Losing Weight and Managing It

There is no substitute for lifestyle modification; Xenical only facilitates the process

Obesity is a serious epidemic regarded as the second leading cause of preventable and unnecessary deaths. It claims nearly 300,000 lives a year in the United States alone (Journal of American Medical Association).

    The excessive storage of energy in the form of fat has many serious health implications. Obesity is an established risk factor for the development of diabetes mellitus, hypertension, stroke, cardiovascular disease, dyslipidemia, gallbladder disease, arthritis, and some cancers. Aside from these negative physical consequences, the psychological burden of the disease is equally hefty.

    Because obesity is thought of as the world's oldest metabolic disorder, weight management in the general population is considered a novel and tough clinical challenge. Recognizing this, to the original cornerstones in the management of weight loss which are diet and exercise, had been added pharmacotherapy, and in extreme cases, surgery.

    A drug that inhibits absorption of dietary fat like orlistat (Xenical) had been particularly helpful.

    At the seventh annual convention of the Philippine Association for the Study of Overweight and Obesity, Prof. James O. Hill of the University of Colorado Health Sciences Center affirmed the beneficial effects of Xenical in weight management. In a symposium on Managing Weight in the Real World: The Xenical Experience, Prof. Hill reviewed the merits of Xenical.

Treatment Goals

    Weight loss can improve one's health. That we all know. According to Prof. Hill, the guidelines released by the National Institutes of Health state that the initial goal of weight loss therapy for the overweight patient is to lower body weight by about 10 percent. Weight losses at five percent or even less can even be helpful.

    Moderate weight loss can significantly decrease the severity of obesity associated risk factors and weight loss of five to 10 percent can enhance health substantially. It is not imperative to bring obese patients to their ideal body weight to achieve substantial health improvements.

    The second goal is the stabilization of ideal body weight. In an obese patient, explained Prof. Hill, the natural course of body weight is not to remain stable but to increase, that to stabilize the weight of a patient already constitutes a successful outcome in weight management. It is rare to bring the weight of obese patients to ideal.

    The baseline in weight loss is a little bit lower using Asian guidelines. But the cornerstones remain the same. In all these, however, there is the requirement for behavioral change to help manage obesity. Drugs do not replace lifestyle change in managing obesity; they simply facilitate it.

The Role of Xenical

    Excess fat or calories are stored as fat by the body, resulting in weight gain, later obesity. As Prof. Hill explained, when you eat fat, your body breaks it down into its simplest components so that it can be digested. In the digestive system, enzymes called lipases help break down fat.

    Xenical is a weight control medication. Unlike other weight control medicines that stimulate the brain to suppress appetite, Xenical uses a fat blocking mode of action that works nonsystemically in the digestive tract. When taken with meals Xenical attaches to the lipases and interferes with these enzymes by forming covalent bonds with them in the stomach and small intestine, which essentially inactivates the enzymes so they are no longer available to hydrolyze dietary fat into an absorbable state.

    This blocks about one-third of the fat intake from being digested. The result of this fat-blocking mode is approximately 30 percent of dietary fat passes through the body undigested, and therefore, not absorbed by the body. The undigested fat is then eliminated in bowel movements.

Xenical-induced Weight Loss

    To examine the effectiveness of Xenical as a medication for weight loss and prevention of weight regain, Prof. Hill presented several studies. The first study evaluated Xenical following one year of treatment. Xenical in combination with diet was shown to be more effective in reducing weight than diet alone. In most cases, weight loss was gradual. Over twice as many Xenical patients lost 10 percent of their body weight.

    Weight loss among patients on Xenical was significantly greater than those on placebo, maintaining an average eight- percent reduction in body weight. Over 50-percent of patients on Xenical maintained an average five- percent weight loss while 33 percent maintained a 10-percent weight loss at the end of two years.

    This study demonstrates that partial inhibition of fat absorption in obese subjects can produce sustained weight loss. And that Xenical is a useful adjunct to dietary intervention in maintaining weight.

    Studies have also shown that there is a significant reduction in other risk factors as a consequence of the sustained weight loss. Among them are:

    o reduction in blood cholesterol levels--both total cholesterol and low density lipoprotein,

    o lowering of diastolic and systolic blood pressure thereby decreasing the risk of heart disease and strokes,

    o reduction of blood levels of uric acid thereby decreasing the risk of gout, and

    o reduction in cases of sleep apnea and irregular breathing during sleep.

    More importantly, there is reduction of blood glucose levels thereby decreasing the risk for the development of diabetes mellitus.

Obesity and Diabetes Mellitus

    According to Prof. Hill, estimates relate 61 percent diabetes cases to obesity, noting that the fatter and more obese the population gets, the higher is the prevalence of diabetes. He added more and more young people are developing diabetes since the 1990s. "Type 2 diabetes is developing at a younger age, and this is a scary trend," he warned.

    Weight management then becomes a major clinical challenge in patients with Type 2 diabetes. It is particularly difficult to produce weight loss solely by diet and exercise in patients with Type 2 diabetes, explained Prof. Hill.

    A couple of recent studies have demonstrated that weight management with Xenical in individuals with impaired glucose tolerance may be effective in preventing diabetes. Prof. Hill stressed that this becomes particularly important in the management of weight loss in the still non-diabetic patient to prevent the development of diabetes.

    In the already diabetic individuals, Xenical benefits patients being treated with sulfonylurea or metformin. In sulfonylurea-treated diabetics, there is a reduction in fasting plasma glucose that actually decreases the dosage for sulfonylurea by 23 percent.

    Patients on metformin, on the other hand, were able to achieve a 10-percent weight loss when treated with Xenical.

    In all, almost 50 percent of diabetic patients on Xenical achieved one-percent reduction in the levels of glycosylated hemoglobin while 61 percent had a one-half-of-one, percent reduction.

Powerful Tool

    Prof. Hill said a new study is now underway under the auspices of the National Institute of Diabetes and Digestive and Kidney Diseases. Dubbed as the Action for Health in Diabetes (AHEAD), the multi-center randomized clinical trial will examine the long-term effects of an intensive lifestyle intervention program compared with diabetes education and support among 5,000 type 2 diabetics. Xenical will be used as part of the medical intervention.

    "It is going to be awhile before we get the outcome but [this study] had the potential to change the way we manage diabetes," Prof. Hill said.