Sunday, 29 July 2012

What shall we do with the fattie sailor?

While the seating issue has superceded the Olympic Opening Ceremony issue and moved attention on from the MuccieD etc issue (I don't think the price of beer bit issue has peaked but as the weather is not too great coming up, they should be fine), I rather liked this editorial from The Lancet, the Doctors' House Magazine, no idea how many read it and how many think they should read it but it sounds a weighty enough tome to me.  It's sort of behind a pay wall but if you register for free you can access stuff like I have:

With two-thirds of the national adult population and more than a third of children and adolescents defined as overweight or obese, the US Food and Drug Administration (FDA) has been under mounting pressure to approve new weight-loss drugs. On July 17, the second new anti-obesity pill,extended-release phentermine and topiramate, received market approval on the heels of lorcaserin (approved on June27). It has been 13 years since the last approval of long-term weight-loss drug orlistat. Safety concerns or lack of efficacy have doomed past applications.The American Society of Bariatric Physicians and the American Society for Metabolic and Bariatric Surgery applauded the FDA's approval of the new drug sand claimed that the tide was turning in the efforts to address the US obesity epidemic. But will these new drugs really make a substantial dent in the burden of obesity in the USA?
As Boyd Swinburn and colleagues emphasised in The Lancet's obesity Series, obesity is not simply the result of individual choice, but a response to an obesogenic environment that promotes weight gain. Consequently, the key to obesity control requires policy interventions—responsibilities mainly shouldered by government, to minimise the environmental drivers such as poor dietary intake and physical inactivity, rather than individually focused interventions.

There is no wonder drug for obesity. In clinical trials, both of the newly approved drugs are used in combination with healthy diet and lifestyle interventions. Furthermore, both have serious risks. For instance, topiramate is associated with increased risk of development of oral clefts (cleft lip and/or cleft palate) in infants born to women treated with it during pregnancy. And there have been concerns that lorcaserin might cause tumours and heart-valve defects. Indeed,long-term cardiovascular morbidity and mortality risks remain unknown, so the FDA requires post-marketing studies for both drugs to assess major adverse cardiac events. Patients with obesity must be well counselled about the risks and benefits of such pharmacotherapy. Whatever the balance of risks and benefits in individual patients, drugs are not the answer for a socially driven problem.
So what will happen with obesity, real or imagined?  The Tobacco Control Industry are rolling out their, Kerching, plan for alcohol and obesity I wonder where they are going to get their inspirational corporate funding from?  ASH etc have enjoyed Pfizer et al looking for their subsidised NRT markets, the extolling of Chantix (scary, scary, scary mind altering drug that may get you off nicotine but will probably make the most of any AHHD wibbles in your personality that you were not previously aware of).  Nicorette used to be only allowed for 12 weeks but now you can take it ad infinitum they would have us believe. The pregnancy studies are incomplete I believe.

But obesity is still looking for a saviour.  Does anyone know anyone who had a joyful journey with Alli (orlistat as mentioned above) that you can buy at Boots?

As I remember from The Lancet obesity issue, no government has successfully implemented a policy on obesity and, from this editorial, no drug firm has got a roll out drug to solve the 'Obesogenic' environment (a new one, even on me).

BTW, don't worry Chantix is going to be the new 'cure' for alcoholism.

Did anyone wonder why Fitness First and David Lloyd are not sponsoring the Olympics?

Just starting to contemplate Alli

The amount of fat calories blocked will depend on how much fat you eat, but most patients block 100 to 200 calories per day
Considering it takes about 750 calories to lose/create a pound of fat, I think users of it will lose more weight washing their pants.  Yuk.

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