English | Italian

"Diet Drugs Work: Why..." (Theme) The lastest total: 100+. you can read with page flip.

close
show list
related videos
2012-12-10 - ONE NEWS - SCIENTISTS TRACE FOOD BUG IN RECORD TIME
Meu Emagrecimento-Gorduras Saudáveis
Home for sale in Ellicottville, NY | $384,900
Nidal Asaad - The Doha Experience with AF Treatment, Catheter Ablations and Other Arrythmias
TV ad in GP surgeries
Home for sale in Ellicottville, NY | $99,900
Continue »
Pop theme

David Haines,Prince Harry,Alex Salmond,Alan Pardew,Kanye West,Ian Paisley,Miss America,John Kerry,Billy Horschel,Danny Welbeck

Related theme

primary care,boston

Diet Drugs Work: Why Won’t Doctors Prescribe Them?


obesity em surgery

2013-12-05 10:59:14

The woman sat on my exam table and pointed to her snug paper gown. “Doctor,” she said, “I need your help losing weight.”

I spent the next several minutes speaking with her about diet and exercise, the health risks of obesity, and the benefits of weight loss—a talk I’ve been having with my patients for more than twenty years. But, like the majority of Americans, most of my patients remain overweight.

Afterward, I realized that what my patient wanted was a pill that would make her lose weight. I could have prescribed her one of four drugs currently approved by the F.D.A.: two, phentermine and orlistat, that have been around for more than a decade, and two others, Belviq (lorcaserin) and Qsymia (a combination of phentermine and topiramate), that have recently come onto the market

and are the first ever approved for long-term use. (Ian Parker wrote about the F.D.A.‘s approval process for new medications in this week's issue.) The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. These new drugs, along with beloranib—which produces more dramatic weight loss than anything currently available but is still undergoing clinical trials—were discussed with great excitement last month by experts and researchers at the international Obesity Week conference in Atlanta.

But I’ve never prescribed diet drugs, and few doctors in my primary-care practice have, either. Donna Ryan, an obesity specialist at the Pennington Biomedical Research Center at Louisiana State University, has found that only a small percentage of the doctors she has surveyed regularly prescribe any of the drugs currently approved by the F.D.A. Sales figures indicate that physicians haven’t embraced the new medications, Qsymia and Belviq, either.

The inauspicious history of diet drugs no doubt contributes to doctors’ reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. Then, in the nineties, fen-phen, a popular combination of fenfluramine and phentermine, was pulled from the market when patients developed serious heart defects. Current medications are much safer, but they produce only modest weight loss, in the range of about five to ten per cent, and they do have side effects.

Still, as Ryan pointed out, doctors aren’t always shy about prescribing medications that cause side effects and yield undramatic results. A five to ten per cent weight loss might not thrill patients, or even nudge them out of being overweight or obese, but it can improve diabetes control, blood pressure, cholesterol, sleep apnea, and other complications of obesity. And, although the drugs aren’t covered by Medicare or most states’ Medicaid programs, private insurance coverage of weight-loss drugs has improved and is likely to expand further under the Affordable Care Act, which requires insurers to pay for obesity treatment. So what prevents physicians from prescribing these drugs?

Several leading experts and researchers attending Obesity Week told me that the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. Even though physicians since Hippocrates have known that excess body fat can cause diseases, the American Medical Association announced that it would recognize obesity itself as a disease only a few months ago. These divergent views on obesity represent one of the widest gulfs of understanding between generalists and specialists in all of medicine.

Lee M. Kaplan, co-director of the Weight Center at Massachusetts General Hospital, thinks that some bias comes from the average physician’s lack of appreciation for the complex physiology of weight homeostasis. Humans have evolved to avoid starvation rather than obesity, and we defend our body mass through an elaborate system involving the brain, the gut, fat cells, and a network of hormones and neurotransmitters, only a fraction of which have been identified. Obesity, Kaplan said, which represents dysfunction of this system, is likely not one disease but dozens.

That one person’s obesity is not like another’s may explain why some people lose a lot of weight with surgery, or a particular diet or drug, and some don’t. Kaplan thinks that if more doctors understood this, they’d view obesity treatment more receptively and realistically. He said, “If I were to say to you, ‘I have this drug that treats cancer,’ and you asked me, ‘What kind of cancer?,’ and I said, ‘All cancers,’ you’d laugh, because you recognize intuitively that cancer is a heterogeneous group of disorders. We’re going to look back on obesity one day and say the same thing.”

