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Diet Drugs Work: Why Won't Doctors Prescribe Them?

timothy posted about 10 months ago | from the perhaps-they-feel-it-isn't-cricket dept.

Medicine 670

Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"

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mechanisms that are not yet fully understood (1, Interesting)

Idimmu Xul (204345) | about 10 months ago | (#45625967)

Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood

shucks, ive no idea, either that or because someone is paying someone else more for something else

No, they don't work (5, Insightful)

Anonymous Coward | about 10 months ago | (#45625987)

Your diet is a perpetual thing, not something you do for a little while to lose weight. Eat healthy, be healthy. Drugs and short term adjustments in what you eat aren't going to do shit.

Re:No, they don't work (3, Interesting)

Cordus Mortain (3004429) | about 10 months ago | (#45626003)

For the long term, I would agree. But some people need to get rid of the weight fast, for example if they are to have elective surgery in the near future. Drugs like these (assuming they work) help get the weight down which would then make surgery safer. Long term though the patient needs to increase their exercise and watch what they eat. Plain and simple.

Re:No, they don't work (1, Insightful)

Anonymous Coward | about 10 months ago | (#45626137)

If it's elective surgery, then they can wait and lose the weight normally.

Re:No, they don't work (1)

Anonymous Coward | about 10 months ago | (#45626159)

We can pay people to follow them around with a tuba and play it each time they walk!

Re:No, they don't work (-1, Flamebait)

clickclickdrone (964164) | about 10 months ago | (#45626013)

This. There is absolutely no point taking medication (FFS) to control your bad habits. As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more. The only caveat being there is some some recent evidence that some people do genuinely have more trouble with this than others but it doesn't make the advice any different. Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.

Re:No, they don't work (5, Insightful)

Anonymous Coward | about 10 months ago | (#45626067)

This. There is absolutely no point taking medication (FFS) to control your bad habits. As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more. The only caveat being there is some some recent evidence that some people do genuinely have more trouble with this than others but it doesn't make the advice any different. Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.

For many people, this is the solution. However, with a bit of hyperbole, your same advice would be true with drug addicts, but not work. You going to tell a heroine addict that they should just quit? Now, for eating too much, it's not nearly so bad, but there are some edge cases where I'm not sure that it's so clear cut. Sometimes the holes that we dig for ourselves are too deep to get out of.

A fine example of the problem (5, Insightful)

Anonymous Coward | about 10 months ago | (#45626075)

The previous post is a fine example of the problem: treating obesity as a moral failing. If you were a "good person" you'd have the willpower, eat right, etc.

Sure, modern lifestyles and diets are a contributor to the problem, but not the entire cause. There is ample peer-reviewed validated research out there that shows that some people are more efficient at metabolizing food, and that you can exercise as much as you like and eat as little, and still not lose weight as much (and suffer a variety of undesirable side effects in the process).

Bear in mind also that the underlying biochemistry of the "average adult" has changed as the result of food and activities during childhood. A travesty to be sure (juvenile onset diabetes, for instance), but now that you have that 20 year old with the screwed up biochemistry (in terms of comparison to 1900s man), you're not going to fix it by changing diet and activity.

And then, there's the practicality problem. If your job, which pays for the food you eat, requires you to sit in a cube with a headset on and a keyboard, no amount of Outside magazine inspired "get out and get fit" exhortation is going to provide an opportunity to "live a healthy lifestyle". Companies talk the talk, but when it comes to adversely affecting productivity, they do not walk the walk: that's why company wellness programs emphasize things like smoking cessation.. it's something you can do on your own time that saves the company money (yes, it's a good thing, but the real point is that the employee is doing the heavy lifting).

And so, after sitting in the cube all day, or inspecting people at a checkpoint, or whatever task there is, you ride the bus to your second job, so you can make the rent on your apartment in the food desert. Not a whole lot of time to prepare that nutritious meal from non-existent ingredients.

So, before exhorting "good healthy ways to eat", let's talk about paying people enough so they can afford to do so (in terms of time available, etc.)

Re:No, they don't work (5, Insightful)

DarkOx (621550) | about 10 months ago | (#45626115)

Diet and exercise is fine advice for someone like me, who the doctor has suggested could stand to lose 15 pounds. I can accomplish that without drugs, and by doing it now, I'll likely improve my eating habits and not find myself needing to take off even larger amounts of weight later. But my eating habits are already pretty good compared to many, and I get lots of exercise ( I love walking and do walk anywhere I can get on foot safely ). I just need to arrest my sweet tooth a little.

Once people become obese though getting enough exercise to burn any serious calories can be very difficult. They can't walk to the store to do their shopping or spend 20min on the elliptical at home because they'd be exhausted after five. Yet they have all these fat cells their body now thinks it needs to maintain screaming eat constantly. Not impossible to conquer with will power alone perhaps but probably really freaking hard; at to the fact that because they can't get exercise easily their metabolism is probably lower than it should be and they can't burn the extra calories by working out so its going to take a seriously long time before they see any improvement. There is nothing more psychologically challenging then lots of hard work, and discomfort without any short term payoffs.

