WEIGHT LOSS AND THE PLATEAU EFFECT

Anyone who has struggled with weight agrees that it seems much easier to gain weight than to lose it. A resistance to lose weight, even when we have excess fat, is scientifically proven.

Our bodies are programmed to gain weight when food intake increases (or exercise decreases) and resist weight loss when food seems to become scarce. This mechanism was developed as a survival technique in times of famine. When food intake suddenly diminishes, the body assumes that food supply is scarce and protects the individual’s survival by resisting weight loss. The body has no way of knowing that a refrigerator full of food is just steps away. The resistance to lose weight can often increase after a couple months of dieting. A person may lose a pound per week for a couple months on a healthy diet and exercise routine but then stop seeing results while still maintaining this regimen. This leveling off of weight loss is known as the plateau effect. Health professionals recommend increasing the intensity or duration of physical activity to fight the body’s determination to keep that extra fat. On the other hand, the plateau effect is a great incentive not to gain too much excess weight in the first place.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

MEASURING FAT: THE SKIN-FOLD TEST

Another method of evaluating a person’s weight is estimating the percentage of body fat. Obese is defined as 32 percent or higher for women and 25 percent or higher for men. The amount of body fat a person has is nearly impossible to measure directly; many tests have been developed to estimate it. Many of these methods estimate body fat percentage by evaluating the density of a person’s body by submerging him or her in water. Since fat is less dense then muscle and bone, formulas can be used that incorporate how much water a person has displaced to estimate his or her body fat percentage.

An easier, yet probably less accurate, way to estimate body fat percentage is a skin-fold test: Calipers measure the thickness of fat on various areas of the body. The calipers, which resemble tongs, are used to pinch typically fatty areas such as the stomach, thigh, or back of the upper arm. The measurements are then plugged into a formula to convert the thickness of these fat folds into a percentage of body fat. The numbers can fluctuate, however, depending on the type of calipers used, the consistency of the measurer, the distribution of body fat of the person being measured, and the formula used. The estimate is also dependent on the measurer testing in a precise location and using a fixed pressure. A measurer who presses too hard would increase the amount of fat measured and overestimate the fat percentage. The number of measurements taken can also affect the body fat estimate. Some formulas rely on seven measurements from the body, whereas other formulas only require three measurements. If a person is measured on the part of the body that is more fatty than other areas that are not measured, that individual’s fat percentage could be overestimated. At best, these percentages might be used to measure the change in one person over a period of time if the same measurer and same areas of the body are used. As with all calculations used to determine the appropriateness of one’s weight, the numbers do not take into account the variations in body type.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

HEALTHY WEIGHT LOSS

A statistic often quoted in dieting literature is that 95 percent of people who lose weight gain it all back. According to the American Obesity Association, this statistic is no longer true and reflects a small study completed in 1959. Losing weight is not easy, but a person who commits to a plan of physical activity and moderate dieting will see results. Most importantly, it is necessary to replace poor dietary habits with good eating habits and exercise in order for the weight to stay off permanently.

Dieting for children who are still growing should be viewed with extreme caution. Children use their calories to develop, unlike adults, and too severe of a caloric restriction could impair this growth. According to the Mayo Clinic, if a child is overweight, weight loss is typically recommended if he or she is more than 7 years old. For overweight children younger than 7, weight maintenance is the goal. Younger overweight children who maintain their weight will actually be slimming down as they gain height, so their BMI will decrease. One general rule is true for any healthy weight loss: A slow and consistent weight loss is best, generally one pound per week.

A child’s weight loss also greatly depends on the habits and eating attitudes of the adults in the home. When buying food for meals at home and school lunches, parents should shop primarily in the outer aisles of the supermarket; this is where stores stock fresh foods such as fruits, vegetables, and dairy products. Sitting down to eat as a family has also been shown to encourage more healthy eating because people sitting at a table rather than in front of the television are generally more aware of their food portions. Parents who limit the number of times the family eats out, particularly for fast food, will improve their child’s nutrition. Parents who prepare their children’s food at home are better able to control the portion size and ingredients. It has been well documented that restaurants have been increasing portion sizes, which has contributed to the obesity epidemic.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

DIET AND EXERCISE

Diet and exercise are two of the most influential factors in weight loss. The term "diet" in this book is meant to refer to the day-today foods that a person generally chooses. It is the daily habits of food choices that have a stronger influence on weight management than the occasional overindulgence. For those who struggle with weight, they will need to restrict the overall amount of high-calorie foods they eat. Being too restrictive, however, can set up a person to fail at eating healthy. Often people become bored and feel deprived if certain groups of food, such as carbohydrates, are kept off limits. The diets with the best chance of success are those that are well balanced and do not demonize any specific foods. Many people evaluate a diet based on how quickly they can lose weight, but the best plans are actually those with which a person can comply long term.