Obesity is potentially, in part, a neurological disease. Jeffrey Flier, an endocrinologist and dean of Harvard Medical School, has shown, like others, that repeatedly eating more calories than you burn can damage the hypothalamus, an area of the brain involved in eating and satiety. In other words, Big Gulps, Cinnabons, and Whoppers have altered our brains such that many people—particularly those with a genetic predisposition to obesity—find fattening foods all but impossible to resist once they’ve eaten enough of them. Louis J. Aronne, director of the Comprehensive Weight Control Program at New York-Presbyterian/Weill Cornell Medical Center, explained to me, “With so much calorie-dense food available, the hypothalamic neurons get overloaded and the brain can’t tell how much body fat is already stored. The response is to try to store more fat. So there’s very strong scientific evidence that obesity is not about people lacking willpower.”

But this message has not found its way into society, where obese people are still often considered self-indulgent and lazy, and face widespread discrimination. Several obesity experts told me they’ve encountered doctors who confide that they just didn’t like fat people and don’t enjoy taking care of them. Even doctors who treat obese patients feel stigmatized: “diet doctor” is not a flattering term. Donna Ryan, who switched from oncology to obesity medicine many years ago, recalls her colleagues’ surprise. “I had respect,” she says. “I was treating leukemia!”

George Bray, also of the Pennington Biomedical Research Center, thinks that socioeconomic factors play into physicians’ lack of enthusiasm for treating obesity. Bray points to the work of Adam Drewnowski at the University of Washington, who has shown that obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Bray said, “If you believe that obesity would be cured if people just pushed themselves away from the table, then why do you want to prescribe drugs for this non-disease, this ‘moral issue’? I think that belief permeates a lot of the medical field.”

Obesity experts with whom I spoke tended to be more optimistic than other physicians about the possibility that obesity can be treated successfully and that the obesity epidemic will be curbed. They point to exciting new research—for example, the finding that an alteration in gut bacteria, rather than mechanical shrinking of the stomach or intestine, may be what causes weight loss after gastric bypass. This raises the possibility that the benefits of surgery might become available without the surgery itself. They also note that public-health efforts seem to be reducing childhood obesity, even in poor communities. But they remain concerned that despite such promising developments, many physicians still don’t see obesity the way they do: as a serious, often preventable disease that requires intensive and lifelong treatment with a combination of diet, exercise, behavioral modification, surgery, and, potentially, drugs.

Louis Aronne thinks this will change as more physicians enter the field of obesity medicine, the physiology of obesity is better understood, and more effective treatment options become available. He likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago. Aronne remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. He predicts that, one day, “some doctors are going to look back at severely obese patients and say, ‘What the hell was I thinking when I didn’t do anything to help them? How wrong could I have been?’ ”

Patients like the woman who asked me to help her lose weight may not have to wait that long. Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively. But we’ll have to want to treat it: as Kaplan argues, “Whether you call it a disease or not is not so germane. The root problem is that whatever you call it, nobody’s taking it seriously enough.”

Suzanne Koven is a primary-care doctor at Massachusetts General Hospital in Boston and writes the column “In Practice” at the Boston Globe.

Photograph by Patrick Allard/REA/Redux.

View Original Article: newyorker.com
Disclaimer statement: The point of this article or rights belongs to the authors and publishers. We take no responsibility for the content of this article and legitimacy.
Do you have any questions about this article, please contact the news source newyorker.com.
Or contact us

Share

Write an article relevant this topic share on facebook share on twitter share on google plus share on oknews share on linkedin share on digg share on reddit share on newsvine share on pinterest share on netlog share on tumblr share on delicious send email print add to favorite