Yea I agree they did it to themselves and when it comes to who should have to pay more for a plane ticket, medical insurance, and similar where obesity decidedly raises costs, yea I think they should be expected to pay. They should have recognized a problem early and done something about it when it was possible, if they became obese as children their parents should have intervened.

But they are where they are now and if a drug can help them better themselves, why would you want to deny them? Once they get healthy they are going to need to learn good habits to stay healthy but that will be much easier for them if they could get healthy first.

Re:No, they don't work (0)

Anonymous Coward | about 10 months ago | (#45626153)

The more fat they have the less they need to eat. You don't lose weight by exercising it off, you lose it buy not gaining more and then letting your body convert the fat back into energy.

Re:No, they don't work (4, Insightful)

DarkOx (621550) | about 10 months ago | (#45626215)

You can't exercise it off because exercise itself does not burn many calories at least not in proportion to what you can easily consume in a sitting. What it does do though is raise your metabolism. it causes your body to basically use more fuel all the time, so that its ready to support those more frequently occurring higher activity levels. So being physically active for a least a little while every day really is very important for most people to maintain a healthy weight.

Re:No, they don't work (1)

Anonymous Coward | about 10 months ago | (#45626261)

They don't need to exercise if they are as large as you suggest - where exercise is impossible. All they have to do is _nothing_. Stop eating.

Sometimes the argument "you don't know how hard it is!" is given about the difficulty they have abstaining from food. That if only us healthy people had an inkling of the monumental effort they have to put forth - we would understand. Well...running marathons is easy, mountain climbing is easy, lifting weights is easy - or MAYBE their excuse smells like their entire attitude that got them into that state: apathetic and lazy.

Re:No, they don't work (1)

m00sh (2538182) | about 10 months ago | (#45626489)

Once people become obese though getting enough exercise to burn any serious calories can be very difficult. They can't walk to the store to do their shopping or spend 20min on the elliptical at home because they'd be exhausted after five. Yet they have all these fat cells their body now thinks it needs to maintain screaming eat constantly.

This is something that I've found very strange.

Why do people come up with strange beliefs? Fat cells screaming to eat! Maybe a good analogy but is it really true?

If someone challenges them, then they hit Google and find some article and reaffirm their beliefs.

My weight touched that obese BMI of 30 but managed to get my BMI down to the low 20s by losing over 50lbs. In my case, I find that my weight problem was due to some very strange beliefs I had been keeping and so questioning these beliefs and experimenting out of them was what worked. Everyone has different reasons for the weight problem but for me that was the problem.

When I wanted to lose weight, I would cut out fat and meat and go vegetarian. I would eat lots of rice, cereal and bread instead.I would buy lots of fruits and eat glasses after glasses of apple and banana smoothies all day. Add to that, I would try to exercise and make it a point to use the elliptical machine for 30 minutes every day. I would lose weight but it would come back if there was a deadline or some stressful event.

My point is that maybe we should be experimental and not dogmatic when it comes to weight loss. Try different things and keep experimenting until you find something that puts in normal weight that you are able to maintain. Question beliefs because there might be that one belief that you use everyday to make food choices that over months and years is causing your weight problems.

Re:No, they don't work (5, Insightful)

Assmasher (456699) | about 10 months ago | (#45626173)

It's not difficult. Eat less, move more.

Perhaps you meant to say "It's not complicated." It is quite obviously difficult for many people.

Re:No, they don't work (4, Insightful)

ShanghaiBill (739463) | about 10 months ago | (#45626347)

There is absolutely no point taking medication (FFS) to control your bad habits.

You are wrong. Nicotine patches have helped millions of people quit smoking. These diet pills have also been shown, in controlled studies, to help many people achieve long term weight loss. Yes, people need to change their habits. But what you are missing, is that the drugs can help them do that. By achieving some weight loss, it can start them on the cycle of positive reinforcement.

Re:No, they don't work (1)

Rob Simpson (533360) | about 10 months ago | (#45626415)

Even if you keep taking them, you'll often regain the weight. Best case scenario for appetite suppressants is you lose 10 pounds and have a 10% higher risk of a heart attack.

Orlistat can be helpful - it blocks fat absorption, so you'll get nasty diarrhea if you don't change your eating habits.

Re:No, they don't work (1)

Anonymous Coward | about 10 months ago | (#45626077)

It's not an either-or condition. Using a short run Rx to help get the weight down (say 3 - 6 months), along with a better diet and exercise, can do a lot more than any of the three individually.

Keep in mind that a psychological component exists in this that has a significant impact. The perception of progress, momentum, or whatever you want to call it - let's call it "success" - plays a major role in the continued participation of the subject when trying to lose weight, as well as keeping it off.

Re:No, they don't work (1)

phrostie (121428) | about 10 months ago | (#45626361)

not only does it send the message that you don't need to exercise, many of these drugs have disclaimers(i've looked) that state that you should not use if you have high blood pressure. guess what, if you are over weight and don't exercise, there there is a good chance you have high blood pressure too.

Fasting (0)

smitty_one_each (243267) | about 10 months ago | (#45626001)

I'm totally waiting for some breakthrough study that shows giving the plumbing a day off now & then is beneficial. But I guess that might hurt profits somewhere. Oh well, so much for scientific inquiry.

