True weight loss is simple but not easy

With one-third of all American adults obese or overweight, it’s no surprise most of us are consumed with finding new ways to shed excess poundage. The problem, of course, is that there’s really only one way.

“It’s all about balance,” said John Pierce, a professor of family and preventive medicine at the University of California San Diego. “Calories in, energy out. Too much of the first and not enough of the second means you gain weight.”

Most Americans probably don’t want to hear it put quite so bluntly. We’d rather spend billions of dollars each year on newfangled diets; fancy gyms and exercise equipment; the latest weight-loss wonder drug. Some of which actually work, provided you know what you’re doing. Here’s some of the latest thinking on losing weight, safely and effectively:

DIET

A healthy weight begins with a healthy diet, and you know what that means: a balance of fruit, vegetables, meat and dairy products, light in sugar and fat. The generic adult diet is about 2,000 calories a day, but that’s just a guideline. Daily calorie intake should be 10 to 12 calories for each pound of ideal body weight. For example, a 150-pound man should eat 1,500 to 1,800 calories a day.

Most people try to lose weight by cutting back calories. One pound of fat equals about 3,500 calories. If you reduce your daily calorie intake by 500, that adds up to 3,500 missed calories by the end of a week and one pound lost.

But it’s rarely that simple or easy, which is why diets promising fast results with minimum fuss proliferate. Some diets actually do achieve measurable weight loss. A recent Stanford University study found that the low-carb, high-fat Atkins diet beat out the Zone, Ornish and U.S. dietary guidelines. Overweight female participants who followed the Atkins plan lost an average of 10 pounds over 12 months, compared with 5 pounds on the Ornish, 6 on U.S. guidelines and 3.5 on The Zone.

But critics of the study noted that few of the participants rigorously adhered to their assigned diets. The Atkins volunteers did best, but then it’s probably easier to follow a diet of bacon and Brie than one featuring apples and asparagus.

The biggest problem with most weight-loss diets, experts say, is that they can’t be sustained. Over the long term, they’re impractical, expensive, boring or just plain bizarre.

“With some diets, people basically starve themselves,” said Pierce. “When that begins to happen, it triggers a response in the body that makes you feel like you have to eat at any cost.”

EXERCISE

There’s no running away from it: If you want to be healthy and maintain an appropriate weight, you must exercise. “Nearly every expert says that,” said Pierce. “In fact, people need to exercise more.”

The current gold standard is 45 to 60 minutes a day of moderate to vigorous exercise. (”Moderate” is defined as enough exertion that talking becomes difficult.) People who haven’t exercised much or at all should begin slowly, under a doctor’s guidance, and build up their exercise time and intensity.

The dietary value of exercise lies in the fact that it boosts the body’s metabolism – the chemical and physical process by which the body converts food into usable energy. But all exercises don’t generate the same metabolic effect. Aerobic exercise tends to rev up the metabolism only while you’re doing it. Conversely, strength training, such as weight-lifting, can increase the resting metabolic rate for hours, even days, after the actual workout because tested muscles demand additional energy to repair and rebuild themselves.

Aside from the usual advice about medical supervision and knowing what you’re doing, some experts add a couple of provisos about working out. First, don’t exercise on an empty stomach. Your body is going to need energy, and the easiest way to get it is to break down muscle mass, not convert body fat. Second, eat soon after you exercise so that, again, your body isn’t cannibalizing itself to ill effect.

DRUGS

Every fat person dreams of a magic pill that will melt away unwanted pounds with no more effort than it takes to lift a glass of water. Or a milkshake.

That pill doesn’t exist. It probably never will. But the diet drug industry is looking hard. Worldwide, there are more than 20 weight-loss drugs in clinical trials and another 30 in the pharmaceutical pipeline.

A few diet drugs are already on the market; none is magic. All produce just modest weight loss; some have dreadful side effects; none works alone. They require other things to happen.

“Like being taken in conjunction with a healthy diet and regular physical activity,” said Jim Sallis, a psychology professor at San Diego State University and program director of the national Active Living Research project.

