Diet Drugs Work: Why Won't Doctors Prescribe Them? 670
Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"
mechanisms that are not yet fully understood (Score:2, Interesting)
shucks, ive no idea, either that or because someone is paying someone else more for something else
DIET OF THE POOR (Score:4, Insightful)
It is the cause. It IS a social one.
It is because of corporate food production, factory farming and industrial "recipes" that make cheap and plentiful Soylent Soy or Corpulent Corn - with added glutimate to overstimulate appetite generation.
These are the product of an agribusiness that has made this production a part of public policy, through the US Farm Bill and other legislative manipulation.
If you are deliberately misinformed, marketed to death, and underpaid, the last thing you need to solve for the attendant health effects is more pills. It's like plugging your nostrils, because you have a cold.
But I bet the pharmaceutical and health-insurance rackets love the idea...
Re: DIET OF THE POOR (Score:4, Informative)
I don't think the government should tell us what to eat, but I do think there is something wrong with the US food supply that calories doesn't cover because rice is horribly high in calories and carbohydrates
Portion size.
What are they putting in the food that most Americans eat that the rest of the world isn't eating?
Nothing really. Most of the world is getting fatter.
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I don't think the government should tell us what to eat...
Of course. Our diet should be left up to the invisible hand, and be determined primarily by profit motive!
People have the choice to low quality unhealthy food, or they can choose to get in their time machine and shop in the past.
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Your attitude is all platitude.
... then you also need to convince them not to buy $200 sports jerseys, $100 bottles of Tequila, and designer clothes...
Your data-less, prejudicial canard is based on the Regan-era false-trope of the "Welfare Queen". It's a way of expressing contempt for the poor and for those who have an economic condition of disadvantage institutionally guaranteed by public and corporate policy. You get to hate, and to justify your lack of compassion. Way to go.
The fact is this: "You need to convince them" is key. Billions of dollars are spend convincing the entire American public they need this valuele
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The original diet drugs were methamphetamines that led to addiction. Then we had heart problems and such from fen-phen and Redux. Are you really going to risk all of that so that y
Re:mechanisms that are not yet fully understood (Score:5, Informative)
Perhaps doctors don't prescribe them because:
- they don't work very well in the short term and not at all in the long term
- they are expensive
- they have lots of bad side effects:
Qsymia has particular risks for pregnancy, as it can cause birth defects if taken in the first months of pregnancy, even before a woman knows she is pregnant. Women of childbearing age must use effective birth control to keep from becoming pregnant while taking Qsymia.
Qsymia should not be taken by:
Pregnant women
People with glaucoma
People who have been told they have an overactive thyroid
People taking a type of antidepressant called a MAOI
People allergic to phentermine or topiramate
Belviq should not be taken by:
Pregnant or nursing women
People taking drugs linked to valvular heart disease, such as cabergoline (Dostinex)
Belviq should be taken with caution by:
People taking certain medicines for depression; migraine; the common cold; or mood, anxiety, psychotic, or thought disorders
Men with conditions that predispose them to erections lasting more than four hours. These conditions include sickle cell anemia, multiple myeloma, and leukemia
Men with a deformed penis
Qsymia and Belviq each come with a long list of important safety information, but this list is different for each drug.
Re:mechanisms that are not yet fully understood (Score:5, Informative)
You might want to review the full research before posting.
> - they don't work very well in the short term and not at all in the long term
Qsymia gives about 10% weight loss beyond "placebo" (which was a diet and exercise program that all treatment arms got.) Weight loss was maintained out to two years, which was the end of the study. Qsymia is a combination of two medications that have been on the market for a long time. Weight loss docs have been prescribing them together for quite a while and I haven't heard any talk about them not working after a certain point. Qsymia just takes two existing meds and makes one pill out of small amounts (if you want to match the Qsymia doses with generics you have to chop tablets as small as an eighth) and uses a time release formula so the side effects (carbonated drinks taste funny and tingling in the fingers are common. I have the change in taste) aren't as bad. There is no research on Qsymia past two years, but there is experience with the components. Belviq is a 5-HT2C receptor agonist, and I'm on a SSRI. I haven't paid much attention to it, but I assume it has data out two years also.
> - they are expensive
True dat. And not covered by a lot of insurance. I buy mine out of pocket. About $170 per month. It's worth it to me.
> - they have lots of bad side effects:
Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.
First, if I, as a 45 year old man, get pregnant on Qsymia it will be news. Much bigger news than a birth defect.
Second, obesity also increases in risk of birth defects.
Third, this is why they have a program to tell people that if you take Qsymia in the first few months of pregnancy there is an increased risk of cleft lip/palate. This is because Qsymia contains topiramate, a medication prescribed about 10,000,000 times a year. Interestingly you can take 400mg a day of topiramate for neurological conditions without a warning, but if you take 23mg a day for weight loss you have to be warned of the risk. Not that there is a bias against obesity or anything...
I think I have posted more in this one topic than in all the rest of the time I have been on slashdot, but this drug has made such a difference in my life.
Re:mechanisms that are not yet fully understood (Score:4, Informative)
Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.
Pregnancy studies are a high risk/low reward proposition, unless you are talking about fertility, anti-miscarriage or other pregnancy related applications, since including pregnant women in a clinical trial has a really high settlement cost if there's a problem with the pregnancy, and an even higher cost if the baby comes out with a birth defect. As an example, women with hair loss get warned against finesteride, since it acts as a 4-5 reductase suppression agent, which, when it occurs naturally (5-ARD), results in conditions from hypospadias needing surgical correction, all the way to full blown X-Y females (sterile of course).
