Obesity Treatment

Treatment

Table 26-5 summarizes treatment approaches to obesity.

Surgical procedures, such as intestinal bypass operations and gastric stapling, are effective in producing weight loss and in improving psychosocial functioning. These surgical procedures may also produce biological change, perhaps by lowering the body weight set point. However, risks of surgery and anesthesia, which are greater in obese individuals, plus the possibility of postoperative complications such as malabsorption syndromes following bypass procedures should limit the indications for these interventions to the treatment of massive and morbid obesity that has not responded to conservative management. Wiring the jaws shut to prevent the intake of solid food may help some individuals, particularly when used in preparation for surgery. The use of intragastric balloons, a noninvasive method of gastric restriction, may also be effective. It should be noted that surgical interventions are never curative by themselves, as many patients regain the weight they lose within 2 years of the procedures.

Amphetamines were once widely prescribed as anorexigenic agents in the treatment of obesity. However, their high potential for abuse limits their use as diet aids. Furthermore, tolerance develops easily. Anorexigenic drugs with low abuse potential include sibutramine, diethylpropion, phentermine, and ma-zindol. Their effectiveness is modest and side ef-fects, primarily anxiety and insomnia, are comparable.

The combination of the serotonin enhancer fenflur-amine with the sympathomimetic amine phenter-mine was widely prescribed in the mid 1990s. The practice of prescribing "fen-phen" was abruptly halted in 1997 with the discovery of heart valve lesions in a large number of these patients. Fenflur-amine has since been withdrawn from the market, and although phentermine remains available, it should not be combined with other serotonin-enhancing agents. Given the limited efficacy and significant risks of appetite suppressants, their use should be limited to patients who are significantly overweight (BMI greater than 30) and they should be used only for brief periods of time.