Drugs against obesity: are they effective?

Drug treatment of obesity has long been taboo. And for good reason! The first drugs used exposed to serious risks to health. Today the most dangerous products have disappeared in favor of new effective therapeutic classes.



The first drugs used in the treatment of obesity were derivatives of amphetamines, including amfepramone, a molecule with properties anorectic (appetite suppressant). Like all the amphetamine family, this molecule was removed from the market for several years. The risk of psychological dependence, psychiatric disorders, depression and cardiovascular disorders that could result in a dangerous drug was likely to cause serious or fatal accidents.

Plants against the scales

Obesity - Drugs from many doctors have turned to herbs to overcome pounds of their patients, especially in cases of slight overweight. Most of these products are made from green tea, of orthosiphon, meadowsweet sometimes associated with a laxative such as kelp. Although not proven efficacy, they are supposed to facilitate energy expenditure and thus fat consumption. Over the counter and not repaid, they are often prescribed by your doctor in conjunction with a balanced diet and dietary change. Attention, like any medication or food supplement, they are consumed in moderation.

Drugs today still under surveillance

To prevent abuse and injury encountered with the first drug, new drugs developed to fight against obesity are prescribed under strict conditions. While their effectiveness has been scientifically demonstrated, these drugs can not only overcome the kilos. They must be systematically associated with dietary management, the cornerstone of treatment.

These drugs are Xenical and SIBUTRAL. The first is today the most used and acts in the intestine without entering the blood. It blocks the action of enzymes involved in digestion of fat (intestinal lipase) and thus prevents the absorption of fat. Note that these fats remain in the stool and can cause anal seepage and flatulence in less than 30% of cases. The Xenical is prescribed in cases of obesity (BMI> 30 kg/m2) and overweight (BMI> = 27Kg/m2) only if the weight is a real danger to health (diabetes, cholesterol ...). To help patients under treatment, Roche who market the product offer a personalized by a dietitian: Program Success Weight.

The SIBUTRAL ® works differently: it has an appetite in the brain. It has many cons-indications including cases of cardiovascular disorders and is prescribed only when diet alone has not borne fruit. The most common side effects are palpitations, high blood pressure and hot flashes. In October 2002, AFSSAPS has also decided to reserve its limitation to certain medical specialists.

To learn more about these products visit the forms and drug Xenical ® SIBUTRAL ®.

Obesity is now an epidemic and mobilized many laboratories and researchers. New drugs should therefore see the day a few years.

The dangers of diet pills

December 2000, Justice French ordered the manufacturer of an appetite suppressant, thereby putting the emphasis on the dangers of such drugs. At the same time, the United States, the Food and Drug Administration went to war against dietary supplements containing ephedrine. Who gets the appetite? Can they be used safely?



On December 22, 2000, the Tribunal de Grande Instance of Nanterre condemned the pharmaceutical manufacturer of appetite Isomeride to pay more than 2.5 million francs in damages to Anna Ferreira. The latter had contracted a disease attributable to the drug, following which she underwent a double lung transplant and cardiac surgery.

Towards the end of appetite?

Since 1985, the Medicines Agency had recommended these treatments for patients with major obesity. They could only be prescribed by hospital doctors or specialists in endocrinology and diabetology. Despite the known risks of pulmonary hypertension, these products continued to be used by people not suffering from obesity, but wishing only to lose a few pounds.

Since September 1999, the marketing of an appetite suppressant is prohibited in France. The risk of hypertension compared with weight loss seemed to finally tip the scales in favor of caution.

Cons of amphetamine appetite!

In the U.S., the Food and Drug Administration recently went to war against weight loss products containing ephedrine, an alkaloid originally amphetamines. Other war-horse, she recently asked pharmaceutical companies to withdraw from the market products containing a chemical substance (of phenylpropanolamine) that increase the risk of bleeding cérébrale2. Overseas, these drugs are given as a nasal decongestant but also as an appetite suppressant ... In very common use in France and the United States, these products are currently undergoing a reassessment of risk by the French Agency safety of health products, according to a press release dated November 14, 2000. But should we therefore call into question all the diet pills?

Effective in treating obesity

Sibutramine, a treatment against obesity marketed in the United States under the name of Meridia and Europe under the name Sibutral ® has proven effective in helping patients lose weight and maintain it. However, the long-term effects of this product are unknown.

Published in the prestigious journal The Lancet3, a study shows the impact of this drug (originally developed as an antidepressant) on volunteers for two years.