One of the biggest challenges children face is that they often must eat the foods presented to them. One example would be school lunches. If a school cafeteria is only selling pizza, fries, and cheeseburgers, then the child without a packed lunch is at an immediate disadvantage for controlling calories. Luckily, some schoolchildren are getting the message that diet is crucial to maintaining health and proper weight. A group of five male students from Maple Point Middle School in Lang-horne, Pennsylvania, desired a healthier option at lunchtime. With the help of their families, they petitioned the school to provide a salad bar. The new salad bar has fresh lettuce, low-fat dressing, and toppings such as chicken, tuna, oranges, cheese, tomatoes, croutons, eggs, and cucumbers. The school sold approximately a week’s worth of lettuce within the first day of the salad bar’s debut. A change in diet such as a hearty salad rather than a cheeseburger can help tremendously in maintaining a healthy weight.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

LIFESTYLE AND GENETICS

Diet, exercise, and genetics clearly play a pivotal role in weight. If obesity seems to run in the family, a struggle with weight could be the result of the genes a person inherited. According to the director of the Genomic Laboratory at Laval University Research Center in Quebec, Canada, an estimated 50 percent of obesity cases are due to genes. Currently, there are seven known gene defects that cause obesity.3 A gene defect is a general term for a gene that causes the body to operate in an undesirable way, generally leading to disease. In this case, a gene defect could contribute to obesity, which then leads to heart disease.

Genetics cannot be controlled, but lifestyle can. One lifestyle choice is the hours of sleep a person gets each day. Sleep can factor into one’s weight. Leptin is a hormone produced in the fat cells that signals to the brain that the body has had enough to eat. It is produced in relation to how much you sleep. Not getting enough sleep can drive down leptin levels. This drop in leptin level in turn can lead to overeating because the brain is not receiving the "full" signal. Another hormone that is affected by sleep is ghrelin. Ghrelin is a hormone produced in the gastrointestinal tract that stimulates appetite. Once food enters the stomach, the body halts ghrelin production. A lack of sleep can cause ghrelin levels to rise, leading to an increased sense of hunger. In essence, a chronic lack of sleep can cause a person to want to eat more and feel less satisfied than he or she would otherwise be when well rested.

Studies by the University of Chicago looked at this relationship between appetite and sleep. The researchers measured levels of leptin and ghrelin in 12 men. After those levels were measured the men were subjected to sleep deprivation for two days. Their levels were measured again. Then they received two days of extended sleep and again these hormone levels were measured. This experiment showed that leptin levels went down and ghrelin levels rose when sleep was restricted. The men also indicated that their appetite increased: Specifically, their desire for high-carbohydrate, calorie-dense foods increased by 45 percent.4 This study shows that sleep deprivation may trigger the appetite and increase the likelihood of weight gain. Sleep, however, is just one of the lifestyle factors that affect one’s weight; stress, dietary habits, and level of exercise also contribute significantly.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

METABOLISM

Metabolism is the body’s process of creating and using energy to support functions such as breathing and digesting. Because we cannot create our own energy from the Sun like plants can, we need to consume food to get energy. If our bodies were not constantly metabolizing food, then we could no longer live. Metabolism involves many complex chemical reactions in the body that enable a person to get a certain amount of energy—measured in calories—from eating an apple or even more energy from a slice of pizza.

Unused energy is stored in the body as fat. Energy reserves are a great survival mechanism, particularly in the days when famine was a threat. In the United States, scarcity of food is no longer a serious threat to survival so people do not have an opportunity to burn these energy reserves or fat. Americans also lead much more sedentary lives than people once did, often going from car to office cubicle with little physical exertion. In contrast, a pioneer who was chopping wood for hours a day would have much less chance of being overweight given the pioneer’s high caloric needs. The abundance of food and reduced physical exertion in the average American’s life has contributed significantly to the problem of obesity in the United States.

