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Abstract
The global pandemic of obesity and overweight now affects between 2.8 and 3.5 billion of the world population and shows no signs of abatement. Treatment for what is now recognized as a chronic disease includes pharmacotherapy, considered an essential component of comprehensive therapy. New drug discovery is robust, but the pace of the US Food and Drug Administration approval for obesity drugs has been glacial, and only a handful of approved drugs are available for treating obesity. In the last 20 years, the US Food and Drug Administration has approved 208 drugs for cancer, 118 for cardiovascular diseases, 168 for neurological diseases, and 223 endocrinologic drugs, but only 6 for obesity, 2 of which have been taken off market. Currently, there are only 9 drugs approved by the FDA for obesity treatment. US physicians have turned to off-label drug use in their effort to care for increasing numbers of patients with excess adiposity. Phentermine is the most commonly used drug for treating obesity. Although approved only for short-term use, US physicians have used it successfully for long-term since its initial approval in 1959. This drug, used off-label for long-term, has proven to be safe and effective, far safer than the disease it is used to treat. Phentermine and diethylpropion, an equally safe but somewhat less effective drug, are both generic and therefore inexpensive. These drugs have been maligned inappropriately because their two-dimensional structure diagrams resemble amphetamine and also because of unproven presumptions about their potential adverse effects. In the face of an increasing epidemic, worldwide obese and overweight patients deserve effective treatment that prescribing these drugs could provide, if rehabilitated and used more frequently. US physicians will likely continue to use any drug proven useful off-label for this illness until such time as more effective drugs are approved.
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Affiliation(s)
- Ed J Hendricks
- Center for Weight Management, Roseville and Sacramento, CA, USA
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Gonzalez-Campoy JM. BARIATRIC ENDOCRINOLOGY AND VERY-LOW-CALORIE MEAL PLANS. Endocr Pract 2017; 23:741-744. [PMID: 28448756 DOI: 10.4158/ep171842.co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ABBREVIATIONS PSMF = protein-sparing modified fast; VLCMP = very-low-calorie meal plans.
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Moldovan CP, Weldon AJ, Daher NS, Schneider LE, Bellinger DL, Berk LS, Hermé AC, Aréchiga AL, Davis WL, Peters WR. Effects of a meal replacement system alone or in combination with phentermine on weight loss and food cravings. Obesity (Silver Spring) 2016; 24:2344-2350. [PMID: 27664021 DOI: 10.1002/oby.21649] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the effects of phentermine combined with a meal replacement program on weight loss and food cravings and to investigate the relationship between food cravings and weight loss. METHODS In a 12-week randomized, double-blind, placebo-controlled clinical trial, 77 adults with obesity received either phentermine or placebo. All participants were provided Medifast® meal replacements, were instructed to follow the Take Shape for Life® Optimal Weight 5&1 Plan for weight loss, and received lifestyle coaching in the Habits of Health program. The Food Craving Inventory and the General Food Cravings State and Trait Questionnaires were used to measure food cravings. RESULTS The phentermine group lost 12.1% of baseline body weight compared with 8.8% in the placebo group. Cravings for all food groups decreased in both groups; however, there was a greater reduction in cravings for fats and sweets in the phentermine group compared with the placebo group. Percent weight loss correlated significantly with reduced total food cravings (r = 0.332, P = 0.009), cravings for sweets (r = 0.412, P < 0.000), and state food cravings (r = 0.320, P = 0.007). CONCLUSIONS Both phentermine combined with a meal replacement program and meal replacements alone significantly reduced body weight and food cravings; however, the addition of phentermine enhanced these effects.
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Affiliation(s)
- Christina P Moldovan
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, California, USA
| | - Abby J Weldon
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Loma Linda University, Loma Linda, California, USA
| | - Noha S Daher
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA
| | - Louise E Schneider
- Department of Nutrition and Dietetics, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA
| | - Denise L Bellinger
- Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, California, USA
| | - Lee S Berk
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA
| | - Alyson C Hermé
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, California, USA
| | - Adam L Aréchiga
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, California, USA
| | - Willie L Davis
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Loma Linda University, Loma Linda, California, USA
| | - Warren R Peters
- Department of Preventative Medicine, School of Medicine, Loma Linda University, Loma Linda, California, USA..
