what about the new medical treatments for obesity?

A NEW GENERATION OF MEDICAL
TREATMENTS FOR OBESITY

Obesity Solutions

“It sounds cool, and, as recently pointed out by the FDA, patients will undertake all sorts of risks and discomfort for the promise of weight loss. Unfortunately, a 9% difference from placebo is not much better than intensive lifestyle intervention alone as recently demonstrated in the Look AHEAD trial which produced an 8.6% increase in weight loss compared with moderate lifestyle intervention in the first year.  Therefore, we find the new and invasive technique of intra-abdominal intermittent vagal nerve blockade carries significant risk of pain and abdominal discomfort, but might deliver no better or even less weight loss than intensive exercise and diet.”   The words of Dr. Raymond Bourey, Head of the  Division of Endocrinology, Diabetes, and Metabolism at St. Louis University Medical School, from a January 15 article by Kristina Fiore for MedPage Today (Weighing In on New Obesity Treatment)He was discussing the new “Weight Loss Pacemaker” (Vagus Nerve Stimulator)

“Weight loss medications do not change the underlying physiology of weight regulation in any permanent way.Trials of weight loss medication have demonstrated that the weight loss effects of these medications are only sustained as long as they are taken and these same benefits occur on introducing the medication in patients previously treated with lifestyle alone. Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.”  Dr. Caroline Apovian and her team from the study discussed in my post below.

“Things have changed dramatically in the past few years. Arm’s-length relationships are a thing of the past, and financial arrangements are hardly limited to grant support. Companies now design studies to be carried out by investigators in academic medical centers who are little more than hired hands supplying the human subjects and collecting data. The companies own the data, analyze it, and control publication.”  From Dr. Marcia Angell’s address to the Department of Health and Human Services (Financial Conflicts of Interest) back in 2000.

“For their part, academic institutions are increasingly involved in deals with the same companies whose products their faculty members are studying. Some institutions are – for a price — allowing companies to set up research outposts in their hospitals and giving them access to students and house officers, as well as to large numbers of patients. They are aligning their interests with those of industry and allowing the boundaries between them to become blurred.”  Dr. Angell from her famous (or infamous as the case may be) editorial in the New England Journal of Medicine, Is Academic Medicine for Sale?

Dr. Caroline Apovian’s accomplishments in the field of medicine read like a veritable Who’s Who.  Not only is she a professor of Pediatrics and Medicine at Boston University School of Medicine, but she is the director of their Nutrition and Weight Management Center as well.   On top of that, Dr. Apovian is the Associate Editor of the Obesity Journal as well as being the co-editor of the Obesity and Nutrition section of the medical journal, Current Opinion in Endocrinology and Diabetes.  Oh; and she also happens to be a successful author with two books under her belt (2007’s The Alli Diet Plan and 2013’s The Overnight Diet).   Not surprisingly, the well-spoken Apovian is one of the media’s “go-to” physicians for TV interviews on medical subjects — particularly if it has anything to do with obesity or weight loss.  In short, Apovivan is one of our nation’s major players in the field of medical weight management.  She also happens to be one of the doctors who has worked the hardest to see obesity officially declared a “disease”. 

I mention Apovian’s accomplishments because she is the leading author of a new study (Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline) published in the latest issue of the Journal of Clinical Endocrinology and Metabolism.  The goal of the new guidelines is to treat the patient’s OBESITY rather than treating all of its individual comorbiites (HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, DIABETES, etc, etc, etc).  Sounds like a noble goal.  It is — until you peel back the curtains and see what’s going on behind the scenes.

According to a recent article on the website Cardiology Today (Symposium Focuses on Consideration of Obesity as a Disease State); while speaking at a the recent Cardiometabolic Health Congress on the Pathophysiology and Treatment of Obesity Symposium, “Apovian cited research identifying obesity as a disease caused by chronic inflammation initiated by excess fat tissue. Some data indicate that obesity can result from hypothalamic inflammation, caused by a gliosis forming in the brain that prevents satiety signals from the gut from functioning properly. This observation, observed in rodent studies and potentially mirrored in human patients, identifies obesity as a disease, as it suggests that managing obesity is not simply a matter of willpower.”  

There is a lot to what Dr. Apovian tells us here.  Firstly she tells us that Obesity is a problem caused by CHRONIC INFLAMMATION.  Unfortunately, I find that even though most people believe they know what INFLAMMATION is; they rarely have a clue (the most common guess is “swelling”, with “infection” coming in a close second).  Secondly, she tells us that fat cells cause Inflammation.  She’s correct, and for the record, fat cells also produce ESTROGEN — the hormone that farmers give their beef to make them fat.  Thirdly, she talks about the role of the Hypothalamus in Obesity — something I have shared with you previously (HERE).  Fourthly, by reading between the lines, she links GUT HEALTH (or a lack thereof) to Obesity.  Fifthly, she talks about “Gliosis“, which is related to the Amyloid Plaques so commonly seen in Alzheimer’s Disease.  And lastly, she tells us that it takes more than willpower for EFFECTIVE WEIGHT LOSS to occur.

