Obesity is the Real Problem

IOTF head warns of diabetes crisis, presents ways to trim the bulge with lifestyle changes, drug intervention

There is an enormous health crisis coming." Thus declared Dr. Philip T. James, chair of the London-based International Obesity Task Force (IOTF), referring to the 300 million to half billion people projected to have diabetes by the year 2025. But he said the real problem is not diabetes but obesity. "Our analysis shows that not only is diabetes preventable, but that 65 percent of diabetics are diabetic only because they put on [too much] weight," he stressed.

    Dr. James was the lone speaker in a medical symposium on Metabolic Complications of Overweight and Obesity: Benefits of Sibutramine hosted by the pharmaceutical products division of Abbott Laboratories October 3 at the Shagri-La Hotel. He cited international studies on obesity, emphasizing proper weight management and the role that sibutramine plays.

    According to Dr. James, diet and inactivity-not genetics-are largely to blame for the surge in the bulge. This, despite the discovery of the gene that predisposes some people to obesity, said Dr. James, noting that "less than one-tenth of one percent of such patients have a single gene defect for obesity."

Brain Shift

    The brain plays a vital role in the development of obesity and the difficulty that overweight and obese people face in shedding off the extra pounds. Explaining why people get fatter as they get older and find it hard to bring their weight back to normal, Dr. James said "there exists a fundamental shift in the set point of the brain."

    He explained: "When a 60-kilo man gains 30 kilos, his brain eventually regards 90 kilos as his normal weight. [And when you put him on diet,] you get physiological, neuronal, and hormonal responses where the brain tells the patient that he is semi starving. Thus, the enormous drive to eat. They are metabolically behaving as though they are semi-starved even though they still have excess calories in the body."

    But getting people to lose weight and keep it is easier said than done. Medication alone is never enough. "You need to have a weight management strategy; the best management is when you got systematic, explicit documentation of what diet people should be on," he stressed.

    Dr. James said studies have shown that a combination of lifestyle modification (diet and exercise) and medication works best in chopping off the extra pounds and managing weight. One proven medication is centrally acting sibutramine. Sibutramine reduces one's sense of needing to eat but is not an anorexigenic drug. It enhances satiety, making one feel fuller earlier. It also has an unusual effect on energy expenditure.

    Dr. James explained that in losing weight, "the metabolic rates go down because the metabolism shuts down and the body loses protein. Sibutramine pushes the intake, the metabolic rate, because it tends to prevent the shutdown. So if you actually measure, under normal circumstances, the effect of sibutramine, it drops the food intake and the difference is managed to 300 or more calories per day."

    Dr. James cited several studies that confirmed the efficacy and safety of sibutramine. In the STORM trial, sibutramine was found effective not only in losing weight but also in maintaining a lower state of energy balance vis-à-vis the placebo group. "Sibutramine increases the success rate of patients by two to three folds. In other words, more of the patients can have a metabolically helpful response by using sibutramine.

    Not only that, sibutramine also helps trim visceral fat and keep waist circumference smaller. With a drop in the level of visceral fat, follow the metabolic benefits-decrease in the levels of triglycerides and very low density lipoproteins, and increase in the level of high density lipoproteins

    Diabetics who find it more difficult to lose weight get more benefits, said Dr. James. Trials show that sibutramine helps lower fasting glucose and HBA1c. In a meta-analysis of HBA1c changes in diabetic studies, a 0.9 percent drop in HBA1c was recorded at a 10 percent weight loss. The predicted cardiac benefits among diabetics are also greater (30 to 40 percent risk reduction), particularly with a five-percent weight loss.

    With these evidence, Dr. James challenged clinicians to engage in a completely new strategy for weight management to help their patients, especially those with co-morbid conditions, get long-term metabolic and clinical benefits.