A Controlled Clinical Comparison of Benzphetamine and D-Amphetamine in the Management of Obesity
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Abstract The changing pattern of obesity‐related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low‐calorie diets ( VLCD s) (400–800 kcal/day) and low‐calorie diets ( LCD s) (800–1200 kcal/day)] can deliver weight loss at rates of 1–2 kg/week. This rate of weight loss can result in 10–20 kg weight loss in 8–12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre‐operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK . Weight loss with formula diet in obesity‐associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre‐diabetes, in early type 2 diabetes and in insulin‐treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some evidence for improved vitamin D status and maintained bone health in elderly obese people with osteoarthritis but more research is needed. Rapid initial weight loss was feared to be followed by rapid weight regain. However, provided initial weight loss is delivered in parallel with an intense education programme about nutrition, cooking, shopping and lifestyle for long‐term maintenance; and where long‐term support is provided, subsequent weight maintenance after VLCDs and LCDs has been shown to be possible. A recent literature review identified high‐protein diets, obesity drugs and partial use of formula meal replacements as methods which can result in statistically significantly greater weight maintenance after initial weight loss with VLCDs or LCDs . Anxiety about serious adverse side effects seems to be unfounded although users need to be aware of both minor and more serious, though very infrequent, adverse events, such as gallstones and gallbladder disease.
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This review addresses the role of nutrition and physical activity in weight management. There is not one standardized approach toward weight loss, but research demonstrates the effectiveness of following a reduced-calorie plan, as well as emphasizing increases in physical activity. Other important elements of consideration include promoting contact with weight management clinicians to provide structure, encouragement, and support. Physical activity alone has not been proven to support weight loss but in combination with a lower caloric intake can be helpful toward achieving weight loss. Sustaining weight loss is difficult for most individuals, so the support of clinicians is valuable not only in the starting phase but in the long term as well. This review contains 1 figure, 4 tables and 37 references Key words: activity, calorie, carbohydrate, diet, dietitian, exercise, intervention, lifestyle, maintenance, obesity, portion, technology, weight
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Obesity is a chronic and heterogeneous medical condition. Weight loss is clearly the most desirable goal in obese subjects management. Successful obesity treatment should be defined as long-term weight loss maintenance. In this chapter, we briefly review the current evidences regarding the treatment of obesity.We searched MEDLINE and PubMed for original articles published between 1995 and 2006, focusing on obesity treatment. The search terms we used, alone or in combination, were 'obesity', 'lifestyle changes', 'diet', 'exercise', 'pharmacological treatment', 'surgical treatment'.The conventional management of obese patients involves weight reduction with lifestyle changes, including dietary therapy and increased physical activity, or a combined approach with lifestyle changes and pharmacological or surgical interventions. Exercise appears crucial in the successful maintenance of weight loss and in fostering cardiovascular health in obese patients. Some anti-obesity drugs, such as sibutramine and orlistat, have been shown to induce a significant weight loss and long-term weight loss maintenance. Surgical therapy is often necessary in morbidly obese patients and generally results in more significant and long-lasting weight loss than other treatments.
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Sibutramine
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Lifestyle modifications should be recommended for every patient dealing with overweight or obesity. Behavior modification is the cornerstone of management. Motivational interviewing, goal setting, and self-monitoring are three techniques with proven efficacy for weight reduction. Because an energy deficit is required to promote weight loss, goal setting should be focused on achieving an overall caloric reduction. No single diet has proven to be superior to others overall in terms of weight loss outcomes. However, a low-carbohydrate (ie, ketogenic) diet has been shown to reduce insulin resistance in patients with diabetes and may be considered for this subgroup of patients. There continue to be conflicting views regarding the superiority of low glycemic index foods for weight loss. Exercise alone has not been shown to produce substantial weight loss, but it is helpful during the weight loss phase to preserve lean muscle mass, and it has a role in weight maintenance. Though sleep deprivation has been implicated in weight gain, the effect of improving sleep quality/duration on reducing excess weight has yet to be studied adequately.
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Obesity management includes primary weight loss, prevention of weight regain, and the management of associated risk factors, such as smoking, hyperlipidaemia and hypertension. All these require lifestyle modification. The success or failure of management will depend on the characteristics of both the patient and the physician (or therapeutic team). Thus, direct statistical comparisons between methods of management may be misleading. Weight loss of 5-10% (usually 5-10 kg and equivalent to 5-10 cm waist reduction for most patients) is generally achievable within 3—4 months. Attempts to achieve weight loss over longer periods of time are usually unsuccessful. Improved clinical, symptomatic and biochemical benefits are very significant with this degree of weight loss. It is therefore unreasonable to pursue an 'ideal' bodyweight. In reported studies, the weight decrease over the first 3—4 months represents the total weight loss. Data collected after this time reflect both the initial weight loss and the ability of the patient and the programme to maintain weight loss. Many reports and study designs do not make this distinction. The principal goal of weight management, whether in primary prevention or in treatment of the obese, is weight maintenance. This goal has to be viewed in the context of a normal tendency to gain weight through adult life. In good hands, dietary and behavioural techniques can maintain significant weight loss for 1 year or longer in about 40% of patients. This increases to about 70% for patients receiving appetite modifying drugs; professional resource requirements are also lower. Surgical approaches are reserved for those with more serious clinical risks. Weight loss in individuals with non-insulin dependent diabetes mellitus (NIDDM) can be achieved in newly diagnosed patients and non-diabetics with comparable success. The goal of interventions in established NIDDM patients should be improved weight maintenance evaluated over 1-2 years, not acute loss achieved in 3 months.
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Obesity is a chronic disease requiring a similar long term approach to management as that of other chronic conditions.This article discusses the role of medications in the overall management of obesity.Management needs to be multifaceted, aiming to alter the patient and family micro-environment to one favouring better weight control through sustainable behavioural changes to physical activity and diet. Weight loss medications may provide additional benefit. Currently we have only two medications suitable for long term therapy--orlistat and sibutramine. Sibutramine, which acts centrally to suppress appetite, has shown efficacy for up to 2 years. Orlistat, a lipase inhibitor, reduces fat absorption and has been shown to reduce and maintain weight for up to 4 years. The effect of these medications is modest, generally providing less than 5 kg weight loss when compared with placebo. Patients need to have realistic expectations and understand the benefits of sustained modest weight loss. It is important that weight loss medications are prescribed in combination with lifestyle modification.
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