The metabolism rates of people vary, which plays a significant role in who will struggle with weight even if eating well and exercising. As a person ages, his or her metabolism will slow down, which contributes to weight gain in older years. Occasionally you will hear people mention that their weight gain is from a thyroid problem. A problem with this gland can definitely affect a person’s weight. The thyroid gland produces a hormone called thyroxine, which affects the speed of metabolism. If the thyroid is damaged, it may become less active with the result of lowered metabolism. This condition is referred to as hypothyroidism. Individuals with hypothy-roidism feel tired, feel constipated, and may have a slower heart rate. The opposite scenario is hyperthyroidism, when the thyroid is too active. The result of an overactive thyroid is weight loss, increased blood pressure, elevated heart rate, protruding eyes, and sometimes even a swelling of the neck referred to as a goiter.

Another factor affecting someone’s metabolism is how much muscle he or she has and how much he or she exercises. Generally, a higher percentage of muscle versus fat on the body increases the metabolism. Exercise can increase metabolism because the body is burning more calories while running, jumping, or walking than while sitting still. The rate at which a person burns calories by sitting still is referred to as basal metabolism. Basal metabolism varies among people and is greatly influenced by genetics. Basal metabolism can be increased by becoming more physically fit. Another way to increase basal metabolism is by taking weight-loss drugs that stimulate the body’s metabolic rate.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

HIGH-FRUCTOSE CORN SYRUP: SWEET POISON?

All sugars are not broken down in the body in the same way. Research from Rutgers University in 2007 showed that high-fructose corn syrup (HFCS), the most common sweetener in sugary drinks and processed foods, might contribute to the nation’s increase in type 2 diabetes.

High-fructose corn syrup does not occur naturally in any foods; it was created in the 1970s as an inexpensive substitute for sugar. Examining the label of many snacks and drinks will reveal HFCS as one of the first few ingredients—which indicates that it is present in greater proportion than ingredients farther down the list.
The biggest health concern is that HFCS contains high levels of highly reactive carbonyls. Chemicals with carbonyl groups are unstable and therefore likely to react with other molecules. Carbonyls, which are present in high levels in the blood of diabetics, are believed to cause tissue damage. Sugar is a more stable molecule and therefore does not produce carbonyls. Limiting the intake of sweeteners is always optimal; when offering sweetened food, parents should check labels and opt for sugar instead of HFCS.

Another disadvantage of having too much sugar in the bloodstream is repeated inflammation. Inflammation in the body is generally associated with infection. The red area around a cut is inflammation, caused by the rush of immune cells combating harmful bacteria that is trying to get into the body. The reddened area will eventually heal and then the redness goes away. A limited amount of inflammation such as this is unlikely to do damage but chronic inflammation can eventually cause tissue damage. Chronic indicates that the inflammation is persistent and ongoing. Too much glucose in the bloodstream can cause inflammation in the body, specifically in the heart.

The degree to which a person must be overweight to suffer from these obesity-related problems is debatable. Clearly those closer to the morbidly obese range have a much greater chance of developing these health problems than someone who has a mere 20 or 30 pounds to lose. A hotly debated 2007 study by the Centers for Disease Control and Prevention in Atlanta, Georgia, showed that people with a BMI between 25 and 30, which is considered overweight but not obese, have a lower death rate than people in the so-called normal, underweight, or obese weight ranges.2 The researchers examined death records for 37,000 adults, along with age and weight to determine an individual’s BMI. These records were then used to track trends in death rates with BMI. This study also found that being overweight did not increase the risk of dying from heart disease or cancer. Perhaps most surprisingly, the data indicated that the overweight were less likely die from other diseases such as chronic respiratory disease, Alzheimer’s, infections, and Parkinson’s. The researchers theorized that perhaps this excess fat served as an extra reserve during periods of illness. This study challenges the traditional notion that being overweight is unhealthy and leads to obesity-related health problems. The obese did not fare as well in this study, however. When researchers looked at the death records of people with BMIs ranking them as obese, they found that this group was at a higher risk for the diseases commonly associated with obesity.

This study has outraged many medical professionals such as Walter Willett, MD, professor of epidemiology and nutrition at the Harvard School of Public Health, who believes the findings should be completely disregarded. He argues that other studies have shown that being overweight can shorten one’s life. Other critics say that the study does not address quality of life. These overweight individuals may not have died from their excess weight, but they may have suffered along the way, with osteoarthritis, for example. Most experts agree that tracking the impact of excess weight over a person’s lifetime is difficult, and that it is particularly difficult to determine at which point certain illnesses or even death can be attributed to excess weight. It is important to realize that this is the first time in history that humankind has had such a prevalence of overweight and obese individuals, and therefore there is no clear data of exactly how this health factor affects death rates.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

IS IT RUDE TO REFER TO CHILDREN AS OBESE?