It's fairly common to warn pregnant women not to take a medication, even if in fact it might be perfectly safe because of the exclusionary nature of the studies. This is purely a legal liability/malpractice issue, not necessarily an issue with the medication itself.
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It's interesting that a long scary list of side effects should be considered routine.
I am not willing to take this risk for a very small temporary benefit.
(BTW, about two years ago I decided I needed to lose some weight. Over 6 months I lost 21 pounds just by eating less and eating healthy and I have kept the weight off. BMI is now 22.)
Weight loss is hard because it involves behavior change. Taking a pill is not an effective solution. Pills have side effects. Pills only cause a small weight loss (at best).
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Those are not side effects, they are contraindications. Big difference.
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You're right. Here are the side effects of Qsymia:
SIDE EFFECTS
The following important adverse reactions are described below and elsewhere in the labeling:
Fetal Toxicity: [see WARNINGS AND PRECAUTIONS and Use in Specific Populations]
Elevation in Heart Rate [see WARNINGS AND PRECAUTIONS]
Suicidal Behavior and Ideation [see WARNINGS AND PRECAUTIONS]
Acute Angle Closure Glaucoma [see WARNINGS AND PR
No, they don't work (Score:5, Insightful)
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In a way, food is like drugs too. Sugars, fats and salts are addictive and the more you eat them, the more you crave for more.
Using pills to suppress that effect to a point where the craving itself has been reduced to a more manageable level sounds like it might work.
Re:No, they don't work (Score:4, Interesting)
Your diet is a perpetual thing, not something you do for a little while to lose weight. Eat healthy, be healthy. Drugs and short term adjustments in what you eat aren't going to do shit.
This.
You can shovel pills down someone's throat all you want, and sure, they'll lose all sorts of weight, but if they're not building the life habits necessary to maintain their weight, they'll stuff their faces with shitty food all over again, and gain the weight back in a matter of months. The very fact that people want a Magic Pill to make them lose the caboose is evidence that they lack the skills, knowledge, and personal discipline necessary to successfully control their own weight. These people need to be told the truth: Losing weight takes work to achieve, and it takes real change of your lifestyle and habits to maintain, and most of all it takes stark honesty with yourself about what you eat and drink, who you are, and how you live your life.
Oh, and before anyone starts attacking me with the "thin privilege" and "fat hatred" crap: I used to weigh greater than 300 pounds once upon a time, had completely ruined my knees, and just didn't give a damn anymore. It took years, but I'm below 200 pounds, can leg press more than 3 times my bodyweight, and participate in a competitive endurance sport, and it was a damned hard road getting to where I am full of wrong turns and hard lessons, so don't sit there and tell me you've "tried everything", or "it's your genetics", or "it's impossible!", or any of the other excuses I see day after day after day. Don't sit there and claim you can be "healthy at any size", because that's utter bullshit. Stop trying to turn your sloth and lack of discipline into some sort of twisted virtue, because it most certainly is not! They say "Denial ain't just a river in Egypt", and your denial of the problem and it's implications is also going to wreck your children's lives as they grow up thinking it's OK to ruin their bodies, and being sabotaged by the poor dietary choices you make for them when they have no choice in the matter but to eat what is put in front of them.
So please, stop being in denial, stop ruining your health, stop ruining your bodies, and stop passing on your lack of discipline and poor choices to the next generation. It's all on you.
__________________________________________
Yes, I gave everyone both barrels with this one. Can't handle the truth? Not my problem. Deal with it.
Re:No, they don't work (Score:4, Insightful)
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I used to think so too but realized there is a nuance (as always) -- drugs may help some people to experience for the first time in many years what it means to be not obese, and that feeling may help them work on their own later on to get there. But I agree, drugs should be used in one-off and extreme cases.
Re: (Score:3, Interesting)
I wish /. had a like button.
I remember when I realized that not only had a chosen to take the stairs because the elevator was taking too long, but I had run up the last flight.
I disagree about only allowing special people to get treatment, but I can totally validate the intangible of losing a bunch of weight after having been stuck for a couple years.
It is all very subtle and nuanced. Slashdot, alas, is not a good forum for intelligent discussion.
The problem, as I see it, is that we are all speaking from o
Re:No, they don't work (Score:5, Insightful)
This. There is absolutely no point taking medication (FFS) to control your bad habits. As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more. The only caveat being there is some some recent evidence that some people do genuinely have more trouble with this than others but it doesn't make the advice any different. Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.
For many people, this is the solution. However, with a bit of hyperbole, your same advice would be true with drug addicts, but not work. You going to tell a heroine addict that they should just quit? Now, for eating too much, it's not nearly so bad, but there are some edge cases where I'm not sure that it's so clear cut. Sometimes the holes that we dig for ourselves are too deep to get out of.
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Sometimes the holes that we dig for ourselves are too deep to get out of.
That's just another way of saying "I've tried everything!" or "It's not my fault, it's my genetics!" or "It's not my fault, it's my thyroid!".
Oh, and it's apples and oranges to compare obesity with heroine addiction.
Denial ain't just a river in Egypt, friend.
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Re:The article is BS (Score:5, Insightful)
Wait? What's that? You mean the metabolic pathways for storing and releasing energy are complex and very different from person to person? You mean that the body actively fights to retain fat stores when less energy is available resulting in crippling pain, headaches, listlessness, inability to cocentrate and insomnia? You mean to say that obesity is caused by numerous interrelated factors that each require corrective action in concert to be effective? It even says so in TFA? Well shucks!