Re:Fasting (0)

Desler (1608317) | about 10 months ago | (#45626019)

Starving your body tells it to burn muscle, thus increasing your body fat percentage. It's why people who do crash diets have higher body fat percentages when they are done than before they started it because there body burned off lots of their lean body mass.

Re:Fasting (0)

smitty_one_each (243267) | about 10 months ago | (#45626103)

Sure. That's what they WANT you to think.

Re:Fasting (0)

Anonymous Coward | about 10 months ago | (#45626269)

Feel free to skip a day or two of eating every week and let us know how that works out for you. Why wait for a study to confirm what you already think you know?

Re:Fasting (5, Informative)

Anonymous Coward | about 10 months ago | (#45626145)

i am sorry this is not biochemistry this is made up "science". When ketosis is entered (by depleting ready carbohydrate resources) the body can metabolise fat into ketones (via the liver). The reason this myth persists is because for decades medical researchers couldn't imagine the brain running without glucose, which is a necessary condition of ketosis. Then some bright spark pointed out that the Innuit have been living like that for millenia and (shock horror), it works on western folks too!

Diet and exercise works every time. Guaranteed. There are no exceptions. If you are not exercising , a good chance you will lose some "lean mass". Loss of muscle through maintenance also occurs, so these statements are no helpful.

*however* biology is all about homoeostasis. When you look at your paunch and flabby bits, ask yourself the question "why does biology hang on to them". The body stores excess sugars as fat, as sugars in the blood are toxic. The hormone insulin causes this sequestration of the sugars into fat cells. If you go on a crash diet , the body is happy to burn up the fat. But the cells are still there. Returning to previous over-caloried state just fills the cells up again. Only by a gradual change onto a *lower* calorie diet will you lose the weight "permanently". Think 6 months minimum. Believe it or not 2lbs/week is a pretty good rule of thumb as the body gradually reallocates the cells. If you want to get "cut" that requires some more extreme measures...;-)

Recent research is showing that being overweight and diabetes are connected, although the data stretches back decades. The biggest FUD of the 20th century is the daily calorie limits. If they ever applied it was to a population that was more active, but modern folks spend way too much time on computers(!).

Biology is very complicated but the rules are simple. Everything in moderation....;-)

"fully understood" (0)

Anonymous Coward | about 10 months ago | (#45626007)

Nothing in medicine is no where near "fully understood."

Re:"fully understood" (0)

Anonymous Coward | about 10 months ago | (#45626091)

Nothing in medicine is no where near "fully understood."

"Understanding" and "Prescribing" are completely different fields and profit centers.

Re:"fully understood" (1)

Lumpy (12016) | about 10 months ago | (#45626235)

Wrong.

In medicine it is fully understood that you can pretty much bleed any patient's wallet dry.

Obesity is curable (1)

DogDude (805747) | about 10 months ago | (#45626017)

Maybe doctors are not prescribing drugs for obesity because it's 100% curable without any kind of drug...?

Re:Obesity is curable (2)

felrom (2923513) | about 10 months ago | (#45626069)

Imagine the money to be made between society's push to make being fat "normal," and the medical community's push to make obesity a "disease." Now they could cash in on treating an ever-increasing number of normal diseased people who are fat, but it's okay, that's normal, but it's a disease too, so go see the doctor!

If obesity was really a "chronic but treatable disease," where has it been the last 200,000 years? Why has it only existed on a large scale for the last 20 - 30 years? Changes in physiology don't move that fast, but changes in culture, attitude, economics, etc certainly do.

Re:Obesity is curable (1)

penix1 (722987) | about 10 months ago | (#45626479)

If obesity was really a "chronic but treatable disease," where has it been the last 200,000 years? Why has it only existed on a large scale for the last 20 - 30 years? Changes in physiology don't move that fast, but changes in culture, attitude, economics, etc certainly do.

Most of the reason things in culture get classified as a disease is so insurance will pay for the treatment. That aside, the biggest changes in the last 50 years has been the advent of chemistry in food production. Processed food has more chemicals added for flavor, color and shelf life than ever before. The further you get away from natural the more unhealthy it is for you. The problem is those same processed foods also happen to be the cheapest.

before anybody pops pills (5, Insightful)

stenvar (2789879) | about 10 months ago | (#45626029)

Ask yourself the following:

(1) Are you cooking most of what you eat yourself?

(2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?

(3) Have you been tracking your calories and weight daily for the past month?

If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.

Re:before anybody pops pills (1)

Anonymous Coward | about 10 months ago | (#45626089)

If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.

Nonsense! If you're terminall ill from cancer, have intestinal parasites, or shattered jaws wired shut, you're going to lose weight. If those are effective, a pill is a far more pleasant alternative.

Re:before anybody pops pills (-1)

Anonymous Coward | about 10 months ago | (#45626213)

If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.

Nonsense! If you're terminall ill from cancer, have intestinal parasites, or shattered jaws wired shut, you're going to lose weight. If those are effective, a pill is a far more pleasant alternative.

Hehehe fat rage is so cute.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626097)

It's really only 3) that is relevant for weightloss. The rest is just to support 3).

