Obesity Medications

[MSPAC]

Has anyone here worked in obesity medicine? I'm having trouble finding a reputable source on an acceptable rate of weight loss.

I've just recently started rx'ing topiramate/phentermine to my patients, working them up with an EKG, assessing their motivation, coordinating their care with the nutritionist, making sure their BMI >30, etc. etc. Well, I had the first three come back for a 2-week FU and on average, they have each lost at least 10 pounds! There is a part of me that thinks this is a little too fast but I can't find data on "how much is too fast?" Literature states you should see at least 3% weight loss in 12 weeks but wowza! 

Could anyone chime in on the research?

[surgblumm]

Have you considered speaking to a Diabetes Educator as well as the nutritionist? Diabetics are notoriously obese and need behavioral changes and a daily food book or diary. The acceptable weight loss for any really successful program over a three month period is .5 pds to 2 pds weekly. Patients who manage this are on the road to a normal BMI. I just do not think that any diet medication is able to correct their indulgences , particularly when eating out. It takes determination, is as difficult as adjusting to marriage and has a plethora of benefits, just like marriage.

[SedRate]

If you're a member, AAPA has a current free CME activity on obesity and obesity education. I can't remember the name but it was pretty informative and had some reference material. Just search their catalog and you should be able to find it; that's how I did. 

Edited June 22, 2019 by Sed
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[Reality Check 2]

1-3 lbs a week was what I was taught.

There are studies showing that slow, steady weight loss stays off longer.

Too many stupid, rash diet plans cause rapid, unsustainable weight loss with unrealistic diets. HCG and other snake oil causing more harm than good.

I have seen too many toxic gallbladders on liquid “medical” diets and kidney stones on ketosis diets. 

If folks can’t learn to eat for a lifetime - efforts are wasted.

The very old but reliable exchange plan has worked consistently over my career for patients and for me. 

Bariatrics is a lifetime of change with some huge complications and long term effects we don’t even know about yet.

Slow and steady wins the race.....

[surgblumm]

Perfect Response, Reality Check. There is and never will be a magic bullet but will require intrepid effort and commitment.

[ventana]

surprised it has not been mentioned yet

 

key to weight loss is not calorie restriction - but instead exercise.

 

1) burns calories

2) kills appetite

3) builds lean muscle mass

4) raises basal metabolic rate

5) is time where you are not sitting at home boredom eating..

6) helps love life, self image, productivity, sleep patterns, insulin resistance and of so much more

 

start at 1/2 hour every day, working up to an our 4-6 days per week (depending on age - old people(I am one) take longer to recover)

 

 

 

 

[CAAdmission]

On 6/23/2019 at 3:28 PM, ventana said:

6) helps love life

 

[Reality Check 2]

CJ - your browser history must be a fun read..........................

[sas5814]

On 6/23/2019 at 2:28 PM, ventana said:

surprised it has not been mentioned yet

 

key to weight loss is not calorie restriction - but instead exercise.

 

1) burns calories

2) kills appetite

3) builds lean muscle mass

4) raises basal metabolic rate

5) is time where you are not sitting at home boredom eating..

6) helps love life, self image, productivity, sleep patterns, insulin resistance and of so much more

 

start at 1/2 hour every day, working up to an our 4-6 days per week (depending on age - old people(I am one) take longer to recover)

 

 

 

 

I both agree and disagree. I can exercise for an hour daily for a week and then eat that many calories in a few minutes. It is pretty tough to exercise your way through a 8000 calorie a day diet. All the benefits of exercise you mentioned are true and more.

It requires a multifaceted approach. Diets don't work because they are diets. Go on a diet...come off a diet.

If it can be boiled down to one thing it would be permanent lifestyle modification. New better habits.

Edited June 26, 2019 by sas5814

[BrainAndCo]

I'm with sas5814; there's no such thing as out-exercising a poor diet, even for the most physically gifted among us. For us regular schmo's, we need to pay close attention to both.

I remember being taught in undergrad exercise science that if you can create a Calorie deficit of 500 kcal/day, you can estimate a "safe" 1lb weight loss per week (500 kcal x 7 days = 3500 kcal; one pound of adipose tissue is worth 3500 kcal).

Of course, you'll also burn more or fewer calories from carbohydrate stores depending on the type of exercise you are doing, which kind of throws a wrench into my calculation there. Maybe try searching the exercise science literature, surely they've updated it since then.

Jordan G Roberts, PA-C
ModernMedEd

[swooshie1]

Calories burned according to macronutrient type depends largely on intensity of exercise. Higher intensity exercise, while using a higher PERCENTAGE of carbohydrate stores,  also results in a higher total caloric expenditure.  One's body becomes more adept at using fat as an energy source at all intensities as one develops endurance and becomes more aerobically trained.  And actually, the studies do not bear out the belief that exercise is the key to weight loss, for reasons stated above: it's too easy to over-consume. It's much too easy to overestimate calories expended and underestimate calories consumed.