Who'd have thought an illness that 100 million people are unable to cope with might actually be difficult to cure?? No, no! That can't be it. Let's just say they're lazy gluttonous porkchops so we don't have to find solutions to a difficult problem. So much easier for us to sleep well at night.
Re:The article is BS (Score:4, Insightful)
His basic assertion that if people eat less calories than they expend they will lose weight is 100% correct. Saying "it's a complex disease and the body wants to store fat and there's different metabolic pathways" is irrelevant - if you eat less, you will lose weight.
Re:The article is BS (Score:5, Interesting)
During World War 2, the "Minnesota Starvation Experiment" was conducted. 30 healthy men had their maintenance level of calorie intake measured for a month or two, and then had that calorie intake cut in half with no changes to their daily minimum half an hour of exercise. At the end of the study, the participants had an average drop in resting metabolism of 30%, and that's not 30% lower than when they were heavier, it was 30% lower than predicted for someone at their new skinnier sizes. Most of the men had developed an eating disorder, a mood disorder (bipolar, depression, etc...), an obsession with food, or all three.
The devil is in the details.
Re:The article is BS (Score:4, Insightful)
Everyone I know who successfully lost weight and kept it off for years did it by making permanent, sustainable, healthy changes in their lives. A few of them learned to like veggies and other healthy foods. Others did that and also formed the habit of regular exercise. The point is to consume fewer calories than you burn until you reach a new equilibrium. Like so many other things that upset people, this works every time it's properly tried.
Re:The article is BS (Score:4, Insightful)
Yes - and it can also make you very sick at the same time. People have starved themselves to death whilst remaining obese. To simply say "eat less, you'll lose weight!" makes as much sense as saying "just remove all the microorganisms from your blood stream, and you'll be cured!" Simple, right? Whilst technically correct, unfortunately it is not at all a useful suggestion. The sooner people stop deluding themselves with trivial knee-jerk responses that tacitly blame the patient, the sooner we can make progress to finding an actual solution for a real problem. Remember: if it was that easy, nobody would be fat.
"Eat less" isn't the same thing as saying "eat nothing or nearly nothing while failing to obtain the nutrients you need".
"Blame" is also a small-minded concern. When I personally needed to lose some weight, there was no concern with fault or blame. I (get this) *took responsibility* for my own condition and made some adjustments to it. Some sustainable, permanent adjustments that did not involve neglecting the nutrition I needed. It was never a problem after that. In fact it was one of the easiest things I've ever done. That's because I took responsibility and accepted that the power to change it was within myself, the exact opposite of victimhood. This is exactly what I never see from fat people. They're victims and they are hostile to the idea that they don't need to be. That's because they don't understand the difference between fault/blame and responsibility/power. That's the part that is "not that easy" for so many because we have such a shallow, small-minded culture that doesn't like to think too deeply about much of anything no matter how much better life can be.
All you are saying is that doing something the stupid and careless way won't yield a good result. This was already known.
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if you eat less, you will lose weight.
Maybe so, but that doesn't mean your weight loss will be 100% FAT loss. On the contrary, consuming less calories can also cause your body to store up MORE fat, to compensate for the food shortage. Numerous studies have shown this effect... you just end up with a smaller "fat" rat than the control subject.
If you gradually switch from "eating more calories than I would have ever needed" to "eating about the right amount, give or take" I strongly doubt you'll have this problem. At least that wasn't my experience. The studies I have seen were all concerning unsustainable fad diets that you could not continue using for the rest of your life.
Re:The article is BS (Score:5, Informative)
Another factor that often gets overlooked in this debate is the role of sugar in our diet. [youtube.com] (Here's a written summary [nytimes.com] of the video.)
Last spring, the convenience stores in my area started stocking fresh fruit, so I switched my habitual breakfast from coffee and a Snickers bar to coffee and a piece of fruit. Around the same time, I saw the video linked above, and started actively avoiding sugar whenever it's convenient. These are the ONLY changes I've made to my lifestyle, but since then I have lost about four inches off my waistline.
Sugar is toxic. Do yourself a favor and avoid it. (Did you know that a 12oz can of coke does as much liver damage as a 12oz can of beer?) And artificial sweeteners are even worse. They mess up your insulin response profile and impede the signals which tell your brain when you've had enough to eat. (If you have a diet coke with dinner, you'll likely eat more food.)
The BBC did a four-part series on the "weight loss industry" earlier this year. It does a pretty good job of exposing the hype and marketing BS behind our current situation. Worth a look. [youtube.com]
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A fine example of the problem (Score:5, Insightful)
The previous post is a fine example of the problem: treating obesity as a moral failing. If you were a "good person" you'd have the willpower, eat right, etc.
Sure, modern lifestyles and diets are a contributor to the problem, but not the entire cause. There is ample peer-reviewed validated research out there that shows that some people are more efficient at metabolizing food, and that you can exercise as much as you like and eat as little, and still not lose weight as much (and suffer a variety of undesirable side effects in the process).
Bear in mind also that the underlying biochemistry of the "average adult" has changed as the result of food and activities during childhood. A travesty to be sure (juvenile onset diabetes, for instance), but now that you have that 20 year old with the screwed up biochemistry (in terms of comparison to 1900s man), you're not going to fix it by changing diet and activity.