Re:before anybody pops pills (4, Interesting)

trout007 (975317) | about 10 months ago | (#45626131)

I lost 40 pounds by drastically increasing my saturated fat intake while reducing my refined carb intake.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626237)

Glad it worked for you but it sounds like you just didn't read up enough on nutrition and dieting; you'd have been better off eating more unsaturated fats.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626299)

So says Dr AC. What website did you get your imaginary doctorate from?

Re:before anybody pops pills (3, Interesting)

trout007 (975317) | about 10 months ago | (#45626307)

I should have clarified. I try to only eats fats that are made through old processes. So meat, dairy, lard, fish and cold pressed plant vegetables like olive, nut, and Avacado oils. Most are high in saturated fat. But unsaturated fats are mostly the byproduct of industrial processes requied heat and solvents. No thanks.

Re:before anybody pops pills (4, Informative)

stenvar (2789879) | about 10 months ago | (#45626367)

So meat, dairy, lard, fish and cold pressed plant vegetables like olive, nut, and Avacado oils.

Cold pressed vegetable oils, avocados, and fish oils are (with a few exceptions) predominantly unsaturated fats. So it sounds like you mostly got the good kind of fat, you simply didn't realize what you were doing.

But unsaturated fats are mostly the byproduct of industrial processes requied heat and solvents. No thanks.

You're confusing unsaturated fats and partially hydrogenated vegetable oils; partially hydrogenated vegetable oils are really bad for you.

Re:before anybody pops pills (3, Insightful)

LordLucless (582312) | about 10 months ago | (#45626139)

Uh-huh. And if you haven't tried living off bananas [wikipedia.org] , limited fasting [wikipedia.org] , acai berries [wikipedia.org] , or whatever the next fad diet to come along is, you haven't seriously tried losing weight either.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626211)

What I listed is common to pretty much all successful (non-fad) diets. You have to be an utter moron to confuse such sensible minimal steps with a "fad diet".

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626289)

So all those asians eating rice are doing it wrong. Gotcha.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626423)

Did I say anywhere that all starches are bad for everybody? If you are trying to lose weight, then cutting starches is the obvious place to start. If you haven't even tried that, you aren't really trying at all.

Re: before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626303)

You forgot gluten free diets.

Re:before anybody pops pills (3, Interesting)

Jah-Wren Ryel (80510) | about 10 months ago | (#45626439)

or whatever the next fad diet to come along is

It is funny how for every fad diet there are tons of people who say it worked for them. That seems to be proof right there that whatever it is that works must be common to all of the diets. My guess is that simply being on a diet makes people more aware of what they are eating and that consciously or unconsciously causes them to eat less. Some people probably find it easier to do that with a specific type of diet, but the underlying mechanism is still the same.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626149)

So what do you eat for breakfast if not bread or some sort of starch?
And also all starch, meat and fat from your diet?
The only thing left is vegetables. Have fun dying from malnutrition.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626179)

Ignorance like yours is why we have an obesity epidemic.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626255)

Ignorance like yours is why we have an obesity epidemic.

Arrogance like yours is why being overweight is treated as a moral failure rather than a medical condition.

I bet your advice to people who suffer from depression is "Cheer up! If you can't be happy then you don't deserve to be happy!"

Asshat

Re:before anybody pops pills (2, Insightful)

DogDude (805747) | about 10 months ago | (#45626177)

#2 is mostly bullshit. It doesn't matter what you eat, in terms of obesity. It's simple calories in, calories out. I eat tons of bread and starchy foods, and can maintain my weight just fine if my calories in are what they're supposed to be.

Re:before anybody pops pills (2)

punker (320575) | about 10 months ago | (#45626267)

Calories in, calories out is true, but the form of the calories is also significant. We are not simple systems. The starch issue is about glycemic response. Essentially, when your body digests starches, it produces insulin. More sugars, more insulin. When the insulin falls off, your body tells you that you're hungry again. It's sort of like a boom/bust cycle, and the result is an urge to overeat because of the hormone response. It's significantly more difficult to maintain proper portions when you're hungry.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626287)

Yeah pretty much. I eat TONS of bread and cereal and carb heavy foods, and I am not even remotely fat. Then again, I do an hour of cardio 4 times a week, and lift 3 times a week.

Re:before anybody pops pills (1)

weilawei (897823) | about 10 months ago | (#45626345)

Yep, if you're any sort of endurance athlete, you're probably familiar with loading up on carbs before an event.

Re:before anybody pops pills (1)

stenvar (2789879) | about 10 months ago | (#45626309)

You're absolutely right: it's balancing calories in/out. Since you're not obese, your appetite control is working and your experience isn't relevant. People who actually are obese and trying to lose weight have a problem stopping to eat when they have already consumed enough calories. That is strongly influenced by the kinds of foods they eat. It happens frequently with starchy foods, foods containing lots of saturated fats, and meats, so any serious dieter should start by cutting those and see whether it helps.

Tons of food (3, Interesting)

Runaway1956 (1322357) | about 10 months ago | (#45626427)

You can eat tons of stuff that isn't so good for you, right? Cool. And, how old are you?