The National Association to Advance Fat Acceptance (NAAFA) believes that children should not be referred to as obese by the medical industry, government, or anybody else. NAAFA believes that referring to children as obese creates an environment in which children feel shame about their bodies. According to NAAFA, the stigmatization of large children has increased over the last 30 years. In fact, overweight children are more likely to be both victims and perpetrators of bullying, according to a study published in the journal Pediatrics. Obese children were more than twice as likely to be intentionally left out of social activities as their normal-weight peers. When obese children were asked to rate their quality of life, they ranked their happiness as low as young cancer patients, reportedly because of teasing and weight-related health problems.

NAAFA would prefer to embrace a variety of body types, even those that are larger, while encouraging healthy eating and physical activity. Medical professionals use the statistics about stigmatizing obese children and the emotional damage it is likely to cause as an additional reason to encourage weight loss. No one knows for sure whether removing the label of obese when referring to an obese child will make the child feel more comfortable with his or her body, but the issue can raise sensitivity about the stigmatization these children are likely to experience.

Although there is much that scientists do not understand about this disease, it is clear that weight and physical activity play a role. The more fatty tissue that a person has, the more resistant his or her body’s cells will be to insulin. Being sedentary is also a risk factor. Physical activity not only controls weight but also helps to burn glucose and is believed to help the body be more sensitive to insulin.

To understand best how obesity and type 2 diabetes are linked, it is important to understand how glucose works in the body. Glucose is the source of energy for the body’s cells and comes primarily from food. After eating, insulin, which is a hormone, is released from the pancreas into the bloodstream. Insulin is like a gatekeeper for the sugar to get into the cells. Without insulin, the bloodstream could be full of sugar but a person’s cells could not access it and he or she would feel lethargic. In a properly working pancreas, insulin levels decrease in response to a drop in blood sugar levels. When the blood sugar dips too low, perhaps because too much time has elapsed since the last meal, the liver releases stored glucose to keep glucose levels at the appropriate range. For people with type 2 diabetes, this careful balancing act does not work properly, resulting in a buildup of glucose in the bloodstream or a potentially fatal situation if the blood glucose falls too low.

Type 2 diabetes is a condition in which the pancreas does not produce enough insulin to regulate the body’s blood sugar level. If the blood sugar is not kept in control, this excess blood sugar may deposit in areas of the body and cause severe long-term consequences. People with diabetes are more prone to heart disease, blindness, kidney damage, and nerve damage.

This nerve damage is referred to as diabetic neuropathy. Diabetic neuropathy can cause tingling or even the loss of feeling in arms, feet, or any part of the body. This loss of feeling can enable cuts to go unnoticed, which can lead to infections. These infections can become so severe that amputation is the only treatment. Diabetic neuropathy is more common among diabetics who have had diabetes for more than 25 years, those who are overweight, and those who have poorly controlled blood sugar levels. In addition to neuropathy, type 2 diabetes also increases a person’s risk of heart disease, blindness, and kidney damage.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

OTHER HEALTH IMPLICATIONS

In addition to diabetes, obesity is linked to heart disease, osteoarthritis (pain in the joints as a result of abnormal wearing of the cartilage), high blood pressure, stroke, gallbladder disease, respiratory problems, and an increased risk of some kinds of cancer such as uterine, breast, and colon cancer. In a 2008 study by the Kaiser Permanente Division of Research in Oakland, California, researchers found a greater incidence of dementia linked with a potbelly, otherwise known as having an apple-shaped body type. In the study, the belly was measured using a set of calipers that measured from the back to the top of the abdomen. Those individuals measuring 10 inches from back to upper abdomen were classified to have an apple-shaped body. Researchers followed up on these individuals an average of 36 years later and found that the individuals with high belly measurements and normal weight were 89 percent more likely to have dementia than people with low belly measurements and normal body weight. Overweight people were 82 percent more likely to have dementia even if they had a low belly measurement and obese people with a low belly measurement were 81 percent more likely to develop dementia than their thinner counterparts. The researchers could not pinpoint exactly why the distribution of fat, not just a higher amount of body fat, would contribute to dementia but did theorize that the abdominal fat likely pumps out substances that harm the brain.¹

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

TYPE 2 DIABETES

Type 2 diabetes was previously referred to as adult-onset diabetes, whereas type 1 was referred to as juvenile diabetes. However, the onset of type 2 diabetes is occurring increasingly in younger people and is now seen in preteens. The statistics of young people developing what was once considered an adult disease is alarming. According to the Institute of Medicine, for children born in the United States in 2000, the lifetime risk of being diagnosed with type 2 diabetes is estimated at about 30 percent for boys and 40 percent for girls. Because type 2 diabetes has become a disease with childhood or adult onset, it is now referred to as noninsulin-dependent diabetes.

