5 Steps to prevent Heart Disease

Sunday, June 28, 2015

The Three Treatments of Obestiy

Again from Handbook of Obesity Edited by Bray and Brouchard Vol. 2 p 397-398 written by Lars Sjostrom:


“As illustrated by the conventionally treated obese control group of SOS, nonpharmacological obesity treatment at primary health-care centers is not, on average, associated with any weight loss in the short or long term.”

“Treatment with currently available antiobesity drugs typically results in 7-10% weight reduction over 2-4 years as compared to 4% to 6% in placebo/lifestyle groups.”

“Reports from SOS trial have demonstrated that sustained positive effects on risk factors over 10 years require persistent weight loss in the range of 10% to 30%.”

“Obese patients with prediabetes and T2D deserve extra attention.
 It is more difficult to achieve conventional or pharmacologically induced weight loss in diabetic obese patients.
Moreover, even when weight loss is achieved almost all patients relapse within a few years. Treatment with sulphonylureas or insulin causes weight gain.
 Thus, obesity not only causes diabetes but is also a complication of diabetes treatment with some medications.
This vicious spiral must be broken for a successful management of T2D.”

“Surgery is the only treatment of obesity resulting, on average, in more than 15% documented weight loss over 10 years.”

My comment in purple:
Orlistat was used in Look Ahead trial link

Graph showing weight loss over 10 years in Look Ahead link

The mantra taught at NY Presbyterian/Columbia College of Physicians course on Obesity in April 2015 was that providers should be satisfied with 5-8% weight loss reduction as it tends to improve risk factors. 

Now that I have read the above text I wonder at the false hope that is presented. 

The good news is that Qsymia (phentermine/topiramate ER) maintained a weight loss of 10.7% from baseline after two years in the SEQUEL study.

No comments:

Post a Comment