Eight European centers recruited 605 obese patients who, for six months, were treated with sibutramine 10 mg daily, combined with an individualized plan of 600 calories per day depending on their need. Result: 80% managed to reduce their body mass more than 5% and participated in the second phase of the program. During the next 18 months, patients were treated either with sibutramine (at 10 mg / day and up to 20 mg / day if weight regain) or placebo. After this period, the results argue in favor of this compound: 43% of the treated group were able to maintain a stable weight against only 16% of the placebo group. In addition, blood tests of those treated show a stabilization of the indicators of this disease: insulin, triglycerides, C-peptide, VLDL cholesterol and uric acid. Finally, HDL cholesterol (good cholesterol) was increasing.

However, some patients had to discontinue treatment because of sibutramine resulted in their increased blood pressure too much. Thus, medical surveillance is still necessary for the long-term treatment of obesity. This is the second clinical trial demonstrating the effectiveness of drug against obesity. The therapeutic arsenal had already Xenical4, which limits the digestion of fats.

This second generation drug, effective and safe, has already helped many obese to reconnect with the pleasures of life. Caution, however, these treatments are in no way adapted to the loss of a few extra pounds.

DHEA: the hormone that makes you lose weight?

DHEA is known to be anti-aging hormone. But they say it would also be an ally thin! Besides being good for memory, the bone, libido, DHEA could reduce obesity. We weighs the pros and cons of this alleged miracle pill ...



You've never heard of dehydroepiandrosterone? But if you are told DHEA, you see immediately what it is?

The hormone of youth?

Senior DHEA hormone weight loss What is this? Quite simply, we do not know exactly! Scientists initially have noticed that it secreted is increasingly up to the age of 20 years. Then she begins to decrease throughout the life of 70 years, it owns only 20% of the reserves of our best years. Not surprisingly, researchers in search of the hormone of youth were then asked: "And if we tried to maintain its high rate throughout life?". Result: the idea of DHEA supplementation would maintain cognitive abilities, the bone ... and boost the female libido.

But it is too early and many older people remain skeptical ... However, one argument will perhaps tip the balance.

Thinsations

So far, various studies showed that DHEA could have some effects on abdominal fat ... of laboratory rats! The question was, is it a miracle that this hormone may act in humans? U.S. researchers have therefore recruited 56 seniors, half receiving DHEA, the other half a placebo for six months. Result: a significant reduction in waist circumference. DHEA has resulted in a reduction of 10.2% body fat in the abdomen in women and 7.4% among men. The subcutaneous fat was in turn decreased by 6% in both sexes ...

Keep diabetes

But the action of DHEA is not only beneficial for the line. In addressing the abdominal fat, this supplementation would fight against the resistance to insulin. What is it? From a condition called metabolic syndrome, a sharp increase. Insulin is the hormone that helps regulate blood sugar in the blood after a meal. It will promote the storage of glucose. But food and obesity promote a "resistance" of the body to insulin, which becomes less and less effective ... until she does more of everything, and that diabetes (read our article on this epidemic diabesity). But the researchers said, DHEA allow insulin to function more optimally, reducing the risks.

No rush

No need to rush hour on DHEA! With regard to its slimming properties, there is a little premature to assert this new benefit. Moreover, the authors are putting up a larger investigation, to verify these new virtues. In addition, we lack perspective on this hormone could increase the risk of hormone-dependent cancers and cardiovascular disorders. In addition to these dangers, side effects are common: oily skin, acne ...

In short, to lose weight, as with aging, there is still no miracle pill, then prefer the simple means: a balanced diet and little physical activity.

Xenical Sibutral

Drugs have emerged in recent years on the French market for treating obesity. If these treatments are very useful in people with a genuine overweight, they are not adapted to those cases or those wishing to lose a few pounds for summer. Moreover, their use is controlled enough to prevent abuse, and their price is a deterrent.



Xenical- The first of these drugs have emerged is Xenical ®. Marketed in Europe since 1998, this product has a mechanism of action wholly original. Indeed, it occurs inside the digestive tract by preventing certain enzymes, lipase, produced by the stomach and pancreas to break down triglycerides into smaller components, fatty acids and monoglycerides.

Result: about 30% of fats are eliminated in the stool without passing through the bowel wall and therefore not be assimilated by the body.

Modest but undeniable effect

The results are interesting with Xenical on weight loss but nothing miraculous. In fact, data from five comparative studies with this medication prescribed at the usual dose of 120 mg three times daily, showed that 20% of obese people manage to lose at least 10% of their weight when they took the Xenical for a year, while following alongside a reduced calorie diet. And this is only a difference of 3.2 kg between patients treated with Xenical and those receiving a placebo (dummy drug Xenical by mimicking its appearance but devoid of active substance).

A product reserved for genuine overweight

Anyway, Xenical can in no way be used to get rid of some curves. The French legislation is strict. This treatment is permitted only in those considered obese, that is to say in those in whom the BMI exceeds 30, or in individuals who are overweight a bit lower, but are At the same time carry cardiovascular risk factors (hypertension, diabetes).

