On February 22nd, 2012, the Advisory Committee to the FDA met to review a new weight loss drug, Qnexa.  This drug is a combination of Phentermine and Topiramate, and the combination yields substantially better weight loss than Phentermine alone, even with lower doses of Phentermine.

In 2010, the same advisory committee voted against Qnexa, and shortly thereafter the FDA opted not to approve the drug.  They also voted against 2 other obesity drugs, and we saw another weight loss drug, Meridia withdrawn from the market too.

If the FDA approves Qnexa, it will be the new first drug approved for weight loss in 14 years.  Although it will not be an appropriate drug for women considering pregnancy or for those with heart disease or high risk of heart disease, it could offer very substantial weight loss for others.  Keep tuned in to our blog for more news regarding Qnexa, and also regarding the other weight loss drugs up for review between now and this Summer.

I am hopeful and excited that 2012 will mark a new era in medical management of obesity, with more modern, improved, effective and safe tools.  A drug like Qnexa can really help close the gap between medically-achievable weight loss results and surgical results.  Also, Qnexa was researched long-term (2 years).  This suggests that the idea of using medication short-term for obesity treatment will be put to rest, and we will manage it long-term with medication, similar to how we approach other chronic medical problems like diabetes or high blood pressure.  A new long-term treatment option would be a powerful tool in our armamentarium.

The American Medical Association “AMA Weigh What Matters” app is a great new tool provided for free! It makes it easy to work with your Physician or Registered Dietitian to establish weight, healthy eating, and physical activity goals, and track your progress toward achieving them. It also calculates your BMI score, and provides a mechanism to view progress reports and email them to your Doctor or RD.

The app is part of Weigh What Matters, a family obesity prevention program developed by the American Medical Association, which encourages patients to work with their physicians to maintain a healthy weight, eat better, and increase physical activity. Weigh What Matters is part of the AMA Healthier Life Steps™ initiative.

This app is available for the Apple iPhone®, iPad® and iPod Touch® on the AMA iTunes store, and for Android devices. The application provides for daily tracking- from the convenience of your cell phone. This can be a great tool for personal accountability, goal setting, and can help you stay on track with your goals.

And whether or not you have a smartphone, you can check out the website at: http://www.ama-assn.org/resources/weighwhatmatters/patients.html. There is a wealth of information on keeping you and your family healthy including an action plan for eating healthy, an action plan for physical activity, and tracking calendars.

Simply search for AMA Weigh What Matters in your app store and download for free!

For our health care workers out there, Dr. Lazarus is honored to have been invited again to participate in Grand Rounds.

This year, the title of my talk is:

Obesity Medicine

Why telling an individual to “Eat Less, Exercise More” is not a helpful treatment strategy for Obesity.

If you are available, it will be at Skyridge Hospital in Lone Tree

Place:  Skyridge Hospital, Lone Tree, CO

Date:  Tuesday, February 7th

Time:  12:00 – 1:00 PM

I hope you can make it!

Wow, it’s already mid-January!   We can now truly say that we survived the holiday stuffing (turkey, ourselves, our friends?) and all of the New Year’s goodies.  Are you already into this year’s remaking, re-fitting and re-planning?  What are your health goals for the next 11 1/2 months?  What is the sweet-spot goal that’s achievable without being meaningless?  Are you looking at pounds lost, calories burned, weights pressed, trails hiked,  roads cycled?  Maybe your goal is to make more healthy meals at home.  What activities can involve your whole family?  Are there foods that you’d like to eat more frequently?  Which super-healthful foods are you willing to try this year?  Which do you plan to avoid?  What foods are kindest to your body?

Once you’ve set a few goals (not more than three – the number shown  to be the limit of our “stick-to-itiveness”),  prioritize them.  This can be by importance to health, by level of enjoyment, or by vote, if your family will is involved.  Next, make up a plan to implement them.  Decide on an end date, or is this  something that needs to be part of your life forever?  How will you create accountability for your behavior changes?  Perhaps you could try telling another person: enlisting  them to “coach” as a helpful monitor  to help  you stay on track.  Set up a calendar of contact dates to go over your successes and challenges with your coach.  Remember to gift yourself with rewards along the way!  Though the nobility of the goal is worthy, we do our best with carrots, not sticks.  At CNC we’re very happy to fill the coaching roll for you!

Happy New Year!

