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Weight Loss Products: Weighing in on the Evidence. Loren Regier BSP, BA RxFiles Academic Detailing Program www.RxFiles.ca November 2007. Kcal: Interesting numbers. Coke 591ml 240 Kcal Mars Bar: 294 Kcal Slurpee 1.18l: 570 Kcal Big Gulp double: 800 Kcal

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weight loss products weighing in on the evidence

Weight Loss Products: Weighing in on the Evidence

Loren Regier BSP, BA

RxFiles Academic Detailing Program

www.RxFiles.ca

November 2007

kcal interesting numbers
Kcal: Interesting numbers
  • Coke 591ml 240 Kcal
  • Mars Bar: 294 Kcal
  • Slurpee 1.18l: 570 Kcal
  • Big Gulp double: 800 Kcal
  • Milkshake, lg: 1,160 Kcal
  • Walk for 60 minutes: >300 Kcal
  • Run for 60 minutes: >800 Kcal
predictors of increased cv risk related to obesity
Predictors of increased CV risk related to obesity?
  • Waist Circumference:
  • <94cm ideal; >102cm high risk
  • <80cm ideal; >88cm high risk
  • Waist/Hip Ratio: >0.95;  >0.85.
  • BMI:>25=overweight, >30=obese.
weight loss management
Weight Loss Management
  • Assess medications for possible drug-related weight gain
    • Antidepressants:
      • Weight neutral/loss: bupropion, SSRIs, moclobemide,

venlafaxine

      • Weight gain: mirtazapine, amitriptyline >

desipramine, nortriptyline

    • Antipsychotics
      • Weight gain: clozapine > olanzapine > quetiapine > risperidone > haloperidol
    • Diabetes medications
      • Weight gain: insulin > SU > glitazones > acarbose
      • Weight neutral/loss: metformin
slide5
Diabetic Medications
    • Weight Considerations
weight loss management6
Weight Loss Management
  • Assess medications for possible drug-induced weight gain
    • Anticonvulsants:
        • Weight gain: valproic acid>lithium, pregabalin>gabapentin, carbamazepine
        • Weight neutral/loss: topiramate, lamotrigine
    • Others:
        • Corticosteroids, flunarizine, medroxyprogesterone, raloxifene>tamoxifene, smoking cessation
weight loss drugs
Weight Loss Drugs
  • Approved for Weight Loss
    • Sibutramine (Meridia®)
    • Orlistat (Xenical®)
  • Off-Label Use:
    • Fluoxetine (Prozac®)
    • Bupropion (Wellbutrin®)
    • Topiramate (Topamax®)
  • Not “wonder drugs”
weight loss drugs8
Weight Loss Drugs

Do Weight Loss Drugs Work?

  • Statistically significant, but modest weight loss (<5kg at 1 year).
    • Sibutramine: -4.5kg (95% CI -5.29 to -3.62kg)
    • Orlistat: -2.8kg (95% CI -3.31 to -2.20kg)
  • Most trials included lifestyle modifications as a co-intervention.
weight loss drugs9
Weight Loss Drugs
  • Sibutramine & orlistat have been shown to reduce & maintain weight loss with continued therapy.
  • Weight regain is common upon discontinuation of therapy.
  • Long term health benefits/safety/efficacy uncertain
weight loss drugs10
Weight Loss Drugs

Weight Loss & Weight Regain?

weight loss drugs11
Weight Loss Drugs

Do Weight Loss Drugs Work?

are weight loss drugs safe
Are Weight Loss Drugs Safe?
  • Sibutramine (Meridia®)
    • ↑ blood pressure by 1-3 mmHg & heart rate by 4-5 beats/min
      • … but is blood pressure offset by weight loss?
      • Health Canada – AR newsletter – case reports
    • Other:
      • Contraindications, drug interactions
are weight loss drugs safe13
Are Weight Loss Drugs Safe?
  • Orlistat (Xenical®)
    • Minimally absorbed (<5%)
    • Tolerability → GI adverse events
    • ↓ absorption of fat soluble vitamins
      • Recommend multivitamin with fat soluble vitamins
    • Other
    • OTC (USA):
      • Alli® 60mg po tid
      • FDA approved OTC use (Feb 07)
weight loss drugs14
Weight Loss Drugs

Cost

  • Sibutramine (Meridia®)
      • 10mg po od 1 month $120
      • 15mg po od 1 month $140
  • Orlistat (Xenical®)
      • 120mg po tid 1 month $155
  • Cost: $ 500-600 / lb lost at 2 years
weight loss herbal products
Weight Loss – Herbal Products

“5 P’s” – Overview

  • Popular
  • Pricey
  • Poly-herbal-pharmacy
  • Paucity of good evidence
  • Possibilities for success or failure
caffeine
Caffeine
  • Often hidden from labelling
    • Guarana, yerba mate, kola
  • Dosage/day – range 40-1,200mg
    • Recommended max ~450mg/day
  • Evidence
    • When combined with ephedra, limited evidence for weight loss effect; otherwise evidence lacking
  • Adverse Effects (AE)s:
    • HA, anxiety, ringing, insomnia,

HR & BP

  • Watch out for amount and AEs
some common products programs
Some Common Products/Programs

See RxFiles Chart:

Weight Loss Herbal “Natural” Products

natural products with not so natural sibutramine
Natural products …with not-so-natural sibutramine
  • There have been several warnings regarding products containing unlabled sibutramine
    • Chao Nongsu Qingzhi Jiaonang Slim Hong Kong , Detox Peptide, Fat Rapid Loss (Xin Yan Zi Pai Mei Zi Jiao Nang), LiDa Daidaihua Slimming Caps, Qianweisu Slimming Herb, Qing Zhi, Super Fat Burning & Reduce Weight
      • http://www.hc-sc.gc.ca/dhp-mps/advisories-avis/index_e.html
  • Buyer Beware!!!
herbal natural wt loss comments
Herbal/Natural Wt LossComments
  • Positives
    • It’s not all bad
    • Food is natural and a great place to make modifications for both weight & overall health
    • Support, accountability and commitment
      • Useful
    • There are some amazing stories…
herbal natural wt loss comments part 2
Herbal/Natural Wt LossComments – Part 2
  • Flip-side (negatives)
    • It’s not all good
    • Not everything natural is safe!
      • Sometimes you have to take the iodine out to make it safe
    • Not everything natural is labelled correctly
    • Nothing will eliminate the need for diet and exercise modifications
weight loss drugs herbs
Weight Loss Drugs & Herbs

Summary

  • Lifestyle modifications – essential
    • {Walk, avoid elevator, limit screen time, pop…}
  • Drug-induced wt gain - considerations
  • Weight loss drugs
    • limited options
    • limited long-term efficacy
    • safety & tolerability considerations
    • Cost considerations
  • Herbal/Natural…
    • Watch out for caffeine & unlabeled extras