Type 2 diabetes is considered a preventable disease. The main difference between type I and type 2 is that type 2 diabetes is a reflection of a person’s lifelong dietary habits. People with type I diabetes generally have a genetic tendency to develop the disease even if there is not a family history of diabetes. Environmental conditions such as exposure to a
virus can also trigger diabetes in susceptible individuals. Risk factors for type 2 diabetes include a family history, age, and race. Family members of people with type 2 diabetes are at an increased risk of developing the disease. Likewise, as one ages, the chances of developing type 2 increase. For uncertain reasons, African Americans, American Indians, and Asian
Americans are more likely to develop type 2 diabetes than Americans of European descent.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

CHILDHOOD OBESITY

The rise in childhood obesity is believed to be due to increases in poor nutrition and inactivity. Television, computers, and other electronics are more popular with children today but generally offer no physical exercise. National guidelines recommend 150 minutes of physical activity per week for elementary school-age children and 225 minutes per week for older children and teens. In one survey completed by the Centers for Disease Control, 27.8 percent of high school girls and 43.8 percent of high school boys reported at least 60 minutes of exercise at least five times per week. High school boys are more likely than girls to be active because they are more likely to participate in sports. According to researchers at the University of South Carolina, one-third of teens are unfit, based on a study of more than 3,000 teens from 1999 to 2002. The definition of "unfit" was determined by a treadmill test where the teens’ heart rates were monitored. The researchers found that overweight teens are much more likely to fail the fitness test than normal-weight teens and that boys are slightly more likely to meet the fitness standard than girls. The findings were troubling to medical professionals because it is well accepted that unfit teens are much more likely to be unfit adults.

Fast food and vending machines in schools also contribute to childhood obesity. For many children, fast food is a weekly or even daily part of their diets. Particularly disturbing is the quantity of sugar children consume today. According to the United States Department of Agriculture, in the early 1800s, the average person consumed approximately 12 pounds of sugar annually. By the 1970s, the annual consumption of sugar jumped to 137 pounds, a figure that has not changed much over the years despite the introduction of many artificial sweeteners. The source of much of this sugar is in processed foods and sweetened drinks.

Processed foods are foods made with processed white sugar, high-fructose corn syrup, and grains such as white flour, in which the plant fiber—and most of the nutrition—has been removed. High-fructose corn syrup (HFCS) is a sweetener created from corn syrup. Most "convenience" foods are processed. The danger with processed foods is that without fiber to slow the absorption of food, the glucose (sugar) from the broken-down food floods the bloodstream, causing the body to produce insulin to handle this excess sugar. The insulin captures the sugar, which may leave the person feeling tired and cranky from a suddenly lower blood sugar level. This cycle is commonly known as a sugar crash, and from a medical perspective is an unhealthy eating style. Having insulin levels fluctuate greatly as a result of a poor diet can increase the chances of developing type 2 diabetes.


Becoming overweight as a child can make weight loss a more significant struggle throughout life. Scientists identified adolescence as a critical period for the development of obesity. A person who becomes overweight during adolescence is much more likely to struggle with obesity later in life. An overweight adolescent has a greater chance of being obese as an adult than an overweight child who has not reached adolescence. The reason for this is that weight gain in adolescence increases the amount and size of fat cells. Once fat cells are created, they cannot be lost through weight loss. When an adolescent tries to lose weight, he or she can only limit the size of the fat cells and not the total number of fat cells. The only way to get rid of fat cells permanently is through liposuction, a surgical procedure in which the fat cells are removed from the body. Liposuction is not a realistic option for most people, so the best way to control adult obesity is to limit the proliferation of new fat cells developed from childhood obesity.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

Fat and Weight Loss

Mary is a 35-year-old mother of two daughters. Although she has always struggled with weight, her weight has hit an all-time high in the past few months. A couple of years ago, she injured her back, which left her unable to work. It was after her injury that she really started to gain weight, reaching more than 350 pounds. She considered back surgery but the doctor told her the risks were too great due to her weight-related health issues. Mary looked into getting her stomach stapled, hoping that she would lose enough weight to allow her to have the back surgery. However, her insurance would not pay for the surgery.

