Weight Loss Generic Drugs F.A.Q.
What is obesity?
Obesity is a health condition characterized by the weight gain through the fat storage with the body mass index (BMI) over 25. An individual is considered overweight if their BMI is from 25 to 30 BMI.
Fatty tissue can be stored in the places of physiological deposits, and in the area of the mammary glands, thighs, and abdomen. Currently, obesity is considered a chronic metabolic disease that occurs at any age and is manifested by an excessive increase in body weight mainly due to excessive accumulation of adipose tissue accompanied by an increase in the incidence of general morbidity and mortality. The incidence of obesity in a civilized society is increasing dramatically, despite the absence of changes in the genetic pool, that is, regardless of hereditary factors.
However, genetic predisposition also plays a role in obesity. For instance, the incidence of obesity is higher in the families with family members who have obesity. The genes responsible for the regulation of the body mass evolved throughout the history and development of human society, but at the same time, the environmental factors that determine the consumption of nutrients and reduced the usual physical activity have also occurred.
Obesity can occur as a result of:
– Imbalance of food consumption and energy spent, i.e. increased consumption of food and low physical activity;
– Pancreas, liver, small and large intestines dysfunctions (obesity of non-endocrine pathology);
– Genetic predisposition.
Obesity itself can be of the different stage:
– 1st is the 29% excess of body weight compared to the perfect weight for a certain height;
– 2nd is the 30-40% excess of body weight compared to the perfect weight for a certain height;
– 3rd is the 50-99% excess of body weight compared to the perfect weight for a certain height;
– 4th is the 100% or excess of body weight compared to the perfect weight for a certain height.
There are two types of obesity based on the fat storage type:
– Male type of obesity (can also occur in women) is when fat is mostly accumulated in the abdomen. This type of obesity is considered the most dangerous as it is related to cardiovascular diseases, diabetes, and even cancer
– Female type of obesity is when fat is mostly accumulated in the tights and buttocks.
Why I gain weight?
Obesity development occurs as a result of the imbalance between the consumed food and physical expenditures of the energy of an individual. The regulation of body mass in the body is carried out through a complex interaction of a complex of interconnected systems that control the body’s energy system: absorbed energy (calories) = energy expended. The development of obesity contributes to a positive energy balance (hypodynamia or lack of physical exercising) and a source of easily available calories, the excess of which accumulates in the body as triglycerides in adipose tissue. Thus, to maintain the energy balance, the body must adjust hormone levels, reduce energy costs, increase nutrient absorption efficiency, correct eating behavior (reduce appetite), and mobilize the missing energy from fatty energy depots. Each of the listed links is regulated by certain genes.
Worth noting, our bodies burn calories just for living, i.e. breathing, eating, digesting food, sleeping, and so on. This is called basal metabolic rate; it is a rate at which our bodies burn calories at rest. There are different calculators to find out your BMR. It is important to know it if you have a sedentary lifestyle. Then you need this number of calories per day and not more to maintain or lose weight. But if you walk daily or exercise, you can adjust your calorie intake by calculating how much calories you burn doing your regular activities. It is important to calculate it individually, first of all, because the rate of calorie burn depends on an individual’s body weight and height. Secondly, it is important to know your personal macros, i.e. the norm of proteins, fats, and carbs in the daily meal plan based on your genetic predisposition to store fat, digestive or hormonal disorders.
What are the risk factors of weight gain?
The major factors that contribute to weight gain and subsequently obesity are:
– Sedentary lifestyle;
– Genetic factors, in particular;
– Increased activity of lipogenesis enzymes;
– Decreased activity of lipolysis enzymes;
– Some diseases, in particular, endocrine diseases (hypogonadism, hypothyroidism, insulinoma);
– Psychological eating disorders (for example, psychogenic overeating), leading to eating disorders;
– Propensity to stress;
– Prader–Willi syndrome;
– Dysfunction of the hypothalamus;
– Lack of sleep;
– Use of psychotropic drugs;
– Use of systemic glucocorticosteroids;
– Use of hormonal contraceptives;
– Use of insulin and insulin replacement medicines.
In the process of evolution, the human body has adapted to accumulate a supply of nutrients in conditions of abundance of food in order to expend this reserve in the conditions of forced absence or restriction of food. It is an evolutionary advantage that allowed humanity to survive. In ancient times, fullness was considered a sign of well-being, prosperity, fertility, and health.
Why is excessive weight dangerous?
