Monthly Archives: October 2013

A Novel Use For Weight Loss Drugs?

This past year two newly approved weight-loss drugs, Qsymia and Belviq, became available. Neither drug produced substantial weight loss in the studies submitted to the FDA. 1 Nevertheless, approval was given because it was understood that many obese individuals need an appetite suppressant to decrease their hunger and adhere to a diet.

These drugs do help some dieters to attain their weight loss goals. And some manage to  maintain their lower weight after cessation of treatment with these drugs. Patients have reported that they are content with smaller portion sizes because their stomachs are smaller and they can then exercise more easily as their weight loss improves their aerobic capacity.  Improvements in their overall health, from lower blood pressure to less strain on their joints, may be sufficient motivation to permanently keep the weight off.   But what about the rest? Those who failed to achieve their weight-loss goal, or lost only trivial amounts of weight while taking these drugs? Some may start re-gaining weight weeks or months after the end of their diet, a phenomenon known from previous generations of weight loss drugs.  Presently there is no systematic way of helping such individuals cope with factors that cause them to regain their weight. They certainly don’t have access to weight loss drugs and most weight loss programs are not set up (Weight Watchers may be the exception) to support people who want simply to stop gaining.  Moreover, this weight gain affects not only the newly slim, but those who are already overweight or obese. Being fat does not prevent one from becoming fatter.

People often gain weight for years, shifting from moderate obesity to morbid obesity, because recurring situations trigger excessive food intake.  Stress, toxic work environments and schedules, family problems, financial worries, sickness, and social isolation are but a few of the reasons behind repetitive overeating and weight gain.

A friend, a tax accountant, gains 20 pounds between February and April every year. He works 7 days a week on income tax returns, eats take- out, and snacks on candy bars to keep himself awake when working late at night.   A relative who is on the roster to take care of an ailing relative every summer also gains weight. She is more or less housebound because the relative is in a wheelchair, and so she eats her way through the kitchen because of boredom and frustration.

A neighbor studying for her Bar Exam gained 15 pounds in 6 weeks because munching on cookies was the only way he could stay at his desk for hours. These three people were already struggling with their weight, and the stress made them gain more.    Sometimes overeating and subsequent weight gain are not due to external stress, but biology. Women suffering from premenstrual syndrome and/or menopause often find themselves eating excessively. Winter blues brought on by reduced hours of sunlight from the late fall into the early spring may cause substantial weight gain, year after year. Shift workers adjusting to a new wake-sleep cycle often gain weight. The problem is so prevalent that this has become a major health risk among such graveyard shift workers.

Medications such as antidepressants, prednisone and even medications for the pain of fibromyalgia are also known to cause weight gain. All of these traps for weight gain can leave one asking what they can do to stay slim.

Might drugs now used to support weight loss be useful for preventing weight gain?  If they can stop overeating in the dieter, could they stop overeating in those who are rapidly gaining weight? Someone who is already considerably overweight might not feel so hopeless about being able to lose the pounds she gained over the winter, or after taking care of her elderly  relative if her weight gain  was minimized by these drugs. It is easier to go on a diet with 30 pounds to lose rather than 80.  Are pharmaceuticals the answer?

Of course before using weight-loss drugs to prevent weight gain, the efficacy of doing so must be studied, and populations identified who may benefit from this new use. And it also may be important to change our attitude toward allowing obese people to use weight loss drugs ‘as needed’ to prevent weight gain.  There is a belief that weight loss drugs are a crutch. Some claim that if obese people rely on a pill rather than willpower to prevent overeating, they will never learn how to control their food intake.  This may be true for some but for others who simply cannot stop their overeating because of their situational and/or biological stresses, why not give them some help?

People with back pain are not told that just because they received a steroid injection, they can’t receive any more even if the pain comes back. People with recurring sinus infections every winter are not told that they can’t have antibiotics this winter because they took them last winter and one winter was enough. And someone battling years of depression does not have medication withheld because it was used for many months a few years earlier. Nor is that person told as he might have been years ago to, “…pull himself out of his depression and get on with life.”

Weight-loss medications should also be used as needed. If they are taken as weight begins to be gained (again), then their control over food intake may stop further weight gain. And when the stress, or hormones, or season of the year causing the weight gain passes, losing the weight will seem an achievable goal rather than something beyond reach.


Are Grocery Delivery Services Driving Weight Gain Home?