I was underweight for much of my life. Around age 25 or so, I FINALLY "bulked up" to 160 pounds. I stayed near that weight right up to about age 47.

Age has some nasty surprises for some of us. One day I looked down, and realized that I had a pot belly. Wow, man! That ain't me!

At the same time, my knees started giving out on me. I don't run any more, can't run. Oh - to be honest, I CAN run, but a quarter mile jog is going to leave me suffering for a week or more.

So, I got a pot belly, I'm far less active, and that pot belly now tips the scales at ~195, has actually reached 200 a couple of times.

At six foot tall, 200 pounds isn't "obese" - but it's unhealthy. For me, at least, YMMV depending on your body build.

When you're over 50, getting close to 60 years old, let us know how easy it is to lose those unwanted pounds. If taking a pill could reduce the number of fat cells for me, I would seriously consider getting some.

However, I do understand the equations very well. Those pills aren't going to do anything good that is permanent. About the only way to remove fat permanently, without serious exercise and diet, is surgery.

I'm NOT willing to go that route.

Re:before anybody pops pills (1)

Lumpy (12016) | about 10 months ago | (#45626227)

Exactly.

Step1 - Stop going to ANY restaurant or delivered food. All of it is utter crap, stop eating it.
Step2 - Buy only foods that are from the fresh food section and meat section. Veggies+Meat and only dark brown breads with whole wheat/grains
Step3 - download and install myfitness pal and do it religiously.
Step4 - repeat.

The biggest is to abandon restaurants completely. Every place from McDonalds to a 5 star bistro only make low grade dog food. Stop eating that crap. This step alone will make a HUGE difference.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626243)

This is exactly the one I will never do. It is the least natural and most invasive in my life.
I prefer the idea of cooking for myself, basic portion control, basic control of starchy foods, etc.
I can't imagine ever getting comfortable counting calories every day. Sorry, not going to happen. I have better things to do with my life.

Re:before anybody pops pills (1)

kick6 (1081615) | about 10 months ago | (#45626249)

Ask yourself the following:

(1) Are you cooking most of what you eat yourself?

(2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?

(3) Have you been tracking your calories and weight daily for the past month?

If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.

And this is why we have such a problem as a culture losing weight. Cut most meat from your diet? Are you fucking kidding me!?

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626259)

"Popping pills" + diet and exercise is more effective than diet and exercise alone. Why would you want people to undergo less effective treatments, other than that you wish to flaunt your moral superiority over people struggling to overcome a deep seated personal problem?

I can only imagine that your advise to someone with extreme social anxiety would be:
1) Spend more time alone
2) Cut out all stressful situations
3) Keep a dream journal for one month
Rather than "seek medical help, and if appropriate take the meds your doctor prescribes".

People need to take responsibility for their own health, but people like you trying to cast others seeking help as weak are part of the problem.

Re:before anybody pops pills (0)

Anonymous Coward | about 10 months ago | (#45626501)

"Popping pills" + diet and exercise is more effective than diet and exercise alone. Why would you want people to undergo less effective treatments, other than that you wish to flaunt your moral superiority over people struggling to overcome a deep seated personal problem?

Because while taking the pills you will even lose weight without changing your exercise. For the majority of patients the alternatives won't be "Popping pills" + diet and exercise vs diet and exercise alone but "Popping pills" and taking the weight loss as confirmation that diet and exercise don't need to be changed vs diet and exercise alone.

Re:before anybody pops pills (2)

Trailer Trash (60756) | about 10 months ago | (#45626357)

I eat all the meat I want and I never gain weight. It's the starches and sugars that cause problems - meat and fat doesn't make you gain weight if you're not eating a bunch of sugar and starch.

I lost weight the old fashioned way (0)

Anonymous Coward | about 10 months ago | (#45626041)

Diet, exercise, and self control. I rarely hear doctors prescribe that either.

I learned bad habits in my teens and twenties. It was hard to break the "all you can eat" mentality when I got to my forties.

It's hard work to maintain my weight. Lots of exercise, continuing to watch my diet, and endless self control to not eat everything in sight.

Re:I lost weight the old fashioned way (1)

weilawei (897823) | about 10 months ago | (#45626355)

It really is easier if you start that way as a kid, but parenting is open season.

Re:I lost weight the old fashioned way (1)

matria (157464) | about 10 months ago | (#45626369)

I never had a television, but I remember a Beverly Hillbillies episode I saw at my grandparent's house, something about "Doctor Granny", The granny ended up "office-sitting" for a doctor, and told one overweight woman to get some tennis shoes and walk, and another one who had trouble sleeping to get down and scrub her floors. Everyone was horrified, except the two women who found the advice to work.

kCal in kCal used = FAT (0)

Anonymous Coward | about 10 months ago | (#45626043)

Simple equation (uh, so I ain't no mathematics teknishun).

Thanks Dice? (0)

Anonymous Coward | about 10 months ago | (#45626045)

Slashdot: Tired of exercise and eating right? Well fellow sir with no discipline, we have your easy solution right here. Just give some dollars to your fellow pharmaceutical giant, and we'll give you a miracle cure.