[{"b":"c","i":"1811519","t":"United Water carrying out hydrant flushing program for 'six to eight weeks' in Bayonne: city officials","a":1},{"b":"b","i":"1191661","t":"Nick Foles remains a QB enigma","a":2},{"b":"b","i":"1191662","t":"At summit against Islamic State, leaders pledge to take 'all means necessary' (+video)","a":3},{"b":"b","i":"1191666","t":"Stay U.K. or go Scot free? Scotland weighs independence","a":4},{"b":"d","i":"853057","t":"Why don't children want to learn the violin?","a":5},{"b":"b","i":"1191641","t":"News Wrap: Shipwrecks off Malta and Libya kill more than 700 migrants","a":6},{"b":"b","i":"1191651","t":"Merger speculation fuel rally among brewers","a":7},{"b":"e","i":"501156","t":"Liz Warren: 'Fair' to Compare Israel\u2019s Actions in Gaza to Holocaust","a":8},{"b":"b","i":"1191628","t":"ChannelAdvisor Announces 2014 Autumn Release - Yahoo7 Finance Australia","a":9},{"b":"b","i":"1191595","t":"\u2018All must know of nation\u2019s past struggles\u2019 - Yahoo News Malaysia","a":10},{"b":"b","i":"1191607","t":"Study by Bradford debt charity reveals impact of fuel poverty on poorest families","a":11},{"b":"b","i":"1191593","t":"Insomniac's 4th Annual Electric Daisy Carnival, Orlando Unveils Exciting Lineup and New Production Details\r\n\t\t\t\t\t\t\t\t\t\t\tFestival returns to Tinker Field November 7-8, 2014","a":12},{"b":"c","i":"1811465","t":"All-Female Group Will Run New NFL ‘Social Responsibility’ Team","a":13},{"b":"b","i":"1191550","t":"Unions hope to negotiate as budget vote nears","a":14},{"b":"b","i":"1191555","t":"Markets Live: Relief rally ahead?","a":15},{"b":"e","i":"501120","t":"Scott Glenn joins 'Daredevil' cast as Matt Murdock's mentor","a":16},{"b":"d","i":"852973","t":"College ranking gains McNeese national recognition","a":17},{"b":"d","i":"852907","t":"Relypsa Announces New Analysis of Phase 3 Data Demonstrating Patiromer's Ability to Rapidly Correct, and Prevent ...","a":18},{"b":"c","i":"1811423","t":"The 10 warning signs of Alzheimer's","a":19},{"b":"e","i":"501087","t":"Striker Christian Benteke returns to training with Aston Villa","a":20},{"b":"d","i":"852876","t":"Christopher Newport University will host forums on Scottish independence, church taxes | Education notebook","a":21},{"b":"d","i":"852884","t":"Long-Term Results of RTOG 0236 Confirm Good Primary Tumor Control and Positive Five-Year Survival Rates for Lung ...","a":22},{"b":"d","i":"852891","t":"Patient-reported data shows RT does not increase risk of lymphedema in node-negative BC patients","a":23},{"b":"d","i":"852892","t":"Manuka honey does not decrease pain of radiation-induced esophagitis for lung cancer patients","a":24},{"b":"f","i":"1065008","t":"Fresno Grizzlies may not renew partnership with Giants","a":25},{"b":"d","i":"852837","t":"Northrop Grumman Announces Scott Harris as Head of Aerospace Programs, Australia","a":26},{"b":"f","i":"1065013","t":"Giants may not renew partnership with Fresno Grizzlies","a":27},{"b":"d","i":"852819","t":"Bilawal Bhutto Zardari to contest 2018 general elections from Benazir Bhutto's seat, Larkana","a":28},{"b":"e","i":"501076","t":"Republicans\u2019 Syria-Rebel Aid Plan Includes Controls","a":29},{"b":"e","i":"501078","t":"Tesla Tumbles After Analyst Raises Cautions About Growth","a":30},{"b":"c","i":"1811388","t":"US Airstrike Targets ISIS Fighters Near Baghdad","a":31},{"b":"f","i":"1064929","t":"Kent State Sweatshirt, \"Holocaust Shirt\" and More: Most Controversial Clothing Ever Sold","a":32},{"b":"d","i":"852775","t":"Argentina Sees 2.8% Growth in 2015 Budget on Expanding Exports","a":33},{"b":"d","i":"852781","t":"Marie Claude Morice presented with Master Clinical Operator Award at