The history of diet drugs is pretty checkered. Amphetamines were once prescribed for weight loss but turned out to have serious risks of addiction, agitation and insomnia. In the 1970s, anti-obesity medications based on the drugs fenfluramine and phentermine appeared. These drugs help maintain high levels of serotonin, a brain chemical that regulates appetite, mood and other functions.

In the 1990s, however, it became clear that “fen-phen” drugs could also cause significant and potentially fatal side effects, from depression to heart valve abnormalities to a deadly lung disorder called pulmonary hypertension. Fen-phen drugs mostly disappeared from the U.S. market in 1997.

Currently, there are three main prescription anti-obesity drugs, though one is not approved for sale in the United States.

Rimonabant (marketed outside the U.S. under the name Acomplia) blocks brain signals that stimulate food cravings. Users say they feel full sooner, thus eating less. A 2006 report in the Journal of the American Medical Association found that 46 percent of obese patients who took Acomplia for two years lost 5 percent to 10 percent of their body weight.

The downside: Acomplia works only as long as it is taken. The same study also reported that 51 percent of the participants dropped out. And another study reported that patients on rimonabant were 2.5 times more likely to discontinue treatment due to depressive disorders.

Sibutramine (marketed as Meridia) debuted in 1997 as an alternative to fen-phen drugs. It also suppresses appetite by moderating serotonin levels and boosting the metabolism, but without the serious side effects. On the other hand, it does increase the risk of high blood pressure, constipation and insomnia, and can adversely interact with other drugs.

Xenical or Orlistat work in the intestine, blocking the absorption of fat. Last year, an over-the-counter version appeared, called Alli. Like prescription diet drugs, Alli generates modest weight loss if used correctly. But using it at all might be problematic.

Because it blocks intestinal absorption, Alli causes consumed fat to be quickly and unceremoniously excreted. Oily bowel movements are so frequent that women are advised to wear panty liners when starting the regimen.

“The way Alli really works is by making people regret eating fat,” said Cheryl Rock, a professor of family and preventive medicine in UCSD’s School of Medicine.

America is indisputably getting fatter by the day. Most alarming, note experts, is the dramatic rise in childhood obesity – up to 9 million kids, a tripling since 1980.

“These kids don’t know what it’s like not to be fat,” said Pierce. “And changing bad eating behaviors is always harder than preventing them in the first place.”

But anyone, said Rock, can lose weight.

“Fatness isn’t about being stupid or lazy. It’s about knowing what to do. And there are a lot of things people can do.”

Source: http://www.paramuspost.com/article.php/20080529230612604

Concerned about Alli side effects

How badly do you want to be skinny? Is it worth soiling your underwear?

Those questions will likely confront users of the new Alli, the first over-the-counter diet drug approved by the U.S. Food and Drug Administration.

Alli (pronounced al-EYE) went on sale for the first time late last month — a stronger prescription form, Xenical, has been available since 1999 — and its promotional material alone makes for strong medicine: The drug, which helps people lose small amounts of weight, can cause oily discharges, uncontrolled bowel movements, and gas if you eat too much fat.

Its marketing effort makes an impression by telling users to wear dark pants and carry extra clothes in case they soil themselves.

“Well, that sounds attractive, doesn’t it?” Jay Leno cracked June 25 on “The Tonight Show.” “You lost a couple of pounds, and you’re on a date with that special girl. ‘Excuse me while I change my pants.’æ”

NBC’s Conan O’Brien also spoke up to pooh-pooh Alli, suggesting that “the drug comes in three forms: pills, capsules and chimichangas.”

Even the serious Boston-based Prescription Access Litigation Project, which often sues drug companies, got gleeful. It gave the drug’s maker, GlaxoSmithKline P.L.C., its ‘With Allies Like This, Who Needs Enemas?’ Award for Irresponsibly Selling a Formerly Prescription-Only Weight Loss Drug Over-the-Counter.

