Obesity Through the Pharmacological Lens

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Rebecca Puhl, Ph.D., Director of Research & Weight Stigma Initiatives at Yale’s Rudd Center, notes that a weight loss of 5% to 10% is considered a success, which is a pretty low bar. Additionally, only between 10% and 20% of patients can maintain a 10% weight loss after a single year. Dr. Puhl also states that a 10% loss is typical for a patient who has had access to and followed “the best behavioral and/or pharmacological treatments.”

Patients and doctors alike can become discouraged by the elephant they just can’t seem to evict from the room: The fact that weight loss rarely lasts. As Dr. Pretlow says, “Obesity remains a substantially frustrating and intractable health condition for millions of young people.”

This causes despair among individuals, and is a big problem for the nation, because by the year 2030 it looks like obesity and its co-morbidities will account for as much as 18% of all health care costs. The prediction is quoted in a paper describing the results of a study that investigated combining two different pharmaceuticals, which also says:

The increase in the prevalence of obesity is a clear indication of the failure of behavioral intervention to produce sustained and meaningful weight loss in today’s obesogenic environment… Many overweight and obese individuals are unable to achieve moderate weight loss with behavioral intervention alone.

Well, these particular researchers would say that, wouldn’t they, because their task is to evaluate a certain drug combo. The catch is, they define behavioral interventions as diet and exercise, period.

Unsurprisingly, a different paper by a different group of researchers with a different focus says this:

However, behavioral strategies developed from social learning theory have been the most thoroughly tested interventions for the treatment of obesity, as well as the interventions shown most clearly to have clinical benefit… Overall, it is concluded that behavior therapy is both the most studied and most effective therapy for treating obesity at present.

To limit the definition of behavioral intervention to diet and exercise, as the drug researchers do, is obviously fallacious. Obesity experts have helped patients lose weight using a number of modalities, such as various types of cognitive behavioral therapyattention modification therapy, dialectical behavior therapy, acceptance & commitment therapy, cue avoidance, hypnotism, role playing, 12-step groups, and relapse prevention training.

Behavioral interventions work better for younger children than for older ones, and extend out to the family, where psychologic counseling for parents is found to be effective. “Family-centered” is good, and so is “culturally tailored.”

As for drugs, only a couple are currently approved as suitable for long-term obesity treatment, and even they frequently cause significant side effects. Part of the problem here is that animal testing can’t really replicate what goes on with humans. Of course, the lab rodents can’t really predict certain “adverse drug events,” like planning to commit suicide.

Another interesting sidebar concerns pharmaceutical corporate-speak. For instance, a report might say, “The high-profile withdrawal of obesity drugs from the market due to safety issues has left physicians with few treatment options,” which is a more genteel way of expressing the concept, “The scandals have left doctors bereft of alternatives and desperate for solutions.”

Your responses and feedback are welcome!

Source: “Clinical Implications of Obesity Stigma,” uconnruddcenter.org, 06/27/13
Source: “Naltrexone/bupropion for obesity: An investigational combination pharmacotherapy for weight loss,” ScienceDirect.com, June 2014
Source: “Behavioral intervention for the treatment of obesity: strategies and effectiveness data,” NIH.gov, October 2007
Source: “A Grizzly Answer for Obesity,” NYTimes,com, 02/12/14
Photo credit: Miran Rijavec via Visualhunt/CC BY

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