TCT","a":34},{"b":"e","i":"501045","t":"Peter Thiel On Why Everything Good Is Actually Bad And Vice Versa","a":35},{"b":"e","i":"501052","t":"20 Entrepreneurs Shaking Up New York's Tech Scene","a":36},{"b":"e","i":"501033","t":"Sturgill Simpson Takes Down Zealots in Blistering Online Post","a":37},{"b":"d","i":"852740","t":"UNISTREAM Money Remittances Volume Through QIWI Kiosks Doubled in the First Half of 2014","a":38},{"b":"d","i":"852750","t":"Defense rests in the Charles Capone's Moscow murder trial","a":39},{"b":"d","i":"852752","t":"Acquisition of Common Shares of Red Tiger Mining Inc.","a":40},{"b":"e","i":"501022","t":"With Minecraft Acquisition, Microsoft Reveals Its Desperation","a":41},{"b":"d","i":"852704","t":"Delrand Resources Announces Proposed Change of Business and Concurrent Private Placement","a":42},{"b":"d","i":"852710","t":"Steve Austin on Sting & More, Bray Wyatt Promotes RAW, Photo of Hulk Hogan and Ken Jeong","a":43},{"b":"f","i":"1064748","t":"Kent State Sweatshirt, \"Holocaust Shirt\" and More: Most Controversial Clothing Ever Sold","a":44},{"b":"d","i":"852668","t":"New Sabotage A.assault Targets Power Transmission Lines in Yemen","a":45},{"b":"d","i":"852672","t":"Qatar- HH the Emir Issues Laws \/For Local Press\/","a":46},{"b":"d","i":"852650","t":"Delhi High Court Verdict on PIL Against Robert Vadra Firms Today","a":47},{"b":"d","i":"852654","t":"UK PM David Cameron warns Scottish independence would be 'painful divorce'","a":48},{"b":"d","i":"852659","t":"By-Elections in 10 States: Counting of Votes Today, Stakes High for BJP","a":49},{"b":"f","i":"1064823","t":"CBS Sports Was Hacked, Translated Into Mock Ebonics Today (Photos)","a":50},{"b":"d","i":"852625","t":"MBS Value Partners Acquires Breakstone Group","a":51},{"b":"d","i":"852626","t":"By 2018, The 'Internet Of Things' Will Be Bigger Than The Smartphone, Tablet, And PC Markets Combined","a":52},{"b":"d","i":"852632","t":"GTIS Partners Expands Global Footprint with Paris Office Opening and Hiring of Real Estate Veteran, Dietrich Heidtmann","a":53},{"b":"f","i":"1064754","t":"Joe's Viewpoint: 9\/11 hoax story","a":54},{"b":"d","i":"852614","t":"Vanguard Mining Corporation Provides Near-Term Financial Guidance","a":55},{"b":"d","i":"852618","t":"Malaysia's Harimau Muda A no match to South Koreans, losing 0-3","a":56},{"b":"d","i":"852584","t":"Ancient Mexican Alcohol Also Worked as Nutrition Supplement","a":57},{"b":"d","i":"852591","t":"Zions Bancorporation Commences Tender Offers to Purchase Up to $500,000,000 Principal Amount of Outstanding Senior Notes","a":58},{"b":"c","i":"1811271","t":"7 things you didn’t read today (but should have)","a":59},{"b":"d","i":"852561","t":"Ike anniversary highlights late-season hurricane threats","a":60},{"b":"d","i":"852543","t":"Veteran Federal Prosecutor Patrick S. Sinclair to Join Ropes & Gray's Government Enforcement Practice in Hong Kong","a":61},{"b":"f","i":"1064687","t":"Quotes from Denver coach John Fox","a":62},{"b":"f","i":"1064768","t":"Retailer apologizes for Kent State sweatshirt","a":63},{"b":"e","i":"500979","t":"Adrian Peterson Can Play Despite Child Abuse -- NYMag","a":64},{"b":"c","i":"1811143","t":"Is Google One of the Best Companies in America?","a":65},{"b":"c","i":"1811123","t":"'Slender Man' Judge Says 'Reason to Doubt' Girl's Competency for Trial","a":66},{"b":"b","i":"1191531","t":"New Analyses Of Phase 2 Study Presented At ASBMR Show Romosozumab Treatment Resulted In Continued Increases In Bone Mineral Density\r\n\t\t\t\t\t\t\t\t\t\t\tRomosozumab Currently in Phase 3 Clinical Development, Pivotal Data Expected in 2016","a":67},{"b":"c","i":"1811128","t":"Featured Stories","a":68},{"b":"b","i":"1191516","t":"Vietnam