Drug Truths

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Diet and Exercise Are Important – But Often Insufficient

with 2 comments

The stories are heartwarming.  A person is vastly overweight and finally decides to do something about it.  Through determination, hard work and a newfound discipline, this person loses 25, 50 or even 100 pounds, thereby changing his or her life.  Perhaps it is a woman who wants to have a child and is told that bearing a child would be life-threatening if she didn’t lose a significant amount of weight.  Perhaps it’s a man who has been ridiculed all his life who decides that he is tired of the verbal abuse.  You may have seen these scenarios played out on Dr. Oz or Oprah, or perhaps on the reality show, The Biggest Loser.  Seeing the changes in these people’s lives after such a physical transformation can be inspiring.

I am a big supporter of diet and exercise.  I once heard a doctor say that if you can somehow put the benefits of exercise in a pill, you’d have a wonder drug.  Yet, despite the obvious benefits and the importance of diet and exercise, recent studies suggest that for the majority of the obese population, just diet and exercise won’t be enough.

If you are worried about the obesity epidemic in the US, two recent New England Journal of Medicine articles might further concern you.  One is entitled “Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice” (NEJM, 365;21, 1959 – 1968, November 24, 2011) and the other is  “A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice” (same issue, 1969 – 1979).  Essentially, these papers are similar in that they look at the effectiveness of different interventions in primary care practices by physicians who were trying to help their obese patients gain better control of their health.   On average, the patients in these studies had a body mass index (BMI)  of about 35 ( e.g., a height of 5’7” and a weight of 220 pounds) and had at least one cardiovascular risk factor (high blood pressure, plasma glucose, or cholesterol).  Both studies had control groups who received usual physician care.  In the behavioral intervention study, besides the control group, one group received additional face-to-face counseling and the other group received advice remotely (telephonic or email).  In the obesity treatment study, the control group was compared to those who received monthly lifestyle counseling and another group who received enhanced counseling plus meal replacements and weight-loss medications.

The good news is that in both studies, those patients who were getting enhanced treatment, be it extra counseling on behaviors, more frequent sessions with their doctors or physician assistants, or enhanced life-style counseling, all had sustained statistically significant weight-loss after two years.  The amount of weight loss wasn’t trivial – it was on the order of 5%.  Even if the counseling was done remotely, the results were meaningful.  Thus, extra time spent by primary care physicians and their associates can make a difference in helping their patients lose weight.

But the disappointing news is that even with the loss of 5% of body weight, these patients are still obese.  For the aforementioned person who loses 5% from their 220 pound frame, their new weight is 209 pounds and their BMI is 34 – still well in the obese range.  When you consider that the Center for Disease Control statistics for 2010 show that there are now 12 states where more than 30% of the adult population is obese, the loss of 5% body weight is just a small step to where we must get to in order to improve the nation’s health.

Obesity is a disease and its impact on the future health of the US cannot be trivialized.  Lifestyle changes are very important and can’t be minimized.  But for millions of Americans, this isn’t nearly enough.  Undoubtedly, the future for obesity treatment will necessitate a three-pronged effort that includes diet/exercise, life-style changes and new drugs.  For the latter, both the FDA and the pharmaceutical industry need to work together to help find safe and effective treatments to enhance a physician’s armamentarium to deal with this problem.

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Written by johnlamattina

December 8, 2011 at 2:38 pm

Posted in Uncategorized

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2 Responses

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  1. John,

    What’s your opinion on the rejection of all three anti-obesity drugs by the FDA last year? Contrave, Qnexa and Lorquess were all rejected. This was despite the fact the FDA panel voted to approve Contrave.

    I think you did a great job outlining the impact of obesity on the health of millions of Americans and the need for a new therapy (drug or otherwise) to help treat it. Despite the fact that millions of Americans will (and do) suffer from obesity related diseases (not to mention the related health care costs), do you feel the FDA is doing a good job balancing the risks and benefits of these drugs when it comes to approving or rejecting the NDAs?

    Mike

    Mike Hamilton

    December 8, 2011 at 3:32 pm

    • MIke,
      Thanks for the comments. I have mixed views concerning the obesity drugs that the FDA is now reviewing. I think the FDA is justifiably worried about the potential extensive use by the general population with any newly approved weight loss drug. Thus, they are demanding a high level of safety for any such compound including a three year study in patients showing that the weight loss is sustained and that there are also beneficial health outcomes such as blood pressure lowering or reduction in blood sugar levels. However, should a compound show good safety., I would hope that the FDA would approve the drug even without other benefits.
      – John

      John

      December 8, 2011 at 10:29 pm


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