Obesity and excessive weight, in general, are proven to be related to certain diseases and disorders:
– Metabolic syndrome is a complex of metabolic, hormonal and clinical disorders that are risk factors for the development of cardiovascular diseases. The basis of the metabolic syndrome is tissue insulin resistance;
– Gastroesophageal reflux disease is the most common diseases of the gastrointestinal tract and is comparable in frequency with peptic ulcer and cholelithiasis. It is bursting out of acidic gastric contents into the lower third of the esophagus. In about 10% of cases, acid reflux is combined with alkaline, that is, the gastric contents and the contents of the duodenum are simultaneously thrown into the esophagus. Reflux develops in obese people, in individuals who eat at night, in alcohol abusers, coffee drinkers, and hard-core smokers;
– Type 2 diabetes mellitus is the presence of insulin resistance (cell immunity to the effects of the hormone) and the violation of its secretion by pancreatic cells;
– Coronary heart disease (CHD) is a disease that combines angina pectoris, myocardial infarction, and atherosclerotic cardiosclerosis. It develops due to the insufficient blood supply to the coronary arteries of the heart due to the narrowing of their lumen;
– Myocardial infarction is the death of a portion of the heart muscle, caused by acute circulatory disorders in this area;
– Stroke is an acute violation of cerebral circulation;
– Arterial hypertension is the most common disease of the cardiovascular system, characterized by high blood pressure;
– Chronic venous insufficiency is a syndrome characterized by impaired venous outflow, which leads to the disorganization of the regional microcirculation system;
– Cholecystitis is an inflammation of the gallbladder;
– Gallstone disease is a disease in which stones are formed in the gallbladder or in the bile ducts;
– Arthritis is an autoimmune disease that leads to chronic inflammation of the joints, in addition, periarticular and some other tissues, organs, and systems of the body are affected, and therefore rheumatoid arthritis is classified as a systemic disease;
– Deforming osteoarthritis is a chronic non-inflammatory disease of the joints (articular cartilage);
– Herniated intervertebral discs is a very thin cartilage plate covering the vertebral body from the disc appears to crack, causing blood to flow into the disc substance and contribute to the rapid development of its hernia;
– Polycystic ovary syndrome is an endocrine disease in which the ovaries are enlarged and contain many small vesicles filled with fluid;
– Cancer is distinguished by malignant tumors arising from epithelial cells in the organs and tissues of the body. Epithelial cells have the ability to quickly divide and multiply. Cancer diseases develop with the transformation of normal cells into tumor cells;
– Pancreatitis is an inflammation of the pancreas;
– Fatty degeneration of the liver is the accumulation of fat in the liver cells;
– Extreme obesity with alveolar hypoventilation is a condition in which people with extreme obesity experience alveolar hypoventilation (unable to breathe deeply and quickly enough), which leads to low oxygen levels and high levels of carbon dioxide in the blood;
– Erectile dysfunction in men is an inability to achieve and maintain an erection. It occurs due to hormonal disorders, developing due to obesity and a decrease in testosterone levels, which leads to androgen deficiency.
According to the WHO statistics, cardiovascular diseases are one of the leading causes of death worldwide. In 2012 alone, more than 17 million people died from them. The main causes of heart problems are excess weight, including excess visceral fat (internal abdominal fat).
How to find out my optimal weight?
Optimal weight for your height can be calculated using body mass index (BMI) calculators online. Or you can calculate it yourself: the formula of BMI is kg of the body weight divided into m2, where kg is a person's weight in kilograms and m2 is their height in meters squared. The perfect range of BMI is between 18.5 and 24.9. If your BMI turns out to be higher than that, you can calculate the optimal weight trying different weight numbers in the formula.
How is obesity diagnosed?
Diagnosis of obesity is first of all based on the calculation of BMI. Then, a doctor who treats it, a nutritionist or endocrinologist, tries to find out the reason for the excessive weight conducting patient’s survey and performing a visual examination. Then, blood tests for hormones and glucose are made. If necessary, a doctor can also appoint the tests of all systems and organs to find out how obesity affected them.
The most accurate method for determining the amount of adipose (fat) tissue in the body is MRI.
How to lose weight fast?
The majority of people who want to lose fat wish to do it fast. Unfortunately, it’s not the best way. All diets that claim that you can lose up to 20 pounds (10 kilograms) per week are pure scams. Following them you can only worsen your health, slow down metabolism, and in the best scenario you will lose weight but only due to the loss of water.
The optimal way of losing fat is calculating your basal metabolic rate to know how much calories you burn while at rest (see in the previous paragraphs how), minimize the number of calories consumed close to this indicator, and add exercises to burn all remaining consumed calories. It is, in general, recommended to cut not more than 10-20% of your current daily calorie intake for healthy weight loss. It can ensure you losing 100-200 grams of fat per day. Not to feel hunger, it is advised to include more vegetables and greens, lean meat, and dairy with low content of fat and minimize simple carbs such as bread, pastry, alcohol, sweets, and especially sweetened drinks.
To lose one kilogram of fat, you need to have a caloric deficit of 8000 kcal. Of course, it’s not a daily deficit of calories. Some people can achieve it in a week, others, in two weeks, and so on. The most important thing about losing weight is consistency.
