to swallow or to cut

To Swallow or to Cut, that is the Question

By Shaun J. Melarvie

We are surrounded by products and procedures promising an easier way

You are the targets of the promises of an easier way, but for the mere cost of…

You want to know if there is an easier way

You’ll know what works, what doesn’t, does it matter, and if it’s worth it

You will be given the information, unbiased and unequivocally

Prescription diet pills are divided into two broad classes

Appetite Suppressants Fat Blockers

I’m full

A pill will only impact your weight if:

I’m full

The only valid studies are randomized and controlled

Control Group Study Group

REAL ONEFAKE ONE ?

? ?

Appetite suppressants act on the brain to cause satiety

CatecholaminesEpinephrineNorepinephrineDopamine

Sibutramine=MeridiaDiethylpropion=TenuatePhentermine=Adipex-P, Fastin, Anoxine-AM

Increased heart rate

HypertensionInsomnia

Sibutramine is FDA approved for long-term use

• 29 Randomized Controlled Trials

• 929 Patients in 3 of the trials

• Ave. of 9.46 pound wt. loss more than placebo

• Time course of at least one year

Phentermine is FDA approved for short-term use

• 108 Patients in a RCT

• 5.8 pound weight loss

more than the control group

• Time course of nine months

There are continually new drugs in the pipeline

Rimonabant=Zimulti

Tesofensine

Fat blockers inhibit the enzyme—lipase--that digests fat

30%

FlatulenceOily stool

Loose stoolFloating stool

UrgencyIncontinence

Orilstat is FDA approved for long-term use

30% of 30% of 1800 calories=160 calories

•28 RCT•602 patients in 11 trials•5.94 pound weight loss

more than control group

•Time course of at least one yr.

Orlistat is “Alli”

?15% of fat blocked?30% of fat blocked

Prescription diet medications can be expensive

$60-$2160 per year

For the expense, is it worth it?

$20/moor

$240/yr

Controlled Caloric Intake ExerciseDiet Pill

6-10 lbs. more than control group

There are many classes of OTC dietary supplements

Chitosan Ephedra sinicaGarcina camogiaHydroxyCitricAcid

Yohimbe

Plantago

Guar gum

Green tea

Chromium

“unlikely to cause weight loss”

“not likely to reduce total body weight”

“limited evidence to support claim”

“without conclusive evidence”

“unlikely to cause weight loss”

“may cause health problems similar to ephedra”

“heart attacks, stroke and even death”

“likely unsafe and should be avoided”

“unlikely to cause weight loss”

Many OTC diet aids are a concoction of several drugs

ChromiumGreen teaBitter orange10% synephrine

ChromiumGlucomannanGreen treeHoodia

HoodiaAdvantra-Z (ephedra-like)

YohimbineCaffiene (200mg)Synephrine

A survey of 402 products contained over 4,000 separate ingredients

• From December 2006 “Journal of the American Diet Association

• 73 Retail outlets

• Mean no. of ingredients per product=10+/-9

Green teaEphedra

Chromium

Just because a drug is OTC does not mean it is safe

Fen-phen“Redux”

Corti Therm

Green TeaCaffeineBitter OrangeGuarana (contains caffeine)HoodiaChromium

POW

Some stand alone OTC diet aids have been studied scientifically

Fullbar &Aquafull

We did a weight-loss

study with Fullbar that

was 3 months

long. On average,

95% of the people in

the study lost weight,

with the average

weight loss being 11

pounds. We want you

to have the same kind

of success and

recommend using

Fullbar over the same

period of time to get the

benefits experienced

by the people in our

study.

Congugated Linoleic Acid (CLA) may reduce fat mass marginally

Great stuff! Hmmm…don’tFeel much different

Green Tea extract may slightly raise the metabolic rate

Diet Induced Thermogenesis (DIT)•most with protein•least with fat

7-keto is a metabolite of the steroidal hormone DHEA

7-ketoGreen teaCaffeineHoodia

7-ketoGreen teaCaffeine

Hoodia is a rare cactus

P-57

Is scientifically proven in rats

P57 is broken down by the liver

P-57

This better be worth it!

Pfizer relinquished rights to P57 in 2002

Most media marketing efforts are misleading at best

“Through years of study and breakthroughs in modern science we’ve discovered the key to long term weight loss success. And you can only find this compound inside of NUPHEDRAGEN, weight loss solution”

“Each bottle of NUPHEDRAGEN retails for $97.00 USD. However, through our limited time special offer, you can buy it today for greatly discounted prices, depending on the quantity you order”

“Lose up to 14 pounds in only 7 days or Your Money Back Guaranteed”“On this exclusive special offer…for $19.99 (seven day supply)“Buy 5 Get 1 Free”“Buy 6 Get 3 Free”“Do not take two weeks in a row”

Eat all you want and still lose weight

“AKÄVAR®-20/50 literally causes excess fat to be pulled from bulging parts of your body!”

“Eat all you want & still lose weight...”

“Clinical trial shows success” Yerba mateGuaranaDamiana

60 capsule supply$39.99

20day Supply

Help rid you body of unhealthy toxins

30g

40g

There are three basic types of Bariatric surgery

Candidates for bariatric surgery are morbidly obese

Restrictive procedures include the LAGB and the VBG

The purely malabsorptive procedures are not commonly done

The Roux-en-Y Gastric Bypass (RYGB) is restrictive and malabsorptive

Bariatric surgery carries a significant risk of morbidity and mortality

Morbidity = Complications and illness

Mortality = Death

Obesity surgery accounts for 2 billion dollars, annually, for hospital costs alone

The results of bariatric surgery are proven and significant, but…

4047 Patients10 year follow-up

2037 in medically treated (control) group2010 in surgically treated group

No weight change in medically treated groupIn surgically treated group

RYGB: wt. loss 25%VBG: wt. loss 16%GB: wt. loss 14%

Deaths in surgically treated group: 101Deaths in medically treated group: 129

400 PoundsWt. loss of 25%= 100 Pound wt. loss

400-100 = 300 Pounds

Laparoscopic Adjustable Band

There are old people

and There are obese people

but, There are no old, obese people

Some bariatric surgery works better than others.

Bariatric surgery does not negate the need to diet

?

Bariatric surgery requires an emotional and financial investment

Mortality

Morbidity

$$$

$$$$$$

$$$

MorbidlyObese

Overweight orLess Obese

Commitment

Motivation

Empowerment

Inspiration

Effort

Obese orOverweight

HealthyWeight

DespairHopelessness

Powerless

HappinessPeace

Enlightenment

Poor HealthEarly Death

Good HealthNormal Lifespan

What Works?

Poor choices

RecidivismMortality

Morbidity

HappinessPeace

Enlightenment

BMR Down-regulation

Counteract: DIT, Exercise, not skipping meals or snacks

Lose weight 30 lbs. at a time

For example: 250 lbs to 150 lbs

The down-regulation is proportionate to the caloric restriction: so,

250

•Goal wt.=220

•2420 cal/day

220

•Goal wt.=190

•2090 cal/day

190

•Goal wt.=150

•1650 cal/day

2 week stability for up-regulation

2 week stability for up-regulation