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Pharmacotherapy for Obesity and Changes in Eating Behavior: a Patient and Physician's Perspective. Adv Ther 2016; 33:1262-6. [PMID: 27246171 PMCID: PMC4939162 DOI: 10.1007/s12325-016-0349-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Indexed: 11/02/2022]
Abstract
This article, co-authored by a patient with obesity, diabetes, and hypertension, and an obesity medicine specialist, discusses the patient's experience with the onset of diabetes complicating obesity and with her frustration living with these diagnoses until finding an obesity medicine specialist physician who helped her lose weight and reverse her diabetes. The patient continues to maintain a significant weight loss and is diabetes free for 5.5 years after treatment initiation. The physician discusses the application of combination treatment that can be effective in diabetes reversal in such cases. He also discusses salient clinical lessons exemplified by this case.
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Haas WC, Moore JB, Kaplan M, Lazorick S. Outcomes from a medical weight loss program: primary care clinics versus weight loss clinics. Am J Med 2012; 125:603.e7-11. [PMID: 22624685 DOI: 10.1016/j.amjmed.2011.07.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/18/2011] [Accepted: 07/24/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Few studies have focused on weight loss programs implemented in community-based primary care settings. The objective of this analysis was to evaluate the effectiveness of a weight loss program and determine whether physicians in primary care practices could achieve reductions in body weight and body fat similar to those obtained in weight loss clinics. METHODS Analyses were performed on chart review data from 413 obese participants who underwent weight loss at a primary care (n=234) or weight loss (n=179) clinic. Participants received physician-guided behavioral modification sessions and self-selected a diet plan partially or fully supplemented by meal replacements. A repeated-measures analysis of covariance was conducted with age and sex serving as covariates; significance was set at P≤.05. RESULTS In 178 subjects (43%) completing 12 weeks of the program, primary care clinics were as effective as weight loss clinics at achieving reductions in body weight (12.4 vs 12.1 kg) but better with regard to reduction in body fat percentage (3.8% vs 2.7%; P≤.05). Regardless of location, participants completing 12 weeks lost an average of 11.1% of their body weight. Participants selecting full meal replacement had greater reductions in weight and body fat percentage (12.7 kg, 3.5%) compared with participants selecting a partial meal replacement plan (8.3 kg, 2.3%). CONCLUSION Primary care physicians can successfully manage and treat obese patients using behavioral modification techniques coupled with meal replacement diets.
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Affiliation(s)
- William C Haas
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Hendricks EJ, Greenway FL, Westman EC, Gupta AK. Blood pressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity. Obesity (Silver Spring) 2011; 19:2351-60. [PMID: 21527891 DOI: 10.1038/oby.2011.94] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a perception that phentermine pharmacotherapy for obesity increases blood pressure and heart rate (HR), exposing treated patients to increased cardiovascular risk. We collected data from phentermine-treated (PT) and phentermine-untreated (P0) patients at a private weight management practice, to examine blood pressure, HR, and weight changes. Records of 300 sequential returning patients were selected who had been treated with a low-carbohydrate ketogenic diet if their records included complete weight, blood pressure, and HR data from seven office examinations during the first 12 weeks of therapy. The mean time in therapy, time range, and mode was 92 (97.0), 12-624, and 52 weeks. 14% were normotensive, 52% were prehypertensive, and 34% were hypertensive at their first visit or had a previous diagnosis of hypertension. PT subjects systolic blood pressure/diastolic blood pressure (SBP/DBP) declined from baseline at all data points (SBP/DBP -6.9/-5.0 mm Hg at 26, and -7.3/-5.4 at 52 weeks). P0 subjects' declines of SBP/DBP at both 26 and 52 weeks were -8.9/-6.3 but the difference from the treated cohort was not significant. HR changes in treated/untreated subjects at weeks 26 (-0.9/-3.5) and 52 (+1.2/-3.6) were not significant. Weight loss was significantly greater in the PT cohort for week 1 through 104 (P = 0.0144). These data suggest phentermine treatment for obesity does not result in increased SBP, DBP, or HR, and that weight loss assisted with phentermine treatment is associated with favorable shifts in categorical blood pressure and retardation of progression to hypertension in obese patients.
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Affiliation(s)
- Ed J Hendricks
- The Center for Weight Management, Roseville, California, USA.
