Doctors Talk about Weight Loss (5): Inventory of Weight

I believe many people, especially girls who love beauty, will be interested in today’s topic. In fact, [weight loss drugs] is a heavy and serious topic.

Currently approved by China Food and Drug Administration (CFDA) for the treatment of obesity, There is and only one drug. There are also many weight-loss drugs that have been approved by the US Food and Drug Administration (FDA) that have not yet entered the Chinese market or have not been approved for weight-loss indications by the CFDA. The shortage of weight-loss drugs in China, Seriously constrains the treatment of obesity, It is difficult for a doctor to cook without rice. And it is extremely disproportionate to this, It is a large number of fake [weight loss drugs] advertisements flooding the media, all kinds of deception, all kinds of fraud, chaos, hiding dirt and accepting dirt. What [pure natural without side effects] [quick weight loss in a week] [0 rebound] [difficult without weight loss]… If you have ever paid attention to weight loss, you should not be unfamiliar with these demagogic slogans. When did what use weight loss drugs? What is a reliable diet pill? I hope the following words can help you to understand these problems systematically and scientifically. Weight loss drugs are not just to eat! Obesity is a disease that not only affects the aesthetic feeling of the body, but also leads to a hotbed of many diseases. There are three major treatment methods for obesity: a. Lifestyle intervention (including exercise, diet and cognitive-behavioral therapy); B. Medication; C. Surgical treatment, in which, Lifestyle intervention is the most important first choice, basic treatment, Both medication and surgical treatment must have strict indications. Take medication as an example, Only for BMI (square of weight/height) ≥ 30 kg/m2, or BMI ≥ 27 kg/m 2 and accompanied by at least one disease associated with obesity, Such as diabetes, hypertension, dyslipidemia, obstructive sleep apnea and other obese patients, Only when weight loss drugs are considered. At the same time, adequate diet, exercise and behavioral therapy must be taken. Due to the many side effects and potential risks of weight loss drugs themselves, efficacy evaluation must be carried out after medication: if the response to drugs is good and the weight loss exceeds 5% after 3 months of treatment, drug therapy can be continued; If satisfactory results are not achieved, Or significant adverse reactions, The original drug should be discontinued, Switch to other drugs or other treatment methods. Take a break, In the past, butterflies are also worried-the following weight-loss drugs we used in those years are like meteors, In 1997, FDA ruled that [fenfluramine] and [dextrofenfluramine] would cause serious damage to the heart valve, revoked its listing license, and Wyeth Pharmaceutical Company of the United States, which produced [fenfluramine], paid up to 890 million US dollars in compensation to patients with heart damage. In 2001, appetite inhibitor [phenylpropanolamine] was found to cause serious consequences such as hemorrhagic stroke, and CFDA stopped its sale and use in China. In 2008, the weight-loss drug [rimonabant], which has invested a huge amount of research and development funds and has high hopes, was found in clinical research [with suicidal tendencies and mental safety risks] and its listing application was revoked. In 2010, Sibutramine, a once-popular weight-loss drug, has been found to be at risk for cardiovascular disease, stroke, The FDA requires drug manufacturers to withdraw automatically from the U.S. Market, CFDA has also stopped its production, sale and use in China, and required manufacturers to recall and destroy the drugs already on the market. The reason why these drugs have to be listed one by one is that they have not completely disappeared. Among many “pure natural weight-loss drugs” that have no three, there are still figures that they should not appear: which weight-loss drugs are available to choose from? 1. There are no heroes in the world, Orlistat is currently the only legal weight-loss drug in China. It was once the only diet drug in the world. It can specifically inhibit enzymes responsible for digesting fat in human gastrointestinal tract. Prevent the absorption of fat in the digestive tract, Thereby reducing calorie intake, As orlistat mainly functions in the gastrointestinal tract, The whole body absorbs less, Once thought to be very safe, It has been approved in more than 100 countries around the world, It was even approved as an OTC by the United States and the European Union. China also converted it to OTC in 2005. And the indications of medication are determined as BMI ≥ 24 kg/m 2 [OTC], which means that the patient does not need a doctor’s prescription. You can go directly to the pharmacy to buy, This greatly expanded the application range of orlistat. During the ten years from 1999 to 2009, About 40 million people have used the drug. But according to the FDA’s comprehensive assessment, It was confirmed that at least 13 people had severe liver damage during this period. Two of them died of liver failure. In chronological order, It is not equivalent to a logical causal relationship, The FDA was unable to determine whether orlistat was responsible for liver damage. Although it could not make an immediate judgment, But the FDA believes it is necessary to convey such information to the public. As a result, a warning was issued in May 2010 that [orlistat use may cause a rare but serious risk of liver damage]. As for whether the drug is used or not, According to the individual situation of the patient, Weigh the pros and cons and make a choice. Until today, [Liver damage] is still a possible risk that orlistat cannot determine and has not ruled out. For patients who are using the drug, Once there are any symptoms and signs of liver dysfunction, Such as anorexia, pruritus, jaundice, deep urine color, light feces color, right upper abdominal pain, The drug should be stopped immediately, See a doctor in time and check liver function. At least the incidence of [liver damage] is extremely low. We can put aside the dispute for the time being and leave it to future generations to resolve. But orlistat has a very clear and embarrassing side effect: uncontrollable anal oil discharge. Imagine that you are eating hot pot with your friends, singing songs, dew dripping chrysanthemums, wet underpants… who can blame? Since you have blocked the process of fat absorption in the intestinal tract, It has to go down the river and take [the door] out. In addition to reducing the intake of fat in the diet from the source, Without a better solution, Even so, Nor can it completely correct the fat drops’ adamant behavior of entering through the back door. For fat friends who are suffering greatly, The doctor’s advice is: Please wear adult diapers. In addition, Due to limited fat absorption, Some fat-soluble vitamins (such as vitamins A, D, E and K) and minerals (such as calcium) are also prone to malabsorption. Long-term drug users, These materials need to be supplemented. 