And then, there's the practicality problem. If your job, which pays for the food you eat, requires you to sit in a cube with a headset on and a keyboard, no amount of Outside magazine inspired "get out and get fit" exhortation is going to provide an opportunity to "live a healthy lifestyle". Companies talk the talk, but when it comes to adversely affecting productivity, they do not walk the walk: that's why company wellness programs emphasize things like smoking cessation.. it's something you can do on your own time that saves the company money (yes, it's a good thing, but the real point is that the employee is doing the heavy lifting).
And so, after sitting in the cube all day, or inspecting people at a checkpoint, or whatever task there is, you ride the bus to your second job, so you can make the rent on your apartment in the food desert. Not a whole lot of time to prepare that nutritious meal from non-existent ingredients.
So, before exhorting "good healthy ways to eat", let's talk about paying people enough so they can afford to do so (in terms of time available, etc.)
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Our food changed sometime in the '70s or '80s. When I was a kid, overweight people were rather rare. Has the "modern" diet gotten us addicted when we're kids -- and still very active -- to foods that we should be eating very sparingly which then cause huge weight gains when we continue to eat them after we reach our early twenties and our post education lifestyle has us sitting in cars,
Re:No, they don't work (Score:5, Insightful)
Diet and exercise is fine advice for someone like me, who the doctor has suggested could stand to lose 15 pounds. I can accomplish that without drugs, and by doing it now, I'll likely improve my eating habits and not find myself needing to take off even larger amounts of weight later. But my eating habits are already pretty good compared to many, and I get lots of exercise ( I love walking and do walk anywhere I can get on foot safely ). I just need to arrest my sweet tooth a little.
Once people become obese though getting enough exercise to burn any serious calories can be very difficult. They can't walk to the store to do their shopping or spend 20min on the elliptical at home because they'd be exhausted after five. Yet they have all these fat cells their body now thinks it needs to maintain screaming eat constantly. Not impossible to conquer with will power alone perhaps but probably really freaking hard; at to the fact that because they can't get exercise easily their metabolism is probably lower than it should be and they can't burn the extra calories by working out so its going to take a seriously long time before they see any improvement. There is nothing more psychologically challenging then lots of hard work, and discomfort without any short term payoffs.
Yea I agree they did it to themselves and when it comes to who should have to pay more for a plane ticket, medical insurance, and similar where obesity decidedly raises costs, yea I think they should be expected to pay. They should have recognized a problem early and done something about it when it was possible, if they became obese as children their parents should have intervened.
But they are where they are now and if a drug can help them better themselves, why would you want to deny them? Once they get healthy they are going to need to learn good habits to stay healthy but that will be much easier for them if they could get healthy first.
Re:No, they don't work (Score:5, Insightful)
You can't exercise it off because exercise itself does not burn many calories at least not in proportion to what you can easily consume in a sitting. What it does do though is raise your metabolism. it causes your body to basically use more fuel all the time, so that its ready to support those more frequently occurring higher activity levels. So being physically active for a least a little while every day really is very important for most people to maintain a healthy weight.
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The more fat they have the less they need to eat.
Unfortunately it doesn't work like that. You'd think severely obese people don't need to eat at all; try that, and you'll end up with lots of dead people.
The human body can't live just on pure calories, there is a constant need for vitamins, minerals and such, without which it just starts dying. Stored fat has none of those, while at the same time using them up in order to get converted into usable calories. Meanwhile, food sources of this stuff are themselves laced with sugar and additional fats, so doing
Re: No, they don't work (Score:5, Insightful)
The reality is that unless you've been 50-100 pounds overweight all your life and worked your way down to a healthy weight for at least 5 years, your opinion about what makes people fat is worth less than dog shit.
Re: No, they don't work (Score:5, Insightful)
Fat != Lazy, there are countless factors involved. Been a single parent? Been in poverty where you can't afford groceries so live off of dollar menu fast food? Been injured where you can't exercise? How about combinations of these things?
In _YOUR_ experience being lazy was why you are fat. Your experiences are seemingly useless when discussing the real issues with obesity in the US.
The primary reason for obesity in the US from numerous studies is Poverty.
Re: No, they don't work (Score:5, Insightful)
Face it, if you're fat, you're most likely lazy too. Stop trying to find scapegoats and start accepting responsibility.
Just as 10/$1.00 Top Ramen and fast food dollar menus promote obesity, the anonymous posting option on Slashdot promotes shitheelery.
Re:No, they don't work (Score:5, Interesting)
There are so many aspects to why we're overweight as a society that it's stupid to cite any one thing as why. Sure, we don't move around enough, either at work or for our leisure time. We're taught that active, physical jobs are low-brow, and that the definition of success is to have others do things for us. We watch TV and sit at the computer instead of taking care of our homes and playing sports and working on things. We eat more than we should calorically. The kinds of things that we eat are bad for us. There aren't many rules about what companies are allowed to prepackage for food for us, and when rules do get passed, the public get pissed off and tries to reverse them.
This, "I don't wanna!" neoteny that our culture has fallen into, regarding getting out, being active, actually doing things is going to be our undoing. I actually support the idea of using medication to stimulate metabolism, at least enough to help us overcome the hump of inactivity, maybe if our metabolic rates were raised for a time before we get active, it'll be easier to get active in the first place.
I'm stuck in the same trap that we're all stuck in, it's Saturday morning and I'm sitting on my ass on the couch on my laptop, not really interested in fixing the compressed air distribution system in my shop or in insulating around the whirlpool bathtub or in putting new hatches on some of the openings to mechanical spaces, I'm warm and comfortable in my laziness. Yes, give me medication that makes it harder for me to sit still, and maybe I'll get my ass up and go do something. At least I finally accepted a few years ago that 99% of what's on TV is crap, so I have one less thing holding me here.