The drug’s backers say that the embarrassment is exaggerated and that the effects can be managed by a low-fat diet.

Only half of all users had “fecal urgency” or related effects in clinical trials, and just 5 percent quit for those reasons, said Vidhu Bansal, director of medical affairs for GlaxoSmithKline’s consumer health division.

“They actually served as a positive feedback tool,” she said. “It reminded them that they cheated on their diet.”

Caroline Apovian, a Boston physician who wrote “The Alli Diet Plan,” which shows how to minimize problems by eating low-fat foods, said she did not understand the shame people might feel over losing bowel control. “It’s also embarrassing to be obese,” said Apovian, who was a paid consultant to GlaxoSmithKline in getting Alli approved for over-the-counter sales. “It’s embarrassing to be dead.”

GlaxoSmithKline executives are pitching Alli as part of a lifestyle change, which includes a commitment to eat better and exercise more. Users can log in their progress on the drug’s Web site — www.myalli.com — and interact with other customers or ask questions of a pharmacist, a nutritionist, a chef and a fitness specialist.

The firm, with a U.S. headquarters in Philadelphia, paid $100 million to Xenical’s maker, Roche, for the rights to sell Alli over the counter. GlaxoSmithKline is spending an additional $150 million in a marketing campaign that includes a 60-second television ad and print ads appearing this month in most major magazines, read by 33 million people.

Bill Trombetta, professor of pharmaceutical marketing at St. Joseph’s University in Philadelphia, said the comedians’ attention has an initial upside. “They got your attention. This is on everyone’s lips,” he said. “You can’t buy this kind of publicity.”

But will the exposure move people to try it?

Maybe at first, said Kelly Brownell, who directs the Yale Center for Eating and Weight Disorders. But he predicts “sales will tail off fairly quickly.”

“The people who will try it won’t lose much weight and won’t provide very good word-of-mouth,” he said.

“Both the benefits and the side effects are overstated,” Brownell added. “It’s not going to hurt many people, and it’s not going to help many people.”

Marion Nestle, a nutrition professor at New York University and a frequent critic of the food industry, noted that many users may replace fat calories by eating more carbohydrates. “A lot of Alli takers will do that and wonder why they aren’t losing weight,” she wrote in an e-mail.

The early results are sketchy.

In the California beach town of Santa Monica, a Los Angeles Times reporter found that Alli bottles were flying off store shelves.

But in Philadelphia, once dubbed the nation’s fattest city, Alli’s arrival appeared to be less of a sensation.

“We do have it in stock. No one has inquired about it,” pharmacist Maria Taylor at Narberth Pharmacy, said last week, echoing several other Philadelphia-area pharmacists. “Maybe it should come with a coupon for Depends,” the adult diaper.

Alli contains 60 milligrams of orlistat — half the amount found in prescription Xenical. The over-the-counter version is taken three times a day with meals and costs from $60 to $67 for a month’s supply. A year’s worth costs at least $720.

The prescription drug’s U.S. sales have been fading, from $135 million in 2002 to $93 million last year.

Despite the fact that obesity rates are surging, an effective drug remains elusive. “Eating is so fundamental for human existence that the body has multiple redundant systems,” said Gary D. Foster, who directs Temple University’s Center for Obesity Research and Education and was a consultant to GlaxoSmithKline for its Alli Web site. “So if you block one pathway, it’s evolutionarily smart to have a backup.”

Alli works by blocking the digestive enzyme lipase, which aids in fat absorption. The firm estimates that Alli blocks about 25 percent of the fat that reaches the gut.

But too much fat can cause oily discharges. “You may recognize it as something that looks like the oil on top of a pizza,” an Alli brochure says cheerily.

That is what happened to Paula Miguel, 35, of Hopatcong, N.J. She was one of 400 people picked by the drug firm to receive a six-month supply of Alli for free.

She said it was hardest the first week to establish her routine to walk more and eat better.

She felt a strong urge to go after downing some greasy crab cakes at a friend’s house. “When I went to the bathroom, it was orangey, like an oil,” she said.