Tracy Boykin, RD

Finding Success

Most individuals that I meet at CNC come in highly motivated and proceed to accomplish their weight loss goals.  Unfortunately, sometimes in the months and years that follow this level of motivation wanes, some weight is regained, and the end result is not only a loss of motivation, but a loss of confidence in the ability to sustain weight loss long-term.

For many, regain comes as a big surprise.  But not for me.  Obesity is a disease, like diabetes or high blood pressure.  With treatment, we can manage the disease, make it undetectable and prevent health consequences.  We treat the disease, it goes away.  We stop treatment, it comes back.  Unfortunately weight regain results in a loss of confidence.  With no confidence it is hard to find motivation.

How Motivated & Confident are You To Lose Weight Now?

Please answer the following two questions:

How motivated are you in your ability to lose weight now?

Low   1—2—3—4—5—6—7—8—9—10  High

How confident are you in your ability to lose weight now?

Low   1—2—3—4—5—6—7—8—9—10  High

If you are highly motivated, right on!  But if your score is less than 5, why?  It doesn’t seem important right now?  There are other more pressing concerns?  For many people, they won’t act unless the motivation is a 10!  But it is hard to maintain that level long-term.  Instead, let’s think about what we could do that would just increase your motivation score by 1 or 2 points.

Finding Motivation

There are lots of effective strategies to improve motivation.  One of my favorites is to find motivation by reading about the successes of others.  That’s why we accept and publish to our web site patient success stories (see the “Patient Results” tab on our web site).  Countless individuals have found a renewed sense of motivation by reading about how others overcame their challenges.

Others find motivation through exploring benefits of weight control.  These include:  improved health, feeling better, having more energy, being able to do the things we want to do, less back and joint pain, fitting in to our clothing,  being able to sit on the floor to play with the kids / grandkids and most importantly, living longer.  Why do YOU  want to lose weight?

Finding Confidence                              

If your confidence level is less than 5 then let’s find a plan to restore confidence in yourself.  When the prospect of losing weight becomes overwhelming, we need to develop a plan that you KNOW you can do.  An office visit with your CNC dietitian is a great starting point.  Confidence building begins with a plan.  Your dietitian can help you pick achievable goals each week.  As you achieve each one, you’ll find your confidence level improving.

Think Small

The idea of trying to lose 20, 50 or 100 pounds can be daunting.  Because we tend to think of things as “all or nothing,” many will do nothing in this situation.  Instead of committing to losing 100 pounds, a monumental task, why don’t we pick smaller actions that we know we can do?

Medically, the first 5 or 10% that we lose provides the vast majority of health benefits.  Often, 10 or 20 pounds is enough to come off of prescription medications for blood pressure, cholesterol, or even diabetes.  Consider some of the following as a starting point:

• Eat  breakfast every day.
• Drink a glass of water before every meal.
• Eat 5 times a day with protein at every meal and snack.
• Keep a food diary.
• Replace 1 or 2 meals a day with fixed calorie meal replacements (for example, a CNC Protein Shake or bar for breakfast helps boost protein in the morning controlling hunger all day.  Another protein in the afternoon helps  prevent fatigue and hunger all evening).
• Use the least convenient restroom, preferably one on a different floor.

These smaller actions will add up quickly and motivate you, and the 10 or 20 pounds that you lose will provide a significant health benefit!

More Tools To Boost  Confidence and Motivation

Remember all the tools you had that boosted motivation and confidence levels last time you were successful?  For most individuals, just one tool doesn’t cut it.  Think about which of the following would be most helpful to you now?

Appetite Control Medication and Medical Review – Consult with our Medical Staff regarding the use of appetite control medication and optimizing other medical problems with respect to weight control (like depression, diabetes, hypothyroidism, menopause, etc.) to help you get back track!

Accurate Body Fat Measurement:  To assess where you are and what is a realistic goal weight.

Action plan for Maintenance – Consult with our Medical Staff to develop green, yellow and red zone plans to keep you in your goal range.

