Medicalizing Obesity

September 8, 2016

The Argument for the Rational Use of Prescription Medications for Treating Obesity

From a report in 2009, Obesity in the United States carried the hefty price tag of $147 billion per year in direct medical costs, just over 9 percent of all medical spending. People who are obese spend almost $1,500 more each year on health care — about 41 percent more than an average-weight person. The biggest driver of these excess costs are prescription drugs, the author said.

However, virtually none of these prescriptions were for the treatment of Obesity. Rather, they were for treating the health consequences, or co-morbidities of Obesity such as Diabetes, Hypertension, Osteoarthritis just to mention a few.The good news is, effective and safe prescription medicines for treating Obesity have been in existence for several decades. The not so good news is that very few of these medications are actually approved by the US Food and Drug Administration (FDA) for treating obesity, and those that are FDA approved are rarely prescribed by US physicians. As preposterous as this seems in light of the burden of the the primary obstacle to Medicalizing Obesity is the Medical Establishment. For example, it was not until July 2013 that the American Medical Association (AMA) even recognized Obesity as a disease. In October of 2010 the FDA pulled the Obesity medication, Meridia (Sibutramine) from the market because in some patients it caused a rise in blood pressure and in patients with pre-existing coronary artery disease, Meridia caused heart attacks, some of which were fatal. While, high blood pressure or a fatal heart attacks are by no means minor risks, they are risks that can easily be avoided by any prescribing physician by following standard-of-care practices, such as monitoring of Blood Pressure and the appropriate screening for Coronary Artery Disease in at-risk populations. Furthermore, the majority of patients that experienced greater than a 5% reduction in their body weight while on Meridia enjoyed a net lowering in their blood pressure. The group of people prescribed Meridia are the same group with the highest risk for developing coronary artery disease, and physicians worth their weight in salt can fully assess their patients for coronary disease before, as well as closely monitor their patients’ blood pressure after prescribing Meridia for their patients. Apparently missing from the debate over withdrawing Meridia from the market place was consideration of the outcome of doing nothing about Obesity, which is as clear-cut a case of medical negligence if there ever was one. To add insult to injury, the medication Sudafed (psuedoephedrine), an over the counter decongestant, taken by millions of Americans every day, has a similar risk as Meridia for raising blood pressure and causing heart attacks in people with pre-existing Coronary Artery Disease (CAD). Seemingly, according to the FDA the benefits of clearing our stuffy noses warrants such risks while a clinically significant reduction in our body weight does not. To further illustrate the Medical Establishment’s perspective on Obesity, Aspirin which was first introduced to the marketplace by the Bayer Corporation in 1905, and the myriad of other non-steroidal anti-inflammatory drugs, or NSAIDs, that have proliferated since, cause 7,500 deaths per year in the US from gastrointestinal hemorrhage, most of which occurred spontaneously without prior warning. Why is there no issue within the Medical Establishment about the risks of these medications, which most of the time they are prescribed it is done so to treat the co-morbidities of Obesity? Yet if a medication that actually treats Obesity poses any of these same risks, it is pulled from the market? According to the prevailing perspective in the Medical Establishment, if you have pain and fever and happen to be obese the advice you will likely get from your doctor, will be to take two aspirins and call her after you become a contestant on The Biggest Loser. Clearly this is an irrational perspective and the time for a change is long overdue. In my next post, I am going to do my first comprehensive update since 2005 on the current medications available to treat the disease of Obesity, so please stay tuned.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist-Corporate Wellness Consultant

Founder-CEO and Personal Physician at,

Optimal Performance MD LLC

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Book Appointment with Optimal Performance MD in Skokie, Illinois

Source: Book Appointment with Optimal Performance MD

Mitchell R Weisberg MD is a Board Certified Internist and Clinical Psychopharmacologist in private medical practice in the Chicago area since 1990. Within his practice, Dr. Weisberg developed and honed a holistic clinical method he calls, Optimal Performance MD, by which he helps his patients optimize their health, well-being and performance.

In August 2017, Dr. Weisberg became the Chief Medical Officer at ViMedicus; a Chicago based Healthcare Services/ Technology startup. ViMedicus services self-insured Organizations creating solutions that combine healthcare intelligence, care coordination, and collaborative communications to empower service providers and help improve the lives of individuals with chronic conditions.

Dr. Weisberg did his Medical School and Internal Medicine training at Rush University in Chicago, where in 1991 he served as Chief Medical Resident in the Department of Internal Medicine. In 2006, Dr. Weisberg received his certification as a Master Psychopharmacologist (MP) from The Neuroscience Education Institute, Carlsbad, CA.  His unique credentials allowed Dr. Weisberg to serve as a Primary Care Neuroscience Consultant and Educator for Eli Lilly and Company, educating his primary care colleagues on the recognition and treatment of Depression, Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder in the primary care setting. In addition, Dr. Weisberg has maintained his Board Certification by the American Board of Internal Medicine since 1990 passing his re-certification examination in October 2014.Dr. Weisberg’s proudest achievement is each of the individuals he helped.

You Agree with each other much more than you think 

I will begin this post with a disclaimer; I am not a certified marriage counselor. Now that this is out-of-the-way, I will also declare that as an Internist and Psychopharmacologist in private practice for nearly a quarter century, I do have a seasoned understanding of human behavior, and my perspective may allow both of you to immediately declare a truce and in the long run may make you both a lot healthier, so both of you, please keep reading.

I want you to think about those things, now and in recent times, that you can’t stand about your spouse. If there are none, then please go watch television or do something else. For the rest of us that are not on our honeymoon, I guarantee you that your spouse can’t stand those same things about him or herself, but they do not realize this just yet. And by no means am I am suggesting that you come right out and tell your spouse this either. In fact, the first piece of marital advice I am going to give you, no matter who you are, is to put your relationship on hold and focus on yourself for a minute or two.

