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Weight Loss Products: Weighing in on the Evidence

Weight Loss Products: Weighing in on the Evidence. Loren Regier BSP, BA RxFiles Academic Detailing Program www.RxFiles.ca November 2007. Kcal: Interesting numbers. Coke 591ml 240 Kcal Mars Bar: 294 Kcal Slurpee 1.18l: 570 Kcal Big Gulp double: 800 Kcal

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Weight Loss Products: Weighing in on the Evidence

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  1. Weight Loss Products: Weighing in on the Evidence Loren Regier BSP, BA RxFiles Academic Detailing Program www.RxFiles.ca November 2007

  2. Kcal: Interesting numbers • Coke 591ml 240 Kcal • Mars Bar: 294 Kcal • Slurpee 1.18l: 570 Kcal • Big Gulp double: 800 Kcal • Milkshake, lg: 1,160 Kcal • Walk for 60 minutes: >300 Kcal • Run for 60 minutes: >800 Kcal

  3. Predictors of increased CV risk related to obesity? • Waist Circumference: • <94cm ideal; >102cm high risk • <80cm ideal; >88cm high risk • Waist/Hip Ratio: >0.95;  >0.85. • BMI:>25=overweight, >30=obese.

  4. Weight Loss Management • Assess medications for possible drug-related weight gain • Antidepressants: • Weight neutral/loss: bupropion, SSRIs, moclobemide, venlafaxine • Weight gain: mirtazapine, amitriptyline > desipramine, nortriptyline • Antipsychotics • Weight gain: clozapine > olanzapine > quetiapine > risperidone > haloperidol • Diabetes medications • Weight gain: insulin > SU > glitazones > acarbose • Weight neutral/loss: metformin

  5. Diabetic Medications • Weight Considerations

  6. Weight Loss Management • Assess medications for possible drug-induced weight gain • Anticonvulsants: • Weight gain: valproic acid>lithium, pregabalin>gabapentin, carbamazepine • Weight neutral/loss: topiramate, lamotrigine • Others: • Corticosteroids, flunarizine, medroxyprogesterone, raloxifene>tamoxifene, smoking cessation

  7. Weight Loss Drugs • Approved for Weight Loss • Sibutramine (Meridia®) • Orlistat (Xenical®) • Off-Label Use: • Fluoxetine (Prozac®) • Bupropion (Wellbutrin®) • Topiramate (Topamax®) • Not “wonder drugs”

  8. Weight Loss Drugs Do Weight Loss Drugs Work? • Statistically significant, but modest weight loss (<5kg at 1 year). • Sibutramine: -4.5kg (95% CI -5.29 to -3.62kg) • Orlistat: -2.8kg (95% CI -3.31 to -2.20kg) • Most trials included lifestyle modifications as a co-intervention.

  9. Weight Loss Drugs • Sibutramine & orlistat have been shown to reduce & maintain weight loss with continued therapy. • Weight regain is common upon discontinuation of therapy. • Long term health benefits/safety/efficacy uncertain

  10. Weight Loss Drugs Weight Loss & Weight Regain?

  11. Weight Loss Drugs Do Weight Loss Drugs Work?

  12. Are Weight Loss Drugs Safe? • Sibutramine (Meridia®) • ↑ blood pressure by 1-3 mmHg & heart rate by 4-5 beats/min • … but is blood pressure offset by weight loss? • Health Canada – AR newsletter – case reports • Other: • Contraindications, drug interactions

  13. Are Weight Loss Drugs Safe? • Orlistat (Xenical®) • Minimally absorbed (<5%) • Tolerability → GI adverse events • ↓ absorption of fat soluble vitamins • Recommend multivitamin with fat soluble vitamins • Other • OTC (USA): • Alli® 60mg po tid • FDA approved OTC use (Feb 07)

  14. Weight Loss Drugs Cost • Sibutramine (Meridia®) • 10mg po od 1 month $120 • 15mg po od 1 month $140 • Orlistat (Xenical®) • 120mg po tid 1 month $155 • Cost: $ 500-600 / lb lost at 2 years

  15. Weight Loss – Herbal Products “5 P’s” – Overview • Popular • Pricey • Poly-herbal-pharmacy • Paucity of good evidence • Possibilities for success or failure

  16. Caffeine • Often hidden from labelling • Guarana, yerba mate, kola • Dosage/day – range 40-1,200mg • Recommended max ~450mg/day • Evidence • When combined with ephedra, limited evidence for weight loss effect; otherwise evidence lacking • Adverse Effects (AE)s: • HA, anxiety, ringing, insomnia, HR & BP • Watch out for amount and AEs

  17. Some Common Products/Programs See RxFiles Chart: Weight Loss Herbal “Natural” Products

  18. Natural products …with not-so-natural sibutramine • There have been several warnings regarding products containing unlabled sibutramine • Chao Nongsu Qingzhi Jiaonang Slim Hong Kong , Detox Peptide, Fat Rapid Loss (Xin Yan Zi Pai Mei Zi Jiao Nang), LiDa Daidaihua Slimming Caps, Qianweisu Slimming Herb, Qing Zhi, Super Fat Burning & Reduce Weight • http://www.hc-sc.gc.ca/dhp-mps/advisories-avis/index_e.html • Buyer Beware!!!

  19. Herbal/Natural Wt LossComments • Positives • It’s not all bad • Food is natural and a great place to make modifications for both weight & overall health • Support, accountability and commitment • Useful • There are some amazing stories…

  20. Herbal/Natural Wt LossComments – Part 2 • Flip-side (negatives) • It’s not all good • Not everything natural is safe! • Sometimes you have to take the iodine out to make it safe • Not everything natural is labelled correctly • Nothing will eliminate the need for diet and exercise modifications

  21. Weight Loss Drugs & Herbs Summary • Lifestyle modifications – essential • {Walk, avoid elevator, limit screen time, pop…} • Drug-induced wt gain - considerations • Weight loss drugs • limited options • limited long-term efficacy • safety & tolerability considerations • Cost considerations • Herbal/Natural… • Watch out for caffeine & unlabeled extras

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