Re:No, they don't work (Score:5, Insightful)
It's not difficult. Eat less, move more.
Perhaps you meant to say "It's not complicated." It is quite obviously difficult for many people.
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So hundreds of millions of people are actually a single entity - "the" hambeast - who you know personally well enough to vouch for their character and motives?
That's some extremely disciplined thinking right there.
Re:No, they don't work (Score:5, Insightful)
There is absolutely no point taking medication (FFS) to control your bad habits.
You are wrong. Nicotine patches have helped millions of people quit smoking. These diet pills have also been shown, in controlled studies, to help many people achieve long term weight loss. Yes, people need to change their habits. But what you are missing, is that the drugs can help them do that. By achieving some weight loss, it can start them on the cycle of positive reinforcement.
Re:No, they don't work (Score:5, Insightful)
> which for 98% of the population is solved with willpower and determination alone
Spoken like someone who's never had to deal with weight issues.
You're a complete asshole. No, really.
>food isn't a addictive as heroin
It's worse, actually. You don't need heroin to live. You need food to live. It's always around. There is no putting it away. There is no removing yourself from the environment that triggers it.
And that's what you don't effin' get.
This calvinist shit really has gotten old.
But hey, you keep going with your preconceived notions about how things "should" work instead of how they do.
--
BMO
Re:No, they don't work (Score:5, Insightful)
This. There is absolutely no point taking medication (FFS) to control your bad habits.
Except for many, weight gain is not about bad habits. As much as the internet likes to have this "energy in needs to be less than energy out" story repeated at all corners, there's tons of reasons why it's not actually that simple. It's been found that overweight people commonly have a large variety of reasons why it doesn't work like that:
There's probably more, and this ignores a whole swathe of psychological reasons why overeating might occur without direct will, or in a similar way to addiction. This is simply some of the list of reasons why you might be fat, by eating the same amount as a skinny person, and exercising the same amount as them.
As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more.
Actually, that's not necessarily true. Commonly one of the reasons for high energy intake in fat people is that they are not processing sugar efficiently any more. This actively contributes to their body telling them they are hungry earlier, and that they want more sugary foods. By getting them down to a healthy weight, and keeping them there for a reasonable time, these diet pills may actually have a sufficient impact on the addiction that it breaks the cycle. That, and of course by reducing appetite they may well help control the brain's assumption of what a healthy meal size is.
Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.
Well done, you are demonstrating exactly the belief that it's a social condition, not a medical one talked about in TFA.
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100 million North Americans are trying to change their diet and it doesn't work. Most weight loss is undone after 3 years. The solution of telling people to "eat healthy" doesn't work. There really isn't much good evidence of what "eat healthy" even means. Think about it. How do you prove scientifically that "eating vegetables" is healthy? Most of the studies are associational. Greeks who eat a "traditional" Greek diet -- and who also climb up and down mountains all day -- have less heart disease. Eskimos w
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before anybody pops pills (Score:5, Insightful)
Ask yourself the following:
(1) Are you cooking most of what you eat yourself?
(2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?
(3) Have you been tracking your calories and weight daily for the past month?
If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.
Re:before anybody pops pills (Score:5, Interesting)
I lost 40 pounds by drastically increasing my saturated fat intake while reducing my refined carb intake.
Re:before anybody pops pills (Score:4, Interesting)
I should have clarified. I try to only eats fats that are made through old processes. So meat, dairy, lard, fish and cold pressed plant vegetables like olive, nut, and Avacado oils. Most are high in saturated fat. But unsaturated fats are mostly the byproduct of industrial processes requied heat and solvents. No thanks.
Re:before anybody pops pills (Score:5, Informative)
Cold pressed vegetable oils, avocados, and fish oils are (with a few exceptions) predominantly unsaturated fats. So it sounds like you mostly got the good kind of fat, you simply didn't realize what you were doing.
You're confusing unsaturated fats and partially hydrogenated vegetable oils; partially hydrogenated vegetable oils are really bad for you.
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You're simply wrong. Saturated fats aren't a problem, and have never been a problem.
That being said, omega3/6 fatty acid balance *is* important. Stick to grass-fed butter rather than corn fed cows.
If you're obese, and serious about changing, stop eating carbohydrates, and dramatically increase animal fat intake, with special attention to omega3/6 fatty acid balance.
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Butter is 3% polyunsaturated fat, and maybe 1% omega-3 if you get grass-fed butter. So, to get the recommended 1-2g of omega-3's per day, you need to consume between 750 and 1500 calories of butter alone. Even if saturated fats don't concern you, that's not going to work for a diet. Other animal fats aren't much better.
Re:before anybody pops pills (Score:5, Informative)
Re:before anybody pops pills (Score:5, Insightful)
Exactly. What do they feed cows to fatten them up for slaughter? Hint it's not fat.
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Oh hell yeah butter coffe. I drink 2 pints of Heavy Cream a week in my coffee.
Try this one. Get a good cocoa powder (just cocoa nothing else). Then get some coconut oil. Put the oil and cocoa powder in a pan or in the microwave and disolve the cocoa powder. Now add that to coffee and blend. It is awesome.
Re:before anybody pops pills (Score:4, Insightful)
Uh-huh. And if you haven't tried living off bananas [wikipedia.org], limited fasting [wikipedia.org], acai berries [wikipedia.org], or whatever the next fad diet to come along is, you haven't seriously tried losing weight either.