2. The scenery is infinitely beautiful, Only in the United States-the rising stars are not fawning on foreign countries by saying so, The four drugs mentioned below, They are officially approved by FDA and are widely used in the U.S. Market. But they have either not entered China yet. Either it is limited to treating other diseases in China and has not been approved by CFDA for weight loss. As a Chinese specialist, I can only look at it with my eyes dry. (1) Cocaselin is very important to the vast number of fat friends. 2012 was a lucky year. The FDA finally broke the 13-year spell of not approving any weight loss drugs. Two new weight loss drugs were approved in a row within one month, Clocarserin is one of them. Clocarserin can act on the feeding center of the brain, suppress appetite, It makes people feel full when they eat less. In addition, It also accelerates the oxidative decomposition of fatty acids, Promote fat metabolism. So as to play a role in losing weight. In fact, The mechanism of action of chlorcarserin is not new. Its family predecessor [fenfluramine] has a similar effect. Once the most popular diet pill of the 1980s, But it was later found to cause heart valve damage and pulmonary hypertension. Has been delisted in 1997. The difference between the two is that, The delisted fenfluramine is a serotonin 2B receptor agonist, The new drug chlorocaserin activates type 2C receptors, This makes it very safe, It suppresses appetite and avoids damage to heart valves, Suitable for obese patients with cardiovascular diseases. Of course, As a new drug, Whether it is really [safe] remains to be confirmed. (2) In lucky 2012, Two slimming drugs have passed the approval of the FDA, which is famous for its strictness. One is chlorocaselin, The other is [phentamine-topiramate] compound tablets. As can be seen from the name, This is actually a combination of two independent drugs. Pentamine is a sympathetic drug. It can inhibit the reuptake of synaptic norepinephrine, It is also a central weight loss drug. Due to the risk of increasing the incidence of heart disease and hypertension, Not recommended for patients with a history of cardiovascular diseases. And there is a risk of weight rebound after withdrawal. Topiramate has long been available in China, but it is not used for weight loss. The drug instructions clearly state in black and white: [This product is used for single and combined treatment of epilepsy.] Why can antiepileptic drugs lose weight? The reasons are complicated, I haven’t figured it out yet, Topiramate’s gorgeous turn was a beautiful accident: People have found that epileptic patients have lost weight after taking the drug. So it began to be used as a potential anti-obesity drug for clinical research, He passed the final examination and took up his post with a certificate. At present, the evaluation of the drug is as follows: Pentamine-topiramate compound tablets can effectively reduce body weight, improve hyperglycemia and dyslipidemia, However, high doses will slightly increase adverse events such as depression and anxiety. (3) Naltrexone/bupropion compound preparation This is another compound drug. It was approved to go public by FDA in October 2014. Naltrexone has a nickname called “drug nemesis”, It is an opioid receptor antagonist, It is used to treat alcohol and drug dependence. Bupropion is used to treat depression and assist in quitting smoking. Both are also used in their original jobs. It was also found to have a weight loss effect. In a clinical study involving 4,500 obese patients, After treatment with naltrexone/bupropion, Forty-two percent of the patients lost more than 5% of their weight. However, FDA also added a [black box] warning when approving naltrexone/bupropion to treat obesity: It is suggested that the drug may increase the risk of suicide and other mental diseases. [Black Box] is the most serious warning placed in prescription drug labels. It also means prohibiting pharmaceutical companies from directly advertising to consumers. In addition, Because bupropion causes blood pressure to rise and heart rate to increase, Therefore, this drug is also prohibited for hypertension patients. (4) Liraglutide in December 2014, The hypoglycemic drug [liraglutide] is approved by the FDA for the treatment of obesity, Becomes the fifth weight-loss drug approved to be marketed in the United States. Other new weight-loss drugs are relatively far away from us. But endocrinologists are all too familiar with liraglutide. It is a hypoglycemic drug of enterotropin, It can regulate insulin secretion, inhibit appetite, delay gastric emptying and increase fullness. Since most patients with type 2 diabetes are overweight or obese, Liraglutide and its similar drugs have excellent performance in sugar control and weight loss. At the same time, the incidence of hypoglycemia is low, This hypoglycemic drug with both effectiveness and safety soon gained favor. In recent years, diabetes treatment guidelines have given it the same status and recommended level as classic oral hypoglycemic drugs and basic insulin. From the treatment of diabetes complicated with obesity, To treat simple obesity, Liraglutide is an important step forward, The prospect is bright. (5) Weight-loss drugs to be surfaced and two new weight-loss drugs have entered Phase II clinical trials in the United States: [selective methionine aminopeptidase 2 inhibitor], [melanin 4 receptor agonist]. It is hoped that in the near future, Can bring new surprises to everyone. Summing up, drugs are no better than other drugs, Not you want to eat, you can eat if you want, It must be scientifically applied under the guidance of doctors. For its own safety, For drugs not listed in this article, especially those [weight loss drugs] like those in the figure, It is strongly recommended to throw it into the garbage as early as possible. The majority of fat friends also don’t expect to rely on drugs to solve obesity once and for all. They are only supplementary treatment after strict diet management and continuous regular exercise. In fact, most mild to moderate obesity people can achieve the effect of continuous weight loss only through lifestyle improvement, without medication.