Re:Thanks Dice? (1)

Lumpy (12016) | about 10 months ago | (#45626201)

They already have that, It's called gastric bypass and liposuction. you dont even have to wait to lose the weight.

Better Solution: Eat Shit (1)

retroworks (652802) | about 10 months ago | (#45626083)

Fat mice, when fed fecal matter from thin humans, lose weight. It seems much less expensive to me than pharmaceuticals, and there are no known side effects. http://www.nytimes.com/2013/09/06/health/gut-bacteria-from-thin-humans-can-slim-mice-down.html?_r=0 [nytimes.com]

Re:Better Solution: Eat Shit (1)

Erikderzweite (1146485) | about 10 months ago | (#45626169)

Eat shit? No, I'm not going to Britain no matter how obese I am.

Re:Better Solution: Eat Shit (0)

Anonymous Coward | about 10 months ago | (#45626219)

Fat mice, when fed fecal matter from thin humans, lose weight. It seems much less expensive to me than pharmaceuticals, and there are no known side effects.

No side effects? Puking your guts up after every meal because you're eating other people's shit would be classified as a side effect. And anyway, where are you going to find enough thin peoples' shit to feed all the fat people?

Re:Better Solution: Eat Shit /. link (1)

retroworks (652802) | about 10 months ago | (#45626321)

Actually, slashdot covered the mice gut bacteria transferred from small amounts of fecal material back in September. I wonder if it's too difficult to patent shit compared to drugs. http://science.slashdot.org/story/13/09/06/2130223/gut-bacteria-in-slim-people-extract-more-nutrients [slashdot.org]

Re:Better Solution: Eat Shit (1)

InsightfulPlusTwo (3416699) | about 10 months ago | (#45626437)

Ok, but can we at least bake the shit into some brownies first?

Dammit Fatso, ... (0)

Anonymous Coward | about 10 months ago | (#45626087)

... I'm a Doctor, not a psychiatrist!

One Thing Is Clear (1, Interesting)

Rambo Tribble (1273454) | about 10 months ago | (#45626109)

Many conditions that are treated with pills could as effectively be addressed with proper diet, nutrition and exercise. Curiously, doctors are rarely averse to prescribing medications for most of these; it is noteworthy that obesity is treated differently. On the other hand, maybe it's time the pills were left on the shelf and patients were required to take responsibility. Big pharma wouldn't like it, but a host of side effects would be avoided, billions of dollars would be saved, and "survival of the fittest" would actually mean something in the social context.

Re:One Thing Is Clear (0)

Anonymous Coward | about 10 months ago | (#45626419)

Many conditions that are treated with pills could as effectively be addressed with proper diet, nutrition and exercise. Curiously, doctors are rarely averse to prescribing medications for most of these; it is noteworthy that obesity is treated differently. On the other hand, maybe it's time the pills were left on the shelf and patients were required to take responsibility. Big pharma wouldn't like it, but a host of side effects would be avoided, billions of dollars would be saved, and "survival of the fittest" would actually mean something in the social context.

And now you know why Big Pharma and the doctors they employ are pretty much not doing a damn thing to prevent obesity.

Good health in a pill? Sure, why not? (5, Insightful)

PeterM from Berkeley (15510) | about 10 months ago | (#45626113)

Hello,

    I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.

    I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.

    And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.

    If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!

--PeterM

Re:Good health in a pill? Sure, why not? (1)

Anonymous Coward | about 10 months ago | (#45626193)

Weight loss in a pill is achievable.

GOOD HEALTH IN A PILL is not.

Re:Good health in a pill? Sure, why not? (0, Insightful)

Anonymous Coward | about 10 months ago | (#45626199)

People are fat because they have poor diets and lifestyles and because most modern food is crap designed to make you crave more. Giving them a pill to remove the symptoms of their poor health will only reenforce their bad behavior and makes things worse. It'd be a loss for everyone. The population will get worse. WEIGHT IS THE EFFECT NOT THE CAUSE. Treating the effects doesn't fix their underlying causes.

Re:Good health in a pill? Sure, why not? (0)

Anonymous Coward | about 10 months ago | (#45626499)

Actually treating the effect is often quite an effective way, especially when it makes it easier to treat the underlying causes (you can't exercise if you are fat, even if you can physically, you often can't due to social pressure, etc)

Specialists? (0)

Anonymous Coward | about 10 months ago | (#45626125)

"Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively"

Change "Specialists" to "Drug Company Sales Specialists" and it will probably be more accurate.

It's puritainism, plain and simple. (0)

Anonymous Coward | about 10 months ago | (#45626165)

There has been so much moralizing about weight--obesity is seen as a moral failure and weight loss is seen as a triumph over the sins of sloth and gluttony--that pills are inevitably seen as the cheater's way out. Old moralizing habits are hard to break; doctors can't go from haranguing people about their dietary practices to quietly slipping them a prescription overnight.

They are scared (4, Insightful)

Matt_Bennett (79107) | about 10 months ago | (#45626185)

I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen [wikipedia.org] debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.

