Treatment of obesity with drugs can be a good option when combined with changes of diet, physical activity patterns and lifestyle habits.
However, the role of drugs for weight loss has been questioned because of concerns about the efficacy, safety and the observation that most patients eventually regain weight when they stop taking drugs. In this paper we discuss the main options for weight loss remedies and their indications.
Every patient undergoing treatment for weight loss should be guided by the doctor to have an achievable objective. The ideal endpoint of treating obesity is return to normal body weight, but this is not realistic in most cases. In one study, for example, obese subjects were asked before the start of treatment on how many kilograms they would lose. Months later, when the initial goal was compared with the actual weight loss, none of the study participants had reached the idealized weight and few were happy with the achieved weight loss. Therefore, the physician and the patient must reach a mutual understanding about the real possibilities of weight loss so that there would be no frustration after a few months' treatment.
In the medical treatment of obesity, loss 10-15% of body weight is considered an excellent result, even when the patient wants further weight loss. Indeed, more than 5% loss in body weight is sufficient to substantially reduce the risk of diabetes and cardiovascular diseases. There is a big difference between losing weight for better health and weight loss necessary to achieve the current standard of beauty imposed by the media.
All patients who are overweight should, before starting drugs, establish a proper diet, a program of exercise and changes in lifestyle. Ultimately, losing weight is a simple account of arithmetic: calories consumed - calories burned. If you eat more calories than you expend, there is no treatment that will make you lose weight. There is no miracle cure and there is no weight loss without effort. There is good medical practice to indicate drugs for weight loss for patients who do not keep to a diet and / or exercise.
The choice of diet pills should depend on the following criteria:
Individuals with a BMI (body mass index) greater than 30 kg / m2.
Sibutramine helps in weight loss by acting directly on brain neurotransmitters responsible for feelings of fullness, among them, serotonin, dopamine and norepinephrine. Sibutramine makes these neurotransmitters circulate longer in the brain, so that the patient won't have the desire to eat. Sibutramine is therefore a moderator of appetite.
Studies show that, if combined with diet and exercise, sibutramine helps to lose on average 10 kg after one year of treatment.
Orlistat
Orlistat is a drug that inhibits fat absorption by the intestine. Permanent use of Orlistat makes the third of the consumed fat not be absorbed and eliminated in feces.
Studies show that, if combined with diet and exercise, Orlistat helps you lose on average 9 kg after one year of treatment.
Among the most common side effects are excessive gas, abdominal cramps, fat droplets in the stool and fecal incontinence. Usually these effects are worse if the patient is not controlling the fat intake. A diet with no more than 30% fat does not usually cause these adverse effects. Other side effects include a decrease in the absorption of some vitamins, like vitamins AD and E and a higher risk of developing kidney stones.
Xenical does not alter the absorption of most drugs, including contraceptives, anti-hypertensive drugs, anticoagulants, antiepileptics, and digoxin, for example.
Fenproporex
Fenproporex is an amphetamine derivative which affects central nervous system, particularly the hypothalamus, reducing hunger. It is, therefore, a drug inhibits appetite.
The fenproporex is banned in most countries, but it's still a prescribed drug in Brazil as black box (like Sibutramine). The drug is very effective, however, the fact that stimulant properties, reducing sleep and increasing the sense of well-being, causes it to be irresponsibly used as a recreational drug (the famous ball).
Fenproporex can cause dependency, therefore, should only be used for short periods, usually no more than four months.
Among the most common side effects are dry mouth, insomnia, tremors and irritability. The amphetamine derivatives also cause increased blood pressure and rapid heartbeat (palpitation).
If there is no real change in lifestyle, the patient usually regains the lost weight after he/she stops taking the drug. Since the anorectic effect disappears, the patient feels hunger again and continues to eat more.
Amfepramone (diethylpropion)
The Amfepramone acts similarly to fenproporex, but is a less potent appetite suppressant. Unlike fenproporex, the Amfepramone is legally marketed in other countries such as the USA, Canada, Australia and Switzerland.
The Amfepramone has side effects that are much like fenproporex and is also used improperly as a recreational drug. Due to the risk of dependence, it should only be prescribed for short periods.
Mazindol
Mazindol, the anorectic drug, is another drug having similar action as amphetamine (although not amphetamine derivative), stimulating the central nervous system acting on satiety. It has similar side effects as the two drugs described above.
Currently the two most prescribed drugs for weight reduction are Orlistat and Sibutramine.
The drugs of first and second line for the weight loss in Brazil are the five mentioned above. However, there are some indicated medications for other diseases that can cause weight loss side effect. The drugs listed below should not be prescribed solely for weight loss and have no results as satisfactory as the drugs described above:
There is no scientific evidence to prove efficacy or safety of many products sold as "natural choices" for weight loss. The substances listed below are often sold as options to lose weight but have no scientific evidence:
Lean Pholia
Pholia black
Gymnema silvestre
Ephedra
Guar gum
Chitosan
Ginseng
Herb-of St. John
Green tea
Hoodia gordonii
Psyllium
Hydroxycitric Acid
Glucomannan
L-carnitine
Bitter Orange (Citrus aurantium)
You must be very careful with products sold as miraculous weight loss products. Many of them contain hidden formulas in your medications such as amphetamines, diuretics, thyroid hormones, fluoxetine, benzodiazepines and ephedrine.
There is no miracle drug, as there is no weight loss without effort. Any treatment that promises to reduce weight quickly and easily should be seen as fraud. In addition to spending your money, you can still be consuming substances that do evil.
Treatment with drugs for weight loss should be done only with medical supervision and never without a nutritional program and exercise associated with it. If the patient is unwilling to control their calorie intake and increase their caloric expenditure through physical activity, the success rate is very low.
Recently I began to grow stout, probably, this is the affect of hormonal changes. I know that it is not necessary to limit strongly my diet in proteins and especially in dairy products. Are there any diets for women of advanced age?