At her weight and with her back problems, Mary feels like she cannot exercise, creating a vicious cycle of weight gain and inactivity. Mary is just one of the 9 million Americans who are morbidly obese. If Mary continues to be morbidly obese she will likely suffer dozens of ailments from arthritis to asthma, and have her life shortened by 20 years. Weight-loss drugs, however, are often covered by insurance; if Mary tries them and is able to reduce her weight by 10 percent, she might become a better candidate for the back surgery she needs.

CHILDHOOD OBESITY

TYPE 2 DIABETES

IS IT RUDE TO REFER TO CHILDREN AS OBESE?

OTHER HEALTH IMPLICATIONS

HIGH-FRUCTOSE CORN SYRUP: SWEET POISON?

METABOLISM

LIFESTYLE AND GENETICS

DIET AND EXERCISE

HEALTHY WEIGHT LOSS

MEASURING FAT: THE SKIN-FOLD TEST

WEIGHT LOSS AND THE PLATEAU EFFECT

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

WEIGHT-LOSS DRUGS: PILLS AND SUPPLEMENTS

Weight-loss drugs are intended to enable patients to lose weight more effectively than diet or exercise alone by suppressing appetite, inhibiting the absorption of fat, or in some cases, increasing the metabolism slightly. Maximum weight loss as a direct result of the drugs will generally show results within the first six months. A patient could also lose weight due to the drugs after the first six months, but it will be a moderate weight loss. The length of time during which a person will continue to lose weight as a direct result of the weight-loss drug depends on how long it takes his or her body to adjust to the medication. Despite the efficacy of weight-loss drugs, the likelihood of losing significant weight without also increasing exercise or making dietary changes is unlikely. For this reason, patients should always incorporate at least some form of exercise and dieting as part of their weight-loss plan. Even if a patient’s weight loss has leveled and he or she has reached a target weight, the individual must continue to take the medication to maintain the weight loss; this is controversial because some doctors believe the safety of taking many of these drugs for decades is not yet well known. We know that many weight-loss drugs cannot be taken long term, and therefore the patient must switch to another weight-loss drug, further increase exercise, or adjust his or her diet.

Weight-loss drugs are generally prescribed for people who are obese, not those who are slightly overweight or those looking to get ultra-slim. The most common guideline used to determine who is underweight, normal weight, overweight, or obese, is the body mass index (BMI). The body mass index is a guideline of how appropriate a person’s weight is given his or her height. BMI is a number that represents weight divided by height squared. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) define the weight status categories with BMI ranges for adults in the following table:





To illustrate what these numbers translate to in pounds, the following information demonstrates various BMI categories for a person who is 5’9" tall.



There are two additional subcategories, morbidly obese and super morbidly obese. Morbidly obese represents people with a BMI of 40.0 to 49.9, and super morbidly obese refers to people with a BMI of 50.0 and above.

Assessing weight with BMI also has its critics in the medical community. The problem with BMI to determine a healthy weight is that is does not account for how much muscle a person has. An extremely muscular person may be considered overweight according to BMI but could be healthy and fit. Consider, for example, the basketball player Shaquille O’Neal. At 7’1" and 325 pounds, O’Neal’s BMI is 31.6, which puts him in the "obese" category. Shaquille O’Neal is definitely not obese; he is extremely muscular, and therefore BMI is not a suitable evaluator of his health. A person also could have a normal BMI but be in poor nutritional health. Elderly people who have lost muscle due to inactivity might be considered a normal weight due to their BMI but in fact may have reduced nutritional reserves.



For children and teens (ages 2 through 19), the criterion for overweight is slightly different than for an adult. For children and teens, BMI age- and sex-specific percentiles are used because the amount of body fat changes with age, and the amount of body fat differs between girls and boys. To be considered overweight, a child or teen would be in the ninety-fifth percentile or higher for his or her age based on BMI. Being in the ninety-fifth percentile, for example, means that
the individual’s BMI is greater than 95 percent of the other individuals in the same age category. A child or teen in the eighty-fifth to ninety-fifth percentile is considered at risk for overweight, according to the Centers for Disease Control. The CDC does not provide a definition for obese children and teens, although the term childhood obesity is used in their literature.

