LivingTruths and lies about weight loss

Truths and lies about weight loss

Obesity treatments that promise to shed pounds quickly and effortlessly are worse than fraud.

Like every year, millions of Spaniards start after the gargantuan Christmas and before the summer some slimming treatment to show off their hearts of palm on beaches and swimming pools. Most are recalcitrant repeat offenders who will fail again. ? Despite the fact that 85 percent of the population is aware that excess weight constitutes a serious health problem, the truth is that it is perceived more as an aesthetic and social issue than as a disease or a common risk factor many chronic diseases, such as diabetes and hypertension ?, says Dr. Juan Soler, president of the Spanish Society of Endocrinology and Nutrition (SEEN). Thecanons of beauty impose thinness as a premise of social, professional and love success: 83% of Spaniards give considerable importance to physical appearance and think that people with extra kilos are discriminated against, according to a survey published last April by the interactive mobile services company Buongiorno Vitaminic.

With these empty premises, the medical approach to overweight and obesity faces a social attitude based on the cult of the image, and motivated by purely aesthetic criteria. This largely explains whyonly one in 5 people would go to the doctor to lose weight, according to a report by SEEN and the Society for the Study of Obesity (SEEDO); and why the vast majority of people want to lose weight quickly and greatly regardless of the cost, the real effectiveness of the method used and the dangers it entails for health. It is a matter of promises. In his professional honesty, the doctor does not offer success in weight loss therapy. Obesity, being a complex disease caused by the interaction of numerous environmental and genetic factors, cannot be tackled with a single solution or a pill to cure it. Today, the progress achieved with weight loss treatments based on scientific evidence is slow, not very promising from the perspective of the patient and difficult to maintain in the medium and long term.

60 euros a month to make a wish come true

Conversely,the miracle products offer a wonderful loss of kilos in a few days and without the slightest effort. Undoubtedly, the ignorance and lack of encouragement of some and the commercial ability of others have made obesity and, in general, overweight a big business. “We calculate that 80 percent of Spaniards who want to lose weight spend an average of 60 euros a month on the most unusual treatments,” says Dr. Basilio Moreno, president of SEEDO. The specialists have worn down the vocal cords warning us thatweight loss should be moderate and progressive, seeking a decrease in fat mass, and that, when this does not happen, there is an elimination of water or lean mass from the body that is recovered with extreme ease. But it is as if they preached in the desert, if we bear in mind that in Spain we allocate 2,050 million euros a year to maintain or recover the line with sometimes unorthodox remedies, according to the prospective study Delphi. In the case of diets, the balanced diet designed by a nutritionist appears to be displaced by the regime of the neighbor or the one that becomes fashionable in women’s magazines, which if they make you lose weight it is at the cost of your health.

The same happens with the so-called miracle products. From the media, the consumer is bombarded with herbal preparations, nutritional supplements, magisterial formulas – the popular slimming capsules – and other comekilo treatments, including homeopathic ones, which lack scientific endorsement and even violate the law. For example, this is the case of the recently withdrawn by Sanidad Removyl, a supposed anti-obesity made with 13 oils that was sold by mail or email, telephone and internet. But what is the reality of pharmacological treatments for obesity? How effective are the advertised miracle products? Are they entirely safe?

An exhaustive report recently published in the journal Medicina Clínica by Dr. Noemí de Villar and other members of the SEEN Obesity Group points out the i’s of the products available for sale for weight loss purposes, the status of the legislation and the scientific evidence that exists in this regard. As can be read in the article, doctors currently have only two specific drugs for the treatment of obesity: orlistat (Xenical) and sibutramine (Reductil). The first is an inhibitor of pancreatic lipase, an enzyme that participates in the digestion of fats by breaking down triglycerides in food and thus reducing them to a mixture of free fatty acids and monoglycerides. All of these bind to bile salts to cross the intestinal wall and pass into the body.

Sibutramine acts on the appetite centers

Several studies indicate that orlistat reduces fat absorption by up to 30%, although it must be administered with caution due to its side effects, such as diarrhea, fecal incontinence and intestinal pain. For its part, sibutramine has its place of operations in the brain, specifically in the appetite center, which regulates the sensations of hunger and satiety. At the biochemical level, this slimming agent inhibits the reuptake at the level of the synapse – the space that separates two neurons – of the neurotransmitters serotonin and norepinephrine. Its administration achieves moderate weight loss and improvement of diseases associated with obesity, but it also has contraindications due to its adrenergic action, which results in tachycardia and increased pulse and blood pressure. This brief list of drugs against fat could be expanded in a few years, as there are some very attractive molecules in the research phase.