Moreover, taking Xenical must be accompanied in all cases the monitoring of a mildly reduced calorie diet. And it will be stopped after 12 weeks if weight loss does not exceed 5% since the introduction of drug treatment. In this one main reason: the clinical work showed that if patients do not respond initially to Xenical, it is highly unlikely to do so thereafter.

Furthermore, this therapy is still prohibited in children, because its effects have not been studied in the latter, and is not recommended for pregnant women or mothers in breastfeeding their babies.

Troublesome side effects

The drug is not dangerous, but it has some drawbacks. Because of its mode of action, the stool becomes oily in 20% of cases and one quarter of patients complain of gas seeps along anal. In addition, Xenical sometimes impedes the absorption of fat soluble vitamins A, D, E and K. These explain possible side effects that doctors usually recommend to patients who follow this treatment, not to consume too much fat, divide the amount on three meals, eat fruit and vegetables in abundance and possibly even take vitamins. This should already be the case if the rules which must accompany the dietary treatment are followed. Roche Laboratories who market Xenical also offer patients a personalized follow: it is the Program Successful Weight. Every month a dietician called for patients to review the monitoring plan and the difficulties in proposing solutions.

It should also be aware that patients with diabetes (which is not uncommon for obesity and diabetes are often associated), weight loss is on average less important. Among those with diabetes, the administration of Xenical may lead to strengthening the monitoring of other drugs to fight against the excessive sugar in the blood or even prohibit certain. Finally, Xenical requires precautions in case of simultaneous administration of certain classes of drugs such as anticoagulants.

The latest: the Sibutral

In September 1999, the appetite suppressants have been withdrawn from the French market, because after many years of use when it was found that some as Isomeride Ponderal and can trigger a very serious disease, the pulmonary hypertension. However, anorectics are perhaps not totally said their last word.

Slimming Capsules: attention danger!

One person died and sixteen others hospitalized for taking diet pills based thyroid extracts. How such an accident could happen? What are the dangers of pharmaceutical preparations for weight loss? These products are legal? A point with Professor Bernard Guy-Grand.



Thyroid extracts prepared on site and for slimming, it proposed that the pharmacy Demours located in the 17th borough of Paris, on prescription from Paris. Until a person dies treated and six others were hospitalized. And more than 120 people have received the capsules in question.

Misuse

Pills régimeMais what is this substance "miracle" slimming supposed to patients who were offered? This thyroid extracts obtained from pig included in compounding (made directly into the pharmacy and not supplied by laboratory). The purpose of these preparations is to administer thyroid hormones to people who suffer from hypothyroidism (the thyroid does not secrete enough). This disease leads to fatigue, depression ... and weight gain. Then administer thyroid extract in healthy individuals, only in a thin object, is it common? "I thought these practices had disappeared. It's like income thirty years back!" said Professor Bernard Guy-Grand, nutritionist attached to the Hotel-Dieu (Paris).

No miracle pill

Indeed, these slimming capsules manufactured in pharmacy were more common a few decades, with a "manual" well known, as pointed out by Professor Guy-Grand "take thyroid extracts, which are added diuretics, potassium and a sedative to counteract the negative effects of hormones. " An explosive cocktail for at least that is far more to keep its promises: "The weight loss is very poor: the thyroid hormones will melt more muscle than fat. And the weight gain will be automatic once the end of treatment "said Professor Guy-Grand.

And of course, these pills are not without risk. Besides the fact that there certainly was an error preparation of the pharmacist in this case, the dangers of thyroid extracts used carelessly are well known: rapid heartbeat, psychological ...

Beware of slimming preparations

In terms of slimming drugs, the legal framework, however, is very strict and can normally prevent abuse. The prescription of thyroid hormone extracts should be done for specific indications, which are not mere loss of weight. In addition, the law forbids Talon 1980 that the compounding mixture psychotropic substances anorectic (appetite suppressant), diuretics and thyroid hormones. The Health Minister also pointed out April 22 that he would take all measures to directly "prohibit this type of compounding-based and prescription thyroid extracts. The only medications such as Xenical, now marketed for the indication of weight loss, are highly controlled and authorizations on the market are lengthy and rigorous.

So if you plan to lose your few extra pounds, beware of all the miracle pills and other methods that promise to lose weight effortlessly. Rebalance your diet and physical activity are essential. Therapies and so-called miracle pills are not the only ones to be wary. Thus schemes completely wacky, with declines of calories too large or risk of deficiency, may also threaten your health. And in all cases, medical follow-up is still a guarantee of seriousness.

Acomplia ®: a new weapon against obesity

Rimonabant (Acomplia) is removed from European market since October 23, 2008.

Molecule entirely new mode of action, Acomplia ® arrives in France. Attention is not a miracle pill but a drug. Discover the real effects and limitations of this new compound.

