Treating Weight First?

The Twitterverse has been busy talking about some new treatment guidelines for fatties. Ragen Chastain posted about a piece from Medscape called “New US Obesity Guidelines: Treat the Weight First,” which also has quotes from the lead author.  I also clicked over to the guidelines themselves. They start with an extremely helpful objective, to wit:

Objective: To formulate clinical practice guidelines for pharmacological management of obesity.

That’s the goal here. That tells you what this is primarily about: weight-loss drugs.  Two more were approved in 2014, at least in the US – Europe has been slower to approve the drugs.

There are a few things in the guidelines that I like.

First: Some medications have weight gain as a side effect.  I consider this is a useful fact for medical practitioners.  It makes no sense to prescribe a drug that has weight gain as a side affect and then chastise patients for the resulting weight gain.

Second: Yes, it makes sense for medical practitioners to be aware that medications can cause weight gain or loss, and to discuss that with patients. A fat patient may prefer a drug that doesn’t cause weight gain. A slender patient may want to avoid drugs that cause weight loss.

Third: They’re measuring that a weight loss drug is “effective” if the patient loses 5% or more of their body weight in 3 months.  If that seems low? Yes, yes it is. Worth anal leakage? I think not.

Fourth:

Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.

This is an important admission. The human body doesn’t like to have its weight set point messed with.

The things I disagree with?  It’s hard to limit myself to just a few, but:

  • I disagree that patients need to be moved from drugs that control chronic health conditions just because the drug may cause weight gain. What are the side effects of the new drug? Is it as effective?  Does the patient have support during the transition?  That matters too — especially with psychiatric meds.
  • I disagree that patients should postpone treating conditions like hypertension until they lose weight. If the patient wants to try lifestyle changes first, fine — but it should NOT be under duress. The medical profession is already known to mistreat fat people. This can become another justification.

On the flip side, I was prescribed a drug that can cause weight loss (Levothyroxine) this fall. The endocrinologist was thrilled that I lost 3lbs after a few weeks of taking the drug.  I don’t care about that.  I care about FEELING BETTER.  Obviously I’m un-American.

Guidelines: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline,

Medscape: New US Obesity Guidelines: Treat the Weight First

Medpage Today: New Guidelines: Treat the Weight First

6 thoughts on “Treating Weight First?

  1. Pingback: No, Really, Treat the PROBLEM | Living ~400lbs

  2. Love your blog! Please note however that levothyroxine is almost always not enough for a person to feel euthyroid/symptom free. Blood tests may look “perfect” on the med, but almost everyone needs T3 added to their T4, or even T3 alone. I don’t agree with everything they say, but stopthethyroidmadness.com is a good place to start,

  3. Not to mention many weight loss drugs are SSRIs which if you are being treated for anxiety (or depression) and take an SSRI, you could end up with serotonin syndrome which can be fatal.

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