even though I don't have to agree with it and I do not. This is the sad truth of the human beind, always redercting responsibility and fault on others instead of admitting the fault is mine. It has been this way from the beginning. God told Adam not to eat of the tree of the knowledge of good and evil, he disobeyed, and when God confronted him and Eve what was the very first reaction. Adam: this woman you gave me, she caused me to sin, and Eve? The serpent did it, the devil made me do it. But when God adresed the consequences He did not say " oh poor little Adam, the woman I gave you made you do it, I forgive you, it's My fault and hers as well".

They all had to deal with the consequences of their actions. Let's stop blaming God or anybody else for the situations we're in it's most likely our fault.

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by randomdudeperson, Mar 02, 2011
"Did you ever see an African obese person, I mean African from Africa that lives there? I've been in Africa, been around 5 different nations, did not see obese people,you know why? they're poor and do not eat a lot."

Not true. I highly doubt you have been in africa at all Marco. There's a difference between poor and starving, and many many people in Africa are obese. read http://www.guardian.co.uk/world/2010/sep/09/south-africa-obesity-survey-health

It's for the exact same reason as anywhere else in the world. Cheap filling foods instead of healthy diets.

If there was a pill that was risk free and worked for weight loss everyone who is overweight would buy it! Even the people who now say they wouldn't. It makes things oh so easy. It would be almost the same for drugs that inhibit myostatin. Everyone wants to look good. And if you can sell that cheap and risk free everybody will eventually use it.

I think the only logical way such a drug could work would be to limit appetite somehow, rather than stopping fat absorption.

Now if science could please invent something to help people like me gain weight that would be great.

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by Barb135, Mar 06, 2011
This is a really good thread, and of course, I'm late again.

There are about as many reasons for obesity as there are obese people, I think, ranging from "too lazy to get off the sofa", to the economy, to other underlying medical issues (both physical and emotional).  

There is solid reasoning behind the thought of cheap, filling food, instead of healthy food, so the economy is a driving force, to a certain extent; however, if you shop carefully, healthy eating can be affordable. For instance, just think of the cereal isle in your local grocery store.  How many people will chose the fruit loops (that have no fruit in them) or other sugary cereals over a whole grain cereal that would be much better for the whole family, and costs the same or less?  How many people will choose white bread over whole grain, when the cost is the same or similar? How many will choose whole milk over low/no fat, even when the cost is the same?  How many will choose a bag of cookies for treats over a bag of apples that cost the same? Frozen, unsweetened fruits/veggies are as healthy as fresh and usually much less expensive.  I watch sales and buy things when they are "buy one, get one".  

I agree that the government has no business telling people what they "can" or "can't" eat or feed their children; however, I do think children should be taught at young ages to choose foods that are better for them.  Some chool breakfasts consist of packaged pancakes dripping with syrup, or packaged burritos that don't even resemble food, lunches consist of pizza with fat dripping off.  Then there's mom or dad pigging out on a carton of ice cream or a bag of chips. What kind of examples are those; especially when that packaged food or the carton of ice cream/bag of chips probably cost more than a fair sized bag of frozen fruit/veggies, or a package of fresh lean meat?  

Grabbing snacks/treats has become much easier than cooking; sitting the kids in front of the TV, with a package of cookies and a soda, is much easier than going outside to play with them.  Before anyone pounces, I'm not saying this is what everyone does, but I do know there are many instances, in which this happens.

Then, there are the medical issues that make weight control difficult - yes, I deal with one myself - Hashimoto's Thyroiditis/hypothyroidism.  When I first began gaining weight - to the tune of about 30 lbs in < 4 months, when I'd never had a weight problem before, I had to fight to get tested, in spite of the fact that I had a lot of the symptoms of hypothyroidism, besides weight gain.  Once I was finally diagnosed, I then began the battle of getting my levels adjusted to alleviate symptoms; again, my doctor fought me every step of the way.  I was sent to an ENT for the "choking feeling" (thyroid related); I was sent to a cardiologist for the low heart rate (thyroid related); my doctor insisted that I needed cholesterol medication (thyroid related); I was offered antidepressants so many times, it's scary.  

I talked to my doctor repeatedly about my weight issue and all I ever got from him was "You need to MOVE more".... come on, give me a break.  I have a major disease that messes up my metabolism and all he tells me is that I need to MOVE more, when I was already working out daily, and eating very little!!!  Did I get help with my weight issue?  No, I was pegged a hypochondriac and had pills shoved at me.

