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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By

Mitchell R. Weisberg, M.D., M.P. 

Forward

Over the next several posts, I am going to update a document I first wrote in October 2006. My primary mission is to expose my readers, whether healthcare providers or laypersons, to the current state of the medical solutions for Obesity. Whenever I discuss the current medical approach to any aspect of the human condition, I replace the common phrase “state of the art”, with “state of our ignorance”. I want my readers to realize as I do, that nearly as soon as I understand and apply the current state of the medical science it becomes outdated if not completely obsolete, which is exactly as I want it to be. With everything I have ever learned about human health and medicine, there is one thing about which I will always be certain; we can always be doing better than what we are now. With that as my only disclaimer, I hope you find this update informative and useful.

Obesity the disease

If I had only one hour to save the world, I would spend fifty-five minutes defining the problem, and only five minutes finding the solution. Albert Einstein

So, while a medical evaluation of Obesity may begin with calculating a patient’s Body Mass Index, it certainly does not end there. To properly treat Obesity, one must first properly diagnose obesity, and this cannot be accomplished with a scale or a mirror. To know whether they are obese (as defined here), most Americans need a thorough history and physical examination by a competent healthcare professional. Only then can they seek solutions, medical or otherwise.

In the posts that will follow, I will show how the definition of Obesity, as I laid it out here, serves as a guide in the medical evaluation (history, physical examination and ancillary testing) and ultimately the medical treatment of Obesity.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist-Corporate Wellness Consultant

Founder-CEO and Personal Physician at,

Optimal Performance MD LLC

 

MEDICALIZING OBESITY

November 21, 2014

The Argument in support of the Rational Use of Prescription Medications

for

Treating Obesity

In  a 2009 report , 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. What that author did not say but this author believes is the upshot from this report is that virtually none of these medicines were prescribed to treat Obesity. Rather, they were prescribed to treat the health consequences (co-morbidities) of Obesity such as Diabetes, Hypertension and Osteoarthritis 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 it seems in light of this information about its medical costs,  the biggest obstacle to Medicalizing Obesity is the Medical Establishment. For starters, it was as recently as July 2013 that the American Medical Association (AMA) first officially recognized Obesity as a disease. For another example, 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 some patients with pre-existing coronary artery disease, Meridia caused heart attacks, some of which were fatal. While high blood pressure and fatal heart attacks are by no means minor risks, they are risks that can be significantly reduced when prescribing physicians practice within the “standard-of-care” such as carefully screening their patients for heart disease before prescribing Meridia and closely monitoring their patients’ blood pressures after they start taking the medication. These are already firmly established practice standards for the general medical care of Obese patients regardless if they are intending to start on a weight loss medicine. Most conspicuous by its absence from the debate over removing Meridia from the marketplace was any consideration of the benefits of Meridia or the risks of not treating Obesity.

Contrast the Meridia story with that of Sudafed (pseudoephedrine), the over-the-counter decongestant taken by millions of Americans every day, which has similar pharmacologic properties as well as risks as Meridia for raising blood pressure and causing heart attacks in some people with pre-existing Coronary Artery Disease (CAD). Seemingly, according to the FDA the benefits of clearing our stuffy noses warrants us taking such risks while a clinically significant reduction in our body weight does not.

As a last example of the Medical Establishments “Hypocritical Oath” when it comes to Obesity is aspirin, brought to the US marketplace by Bayer in 1905 and the proliferation of the myriad other non-steroidal anti-inflammatory drugs (NSAIDs) that followed. A rarely mentioned fact is that this class of medications, available without a prescription, causes 7,500 deaths annually in the US, primarily from gastrointestinal hemorrhage, most of which occur spontaneously without warning. Why isn’t the FDA suggesting we take these medicines off the market, while a medicine that actually treats Obesity that carries the same and even lower risks,  is pulled from the market? Adding to the irony, the primary reason people take NSAIDs is for the treatment of the co-morbid condition of Osteoarthritis, a co-morbid condition of Obesity. So, according to the prevailing perspective of the Medical Establishment if you are an Obese patient and you call your “Care Provider” because you are suffering from arthritis pain, the advice you will likely be given is, “take two aspirin and call me when you are a contestant on The Biggest Loser.

As you may have noticed, this author’s primary argument in support of the rational use of prescription medications for the treatment obesity is their irrational disuse. Clearly the time for changing this antiquated perspective is long overdue. In my next post, I am giving my first comprehensive update since 2006   on the current prescription medicines for the treatment of the disease, 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

2d11f99Mitchell R. Weisberg, MD, MP- Board Certified Internist/Master Psychopharmacologist 

With extensive training and a quarter-century of clinical experience in both Internal Medicine and Psychopharmacology combined with his inherent passion for people and problem solving Dr. Weisberg has been optimizing health, wellbeing and performance, one individual at a time since 1990.

Dr. Weisberg graduated from Rush University Medical School in 1987 where he then completed his 3-year residency training program in Internal Medicine. In 1991 Dr. Weisberg was honored to stay on at Rush to act as Chief Resident in the Department of Internal Medicine. In 1992 Dr. Weisberg founded his private practice where,  in spite of the tumult within the healthcare system, he has happily remained ever since.

Committed to being a “life-long medical student”, 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.

With his training and extensive clinical experience in Psychopharmacology,  Dr. Weisberg offers a more holistic approach to the assessment and treatment of patients than most of his Internal Medicine Colleagues. Embedded in his General Internal Medicine Practice, Dr. Weisberg is proud to offer comprehensive treatment in the following areas:

Mental Health

Weight Management

Performance Management

See what Dr. Weisberg’s patients have to say about him in

Patient Reviews

Contact Information

Optimal Performance MD

Mitchell R. Weisberg, MD,MP

4711 W. Golf Road Suite 1200

Skokie, IL. 60076

Phone (847) 999-5120 x 1

e-mail drweisberg@optimalperformancemd.com

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