#97 Medicine

MEDICATIONS AND HERBAL REMEDIES
There are many over-the-counter diet products. These include herbal remedies. Most of these products do not work and some can be dangerous. Before using an over-the-counter or herbal diet remedy, talk to your health care provider.
Several prescription weight loss drugs are available, including orlistat (Xenical) andphentermine (Ionamin, Adipex-P, Fastin).Sibutramine (Meridia) is no longer on the market. Ask your health care provider if these are right for you.
Usually, you can lose between 5 and 10 pounds by taking these drugs. People usually regain the weight when they stop taking the medication, unless they have made lasting lifestyle changes.
SURGERY
Weight-loss surgery may be done to help you lose weight if you are very obese and have not been able to lose weight with diet and exercise.
Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after the surgery.Talk to your doctor to learn if this is a good option for you.
The two most common weight-loss surgeries are:

• Laparoscopic gastric banding -- the surgeon places a band around the upper part of your stomach, creating a small pouch to hold food. The band helps you limit how much food you eat by making you feel full after eating small amounts.
• Gastric bypass surgery -- helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and other nutrients from the food you eat.

You may have complications from these surgeries. One problem some people have is throwing up if they eat more than their new small stomach can hold.

Support Groups

Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.
See: Eating disorders - support group

Complications

Obesity is a significant health threat. The extra weight puts added stress on all parts of your body.
Medical problems commonly resulting from untreated obesity and morbid obesity include:

• Type 2 diabetes and metabolic syndrome
• High blood pressure, heart disease, and stroke
• Obstructive sleep apnea and other sleep disorders
• Certain cancers, including breast and colon cancer
• Depression
• Osteoarthritis

Extreme obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. These conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death.

Calling your health care provider

Schedule an appointment with your health care provider if you or your child is obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.

References

1. Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007;91:353-381. [PubMed: 17509383]
2. Richards WO, Schirmer BD. Morbid obesity. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 17.
3. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297:969-977. [PubMed: 17341711]
4. Seagle HM, Strain GW, Makris A, Reeves RS; American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009;109:330-346. [PubMed: 19244669]
5. Thompson WG, Cook DA, Clark MM, et al. Treatment of obesity. Mayo Clin Proc. 2007;82:93-101. [PubMed: 17285790]
6. Svetke LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139-1148. [PubMed: 18334689]
7. Kaplan LM, Klein S, Boden G, et al. Report of the American Gastroenterological Association (AGA) Institute Obesity Task Force. Gastroenterology. 2007;132:2272-2275. [PubMed: 17498517]