New CNC Tools for SUCCESS

Did you know that over the past year CNC has developed lots of new tools to help YOU with life-long weight control?  Best of all most are FREE!  Let’s look at a few of the improvements we made this past year:

1. Monthly e-Newsletter Service:  Packed with success stories, timely weight loss tips, coupons for our on-line store, recipes, and updates in medicine and nutrition.  This is written by the professional staff at CNC.  If you are not receiving this newsletter, you may have missed lots of exciting news!  Examples include:

• Success Stories:  Read about Peggy’s 221 pound weight loss journey, how a 50 pound weight loss saved Jean’s life, Pam’s remarkable 54 pound weight loss story and countless others.
• Medical News:  The FDA will re-consider a new weight loss drug in April that can help obese individuals lose over 14% of their total body weight.  Also, did you see the 3 most effective determinants of successful weight loss according to the latest medical research (Look Ahead Study)?^*
• Weight Loss News:  The FDA took steps in December to stop the HCG weight loss scam due to its ineffectiveness.
• Meal Plan Updates:  CNC now offers full Optifast meal replacement programs designed to help individuals quickly, safely and simply lose 50 pounds or even more.
• To Sign Up For Our Free Newsletter:  Just click the “Subscribe” button in the bottom right of the footer on every page on our web site. (or click here)

2. Medical Weight Loss Blog:  Our blog now contains 150 articles written by the staff at CNC on a wide variety of relevant topics.  Just head over to the web site and click “Blog” in the top menu bar.

3. On-Line Store:  Do you enjoy the protein shakes, bars, soups, snacks and other items at CNC?  Our foods are now available to CNC patients through our online store.  There are lots of new flavors to choose from.  They keep getting better and better every year!  Foods can be shipped via UPS to your doorstep or picked up at the office.

4. CNC Facebook Page:  We’re social!  Harness the power of social networking to achieve your goals!  “Like Us” on Facebook to keep in touch (link on bottom-right of web site).

5. Lifestyle Education Series:  Ready to take the next step in making the lifestyle adjustments necessary to maintain weight loss?  This series, produced by the health professionals at Optifast is available to patients of CNC regardless of which meal plan is followed.  Inquire at the front desk for more information on how to use these modules to learn these strategies.

Food can CURE disease

It is well established that certain types of foods can cause disease.  Excess salt can elevate blood pressure and excess trans-fats can contribute to early heart disease.  Have you considered that we can use foods to cure disease?  In addition to weight control, medical diets can be used to address a wide range of medical problems including:

• Diabetes / Pre-Diabetes
• High Cholesterol / Blood Pressure
• Irritable bowel syndrome
• Migraine Headache
• Fatigue

Diabetes

An ongoing study called Look Ahead is looking to see if a modest amount (8%) of weight loss through diet and exercise is an effective treatment strategy.  The results are already amazing – those with successful weight loss have much better diabetes control with less prescription medication.  At CNC we’ve had a high level of success helping type II diabetics achieve excellent control, and have even helped many come off of insulin injections.

Cholesterol

When it comes to high cholesterol, many individuals try a low fat diet, red yeast rice or fish oil, only to find that on re-test the numbers have gotten even worse.  Statin drugs are the next step.  A study this year demonstrated a dietary intervention that lowered cholesterol by 14%, similar to some prescription statin drugs, with none of the risks or side effects!  We have put together a user-friendly version of this protocol.

JAMA. 2011; August:831-838

Reduce Risk of Death

Also published in 2011, a study showed that adhering to a low-risk lifestyle reduced the risk of sudden cardiac death (SCD) by 92% (lowest risk vs. highest risk life style groups) during the 26 year study term in 81,722 US Women!  Low Risk Lifestyle:

• Not Smoking
• Achieving a normal weight (BMI)
• Exercising 30 or more minutes / day
• Eating a healthy diet

Irritable Bowel Syndrome

Even IBS improves with proper dietary intervention.  This past November, the Wall Street Journal reported on using specialized diet to improve symptoms of IBS by reducing foods rich in fermentable sugars.

If you are interested in managing your medical condition(s) through proper diet, call us at 303-750-9454 and set up a consultation with your Registered Dietitian to discuss ways in which YOU can take control!

Many individuals take New Years as a time to seriously reconsider their health.  In fact, over the next several weeks, I expect to meet many new patients in the office with the goal of losing 50 or more pounds.

If you’re wanting to lose a lot of weight and keep it off, why not pick an approach designed to do this?  Optifast full meal replacement programs are quick, easy and safe, and in clinical studies help individuals lose 52 pounds in about 5 months. Many go on to lose 75, 100 pounds, or even more.

Optifast Soups

Optifast Ready To Drink

So, what are you waiting for?  Call the office at 303-750-9454 if you’d like more information on whether or not you should try an Optifast program.