There are in France nearly 10% of obese and over 15% of children are concerned. Momentum, the disease primarily benefits the disruption of food and a sedentary lifestyle.



A mode of action

Rimonabant (Acomplia ®) is the first drug of a new therapeutic class. It acts on the endocannabinoid system recently discovered. This system would regulate the weight, energy balance and glucose. It would be overactive in people with excess fat in the abdomen.

It works by selectively blocking the cannabinoid type 1 (CB1) found in the brain, liver, gastrointestinal tract, muscle and abdominal fat cells. It thus controls the hyperactivity of the endocannabinoid system.

Effective in reducing weight, it is indicated in the management of obese or overweight severe disorder of carbohydrate (especially type 2 diabetes) or associated lipids (high cholesterol).

Recommended for overweight, flunked in weaning

The effects of Acomplia ® has been tested in humans in four studies involving over 6600 obese or overweight. Result: After one year, loss of weight of all treated patients was higher than those on placebo: they lost on average 4.9 kg more, except in the context of the study on patients with diabetes, difference observed was 3.9 kg. The drug also reduced the risk of weight regain.

Tested in the context of smoking cessation on nearly 7000 patients, it could not demonstrate real benefits. The laboratory has decided to withdraw its application for marketing in this indication. It does not make sense in the context of smoking cessation.

The main side effects are nausea, mood alteration with depressive disorders, anxiety and dizziness. This medication can be prescribed to patients with renal or hepatic or uncontrolled serious psychiatric disorders, like major depression.

A drug and not a miracle pill

Warning: this drug is not a miracle pill for people seeking to lose a few pounds. It is a drug for people suffering from obesity and overweight. Please note, obesity is defined by a BMI ≥ 30 kg/m2 and overweight is defined by a BMI> 25 kg/m2. Calculate your online body mass index. The main risk is not aesthetic. Such overweight exposes people to potentially serious medical complications including cardiovascular disease and diabetes.

Finally, remember that the management of obesity and overweight based on any pre-implementation of lifestyle modifications (diet, practice of regular physical activity), treatment of diseases possibly associated, and if necessary, the prescription of a drug indicated in this context.

Dietitian or nutritionist?

Overweight, chronic disease ... Sometimes, eating healthy does not just happen. It is thus sometimes necessary to consult a nutritionist or dietitian, to better balance their diet. We are giving an update on these two professions.




Nutritionist or dietitian?
It is not necessarily easy to make a difference. Yet, when one is faced with a problem of nutrition or a disease requiring special monitoring, it is important to find the right person.

Dietitian or nutritionist: what training?

Dietitian or nutritionist? Dietitians have a degree of state: BTS or DUT dietetics. They exercise their profession in a cabinet, a liberal, or in various health facilities and catering. As they share their know-how both in collaboration with physicians in hospitals and within communities such as schools or businesses.

The nutritionist has, meanwhile, trained in basic medical endocrinology, pediatrics, general medicine or gastroenterology. He then completed a specialty in nutrition in a university. As dietician consult either liberal or within a hospital or clinic.

Nutritional problems: when to see?

"Nearly 80% of my patients come to consult me on the advice of their GP" says Dr. Guerin-Sacreste, nutritionist. Unlike a visit to the dietitian in private practice, consulting a nutritionist is reimbursed by social security (if being sent by his general practitioner). Also, be careful and costs of consultations, as some doctors practice overruns fee.

Dr. Guerin-Sacreste said "a majority of my obese patients with or without complications. But I also met women followed for pregnancy as well as people with type 2 diabetes. For Laffond Anais, a dietician at Paris, the profile of patients is different: "I get mostly women 20-40 years, wishing to lose weight, they come to me spontaneously or following advice from their GP.

If doctors, nutritionists and dietitians practicing in the same field, only doctors are allowed to prescribe medication. Thus, for disorders of weight without complications, you can see both the other one. In contrast, for problems with diabetes or obesity such as hypertension, a visit to the doctor will be more suitable. Moreover, "dieticians have generally a more concrete and more practice-oriented food. This is also why they act in a complementary manner with physicians in medical networks," says Anais Laffond.

Nutritionist or dietitian: choose the right partner

"It's mostly a question of trust, as a general practitioner advise a dietician, while another advise a physician specializing in nutrition," says Dr. Guerin-Sacreste.

Whether dietitian or nutritionist, it is important to establish a good relationship from the start with your partner. According to Anais Laffond "good consultation is characterized by an exchange of at least half an hour to an hour in order to know the habits of his patient. This discussion is essential to propose a plan and follow custom.

For extra weight or the management of chronic disease, beware of promises miracles. Choose a professional who can set goals and choose a simple plan for your situation. Finally, do not hesitate to seek advice from your GP.