Hypothyroidism is only one medical issue that causes weight problems and I think the medical community needs to be more willing to look at the whole picture,  rather than offering yet more pills to solve every problem.  Had I not insisted on a certain type of treatment, I would still be struggling with much more than weight issues.

Would I take a pill to help me lose weight?  I'd like to say no, because I see too many people on weight loss pills or drastic diets, and while they lose weight initially, they almost always gain back whatever they lost, if they go off the pills or the diet; however, in reality, if something were available that really worked and was affordable, I'd certainly be tempted, since I know that my weight contributes to my blood pressure levels and increases my risk of diabetes, heart disease or other problems.   I do not think that pills should be allowed as a means of avoiding proper diet/exercise; if used at all, they should be in conjunction with diet and exercise.  

  






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by dennysgirl53, Mar 24, 2011
My Dear ADiJanni,
As a fellow R.N. also working in various critical care areas over the past 38 years I feel obligated to reply to your post. The very last thing ANY patient needs is to be the brunt of any health care PROFESSIONAL's predjudices. We are their to care for the patient's we are assigned to. Care does not just include physical as I am sure you were taught. Would you be  equally upset about the race of your patient, their sexual orientation, their lack of money,education or I.Q.? I don't know...if a homosexual tests positive for HIV..."oh they deserve it,they should have used a condom", or the Smith's have just had their sixth child in six years..." and Mr. Smith is still unemployed",and what about the Down's Syndrome newborn..."I would have had an abortion",and on and on. Believe me, I have never cared for a severly morbid obese patient that said, "I am just thrilled to weigh 527lbs., it was just what my parents yearned for me to become".Truthfully I have not come across an obese patient that could not write their own diet book, they have tried them all! The other hard fact is that among the severly morbid obese population a very high percentage have been sexually abused as children. This is not about condoning it is about being empathetic. Try saying for example to one of these big fat pigs who are obviously stupid,careless,smelly,self-centered,uneducated, and let us not forget lazy that you too have to monitor your food intake and push yourself to exercise etc. You might also consider providing literature on Overeaters Anonymous or even attending a meeting or two. By the way, you are still overweight yourself, good job getting down from 180lbs.but....you have to try harder, remember , "its just mind over matter", "you are what you eat".
One last thing if you should roll into my workplace I promise not to judge you by your size, if I can't turn you or transfer you to a chair ( and your extra 20lbs.)  I'll  call for assistance, and if you apologize for being troublesome, I will reassure
you that it is my pleasure to be able to care for you.

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by beaner0630, Oct 16, 2011
Hi Everybody!

I would take a pill in a heartbeat to control my weight.  I am only 30 yrs old, and was always pretty athletic throughout high school, until about age 16.  This was the age when I was diagnosed with Hashimoto's thyroiditis, I was about 20 pounds overweight and continued to put on the weight, without eating more or exercising less.  Heck, I even joined Curves in my 20s and couldn't shed the pounds.  About 4 years ago I started falling for no reason at all and my legs just stiffened, I ended up having to move out by my Mom, whose a RN.  They diagnosed me with a rare neurological condition called Stiff Persons Syndrome.  That winter, some lady spun around on the freeway, hitting a patch of black ice, I too couldn't stop.  We hit head on.  My legs from being stiff all the time were shattered and I was in a wheelchair for about a year.  They had to fuse my ankle and put pins in my bones.  By then I was over 400 pounds.  My endocrinologist referred me to a metabolic clinic and they found out that I have a common disease found in many people with weight issues, called Insulin Resistance Disorder.  It's like pre-diabetes.  Believe me, I cried.  How upsetting at the age of 28 or 29 to find out that you are pre- diabetic?  Well, anyhow...they put me on Metformin and I have lost over 100 pounds in the past year, with trying to get on the treadmill too.  Now that I told everybody my whole life story (sorry, I'm just hoping for some answers or suggestions here), I just wish that exercise was easier and getting the weight off was easier.  The pain in my legs is horrible and if there was that "magic" pill, yes I would take it in a split second.  So, you people that say that it's from people that sit around and are lazy and don't eat right and all this stuff, it isn't always the case.  We have a garden that we eat fresh veggies from daily that I am grateful for and I am still fat, and those that don't have what I have and live on food stamps and eat pizza?  Well, pizza and pop tarts are a lot cheaper than the nutritious stuff if you price it out.  Farmers can't afford to make their stuff cheap, can't blame them.  Okay, I'm done.  Thanks for listening and hopefully some chemist does discover that pill.  I'm waiting:)

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