If not Optifast, we also have good success with large amounts of weight loss with our Modified Fast Program in which individuals can eat real food and/or protein supplements, and also with our Advanced Program, which adds back in fruit, more vegetables and dairy.

Whichever approach suits you the best, how about picking a great goal for 2012 – to get healthy!

Happy Holidays.

Healthy, housebound and full of holiday cheer? Give yourself the gift of exercise.

Plummeting temperatures, short tempers and Mariah Carey’s “All I Want for Christmas Is You” being played on a loop at a Walgreens store near you are perhaps the most telling signs that the holidays are here, but spikes in patronage at gyms across the country are additional evidence of the holiday season – and the excess calories that accommodate it.

Still, many normally disciplined exercisers looking to shed weight gained by November’s pumpkin pie and December’s Christmas desserts (yum) wait until after the new year to do so. While there’s more than a few good excuses for this — “the line to use the elliptical machine at the gym was too long,” “I was busy mother-in-law proofing my home,” “my dog ate my yoga mat,” “I just didn’t have the time” — there are also a few good ways to stay fit at home during the holidays without needing expensive exercise equipment, a gym membership or a whole lot of time. Sure, repeatedly lifting bulky cookbooks is a good start, but we have a few other ideas …

1.  Weighty decisions: No matter how harried things get during the holidays, pumping iron or adding resistance with a homemade weight is a surefire way of alleviating stress, burning a few calories and channeling your inner DIY-er. While filling an old plastic milk jug or laundry detergent bottle with sand or water is one popular way to go about making your own weights, penny-filled tennis balls,  tube socks stuffed with dry beans, and basketballs filled with rice are other possibilities that involve creative reuse. If making your own equipment holds limited appeal, rummage through the attic or garage for an old pair of dumbbells — it seems that every attic or garage has a pair hidden away somewhere. If none materializes, hit up a local thrift store or garage sale.

2.  Give me 20: Not keen on strength training with upcycled detergent bottles? No sweat. There are numerous equipment-free repetitive exercise activities like jumping jacks, running in place, squats, planks and push-ups often performed in a gym that can just as easily be done at home. Some tasks can be performed in the kitchen as you wait for the holiday roast to finish. Just make sure you have adequate space and some decent non-holiday music to keep you moving.

3.  Got stairs? Use them: Here’s an idea: Every morning that you go downstairs to fix yourself breakfast before work, walk back up those stairs. And down again. Repeat if necessary. Bonus points for carrying something heavy (i.e. a load of laundry) while doing so. If you live in an apartment building with an elevator, just pretend the elevator is out of service a handful of times per week. Walking up (and down) stairs provide numerous benefits including improved cardiovascular health and the lowering of LDL (bad) cholesterol. Stairs can also be used for leg toning step exercises.

4.  Walk around the block: Although the weather may be frightful around the holidays, sometimes it helps to get out of the house and clear your head with a zesty constitutional. If you’re super busy and tied to home, there’s no need for an epic, hours-long stroll … simply take a 20-minute breather that consists of a couple laps around the neighborhood. It’s a great way to sneak in some low-impact aerobic exercise and gawk at your neighbors’ holiday light displays.

-Charleen  Ryszkowski is a Wellness Coordinator at Ascent Therapy Clinics

New Fitness Opportunity

Are you looking for a new fitness challenge for the New Year? Our friends at Ascent Wellness are starting a new Summit Challenge and are you can sign up now! This innovative program combines small group sessions with a personal trainer (3-5 participants per class), strength and cardio training and fitness assessments. For more information call the DTC location at 720-529-4802 or the Littleton location at 303-978-9200 and let them know you heard about them from CNC. You can also find out more information on their website at http://www.ascentwellnesscenters.com/SummitChallenge3.htm

Image: photostock / FreeDigitalPhotos.net

The FDA is again considering approval of an experimental weight loss drug it rejected a year ago over concerns about potential heart problems and birth defects in babies born to women who take the drug.

California-based pharmaceutical company Vivus Inc, is now asking for limited approval for its oral combination drug Qnexa, which would exclude women in their childbearing years.

According to the company, the FDA is scheduled to make an approval decision next April. If approved, the drug could be commercially available soon after that.

That would make Qnexa the only prescription appetite suppressant approved for long-term use available in the U.S. The only other widely marketed prescription weight loss drug, orlistat – sold by prescription as Xenical and over-the-counter as Alli – works by blocking dietary fat absorption.

