Weight Loss Products: Weighing in on the Evidence

1
Weight Loss Products Weighing in on the Evidence

• Loren Regier BSP, BA
• RxFiles Academic Detailing Program
• www.RxFiles.ca
• November 2007

2
Kcal Interesting numbers

• Coke 591ml 240 Kcal
• Mars Bar 294 Kcal
• Slurpee 1.18l 570 Kcal
• Big Gulp double 800 Kcal
• Milkshake, lg 1,160 Kcal
• Walk for 60 minutes gt300 Kcal
• Run for 60 minutes gt800 Kcal

3
Predictors of increased CV risk related to
obesity?

• Waist Circumference
• ? lt94cm ideal gt102cm high risk
• ? lt80cm ideal gt88cm high risk
• Waist/Hip Ratio ? gt0.95 ? gt0.85.
• BMI gt25overweight, gt30obese.

4
Weight Loss Management

• Assess medications for possible drug-related
  weight gain
• Antidepressants
• Weight neutral/loss bupropion, SSRIs,
  moclobemide,
• 
  venlafaxine
• Weight gain mirtazapine, amitriptyline gt
• desipramine,
  nortriptyline
• Antipsychotics
• Weight gain clozapine gt olanzapine gt quetiapine
  gt risperidone gt haloperidol
• Diabetes medications
• Weight gain insulin gt SU gt glitazones gt acarbose
• Weight neutral/loss metformin

5

• Diabetic Medications
• Weight Considerations

6
Weight Loss Management

• Assess medications for possible drug-induced
  weight gain
• Anticonvulsants
• Weight gain valproic acidgtlithium,
  pregabalingtgabapentin, carbamazepine
• Weight neutral/loss topiramate, lamotrigine
• Others
• Corticosteroids, flunarizine, medroxyprogesterone,
  raloxifenegttamoxifene, smoking cessation

7
Weight Loss Drugs

• Approved for Weight Loss
• Sibutramine (Meridia)
• Orlistat (Xenical)
• Off-Label Use
• Fluoxetine (Prozac)
• Bupropion (Wellbutrin)
• Topiramate (Topamax)
• Not wonder drugs

8
Weight Loss Drugs

• Do Weight Loss Drugs Work?
• Statistically significant, but modest weight loss
  (lt5kg at 1 year).
• Sibutramine -4.5kg (95 CI -5.29 to -3.62kg)
• Orlistat -2.8kg (95 CI -3.31 to -2.20kg)
• Most trials included lifestyle modifications as a
  co-intervention.

9
Weight Loss Drugs

• Sibutramine orlistat have been shown to reduce
  maintain weight loss with continued therapy.
• Weight regain is common upon discontinuation of
  therapy.
• Long term health benefits/safety/efficacy
  uncertain

10
Weight Loss Drugs

• Weight Loss Weight Regain?

11
Weight Loss Drugs

• Do Weight Loss Drugs Work?

12
Are Weight Loss Drugs Safe?

• Sibutramine (Meridia)
• ? blood pressure by 1-3 mmHg heart rate by 4-5
  beats/min
• but is blood pressure offset by weight loss?
• Health Canada AR newsletter case reports
• Other
• Contraindications, drug interactions

13
Are Weight Loss Drugs Safe?

• Orlistat (Xenical)
• Minimally absorbed (lt5)
• Tolerability ? GI adverse events
• ? absorption of fat soluble vitamins
• Recommend multivitamin with fat soluble vitamins
• Other
• OTC (USA)
• Alli 60mg po tid
• FDA approved OTC use (Feb 07)

14
Weight Loss Drugs

• Cost
• Sibutramine (Meridia)
• 10mg po od 1 month 120
• 15mg po od 1 month 140
• Orlistat (Xenical)
• 120mg po tid 1 month 155
• Cost 500-600 / lb lost at 2 years

15
Weight Loss Herbal Products

• 5 Ps Overview
• Popular
• Pricey
• Poly-herbal-pharmacy
• Paucity of good evidence
• Possibilities for success or failure

16
Caffeine

• Often hidden from labelling
• Guarana, yerba mate, kola
• Dosage/day range 40-1,200mg
• Recommended max 450mg/day
• Evidence
• When combined with ephedra, limited evidence for
  weight loss effect otherwise evidence lacking
• Adverse Effects (AE)s
• HA, anxiety, ringing, insomnia,
• ? HR BP
• Watch out for amount and AEs

17
Some Common Products/Programs
See RxFiles Chart Weight Loss Herbal Natural
Products
18
Natural products with not-so-natural sibutramine

• There have been several warnings regarding
  products containing unlabled sibutramine
• Chao Nongsu Qingzhi Jiaonang Slim Hong Kong ,
  Detox Peptide, Fat Rapid Loss (Xin Yan Zi Pai Mei
  Zi Jiao Nang), LiDa Daidaihua Slimming Caps,
  Qianweisu Slimming Herb, Qing Zhi, Super Fat
  Burning Reduce Weight
• http//www.hc-sc.gc.ca/dhp-mps/advisories-avis/ind
  ex_e.html
• Buyer Beware!!!

19
Herbal/Natural Wt LossComments

• Positives
• Its not all bad
• Food is natural and a great place to make
  modifications for both weight overall health
• Support, accountability and commitment
• Useful
• There are some amazing stories

20
Herbal/Natural Wt LossComments Part 2

• Flip-side (negatives)
• Its not all good
• Not everything natural is safe!
• Sometimes you have to take the iodine out to make
  it safe
• Not everything natural is labelled correctly
• Nothing will eliminate the need for diet and
  exercise modifications

21
Weight Loss Drugs Herbs

• Summary
• Lifestyle modifications essential
• Walk, avoid elevator, limit screen time, pop
• Drug-induced wt gain - considerations
• Weight loss drugs
• limited options
• limited long-term efficacy
• safety tolerability considerations
• Cost considerations
• Herbal/Natural
• Watch out for caffeine unlabeled extras