Prime Time Replay:
Dr. Louis Aronne
on Weight Loss Drugs
MsgId: *breakthru_medicine(1)
Date: Wed Oct 2 20:58:36 EDT 1996
From: moderator At: 206.80.176.55
Hi, this is Madeleine Lebwohl, moderator of Breakthrough Medicine. Tonight I'll be interviewing Dr. Louis J. Aronne, clinical professor of medicine at Cornell University Medical College and director of the Comprehensive Weight Control Program in New York. Dr. Aronne is also the host of a cable T.V. show on the TV Food Network at 6pm EST, and is the author of the book, Weigh Less, Live Longer.
MsgId: *breakthru_medicine(6)
Date: Wed Oct 2 21:08:35 EDT 1996
From: Aronne At: 152.163.233.9
Hi, this is Dr Lou Aronne.
MsgId: *breakthru_medicine(7)
Date: Wed Oct 2 21:11:20 EDT 1996
From: moderator At: 206.80.176.55
Welcome, Dr. Aronne. I'd like to begin our chat by discussing very much in the news, the diet medication, Redux. Perhaps you can give us some thoughts on the use of medication for weight loss.
MsgId: *breakthru_medicine(8)
Date: Wed Oct 2 21:13:43 EDT 1996
From: Aronne At: 152.163.233.33
The use of medication in obesity treatment is not new, nor are the medications new. What is new is the way in which we look at obesity. Since the discovery of leptin, it has become clear that the body tries to regulate weight; treatment with meds now makes more sense.I think that we will see as time goes on that the treatment of obesity will resemble the treatment of hypertension-we will treat earlier and with more tolerable medicine and the goal will be prevention of weight gain.
MsgId: *breakthru_medicine(11)
Date: Wed Oct 2 21:16:52 EDT 1996
From: moderator At: 206.80.176.55
Are some medications safer than others? Is there an acceptable trade-off, medically, for how people use diet medications considering the fact that there are side effects?
MsgId: *breakthru_medicine(12)
Date: Wed Oct 2 21:19:10 EDT 1996
From: Aronne At: 152.163.233.33
The newly approved drug, Redux, is a reasonable treatment if you are 30% or more over weight . It must be used in conjunction with diet and exercise and can't stick with the program. There are risks to using it as there are risks with the use of all medications.The combination of 2 drugs, phen/fen (for phentermine and fenfluramine) has more side effects but is a bit more potent.
MsgId: *breakthru_medicine(14)
Date: Wed Oct 2 21:22:40 EDT 1996
From: moderator At: 206.80.176.55
In your book, Weigh Less, Live Longer, you discuss the alternatives to medication, such as exercise and diet. Can people who are candidates for medication hope to get the same results if they follow a solid regime that changes their eating habits?
MsgId: *breakthru_medicine(15)
Date: Wed Oct 2 21:26:46 EDT 1996
From: Aronne At: 152.163.233.17
Remember, I'm not for 1 minute suggesting that medicine be used instead of diet and exercise. Medicine helps with compliance when someone is willing. Many people can lose weight and maintain it for a long time without medication if they exercise regularly. Can they get to their ideal body weight? Usually not -- but they can lose some and prevent further weight gain.
MsgId: *breakthru_medicine(17)
Date: Wed Oct 2 21:30:02 EDT 1996
From: moderator At: 206.80.176.55
So what kind of reactions do you see in your office among patients, if you compare the ones taking medication for weight loss, and the ones on the diet/exercise regime?
MsgId: *breakthru_medicine(18)
Date: Wed Oct 2 21:31:19 EDT 1996
From: Aronne At: 152.163.233.17
We start every patient on diet and exercise and add medicine if the patient needs it. If they do well without the medicine we don't use it. We now know that when you go on a diet, levels of leptin (and perhaps levels of other, as yet undiscovered, hormones ) are reduced in the blood. As a result metabolic rate slows and appetite increases. Thus the dieter is fighting his or her own metabolism.The currently available medications like Redux help to turn the tables in the patient's favor , but it can't do anything about the drop in leptin production by the fat cells-that's why it isn't always successful, and why some people regain weight despite taking medicine.
MsgId: *breakthru_medicine(21)
Date: Wed Oct 2 21:37:15 EDT 1996
From: moderator At: 206.80.176.55
So the body isn't complacent when you start a diet--it reacts to a change in your eating pattern. This brings me to the question of the genetic component of obesity. How does this affect the dieter?
MsgId: *breakthru_medicine(22)
Date: Wed Oct 2 21:38:47 EDT 1996
From: Aronne At: 152.163.233.17
Once we have compounds like leptin that can block the fat cell's compensation, we should be able to do better, but it's not certain yet. Leptin injections have recently been strted in the first humans, but the results are not yet known.The genetic component in obesity is stronger than in almost any other disease studied. What you inherit is the ability to gain weight. Your environment, how much food is available and how much exercise you do determines whether or not you will gain. Conditions in our society now favor weight gain in almost everyone. It's been estimated that everyone in the USA will be obese by the year 2230 if we don't do something. Since genes can't change that rapidly, evironment must also play a significant role.
MsgId: *breakthru_medicine(24)
Date: Wed Oct 2 21:45:36 EDT 1996
From: moderator At: 206.80.176.55
If obesity is considered a medical condition, then a statistic like that might sound like an epidemic. Is this something everyone should begin assessing in terms of their own health?
MsgId: *breakthru_medicine(25)
Date: Wed Oct 2 21:48:48 EDT 1996
From: Aronne At: 152.163.233.17
I believe so. If it were any other disease, it would be considered an epidemic. The rates of obesity in children are even greater than they are in adults, and 1/3 of the adult population is at some medical risk from their obesity -- this means they have a higher risk of developing diabetes, hypertension, and high cholesterol than someone at normal body weight.
MsgId: *breakthru_medicine(26)
Date: Wed Oct 2 21:51:23 EDT 1996
From: moderator At: 206.80.176.55
So how do we explain our society's obsession with good health, fitness and a trim appearance, and the relative calm with which people approach weight gain that affects their health? I mean it in the context of looking for a cure or effective treatment for hypertension or diabetes, and the need to prevent their onset, and the need to prevent the onset of obesity.
MsgId: *breakthru_medicine(28)
Date: Wed Oct 2 21:57:20 EDT 1996
From: Aronne At: 152.163.233.33
The wrong people seem to be trying to lose weight. What I mean is that models are emaciated at the same time that the average american woman is heavier than ever. I think that many people are demoralized and give up trying . They give into the pervasive food messages that surround us. The food industry in the USA makes far more food than we need to survive -- how do they increase profits every year? They sell more food to us. The bottom line -- although people may be obsessed with looking trim, the average person in this country is not doing enough to maintain their body weight.
MsgId: *breakthru_medicine(30)
Date: Wed Oct 2 22:06:24 EDT 1996
From: moderator At: 206.80.176.55
Thank you, Dr. Aronne, for joining me on Breakthrough Medicine. Good night.
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