In a study submitted to the FDA last year in Vivus’ original filing, and published in the journal Obesity late last week, people who took the highest dosage of Qnexa for a year lost, on average, about 14% of their bodyweight. They showed improvements in blood pressure,cholesterol, triglycerides, and blood sugar.

Qnexa Combines Two Drugs

Qnexa combines low doses of the stimulant phentermine – long used for short-term weight loss — and the anti-seizure and migraine drug topiramate, which has also been used “off label” to treat binge eating. “Off label” refers to drugs that are prescribed by doctors as treatments for conditions that are not specifically approved by the FDA.

Last fall, an FDA panel voted against the drug’s approval, citing North American drug registry data showing that babies born to women who took topiramate had up to a 20-fold increase in cleft palates.

Vivus Inc. president Peter Tam tells WebMD that subsequent investigations involving other databases suggest that the risk for the oral birth defect is actually much lower.

Based on the new information, the FDA agreed to let the company resubmit its application for limited approval for use in adults who are not likely to become pregnant.

At the request of the FDA, the company is also examining more than a decade of medical claims records involving women who took topiramate during pregnancy to treat seizures, migraines, and other conditions, Tam says.

‘Most Effective Drug Since Fen-Phen’

The newly published study included 1,267 severely obese people treated at 91 sites across the country.

Study participants took one of two doses of Qnexa or a placebo once a day during the year-long study. All were advised to follow a modest lifestyle modification/weight loss program that included counseling and a 500 calorie-a-day reduction, increased water intake, and increased physical activity.

Fifty-three percent of the placebo-treated patients remained in the study for the entire year, compared to 61% of the lower-dose Qnexa-treated patients and 66% of the higher-dose patients.

The most commonly reported side effects were tingling, dry mouth, constipation, and a tinny taste in the mouth.

At the end of the study, average heart rate increased by one beat per minute in the higher-dose Qnexa-treated patients and by less than one beat per minute in the lower-dose patients.

Diabetes specialist and study co-researcher W. Timothy Garvey, MD, of the University of Alabama at Birmingham, says based on the research Qnexa appears to be the most effective weight loss drug since the Fen-Phen weight loss regimen. Fen-phen was a combination of two separate drugs — fenfluramine and phentermine. Fenfluramine, which was linked to potentially fatal heart problems, was pulled from the market in the late 1990s.

Among patients who completed the study:

*The average weight loss for patients on the higher dose of Qnexa was 14.4% of body weight, compared to 6.7% among patients on the lower dose and 2.1% among patients taking a placebo.

*48% of those in the higher-dose group lost 15% or more of their body weight, compared to 12% in the lower-dose group and 6% in the placebo group.

Sixteen percent of patients treated with the highest dose of the experimental combination drug dropped out of the study early because of the side effects, compared to 11% of patients in the lower-dose group and 8.4% of people who got the placebo treatments.

Tough Times for Weight Loss Drugs

Tam says he is optimistic that Qnexa will be approved. But he acknowledges that the regulatory climate for weight loss drugs has been stormy of late.

Last October, in the same month that the first Qnexa application was rejected, the FDA also rejected Arena Pharmaceuticals’ application for its weight loss drug lorcaserin for safety reasons . The agency also forced the withdrawal of the diet drug Meridia from the market after 13 years, citing concerns about heart attack and stroke risk.

Weight loss specialist Louis Aronne, MD, of Weill Medical College at Cornell University, says the FDA may feel pressure to approve Qnexa because it is effective, as long as the company shows that it can limit its use to those for whom it is approved.

Aronne directs the Comprehensive Weight Control Program at New York-Presbyterian Hospital.

“Obesity is a huge and growing medical problem and we need effective drugs to treat it,” he tells WebMD.

He says just as weight loss surgery is now considered more of a medical than cosmetic procedure, a new generation of weight loss drugs will be thought of in the same way.

“This is not a cosmetic issue, it is a medical one,” he says. “Weight loss has all kinds of health benefits, including improving blood pressure, diabetes, sleep apnea, and stroke and heart attack risk.”

Bariatric surgeon Mitchell Roslin, MD, agrees, but he tells WebMD that his concerns about Qnexa remain. Roslin is chief of obesity surgery at Lenox Hill Hospital in New York City.

“We don’t know if this drug is safe enough for patients to stay on it to maintain their weight loss,” he says. “It clearly works better than other drugs out there, but the questions remain — at what cost and for how long?”