In this sense, it is worth mentioning the beta-3 adrenergic agonists , which stimulate the so-called uncoupling protein or thermoginine so that it literally wastes part of the body’s energy; and estrone oleate , a molecule produced by the adipocyte – the fat cell – that invites the hypothalamus to appease the appetite without interrupting the burning of calories. Another adipocyte product that also operates at the hypothalamic level is leptin. This hormone synthesized by the ob gene reduces fat intake and storage by acting on two types of neurons: on the one hand, it suppresses the neuronal activity of neuropeptide Y (NPY), and on the other it improves the action of neurons known as proopiomelanocortins. (POMC). Conversely, the absence of leptin increases appetite and fat deposition thanks to the excitation of NPY neurons and the inhibition of POMC.

If you are thinking of starting a weight loss treatment, remember this list of tips.

? Be wary if they sell you slimming capsules in the doctor’s office. The only authorized place for its dispensing is the pharmacy. Verdades y mentiras de los adelgazantes

? There is no medical or scientific evidence that justifies the treatment of obesity with magisterial formulas.

? Laxatives cannot cause weight loss, since the absorption of nutrients has already occurred at the point in the body where they act.

? Thyroid hormone should only be used in cases where the thyroid gland is working abnormally, such as hypothyroidism. In addition, this hormone favors the consumption of proteins and decreases calcium in the bones, which accelerates osteoporosis.

? Diuretics cause a decrease in body water volume and what is actually left over by obese people is precisely fat.

No drug treatment has slimming results without effort or without diet.


A magisterial formula that is fraudulent

Last April, the discoverer of leptin, Jeffrey M. Friedman, of the Howard Hughes Medical Institute, in the USA, announced in the journal Science that this hormone induces a reorganization of the patterns of nerve connections in areas of the brain that regulate eating behavior, at least in obese mice obtained by genetic engineering. In light of the results, Friedman also suggests that in our brains there is a natural variability of brain patterns related to dietary behavior that could greatly influence whether a person is obese or thin. Apart from orlistat and reductil, doctors temporarily use other drugs such asadjuvants or supplements to weight loss regimens. We are talking about epigallocatechol gallate,diuretics, thelaxatives, the biguanides and thethermogenic medications, such as ephedrine, caffeine, and? -agonists. These drugs, moreover, are usually part of the magisterial formulas known as slimming capsules that, together with various compounds capable of producing anorectic, satiating, laxative, diuretic and tranquilizing effects, a priori facilitate weight loss. It should be noted that these cocktails that combine different active ingredients have been banned since 1997 and are only marketed fraudulently.

Now, the use of other magisterial formulas, homeopathy products and nutritional supplements -lactic serum, chitosan,Apple vinager– Under the guise of anti-obesity miracle products, it is not penalized in Spain or in the rest of Europe. “It can only be reported in the event that the slimming agent does not comply with the legislation or – and this is the important thing – if it is shown that it has a harmful or toxic action in people who have used them in the dosage indicated on the container”, warns the doctor To usually do. On the other hand, except for drugs administered with a prescription, in the case of drugs and some preparations of medicinal plants to prevent or cure obesity, almost all slimming products are registered and marketed without the need for scientific data and clinical trials that corroborate its therapeutic goodness. This is the case of parapharmacy products, which include food substitutes in low-calorie diets; of the so-called advertising pharmaceutical specialties (EFP), whose anti-obesity ingredients are considered useful or safe for health, and of many preparations of plant origin. Other groups of substances that do not have their own registration, such ascertain capsules against the extra kilos, scratch the misleading advertising so as not to fall into illegality. By not being able to indicate on the packaging “it is used for the treatment of obesity”, they include the expression “complementary or adjuvant in weight loss diets”, according to the aforementioned study carried out by the Obesity Group. This also highlights medicinal plants – with the exception of medicinal plant drugs with therapeutic indication authorized and supervised by the Medicines Agency – that are sold as slimming in pharmacies, herbalists and large supermarkets. None of the phytotherapy products offered to lose weight have such a virtue, since their true therapeutic indication is different and, furthermore, they are not as harmless as they are advertised in the leaflet (see box on page 50).

More than 70 treatments that do not lose weight

After analyzing more than 70 commercial names of known products to combat overweight, which together include fifty active principles, none of them can argue their efficacy – and safety for health – with scientific data or minimally verified clinical trials. So clear.


Enrique M. Coperías

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