In the United States, one-third of all adults are overweight, a statistic that has been consistent since 2002; the percentage of overweight children, however, is on the rise. According to the Mayo Clinic, since the 1980s, the prevalence of overweight children ages 6 to 11 doubled and the number of overweight teens tripled. According to the Centers for Disease Control, approximately 18.8 percent of U.S. children and 17.1 percent of teens are overweight. Being an overweight child or teen greatly increases the chances that he or she will be an overweight adult and therefore be at a greater risk for obesity-related health disorders, such as type 2 diabetes and heart disease.

The U.S. Food and Drug Administration (FDA) is the agency responsible for protecting the public from unsafe drugs; however, the FDA has much more control over prescription drugs than it does over nonprescription drugs and dietary supplements. A dietary supplement is a pill, capsule, powder, or liquid that supplies nutrients such as vitamins or minerals. A multivitamin is an example of a dietary supplement. Taking fish oil to assist with lowering blood cholesterol would be one way that a person might use a dietary supplement. Although the nutrients in supplements are in foods, the FDA does not consider them foods.

Drugs that require a prescription must produce research to show that they are safe and effective before the FDA approves them for sale. Dietary supplements do not have to be approved by the FDA to be sold. Dietary supplements must not, however, be marketed on false or misleading claims. The FDA can only intervene after the product has reached the market and there is evidence that it is dangerous to human health. This lack of regulation has proven to be a danger to the public, as is the case with ephedra, which caused several deaths before the FDA stepped in and banned this supplement.

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

Weight, Obesity, and BMI

Obesity is a worldwide epidemic. Approximately one out of every three Americans is obese, according to the National Institutes of Health. Particularly disturbing is the increase of obesity in children. According to the Nemours Foundation, 10 percent of 2- to 5-year-olds and more than 15 percent of children between the ages of 6 and 19 are overweight.1 In response to this trend and in consideration of the health risks of being overweight, weight-loss drugs are in great demand. Weight-loss drugs refer to any over-the-counter or prescription drug used for weight loss. Like any drug, these weight-loss aids present varying degrees of risk. Many doctors advise patients to assume the risks of these drugs even to experience the average 5- to 10-percent weight loss. This risk was grossly miscalculated, however, with drugs such as Redux and Fen-phen, which caused some consumers permanent heart and lung damage. This book will describe the health and emotional implications of being overweight, the biological mechanisms of weight-loss drugs, and the benefits and side effects of these drugs.

WEIGHT-LOSS DRUGS: PILLS AND SUPPLEMENTS

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

The Use and Abuse of Drugs

For thousands of years, humans have used a variety of sources with which to cure their ills, cast out devils, promote their well-being, relieve their misery, and control their fertility. Until the beginning of the twentieth century, the agents used were all of natural origin, including many derived from plants as well as elements such as antimony, sulfur, mercury, and arsenic. The sixteenth-century alchemist and physician Paracelsus used mercury and arsenic in his treatment of syphilis, worms, and other diseases that were common at that time; his cure rates, however, remain unknown. Many drugs used today have their origins in natural products. Antimony derivatives, for example, are used in the treatment of the nasty tropical disease leish-maniasis. These plant-derived products represent molecules that have been "forged in the crucible of evolution" and continue to supply the scientist with molecular scaffolds for new drug development.

Our story of modern drug discovery may be considered to start with the German physician and scientist Paul Ehrlich, often called the father of chemotherapy. Born in 1854, Ehrlich became interested in the ways in which synthetic dyes, then becoming a major product of the German fine chemical industry, could stain selectively certain tissues and components of cells. He reasoned that such dyes might form the basis for drugs that could interact selectively with diseased or foreign cells and organisms. One of Ehrlich’s early successes was his development of the arsenical "606"-patented under the name Salvarsan-as a treatment for syphilis. Ehrlich’s goal was to create a "magic bullet," a drug that would target only the diseased cell or the invading disease-causing organism and have no effect on healthy cells and tissues. In this he was not successful, but his great research did lay the groundwork for the successes of the twentieth century, including the discovery of the sulfonamides and the antibiotic penicillin. The latter agent saved countless lives during World War II. Ehrlich, like many scientists, was an optimist. On the eve of World War I, he wrote, "Now that the liability to, and danger of, disease are to a large extent circumscribed-the efforts of chemotherapeutics are directed as far as possible to fill up the gaps left in this ring." As we shall see in this volume, it is neither the first nor the last time that science has proclaimed its victory over Nature only to have to see this optimism dashed in the light of some freshly emerging infection.