Re:They are scared (5, Interesting)

meander (178059) | about 10 months ago | (#45626343)

Nah, as a doctor (in Australia, but i suspect most places are the same), we prescribe them only when a patient goes on & on, "but honestly, I dont eat much...", especially when the waiting room queue is getting longer.

We know they work, for a few months, before becoming less and less effective.

I'm guilty, I prescribe them to turn off a patients demands and get them out of my room, knowing they will see that the response is poor after the first few months.

Eat less, do more. That is reality, everything else is bullshit, or very temporary.

After 3 or 4 months, when the drugs stop working, some are ready to face reality. Those I can work with.

Re:They are scared (1)

Rob Simpson (533360) | about 10 months ago | (#45626509)

Why can't it be both?

Statistically significant weight loss in a hyped clincal trial, but little clinical significance if you read between the lines - which becomes blatantly obvious after the drug has been on the market for a few years. If it's an anorexiant, it'll probably be taken off the market eventually because of a small but significant risk of stroke/heart attack.

Re:They are scared (0)

Anonymous Coward | about 10 months ago | (#45626445)

I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen [wikipedia.org] debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.

I'm curious, do you simply ignore the guy talking very fast in every single ad on television or radio for any kind of medicine who's trying to cram the 217 known side effects in the last 17 seconds of the commercial?

Believe me, "they" are not scared of liability. They employ armies of lawyers to deal with it that ensure they stay rich while the class-action suit ends with 17 cents in the victims pocket.

Simple.... (1)

Lumpy (12016) | about 10 months ago | (#45626189)

Most doctors education is lacking, Once the leave med school I don't see them going back for more education. My family doctor of 45 years graduated med school and became a GP in 1955, he even delivered me when I was born, and I saw him regularly until he died this past year. I know his education in medicine was way out of date but he was smart enough to refer me to a different doctor or specialist when It was needed. GP's need to do the same and refer patients to specialists that have more recent education that know about the treatments.

I know my doctor was the exception, he did house calls and worked until he died. I know he charged people what they could pay and refused to abide by the "minimum pricing racket" that the insurance companies and feds require. He became a doctor to help people, not to become wealthy. And he helped people all the way to the moment he died.

And yes the last 2 decades I drove all the way back to that small town to visit him as my doctor. Because I wanted a doctor that cared about people, not his Porsche. (He drove a Chevy btw...)

Re:Simple.... (1)

Luckyo (1726890) | about 10 months ago | (#45626389)

Most doctors are educated on constant basis by various pharmaceutical companies. Basically company pays for a weekend trip to a nice spa, that includes lectures on their lines of drugs, and what they do.

This is pretty much international phenomenon, and it's often frowned upon as it's seen as a form of bribing. As a result it's often legislated just how much companies can offer doctors, and how long such "vacations" can last and so on.
But these are also viewed as pretty much mandatory to keep doctor's knowledge base up to date, so they are not completely banned.

Re:Simple.... (1)

meander (178059) | about 10 months ago | (#45626391)

In my primary physician cohort, now 30 years out, about a third are very active in keeping up to date, a third meet statuary requirements by doing assorted online courses, and I worry about the other third, who get by doing mickey mouse courses that get them over the line.

Pick who you see. Most, even the out of date, are fine for most conditions, but some are better for when the going gets tough.

"Wholistic Medicine" (1)

xate (784379) | about 10 months ago | (#45626221)

How about prescribing a non-american diet, and more physical activity.
The way that humans gain weight hasn't changed over time.
Our diets and activities have.

"It is no measure of health to be well adjusted to a profoundly sick society." ~ Jiddu Krishnamurti

Re:"Wholistic Medicine" (0)

Anonymous Coward | about 10 months ago | (#45626515)

Can I buy this diet ready made in the supermarket, if not, it's going to be a pain in the ass for many people who do not have the time to cook for an hour or more as most other culture's foods require.

Weight isn't the problem, it's a symptom (5, Interesting)

neilo_1701D (2765337) | about 10 months ago | (#45626223)

My wife is morbidly obese. She for years has tried to lose weight with various diets and drugs. These had temporary weight loss effects, but all ultimately failed.

Why? Was my wife of inferior moral fiber and simply unable to follow through? Is she simply someone who needs to eat from a smaller plate, sit further away from the table, exercise more, eat less sugar, eat less carbs, eat more carbs, follow some arcane points system?

Nope. None of that works.

I'm a software engineer. Failure is a daily occurrence, and when we fail and study the failure, we learn the underlying problems and then we have success; and I've constantly encouraged my wife to keep trying. And she has; for over 10 years.

Two years ago, she contacted a weight counsellor / psychologist in Florida. In that time, they have peeled back the layers of her life, looking for the real, underlying problems. And, they found them. Who knew, for example, that being sexually abused as a 4yo child for years would cause problems? Who would have thought that when the attacker (a family "friend" next door) said things like "you would look prettier if you lost a bit of weight", it causes problems like gaining weight to try and make the pain go away? Why on earth would a narcissistic mother cause problems - especially when a 4yo comes to her bleeding from the vagina and covered in semen, and the mother simply wipes it away and says it never happened?

My wife's weight is far from something to be ashamed of. Instead, it's the mark of a person who came through some of the most horrendous things you can imagine - and lived.