Vet Who Risked Life, Evaded Tiger Awarded Medal of Honor","a":69},{"b":"b","i":"1191517","t":"Brookshire Brothers teams up with East Texas Food Bank for food drive","a":70},{"b":"c","i":"1811109","t":"Poll: 62% of White St. Louisans Think Michael Brown Shooting Was Justified","a":71},{"b":"e","i":"500920","t":"ScienceInsider","a":72},{"b":"b","i":"1191494","t":"Beyonc\u00e9 and Jay Z Get Naughty in 'Bang Bang' Film Credits Sequence","a":73},{"b":"e","i":"500867","t":"Republicans Think The Gender Pay Gap Is "Okay"","a":74},{"b":"e","i":"500885","t":"Wendy Williams makes good on promise to actually eat crow on talk show","a":75},{"b":"b","i":"1191461","t":"Greenhouse Partners Hosts \u201cGetting Your Brand Right from the Start\u201d Session for Denver Startup Week 2014 - Yahoo Finance Canada","a":76},{"b":"b","i":"1191445","t":"B&R founder Raybould dies at 92","a":77},{"b":"b","i":"1191434","t":"Lindblad Expeditions to Implement Adonis Suite to Coordinate Ship-to-Shore HR and Payroll Processes","a":78},{"b":"c","i":"1811071","t":"Tar Heels hope to improve tackling against Pirates","a":79},{"b":"f","i":"1064446","t":"LA Can Finally Watch the Dodgers: Time Warner to Simulcast Final Games","a":80},{"b":"b","i":"1191401","t":"Kanchun Kaushal & Rajesh Haldipur: Big Brother & the Indian law | Business Standard Column","a":81},{"b":"b","i":"1191403","t":"Hertz 24\/7 Expands Offerings To Peter Cooper Village And Stuyvesant Town\r\n\t\t\t\t\t\t\t\t\t\t\tHertz Car Rental Partners with NYC Development to Offer Convenient New Service","a":82},{"b":"b","i":"1191406","t":"Jumio Taking the Lead through Innovation","a":83},{"b":"b","i":"1191416","t":"Search continues for suspect in robbery near UPMC Hamot","a":84},{"b":"c","i":"1811050","t":"Apple sends OS X Yosemite Public Beta 3 out to testers","a":85},{"b":"b","i":"1191370","t":"French Tennis Player Hits A Ridiculous Between-The-Legs Shot During Davis Cup Match","a":86},{"b":"c","i":"1811034","t":"African Barrick to Drop Parent\u2019s Name in \u2018Rebranding\u2019","a":87},{"b":"b","i":"1191357","t":"Marcy Kaptur calls for a citizen-sampling brigade for Lake Erie water","a":88},{"b":"c","i":"1811026","t":"CalPERS health insurance open enrollment starts today","a":89},{"b":"e","i":"500833","t":"Cameron Says Scots Independence Dream Risks Painful Split","a":90},{"b":"b","i":"1191348","t":"Cumulus Global Tops CRN Fast Growth 150\r\n\t\t\t\t\t\t\t\t\t\t\tRanks #1 Among Elite Group of Fastest Growing Solution Providers in the IT Channel","a":91},{"b":"b","i":"1191353","t":"Teva Canada Announces the Launch of (Pr)Teva-Ezetimibe, a Generic of (Pr)Ezetrol\u00ae - Yahoo Finance Canada","a":92},{"b":"b","i":"1191291","t":"SBA Administrator Kicks-Off Hispanic Heritage Month\r\n\t\t\t\t\t\t\t\t\t\t\tAdvocates for Hispanic Entrepreneurs in NYC","a":93},{"b":"b","i":"1191292","t":"The Campaign Trail: Questions continue over spying claims","a":94},{"b":"b","i":"1191294","t":"Domo Named to the 2014 Emerging Elite by MWCN","a":95},{"b":"b","i":"1191296","t":"Sebi eases norms, extends deadline for woman director","a":96},{"b":"c","i":"1810961","t":"Microsoft Windows 8.1","a":97},{"b":"c","i":"1810942","t":"More than 700 migrants feared dead in Mediterranean sinkings","a":98},{"b":"c","i":"1810928","t":"stltoday.com","a":99},{"b":"f","i":"1064204","t":"Time Warner Cable Will Air Final 6 Dodger Games on Broadcast Station KDOC","a":100}]

100

"Diet Drugs Work: Why..." IN THE COMMUNITY!

Facebook
    Twitter

      PHOTO

        No results related
      Share one Sentence

      Manage my submission

      United Water carrying out hydrant flushing program for 'six to eight weeks' in Bayonne: city officials