Re:before anybody pops pills (Score:4, Interesting)
or whatever the next fad diet to come along is
It is funny how for every fad diet there are tons of people who say it worked for them. That seems to be proof right there that whatever it is that works must be common to all of the diets. My guess is that simply being on a diet makes people more aware of what they are eating and that consciously or unconsciously causes them to eat less. Some people probably find it easier to do that with a specific type of diet, but the underlying mechanism is still the same.
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Calories in, calories out is true, but the form of the calories is also significant. We are not simple systems. The starch issue is about glycemic response. Essentially, when your body digests starches, it produces insulin. More sugars, more insulin. When the insulin falls off, your body tells you that you're hungry again. It's sort of like a boom/bust cycle, and the result is an urge to overeat because of the hormone response. It's significantly more difficult to maintain proper portions when you're hungry
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You're absolutely right: it's balancing calories in/out. Since you're not obese, your appetite control is working and your experience isn't relevant. People who actually are obese and trying to lose weight have a problem stopping to eat when they have already consumed enough calories. That is strongly influenced by the kinds of foods they eat. It happens frequently with starchy foods, foods containing lots of saturated fats, and meats, so any serious dieter should start by cutting those and see whether it h
Tons of food (Score:4, Interesting)
You can eat tons of stuff that isn't so good for you, right? Cool. And, how old are you?
I was underweight for much of my life. Around age 25 or so, I FINALLY "bulked up" to 160 pounds. I stayed near that weight right up to about age 47.
Age has some nasty surprises for some of us. One day I looked down, and realized that I had a pot belly. Wow, man! That ain't me!
At the same time, my knees started giving out on me. I don't run any more, can't run. Oh - to be honest, I CAN run, but a quarter mile jog is going to leave me suffering for a week or more.
So, I got a pot belly, I'm far less active, and that pot belly now tips the scales at ~195, has actually reached 200 a couple of times.
At six foot tall, 200 pounds isn't "obese" - but it's unhealthy. For me, at least, YMMV depending on your body build.
When you're over 50, getting close to 60 years old, let us know how easy it is to lose those unwanted pounds. If taking a pill could reduce the number of fat cells for me, I would seriously consider getting some.
However, I do understand the equations very well. Those pills aren't going to do anything good that is permanent. About the only way to remove fat permanently, without serious exercise and diet, is surgery.
I'm NOT willing to go that route.
Re:before anybody pops pills (Score:4, Interesting)
Not true at all. An extreme example would be 1 teaspoon of sugar, and 2 lego bricks. Both contain a fairly similar amount of energy. Only one of these will actually make it into your body if consumed.
This example is obviously dumb, but it's true of all foods –varying amount of the energy in those foods will actually make it into your body. Worse, varying bodies will get varying amounts of energy from them. This can be caused by bacterial fauna, metabolic rate, genetic efficiency of processing, the body's current state and hence it's desire to store or dispose of foods, etc.
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Sorry DogDude, but you've barked up the wrong tree. Calories in, calories out is a gross simplification that glosses over the most important factors of biochemistry.
Fat accumulation is driven by insulin, and the specific insulin resistance of fat cells versus other cells. You may be one of the lucky folks who is particularly insulin sensitive, allowing you to eat whatever you want without fat accumulation. Bully for you. On the other hand, anyone who is obese is suffering from a biochemical problem, not
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Exactly.
Step1 - Stop going to ANY restaurant or delivered food. All of it is utter crap, stop eating it.
Step2 - Buy only foods that are from the fresh food section and meat section. Veggies+Meat and only dark brown breads with whole wheat/grains
Step3 - download and install myfitness pal and do it religiously.
Step4 - repeat.
The biggest is to abandon restaurants completely. Every place from McDonalds to a 5 star bistro only make low grade dog food. Stop eating that crap. This step alone will make a HUGE
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I eat all the meat I want and I never gain weight. It's the starches and sugars that cause problems - meat and fat doesn't make you gain weight if you're not eating a bunch of sugar and starch.
Re:before anybody pops pills (Score:5, Insightful)
Re:before anybody pops pills (Score:5, Insightful)
You can get all the nutrients you need to be healthy entirely from plants.
Well... physically healthy, anyway. I'm not making any claims about the emotional or mental health of people who refuse to eat bacon.
Better Solution: Eat Shit (Score:2)
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Eat shit? No, I'm not going to Britain no matter how obese I am.
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The Brits aren't skinny because they eat shit, they are skinny because given the option of eating British food and starving, they starve.
Re:Better Solution: Eat Shit /. link (Score:2)
One Thing Is Clear (Score:2, Interesting)
Good health in a pill? Sure, why not? (Score:5, Insightful)
Hello,
I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.
I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.
And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.
If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!
--PeterM
Re:Good health in a pill? Sure, why not? (Score:5, Insightful)
What's so funny about this (and reinforced by the other replies to your post) is that people really object to the morality of other people "getting away with something" -- eating too much of the wrong food and not exercising enough.
I'm surprised they don't object to people with infections being treated with antibiotics, since if they had better hygiene they wouldn't get sick.
Why should you care if someone else is healthier by taking a pill?
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Hello,
I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.
I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.
And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.
If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!
--PeterM
Health is something that isn't nearly as simple as almost everyone seems to love to believe. The truth, based on current medical evidence, is that something like 60% of "obese" people are by all metrics besides BMI perfectly "healthy", while something like 60% of the people who are part of the epidemic of diabetes and afflicted with massive amounts of cardiovascular disease are people of normal body weight who everyone assumes are "healthy" solely due to their "normal" BMI. It just plain isn't that simple.