A supermarket home-delivery service announced today that it would be able to replenish food almost as soon as their customers finish eating. If you polish off the bag of chocolate chip cookies at 11 pm, or scrape the last of the banana-peanut butter frozen yogurt from the carton, all you have to do is scan the barcode with your smartphone and a new order instantly is sent to your virtual shopping cart. Delivery is the next day….No more ruefully looking at the bag of potato chips containing only a few crumbs and muttering (in the words of a classic advertisement), “I can’t believe I ate the whole thing.” Rather, you can now say,“ I ate the whole thing and guess what? I am getting some more.”

In the old days, maybe ten years ago, running out of food was a nuisance. No more milk to go with the cookies? Chip dip all gone after the Sunday football game? All the peanut butter-stuffed pretzels eaten by your kids? The items were put on a list. They would be replenished only when you had the time, in your busy overscheduled life, to get to the supermarket, find the items on the shelves, stand in the checkout line, get in your car and fight traffic, and maybe bad weather, on the way home. The kids might be warned not to eat all the snacks. Finishing off the frozen yogurt might be halted if the replacement wasn’t entering the freezer for a while. And, just maybe, you might be tempted into deciding that you are not going to stock up on junk food snacks during your forthcoming supermarket trip because it would be healthier for all of you to eat fruit and rice crackers rather than nachos and cheese during next scheduled sporting event. An inconvenient health, as it were.

But now with the ability to order or reorder foods instantly, you may not take the time to reflect on the caloric cost of doing so. Out of nachos? Two seconds later, another bag is in your virtual shopping cart. Who wants to count calories?

Restaurants have been delivering meals for decades and most people do not use this service to eat excessively. They order a reasonable amount of food and only from one restaurant. But the solitary overeater may order meals from two or three restaurants each night because of embarrassment of ordering too much food from a single vendor. A massively obese weight-loss client of mine (he weighed over 500 pounds) told me that he would stagger his take-out orders so only one delivery person would show up at a time. “Once, orders from the Chinese restaurant and the pizza chain showed up together. I mumbled something about having guests, but I doubt if I fooled anyone,” he told me.

But restaurants that deliver do not have the same seemingly unlimited supply and variety of foods found in a supermarket. I do not think that Ben and Jerry’s delivers (not yet anyway) and so if you are yearning for a brownie, topped with ice cream, fudge sauce and whipped cream, the supermarket, not the ice cream store, is your most probable source of all of these components. To be sure, if your yearning for this brownie sundae comes about at midnight, you are out of luck. Planning this treat requires putting the ingredients in your virtual shopping cart many hours earlier so it can be delivered to your kitchen. But if you are really desperate for that treat, a taxi may be available to bring it to your door, or you to the late night convenience store for an overpriced indulgence.

Overeating by people already struggling with their weight is usually done in private. Very few obese people will eat massive amounts of food in a social setting. Indeed, some will not even overeat in front of family members, preferring eating in their cars, or when the house is empty or everyone is asleep. Moreover, the fattening “I shouldn’t be eating this,” foods may be concealed to prevent criticism from thinner family members. Thus supermarket delivery services are really perfect enablers of overeating. The foods can be ordered in secret on a smartphone and delivered when no one is at home, and eaten in secret.

Of course, supermarket delivery systems are a blessing for people who cannot get to the supermarket easily or at all. The elderly, or parents with small children, people whose work and travel make supermarket shopping almost impossible to schedule, or those who have to take public transportation to the food market, benefit from home delivery. Those without convenient transportation, parents with young children, the elderly, people recovering from an illness or surgery, or with a bad back, are fortunate to have access to such services. But is it possible that, for some, ordering food may be as addictive as ordering fake diamond rings from a home shopping channel?

Television shopping networks can fill the time of insomniacs, the lonely and those who feel that buying stuff is a substitute for other things missing in their lives. Some, for whom the shopping becomes an addiction, go into debt to pay off their purchases. In a like manner, shopping for food from home may do more than supply foods for nourishment of the body. Contemplating what foods to order, thinking of how they will taste, planning private eating binges and then filling up the virtual shopping cart occupies times that otherwise may feel lonely and isolated. The promise of the food delivery the next day can be viewed as a delivery of pleasure and entertainment. But, alas, only excess calories and their consequences are in that cart.

For some, home food delivery is a prescription for massive overeating. An acquaintance whose mother died from the complications of obesity told me that after she and her siblings left home, her mother, who by then could no longer walk due to her weight, would order food from one of those services. “I think she ate even more because the supplies kept coming. She never had to worry about running out of food,” she told me. “And the food kept her company. It was her only friend.”

Nonetheless, the needs of those who look to food to diminish their emotional pain are very real. And until we find effective ways of reaching out to these people, it is possible that their only recourse will be to wait for the delivery of their supermarket food order to make themselves feel better. Was this what the founders of Peapod expected as a client base, I wonder?