Besides the general recommendations such as diet, limited calorie intake, and exercising, you can also add to your plan supplements that boost metabolism or prevent fats from your meals from absorption. For instance, fats are not transformed into body weight when you use Orlistat by Signature pharmaceuticals. But please keep in mind that the use of the medication implies that you will still cut fats consumption. On top of that, you must first consult your physician or nutritionist to be sure that medication use is safe for you.
How is obesity treated?
Obesity treatment is divided into three major groups:
– Non-drug treatment implies the following of low-calorie diet and increase of physical exercising. It is the optimal and most healthy way to lose fat;
– Drug treatment methods include the use of medications that either suppress appetite, lower fats consumed with food transformation into the body fat, as well as hormonal medicines.
Surgical treatment methods include:
– Liposuction. The removal of excess fatty tissue from the skin;
– Abdominoplasty. The removal of saggy and/or large abdomen;
– Bypass enteroanastomoses. An operation that turns off a part of the small intestine from digestion;
– Gastric rings (Gastric Band), which are superimposed on the stomach, reducing its volume and, accordingly, accelerating the time of saturation.
What are weight loss medications?
– Phentermine. It acts as a neurotransmitter norepinephrine reducing appetite. May cause nervousness, headache, and insomnia;
– Orlistat (Xenical) is an inhibitor of pancreatic lipase, reduces fat absorption by approximately 30%, does not suppress the feeling of hunger but can cause stool incontinence;
– Metformin affects the metabolism of carbohydrates, especially indicated for obesity associated with diabetes.
– Sibutramine (Meridia) is a serotonin and norepinephrine reuptake inhibitor. The drug affects the centers of saturation and thermogenesis, located in the hypothalamus. The drug is contraindicated in patients with uncontrolled arterial hypertension!
– Fluoxetine (Prozac) is an antidepressant. It is recommended by some experts to suppress appetite but there is no information about long-term effects.
– Bupropion (Wellbutrin, Zyban) is a norepinephrine and dopamine reuptake inhibitor that suppresses appetite.
– The combination of ephedrine with caffeine is a sympathomimetic; it stimulates alpha and beta-adrenergic receptors, and the production of norepinephrine. Medication use is widespread in Denmark for the treatment of obesity.
– Topiramate is an antiepileptic drug that reduces body weight through an unidentified mechanism.
– Naltrexone is an opioid receptor antagonist that suppresses cravings for tasty foods.
– Liraglutide (Victose, Saxenda) is a GLP-1 receptor agonist. Presumably, it enhances the action of leptin (a saturation hormone) through the suppression of its soluble receptor.
Despite a large number of drugs for the treatment of obesity, almost all of them were banned by the Food and Drug Administration of the United States because of serious side effects. Currently, five of them have been approved: Orlistat, Lorcaserin, phentermine-topiramate, bupropion-naltrexone, and liraglutide.
It is also important to keep in mind that the majority of these medications are prescribed only for people whose body mass index is over 27. In other cases, it is recommended to change eating habits and incorporate exercise for body mass loss.
Who can use weight loss medications?
It depends on the type of medication an individual wants to use.
For instance, some of the medications are not advised for children while others can be used in kids older than 12 years. It is, in general, recommended to consider weight loss medications if diet and exercising don’t work and if you have the BMI over 27.
Who cannot use weight loss medications?
Weight loss medications have different contraindications for use but all of them are certainly prohibited for pregnant and breastfeeding women and kids. Although, kids older than 12 years of age can be given medications that prevent lipids metabolism and their transformation into body fat.
Orlistat is contraindicated in malabsorption syndrome, at the age of fewer than 12 years, nephrolithiasis and hyperoxaluria (since the use of Orlistat increases the concentration of oxalates in the urine), during pregnancy and breastfeeding;
Lorcaserin is contraindicated in any allergy during the use of medication, age below 18 years, pregnancy, and breastfeeding.
Phentermine/Topiramate is contraindicated for pregnant and breastfeeding women, kids, glaucoma, thyroid dysfunction, with MAO inhibitors and two weeks after their use discontinuation, intolerance of the medication, or idiosyncrasy to sympathomimetic amines.
Bupropion-Naltrexone is contraindicated in any diseases associated with seizures, eating disorder such as bulimia or anorexia nervosa, combined with opioid pain medicines or formulations to cure opioid dependence and with MAO inhibitors. It also mustn’t be used in pregnant and breastfeeding women and kids.
Liraglutide is prohibited to be used in type I diabetes, severe heart, liver and kidney failure, diabetic ketoacidosis, paresis of the stomach, inflammatory bowel disease, and individual intolerance. It also must not be used by pregnant and lactating women and given to children. If you use the medication and develop any side effects, it may indicate that you poorly tolerate the medication and must stop its use.