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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to realize as I do, that nearly as soon as I understand and apply the current state of the medical science it becomes outdated if not completely obsolete, which is exactly as I want it to be.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

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.

The Workplace Wellness Solution for the Performance Driven Organization

Mitchell R. Weisberg, MD, is the Founder and CEO of Optimal Performance, MD. From his unique vantage point as both an Internist and Psychopharmacologist he sees workplace wellness as a potential remedy to much of what is ailing this nation’s healthcare system. Yet these programs have failed to deliver on their promise to improve an Organization’s bottom line, and Dr. Weisberg has spent the last four years seeking to understand why this is. The product of this effort is a redesigned and simplified workplace wellness solution which addresses the underlying problems causing traditional wellness programs to underperform. He calls it, The Workplace Performance Optimizer and he bases it on his clinical maxim; to get workplace wellness programs to work well, leave the well enough alone.

Dr. Weisberg views the members of our nation’s service based workforce as “knowledge athletes”, whose performance measures serve as their best vital sign. Similar to professional sports teams, The Workplace Performance Optimizer creates plans that address each employee’s performance needs by adding a clinical perspective to an Organization’s Balanced Scorecard.The most fundamental change in Dr. Weisberg’s wellness solution is that he leverages the Organization’s existing Employee Performance Metrics as the mechanism for driving participation in workplace wellness programs.  By leaving the well enough alone and focusing strictly on employees who are having performance issues ensures that the program’s improvement goals align directly with the Organization’s, and that it delivers measurable feedback on employee performance. Another change is to shift away from health and wellness care being delivered primarily by “wellness vendors”, towards aligning the healthcare professionals in the Organization’s existing network. Currently, our nation’s healthcare system in general and primary care physicians (PCPs) specifically, are essentially failing to offer employee wellness services. The reasons for this are too many to count here, but until employers insist on this changing, things will certainly stay exactly as they are. Rather than accepting the things as they are, helping employers get their money’s worth from the health care system for which they are already paying is the centerpiece of Dr. Weisberg’s workplace wellness solution. Improving use of this vital resource is the only way employers will see measurable improvements in employee performance and reductions in their healthcare costs.

By assisting employers through making these fundamental changes, Dr. Weisberg guarantees measurable improvements in employee performance to any Organization willing to adopt his wellness solution. And through more effective alignment of the Organization’s established provider network, Dr. Weisberg also guarantees his Workplace Performance Optimizer will deliver where traditional wellness programs continue to fail; cutting healthcare costs.

Dr. Weisberg is eager to meet with the stakeholders of your Organization to show his workplace wellness solution.

Call (847) 999-5120 x 3 or

e-mail drweisberg@optimalperformancemd.com

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