From these advances, however, has come the vast array of drugs that are available to the modern physician. We are increasingly close to Ehrlich’s magic bullet: Drugs can now target very specific molecular defects in a number of cancers, and doctors today have the ability to investigate the human genome to more effectively match the drug and the patient. In the next one to two decades, it is almost certain that the cost of "reading" an individual genome will be sufficiently cheap that, at least in the developed world, such personalized medicines will become the norm. The development of such drugs, however, is extremely costly and raises significant social issues, including equity in the delivery of medical treatment.

The twenty-first century will continue to produce major advances in medicines and medicine delivery. Nature is, however, a resilient foe. Diseases and organisms develop resistance to existing drugs, and new drugs must constantly be developed. (This is particularly true for anti-infective and anticancer agents.) Additionally, new and more lethal forms of existing infectious diseases can develop rapidly. With the ease of global travel, these illnesses can spread from Timbuktu to Toledo in fewer than 24 hours and become pandemics. Hence the current concerns about avian flu. Also, diseases that have previously been dormant or geographically circumscribed may suddenly break out worldwide. (Imagine, for example, a worldwide pandemic of Ebola disease, and how this event would totally overwhelm public health agencies.) Finally, there are serious concerns regarding the possibility of man-made epidemics occurring through the deliberate or accidental spread of disease agents-including manufactured agents, such as smallpox with enhanced lethality. It is therefore imperative that the search for new medicines continues.

All of us at some time in our life will take a medicine, even if it is only aspirin for a headache. For some individuals, drug use will be constant throughout life. As we age, we will likely be exposed to a variety of medications-from childhood vaccines to drugs to relieve pain caused by a terminal disease. It is not easy to get accurate and understandable information about the drugs that we consume to treat diseases and disorders. There are, of course, highly specialized volumes aimed at medical or scientific professionals. However, such texts require their readers to possess a sophisticated knowledge base and experience. Advertising on television is widely available but provides only fleeting information, usually about only a single drug and designed to market rather than inform. The intent of this series of books, Drugs: The Straight Facts, is to provide the lay reader with intelligent, readable, and accurate descriptions of drugs; an explanation of why and how they are used; and information about their limitations, their side effects, and their future. It is our hope that these books will provide readers with sufficient information to satisfy their immediate needs and to serve as an adequate base for further investigation and for asking intelligent questions of health care providers.

The present volume, Weight-Loss Drugs, discusses a group of drugs that are employed in the control of weight. The twenty-first century presents an ironic picture of a world population expanding simultaneously in both number and size. The ready availability of highly palatable, energy-dense foods has, together with major lifestyle changes, resulted in a population that is increasingly overweight or obese. This epidemic of weight increase is not confined to adults, but is also an increasingly serious problem with children. To be sure, this epidemic is not uniform-the world is still dramatically unequal, and the number of obese individuals is counterbalanced by an even greater number of people for whom the arrival of the next meal is uncertain.

How to tackle this global epidemic of obesity is a major problem. It is both a medical and a public health problem. It is quite clear that public health measures must be a major component of any approach; and that these interventions, involving diet, exercise, and education, must start at an early age. Intervention with drugs will also be a part of an integrated approach, but the complexities of the physiological processes that control feeding behavior make this a very difficult task. The drugs that are available and that are discussed in this volume are far from satisfactory, and some have been associated with extremely serious side effects, including death, and virtually all are subject to abuse. Awareness of these limitations is a vital component of any effort to tackle the problems of overweight and obesity.

David J. Triggle, Ph.D.
University Professor School of Pharmacy and Pharmaceutical Sciences State University of New York at Buffalo

Source: "Drugs The Straight Facts: Weight-Loss Drugs," Chelsea House, 2009

Weight-Loss Drugs

Weight-Loss Drugs (Drugs: the Straight Facts)
Chelsea House, 2009

Table of Contents:

The Use and Abuse of Drugs (David J. Triggle, Ph.D.)

1. Weight, Obesity, and BMI
2. Fat and Weight Loss
3. Appetite Suppressants
4. Lipase Inhibitors
5. Fen-Phen and Redux: The Making and Unmaking of Drugs
6. Stimulants
7. Going Off Label for Weight Loss
8. The Future of Weight-Loss Drugs

Weight, Obesity, and BMI