I know that at first glance, this appears as pretty radical advice from someone who is not a marriage counselor and does not even know who he is talking to. But trust me, I’m a doctor; if you have a marital problem, you have yourself a health problem. But, I don’t really expect you to just take my word for it, even if I am a doctor, so here is the rationale for my advice; I base it on that  seasoned understanding of human behavior that I may have mentioned once already. Please take a few minutes, click on the following link and fill out the form (keep it private, of course). Health and Well-being Inventory I will be here when you come back.

OK, I am not a marriage counselor and I also can lie once in a while. Sleep well. We’ll continue the exercise with my next post coming soon.

Mitchell R. Weisberg, MD

Founder/CEO/Internist/Psychopharmacologist/Personal Physician:

Optimal Performance MD

I cut and pasted an e-mail from a patient who asked me a question this evening. As soon as I read it, I thought the answer was worth sharing with my readers; both of you.

(I removed all personal identifiers to protect my patient’s confidentiality.)

Dear Dr. Weisberg,

The doctor I worked with before I began working with you almost two years ago gave me a different diagnosis  than you gave me. She said I had LD, a Learning Disability. I looked up in a dictionary what the word disability means and here is one of the definitions that I came across

— state of being disabled or limitation in the ability to pursue an occupation because of a physical or mental impairment. I am struggling to understand this word and how it applies to me. I realize that this definition can just be one of many definitions and I am pretty sure that this definition does not apply to me, but it made me think of a question to ask you. Do you believe that if a person truly has LD, they can outgrow it? Thank you for your explanation.

My response:

Wow! You are asking very difficult questions and I could not be more proud! (Disclaimer: This does not mean that I am always going to answer your difficult questions, but today’s question came at a time when I am in the mood to answer it, and as you are aware, moods are subject to change without prior notice.)

With regards to your question whether someone can outgrow a disability, my short answer is a definite yes but the reasons  for this are many, but I will at least attempt to show you the abbreviated version:

  • Let’s begin, as I always do  when I am solving a problem,  by deconstructing “disability”. Deconstructing, is a method of analysis by which I peel back the layers of any phenomenon, such as a disability, as if I am peeling back the layers of an onion to see what lies beneath the surface. If  we peel back the layers of a person’s disability,  we will see a whole collection of impairments to the person’s ability to function normally. When I translate the process of deconstructing into the language of clinical medicine a disability translates to syndrome and the collection of impairments  roughly translates to symptoms. Before I go too far on this tangent, I am going to personalize it to a topic in which I have an honorary PhD; the science of YOU. Let’s start with your “other” diagnosis, LD and peel it back and take a closer look at the collection of impairments to your ability to learn normally. As I know you will recall, at our first meeting the first thing that I did was peel back your diagnosis, or syndrome to see the next layer. I did this on page two of that megillah of an intake form that I tortured you with even before we had our first face to face meeting (please see OPMD Comprehensive Health Assessment Intake Form) By the end of our first meeting I peeled you back as close to the core as I possibly could. There is no other way, that I can think of, to understand YOU or anyone else, for that matter, who I want to help become abled. By peeling back the of YOU that I first met on 11/17/2011 I discovered that the “YOU Syndrome” was composed of the following impairments to her ability to function normally:
    • Excessive distractibility This is a more efficient way of describing impairments in your ability to pay attention  and your hyperactivity and brings up a teaching point that I cannot resist. Distractibility, or the inability to decide which stimulus or stimuli in one’s surroundings is most important, is the primary malfunction in the brain of the person with  ADHD (Attention Deficit Hyperactivity Disorder). Constantly distracted, a person with ADHD can pay attention, but not to just one particular thing; their impairment is in their ability to filter the unimportant from those stimuli in their environment that are important; and as a result they move inappropriately (hyperactivity also known as hyperkinetic). So, little Tommy is, in fact, paying attention to his teacher, but he is also paying attention to the pretty bow in little Susie’s pretty hair, who is sitting in the seat right in front of him and to his friend little Joey, who he sees outside the classroom window playing soccer. Just a moment ago, little Tommy was paying attention to his teacher, but then he also just had to touch little Susie’s pretty bow and go to the window and cheer on little Joey. Oh yeah, I forgot to mention, little Tommy just got an iPhone for his birthday. I’m exhausted just writing this, I can’t even begin to imagine how little Tommy must feel. OK, back to the YOU Syndrome.
    • Excessive fear and worry, also known as Anxiety

YOUR collection of impairments is not all that long; only two that I could find, but just like that, we deconstructed the YOU Syndrome. We peeled back the layers of YOU, far enough so we could rationally decide which molecules to throw into that bowl of liquid floating inside YOUR skull; a few molecules that cut YOUR distractibility and some molecules that help YOU not be afraid and molecules that help YOU not worry to the point that YOU destroy YOUR new physician’s office furniture. As I am describing this process I cannot help but realize how similar it is to when I take my first spoon full of bland soup and add I a little salt and a pinch of pepper to get it to taste delicious. Which leads me to a new diagnostic insight into the YOU Syndrome. I hope you are ready for this? I am about to update your diagnosis to match your current clinical status. Here it is, 8 years of post-graduate education followed by two decades of clinical experience then 17 months of research into the YOU Syndrome and here it is my professional clinical opinion of YOU:

  • Patient Name: YOU
  • Diagnosis: A Delicious Bowl Of Soup Syndrome
  • Prognosis: Excellent

So, what was your question? Oh yeah, can someone outgrow a disability?

My answer is yes, and YOU are all the proof I need!

END POST

Mitchell R. Weisberg, MD, MP

Founder/CEO, Internist/Psychopharmacologist and Personal Physician at:

Optimal Performance, MD

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