O
They are scared (Score:5, Insightful)
I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen [wikipedia.org] debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.
Re:They are scared (Score:5, Interesting)
Nah, as a doctor (in Australia, but i suspect most places are the same), we prescribe them only when a patient goes on & on, "but honestly, I dont eat much...", especially when the waiting room queue is getting longer.
We know they work, for a few months, before becoming less and less effective.
I'm guilty, I prescribe them to turn off a patients demands and get them out of my room, knowing they will see that the response is poor after the first few months.
Eat less, do more. That is reality, everything else is bullshit, or very temporary.
After 3 or 4 months, when the drugs stop working, some are ready to face reality. Those I can work with.
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You might look into lowering her overall carbohydrate intake, not just the sugar and candy.
I've been cycling vigorously for nearly an hour every day for the last 2 years and actually gained more weight. Until 3 months ago - when I went on a low-carb diet. With that simple change, I've lost more than 30 pounds. I don't restrict calories and eat whenever I'm hungry - I've just gotten rid of all the things like bread, potatoes, rice, etc.
What motivated me for this was a talk about the hormones around appeti
Simple.... (Score:2)
Most doctors education is lacking, Once the leave med school I don't see them going back for more education. My family doctor of 45 years graduated med school and became a GP in 1955, he even delivered me when I was born, and I saw him regularly until he died this past year. I know his education in medicine was way out of date but he was smart enough to refer me to a different doctor or specialist when It was needed. GP's need to do the same and refer patients to specialists that have more recent educ
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Most doctors are educated on constant basis by various pharmaceutical companies. Basically company pays for a weekend trip to a nice spa, that includes lectures on their lines of drugs, and what they do.
This is pretty much international phenomenon, and it's often frowned upon as it's seen as a form of bribing. As a result it's often legislated just how much companies can offer doctors, and how long such "vacations" can last and so on.
But these are also viewed as pretty much mandatory to keep doctor's knowle
Weight isn't the problem, it's a symptom (Score:5, Interesting)
My wife is morbidly obese. She for years has tried to lose weight with various diets and drugs. These had temporary weight loss effects, but all ultimately failed.
Why? Was my wife of inferior moral fiber and simply unable to follow through? Is she simply someone who needs to eat from a smaller plate, sit further away from the table, exercise more, eat less sugar, eat less carbs, eat more carbs, follow some arcane points system?
Nope. None of that works.
I'm a software engineer. Failure is a daily occurrence, and when we fail and study the failure, we learn the underlying problems and then we have success; and I've constantly encouraged my wife to keep trying. And she has; for over 10 years.
Two years ago, she contacted a weight counsellor / psychologist in Florida. In that time, they have peeled back the layers of her life, looking for the real, underlying problems. And, they found them. Who knew, for example, that being sexually abused as a 4yo child for years would cause problems? Who would have thought that when the attacker (a family "friend" next door) said things like "you would look prettier if you lost a bit of weight", it causes problems like gaining weight to try and make the pain go away? Why on earth would a narcissistic mother cause problems - especially when a 4yo comes to her bleeding from the vagina and covered in semen, and the mother simply wipes it away and says it never happened?
My wife's weight is far from something to be ashamed of. Instead, it's the mark of a person who came through some of the most horrendous things you can imagine - and lived.
The reason all the diets and drugs failed? Denial of the past and the problems in it. Simply becoming an adult doesn't mean the past will not affect you.
The future? Looking good. Since breaking through and working through all of her past, the underlying need to eat compulsively has gone. Guess what? She's loosing weight without a restrictive diet, drugs, surgery - whatever.
Obesity isn't a "disease" or anything like that. It's the symptom of something else. Medical dollars are best spent for people who are ready to lose the weight AND deal with their pasts by supplying them with competent psychologists, not the latest diet pills.
pills work, but only short term (Score:5, Interesting)
As a primary care physician, I gave in years ago. I now prescribe assorted appetite suppressants whenever some one asks me, it saves me lots of arguments, and a lot of time.
However, I get them back monthly for weigh ins. The drugs work great for a couple months, losing 4~8kg a month, then tapering off to nothing. Folk then realise that this is not a wonder cure.
The only stuff that works long term is eating less +/- exercising more, or surgery to shrink your stomach (actually the latter works pretty well, better than pills long term, in my experience. little change out of $10K, but probably worth it)
Pills are short term appetite suppressants. The following year, you are back to your previous weight, but your wallet is much lighter. Look to advice that you already know about for long term losses.
Here's another thing that works: (Score:5, Interesting)
Comment removed (Score:5, Insightful)
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Hi mate, I'm a type 1 diabetic in my mid thirties and I empathise completely with your comments and hope you're looking after yourself and keeping your HbA1c levels as low as possible.
In my experience I am constantly surprised by the lack of actual knowledge and education about diabetes. Sure, there's lots of awareness, which is good, but nobody seems to actually know anything. And unfortunately, I have to include doctors in that category. I've had the good (or bad) fortune to have my condition assessed in
Anger and obesity (Score:3, Insightful)
Im always amazed at the level of anger when the topic of obesity comes up. If there is a pill that helps fat people get skinny, so what? The logic must go like this "I put so much work into being fit, I am upset when someone else gets similar benefits without that same effort."
Manic
Re:Anger and obesity (Score:5, Insightful)
Actually they do work. (I'm on one of them.) (Score:3, Interesting)
(tl:dr The drugs work. People think about obesity wrong.)