While on some level I would agree with this last point above, the fact remains that addiction to high glycemic index carbohydrates is something that must be dealt with if there is to be any headway made in the battle of the bulge (HERE are my many posts on Sugar Addiction).  In other words, in the same way that drugs do not provide solutions to obesity (see Apovian’s quote from the top of the page), neither do they supply solutions to addiction.  If you are addicted to food, there is a point where you will have to knuckle down and use — well — some willpower.  The idea that drugs or a lifestyle change is going to completely remove cravings — particularly in the first week or two — is a pipe dream.   For ideas on how to best conquer a Sugar Addiction, take a look at the previous link (numerous articles).

The key to getting insurances to pay for various treatments (i.e. drugs and surgeries) is to make sure that said treatments are for a very specific disease.  Heartburn becomes ACID REFLUX DISEASE.  Degenerative Osteoarthritis becomes DEGENERATIVE JOINT DISEASEADRENAL STRESS becomes FIBROMYALGIA.  Obeisty is no longer something that you have done to yourself; it’s now a disease And if no one can figure out what’s wrong with you, it’s always DEPRESSION.   And on, and on, and on it goes.

“According to new guidelines released by the American Heart Association, American College of Cardiology and The Obesity Society in November 2013, doctors should consider obesity a disease and more actively treat obese patients for weight loss.”  Taken from a January 5, 2015 article on the website of the American Heart Association (Treating Obesity as a Disease).  The AMA recognized obesity as a disease in June of 2013.

Everyone knows that there is big money in the pharmaceutical and medical device industries.  Couple this with the weight loss industry (the January 2, 2013 issue of US World News and Report said that, “Americans spend north of $60 billion annually to try to lose pounds“), and you can see why a marriage between these two fields is the equivalent of owning your own mint, complete with a printing press and plenty of green ink!  And this is where the problem lies with Apovian’s premise. 

I have shown you over and over and over again that EVIDENCE-BASED MEDICINE cannot be trusted because of; well….. money.   What percentage of the scientific medical studies have been tainted by financial conflicts of interest?   Years ago, Dr. Marcia Angell (past editor of the New England Journal of Medicine) asked the question via the pages of the Journal, “IS ACADEMIC MEDICINE FOR SALE?“.   After answering the question herself, she published a study by Dr. Thomas Bodenheimer (a medical professor at University of California in San Fransisco) revealing that virtually all medical studies are tainted by serious and multiple financial conflicts of interest.  As I comment on Dr. Apovnia’s study, I have to wonder if anything has changed?

Apovnia has a track record of promoting drugs she has financial ties with.  Case in point, her work with the drug Alli (Orlistat / Xenicil) made by GSK (she wrote a book touting Alli — a medicine that Mayo Clinic said would help you lose an additional few pounds a year above and beyond diet / lifestyle modification).  If you go to the website DOLLARS FOR DOCS by ProPublica, you can see that Apovnia has financial ties to GlaxoSmithKline.  It comes as no surprise that she touts several weight loss drugs specifically by name in her study.   Should we be surprised, considering the study itself warns us that Dr. Apovian has, “Significant Financial Interest or Leadership Positions in Zafgen Inc, MYOS Corporation, Eisai, Vivus, Orexigen Theraputics, Takeda,” as well as being an,NIH grantee or reviewer“?

The companies or organizations that the other doctors that did this study have financial ties to or are in positions of power include, “the American Board of Obesity Medicine, Jamieson Laboratories, Pfizer Inc, Healthcare Research Consulting Group, Marwood Group, Novo Nordisk A/S, Eisai Inc, Rhythm, Johnson & Johnson, Ethicon Endo-Surgery Inc, GI Dynamics, GLG, MYOS Corporation, BMIQ, The Obesity Society, PCORI contract recipient, Enteromedics Inc, Mayo Clinic, Division of Preventive Medicine, Jansenn, Scientific Intake, Obesity Action Coalition, and one board member of the American Physician Nutrition Specialists.”  Whew!  Sort of reminds me of the crazy number of Financial Conflicts-of-Interest that we saw with the recent change in our CHOLESTEROL GUIDELINES.

If you do nothing other than browse through the titles of my posts filed under EVIDENCE-BASED MEDICINE, you will quickly come to the realization that in the field of academic medicine, money talks.  If you are serious not only about losing weight, but about getting your life back, why not take a few minutes to look at some of the links found in this post.  Or you could simply start HERE.

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