The reason all the diets and drugs failed? Denial of the past and the problems in it. Simply becoming an adult doesn't mean the past will not affect you.

The future? Looking good. Since breaking through and working through all of her past, the underlying need to eat compulsively has gone. Guess what? She's loosing weight without a restrictive diet, drugs, surgery - whatever.

Obesity isn't a "disease" or anything like that. It's the symptom of something else. Medical dollars are best spent for people who are ready to lose the weight AND deal with their pasts by supplying them with competent psychologists, not the latest diet pills.

Re:Weight isn't the problem, it's a symptom (-1)

Anonymous Coward | about 10 months ago | (#45626477)

This is just an excuse. There are plenty of rape victims who do not share your wife's gluttony.
Does that mean she is worse person than them? Yes. Yes it does.

Why turn to drugs? (0)

Anonymous Coward | about 10 months ago | (#45626229)

When you can just eat less.

food industry (0)

Anonymous Coward | about 10 months ago | (#45626233)

the food industry does not want people to suppress appetite. they're trying to have people eat more, not less

pills work, but only short term (5, Interesting)

meander (178059) | about 10 months ago | (#45626241)

As a primary care physician, I gave in years ago. I now prescribe assorted appetite suppressants whenever some one asks me, it saves me lots of arguments, and a lot of time.

However, I get them back monthly for weigh ins. The drugs work great for a couple months, losing 4~8kg a month, then tapering off to nothing. Folk then realise that this is not a wonder cure.

The only stuff that works long term is eating less +/- exercising more, or surgery to shrink your stomach (actually the latter works pretty well, better than pills long term, in my experience. little change out of $10K, but probably worth it)

Pills are short term appetite suppressants. The following year, you are back to your previous weight, but your wallet is much lighter. Look to advice that you already know about for long term losses.

A sign of the times (0)

Anonymous Coward | about 10 months ago | (#45626293)

Yep, its not your fault and "medication" is the answer.

What about lawsuits from things like fen-phen (http://en.wikipedia.org/wiki/Fenfluramine/phentermine).

Try eating less?

Everyone wants the "quick solution" and if one isn't available something else to blame other then their own bad habits.

I've known a few overweight people and most of their family was also overweight. After going to their house for dinner a few times I saw a possible cause but instead you will hear about "genetics" or some such.

Perhaps physicians are just sick of the BS (0)

russotto (537200) | about 10 months ago | (#45626395)

They have patients coming in day in and day out who swear they eat like a bird and they exercise regularly and are still gaining weight. Perhaps 1 in 1000 of these patients have some medical condition; the rest will likely have been eating candy bars in the waiting room, or will constantly snack on "energy bars", or whatever. And they hold bizarre ideas of what sorts of foods "don't count" (like celery... with dip).

Giving them drugs is just a waste of time, effort, and drugs. And if they don't work or have side effects, lawsuit time.

Re:Perhaps physicians are just sick of the BS (1)

meander (178059) | about 10 months ago | (#45626481)

Never been sued, and unlikely to happen. I tell them these drugs will work, for awhile only. I describe the side effects. If they get them, well stop taking them for christ's sake!. A couple days later the drugs are out of their system.

I understand that reality and my patients do as well. Its folk who cant lose weight, and find psychopathic lawyers who will blame someone else, for a big fee, that screw with the system. That gets into the news, but it is really very rare. I don't have any colleagues who have been sued over this, in 30 years.

It's not a disease of "poverty" (-1, Troll)

Trailer Trash (60756) | about 10 months ago | (#45626405)

But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty.

Poverty is the inability to meet basic needs - water, food, clothing and shelter. People in true poverty are underweight and often die from malnutrition.

In the US, the lower classes (who are "poor") have a big problem with obesity. This is typically due to eating too much starch and junk food. The problem isn't caused by being poor, but rather is correlated with the same bad financial habits - specifically the inability to delay gratification - that's makes them poor in the first place. This doesn't describe *everybody* who is poor in America, but it seems to be a majority. Listen to Dave Ramsey for an hour and you'll hear people who are poor and yet make $100,000/year. Actually, just read a story yesterday about a guy who won $27,000,000 in powerball and died penniless a few years later.

Hardly surprising (1)

jonwil (467024) | about 10 months ago | (#45626517)

I suspect many doctors are reluctant to proscribe diet pills because then people will think "if I take these pills, I can keep eating all the junk I want/not exercising and yet still loose weight" which is not true.

Lazy, or find exercise friggin boring? (1)

empty_other (1116615) | about 10 months ago | (#45626533)

If someone could tell me exactly what and how much to eat and how much and how hard to exercise. But dieting is all a lot of guesswork and maybes, and each and every person is an unique snowflake now'a'times that this can evidently not be solved by science.. Seriously; exercising is boring and so is food, and i would like to do them both as little as necessary.

Another thing, no one has ever straight out told me to go hungry to lose weight. The closest was the diplomatic answer (after i directly asked) that i should "redefine what hungry is"... ?!? What? Is dieting some kind of zen thing? Stupid. I would rather have the pills than deal with all this confusion and guesswork.

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