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Medical Interventions and Weight Loss

Harry Mills, Ph.D.

Diet Pills

Various "diet" pills have been around for decades. All existing pills produce at best only moderate results, and come with significant negative side effects. Some are addictive drugs, and others have been pulled off the market due to concerns about lethality. While there are a few weight loss prescription drugs currently available, all have side effects. They may not work for everyone, and the lost weight is usually regained when the drugs are stopped. At the present time there are no pharmaceutical silver bullets for weight loss.

  • Amphetamines were long the diet drug of choice. They supposedly facilitated weight loss by stimulating the metabolism and reducing appetite. The 10 or 20 pound weight loss possible with amphetamine before the drugs would lose their effectiveness came with a steep price. Amphetamines are addictive drugs in the same family as Cocaine and "Crystal Meth" that cause significant withdrawal symptoms when people try to stop using them, and sometimes produce lingering cravings that perpetually tempt former users to resume. They interfere with sleep and in general exhaust the body by keeping it in a constant state of arousal. In large doses they cause hallucinations and psychiatric disorders and can dangerously raise heart rate and blood pressure. They can also cause congestive heart failure, seizures, and sudden death.

  • Fenfluramine and phentermine came onto the market in the 1970s as individual weight loss drugs. A combination of these drugs known as Fen/Phen became available in 1994 following positive results in a research study. A similar drug, dexfenfluramine, was marketed as Redux beginning in 1996. None of these drugs were capable of causing significant weight loss. On average, weight loss of about six pounds could be expected. Both Redux and Fen/Phen were pulled from the market in 1997 when it became apparent that some users of these drugs developed heart valve problems, high blood pressure and neurotoxicity.

  • Herbal, "natural" diet drugs also can be dangerous. More recently, the herbal medicine Ephedra which at one time marketed as a weight loss product was similarly removed from the marketplace due to health concerns including instances of sudden death.

  • Caffeine is sometimes used to aid weight loss because it slightly increases metabolism and slightly decreases appetite. Unfortunately it also can raise heart rate to dangerous levels, cause sleep disturbances, and raise blood pressure.

  • Carb blocker drugs help some people to lose an insignificant amount of weight at the price of significant gastrointestinal symptoms including gas, bloating and diarrhea. Fat blocker drugs are similarly touted as diet aides, but have never been shown to promote weight loss. Instead, fat blocker drugs reduce the absorption of fat-soluble vitamins.

Any dieter considering the use of medicines or herbal preparations to assist with their weight loss program should check with their doctor and pharmacist first, especially if they are taking prescription medicines. Medicines, supplements and herbal preparations can potentially interfere with the functioning of other prescription medications. Inappropriate combinations of medications and/or supplements may have serious health implications.

Surgical Intervention for Weight Loss

Weight loss surgery (otherwise known as bariatric surgery) changes the anatomy of the digestive tract so to limit the amount of food people can eat and digest. Bariatric surgery carries significant risks, including the possibility of death, and requires significant lifestyle changes of patients when it is successful. Because of these risks and responsibilities, bariatric surgery is usually reserved as a treatment of last resort for severely obese people whose lives are threatened by serious health problems as a result of their obesity.

Gastric bypass, the most common type of bariatric surgery, restricts stomach size. The surgeon creates a small pouch at the top of the stomach by stapling off the rest of the stomach volume. This pouch is about the size of a small egg and capable of holding only about one-half ounce of food at a time. Portions of the small intestine are then bypassed by attaching lower segments directly to the stomach pouch. This arrangement substantially reduces the body?s ability to absorb calories. Some surgeons are able to perform this surgery laparoscopically, creating only small incisions.

Candidates for gastric bypass surgery are usually screened in advance by a multidisciplinary medical team which attempts to determine if the surgery is right for each patient. Undiagnosed psychological issues such as depression or substance abuse might hinder patients' commitment to necessary lifestyle changes and/or make it less likely patients are capable of coping with changes in body image. Though we all believe that a slimmer body would improve our social and occupational functioning, this is not always the case.

Gastric bypass surgery can produce dramatic results at the price of substantial risk. People who survive the surgery face the possibility of the surgical opening between the stomach and small intestine closing. Dilation of this opening must occur, either via further surgery or via a mouth tube should this happen. Bleeding ulcers are also common post surgery and may require surgical or medicine remediation. During the first six months bypass patients vomit or suffer severe pain if they eat too much. Meals are reduced to tiny portions and eaten four to six times a day. Over time the amount one can eat increases.

Bypass patients have less opportunity to absorb nutrients from food and are at risk for mineral and vitamin deficiencies. Patients may need to take a daily multivitamin with iron and B vitamins for the rest of their lives. If the gallbladder was not removed during surgery, additional bile supplements may need to be taken in an effort to prevent the development of gallstones.