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Hendricks EJ. Should the FDA approval process for weight-loss drugs be modified? Am J Health Syst Pharm 2011; 68:2094-5. [DOI: 10.2146/ajhp110228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ed J. Hendricks
- Ed J. Hendricks, M.D., is Medical Director, Center for Weight Management, 2510 Douglas Boulevard, Suite 200, Roseville, CA 95661
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Affiliation(s)
- Ed J. Hendricks
- Center for Weight Management, 2510 Douglas Boulevard, Suite 200, Roseville, California, U.S.A
| | - Richard B. Rothman
- Belite Medical Center, 3923 Old Lee Highway, Suite 61A, Fairfax, Virginia, U.S.A
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Hendricks EJ. Rhabdomyolysis and phentermine: Coincidence, not causation. Am J Health Syst Pharm 2011; 68:1386, 1395; author reply 1395. [DOI: 10.2146/ajhp110118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ed J. Hendricks
- Center for Weight Management 2510 Douglas Boulevard, Suite 200 Roseville, CA 95661
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Rothman RB, Hendricks EJ. Phentermine cardiovascular safety. Int J Cardiol 2010; 144:241-2; author reply 242-3. [DOI: 10.1016/j.ijcard.2008.12.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
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Phentermine cardiovascular safety. Am J Emerg Med 2009; 27:1010-3. [PMID: 19857423 DOI: 10.1016/j.ajem.2009.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 07/19/2009] [Indexed: 11/20/2022] Open
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Hendricks EJ, Rothman RB, Greenway FL. How physician obesity specialists use drugs to treat obesity. Obesity (Silver Spring) 2009; 17:1730-5. [PMID: 19300434 DOI: 10.1038/oby.2009.69] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Specialist physicians may have prescribing habits that are different from nonspecialist physicians. Little is known about the prescribing habits of physicians specializing in the treatment of obesity. An anonymous survey was given to the physician members of the American Society of Bariatric Physicians (ASBP). There was a 35% response rate (266 physicians) to the questionnaire that was represented nationally. Almost all prescribed medications and all of them recommended phentermine. The average maximal dose of phentermine was above that approved in the package insert, and these physicians disagreed with the National Institutes of Health (NIH) Obesity Treatment Guidelines. Phendimetrazine, metformin, and phentermine plus L-5-hydroxytryptophan (5-HTP) with carbidopa were all used more frequently than either orlistat or sibutramine. The combination of sibutramine and orlistat as well as 5-HTP/carbidopa were prescribed by 14 and 20%, respectively. As 5-HTP-carbidopa was a combination not previously reported for the treatment of obesity, a retrospective chart review was performed in a single obesity practice, which may not be representative. Twenty-two subjects had a 16% weight loss with phentermine over 6 months and an additional 1% weight loss with the addition of 5-HTP/carbidopa for an additional 6 months. One subject who started on 5-HTP/carbidopa alone lost 24.4% of initial body weight over 6 months. This questionnaire revealed that 20% of the obesity specialists responding to the survey used phentermine plus of 5-HTP/carbidopa, an unreported combination. A controlled, randomized, clinical trial to evaluate the safety and efficacy of this combination in treating obesity should be considered.
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Affiliation(s)
- Ed J Hendricks
- The Center for Weight Management, Roseville, California, USA
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Annunziato RA, Timko CA, Crerand CE, Didie ER, Bellace DL, Phelan S, Kerzhnerman I, Lowe MR. A randomized trial examining differential meal replacement adherence in a weight loss maintenance program after one-year follow-up. Eat Behav 2009; 10:176-83. [PMID: 19665101 DOI: 10.1016/j.eatbeh.2009.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 03/31/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
Abstract
The purpose of the present study was to examine the relationship between patterns of meal replacement (MR) adherence and changes in outcomes during a behaviorally-oriented weight loss program. Data from the present study are based on sixty female participants (age: 29-62 years, BMI: 27.99-37.50 kg/m(2)). Participants were randomized into either a control or experimental condition, which tested the use of MRs during weight loss maintenance. Outcome measures included body weight, depression, physical activity, cognitive restraint, disinhibition, hunger, and binge eating collected at four assessment points. Within the experimental condition, we further examined adherence to MRs and its relationship with the outcome measures. We found evidence of differences at baseline on some measures (e.g., weight, physical activity and depression) while on others (cognitive restraint, disinhibition, and hunger), differences that emerged over the course of treatment. Further research is necessary to determine if there are measures associated with successful MR use that can be detected at baseline and if MR adherence itself leads to changes in eating behavior.
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