But, she said, that happened only once since she began April 18. Overall, she said, she has lost 23 pounds, falling to 170 pounds on her 5-foot-3 frame. “It’s not as bad as they say,” said Miguel. “I eat better … I’m more active. For me, it works fine.”

The company said users could expect to lose an average of 10 pounds in a year. But that’s high, independent experts say. The more potent prescription version helped participants lose an average of 6.3 pounds by the end of a year, according to researchers who analyzed 50 studies for a 2005 article in the Annals of Internal Medicine.

Paul Woolf, chairman of the department of medicine at Crozer-Chester Medical Center in Chester, Pa., was on the FDA advisory committee that in 2006 recommended that Alli be freed from prescription status.

He called Alli “a real niche product” that causes modest weight loss.

“No one is going to abuse it,” he said. “They’re going to be very unhappy if they do.”

Source: http://www.southbendtribune.com/

FDA approves first over-the-counter diet pill

You won’t lose weight in your sleep or shed pounds while eating anything you want — that’s the sobering message from the maker of a weight loss pill poised to hit shelves next month.

GlaxoSmithKline on Tuesday opened an educational exhibit in New York City to prepare the country for alli, the first over-the-counter diet pill approved by the Food and Drug Administration.

While the cautionary marketing approach may not trigger stampedes to the counter, analysts say the drug’s fate hinges on the pharmaceutical giant’s ability to convince people that diet pills aren’t a magic bullet.

“We’ve done everything to go out of our way to be honest,” said Steve Burton, vice president of the weight control division at GlaxoSmithKline Consumer Healthcare. “We’re taking a very different approach than the fad diets people are constantly exposed to.”

Omro pharmacist Ken Bressers said diet pills are enormously popular, but he reiterates the philosophy of GlaxoSmithKline.

“The problem with diet pills is that no pill will work on its own,” he said. “You can’t sit in front of the TV every day and lose weight. You’ve also got to eat a low-calorie, well-balanced diet and get exercise.”

Bressers said alli is attractive because it doesn’t mimic the usual diet pills that are currently on the market that act as stimulants, which can be dangerous for people with certain health conditions.

“This can be taken safely,” he said.

In clinical trials, the FDA says that people using alli lost an additional 2 to 3 pounds for every 5 pounds lost through diet and exercise. The FDA approved alli to be sold over the counter in February.

When taken with meals, the drug blocks the absorption of about one-quarter of any fat consumed. That fat — about 150 to 200 calories worth — is passed out of the body, potentially resulting in loose stools.

Alli only affects the digestive system, Glaxo says, and is the only safe over-the-counter diet drug that’s been shown to work.

Renee Neubauer, registered dietitian for Aurora Health Care, said FDA-approval for the drug is a good sign, considering most other diet pills aren’t regulated in any way.

“Other manufacturers don’t have to prove safety or effectiveness to the FDA,” Neubauer said. “No studies are done on them, and what manufacturers put in the drug isn’t regulated, either.”

While Neubauer said it’s good GlaxoSmithKline is being honest about effectiveness, and that the drug is FDA-approved, she would not recommend diet pills.

“I would rather work with someone one-on-one to change some aspects of their diet and help them make realistic changes,” she said. “You also want to work exercise in, too.”

The drug will come in “starter kits” containing a food journal, a healthy eating guide and a fat and calorie reference guide. A 60-capsule kit will cost about $50 while a 90-capsule pack will cost about $60. Recommended usage is one or two pills daily.

Labeling indicates alli is appropriate for anybody who is overweight, or has a body mass index of 25 or higher. A body mass index over 30 is considered obese.

Bressers said Omro Health Mart will carry the pill, once its released, but does not yet know what it will cost.

Eric Schramm, clinical pharmacist for ThedaCare, wouldn’t necessarily turn someone away from alli.

“If the pill helps give someone a start who might be having a hard time getting going, I think it’d be a good thing,” Schramm said.

Source: http://www.thenorthwestern.com/