To those that say they don't work, I would suggest you look at the trials. One of the differences between these regulated prescription drugs and supplements or (most) diets is that there are actual double-blind placebo controlled studies behind them. They do work. There is very good research to show that they do.
Qsymia, which I am on, gives an average of ten percent body weight loss beyond placebo, and the weight stayed off out to two years, which was the end of the study. I went from 269 to 253 in my first six weeks (13 pounds or 4.8%.) I feel much better now, and I have taken up weight lifting again. My weight isn't dropping, but I am clearly losing fat and gaining muscle. My weight is pretty stable, but I can feel ribs that I haven't felt since the nineties. None of my leather belts fit anymore. I'm wearing a belt with a friction buckle until I stop shrinking.
I also just got my quarterly labs back and my A1c is down 1.2% and my lipids are great. I'm getting lightheaded when I stand up too fast (orthostatic hypertension;) I have an appointment next week to talk to my doctor about reducing my blood pressure medication. You don't just lose weight, but the comorbidities go away with about 5% weight loss.
The main problem with obesity drugs can be seen in the comments here. People for whom obesity is not a disease don't understand what it is like to fight the disease. I'm old enough to remember when depression was treated the same way as obesity is treated now. Polite people said "try to think happy thoughts." "Just snap out of it" was a more common response. Today most people understand that some people have broken brain chemistry, and telling a depressed person to work harder at being happy isn't going to work. The researchers understand that obesity is a disease, and telling people to work harder at being healthy isn't going to work either. But most people don't understand that yet.
To the person who said diet pills are short term only, you are right and wrong. When a person who is on medication for a chronic condition stops taking their medication, the condition returns. That is how you know the medication is working. Obesity is a chronic condition. Because obesity was once thought of as something that could be cured, like an infection, pills used to be given for a short period. People would lose weight on the meds, the doctor would pronounce them cured, they would stop the meds, and they would regain the weight (and the high blood pressure, and the diabetes, and the dislypidemia, and all the other fun stuff that goes along with central body fat.) The researchers and educated doctors now understand that obesity is a chronic condition that responds well to medications. (It also responds very well to *intensive* lifestyle modification and surgery. Most doctors miss the word "intensive" in that sentence, which is the subject of another rant.) The current expectation is that you stay on the drug the rest of your life, possibly with drug holidays.
For me, Qsymia has been life changing. I had lost about 100 pounds of fat over about six years, but I was stuck and I still had type 2 diabetes, high blood pressure, and horrible lipid numbers. I was working out, hard, at least eight and a half hours a week plus two 50 minute weight lifting sessions with a private trainer. I watched what I ate, but I was still obese and I still had the health problems. Eventually I got discouraged and stopped working out hard. I still did 300 minutes a week on a treadmill, but I wasn't killing myself in the gym or lifting. Interestingly, I lost muscle and gained a little fat, but it made very little difference to my overall health. With Qsymia my eating changed dramatically, I lost a bunch of fat, and my lab numbers got better.
Whether you prefer anecdote or data, the result is the same. Qsymia is a game changer.
(Some disclosure. I'm a computer guy with no medical training. My girlfriend is an MD wh
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Imagine the money to be made between society's push to make being fat "normal," and the medical community's push to make obesity a "disease." Now they could cash in on treating an ever-increasing number of normal diseased people who are fat, but it's okay, that's normal, but it's a disease too, so go see the doctor!
If obesity was really a "chronic but treatable disease," where has it been the last 200,000 years? Why has it only existed on a large scale for the last 20 - 30 years? Changes in physiology do
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Imagine the money to be made between society's push to make being fat "normal,"
http://www.imdb.com/title/tt1368440/reference [imdb.com]
Re:Fasting (Score:5, Informative)
i am sorry this is not biochemistry this is made up "science". When ketosis is entered (by depleting ready carbohydrate resources) the body can metabolise fat into ketones (via the liver). The reason this myth persists is because for decades medical researchers couldn't imagine the brain running without glucose, which is a necessary condition of ketosis. Then some bright spark pointed out that the Innuit have been living like that for millenia and (shock horror), it works on western folks too!
Diet and exercise works every time. Guaranteed. There are no exceptions. If you are not exercising , a good chance you will lose some "lean mass". Loss of muscle through maintenance also occurs, so these statements are no helpful.
*however* biology is all about homoeostasis. When you look at your paunch and flabby bits, ask yourself the question "why does biology hang on to them". The body stores excess sugars as fat, as sugars in the blood are toxic. The hormone insulin causes this sequestration of the sugars into fat cells. If you go on a crash diet , the body is happy to burn up the fat. But the cells are still there. Returning to previous over-caloried state just fills the cells up again. Only by a gradual change onto a *lower* calorie diet will you lose the weight "permanently". Think 6 months minimum. Believe it or not 2lbs/week is a pretty good rule of thumb as the body gradually reallocates the cells. If you want to get "cut" that requires some more extreme measures...;-)
Recent research is showing that being overweight and diabetes are connected, although the data stretches back decades. The biggest FUD of the 20th century is the daily calorie limits. If they ever applied it was to a population that was more active, but modern folks spend way too much time on computers(!).
Biology is very complicated but the rules are simple. Everything in moderation....;-)
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Medical History of Ketogenic diets (Score:3)
i am sorry this is not biochemistry this is made up "science". When ketosis is entered (by depleting ready carbohydrate resources) the body can metabolise fat into ketones (via the liver). The reason this myth persists is because for decades medical researchers couldn't imagine the brain running without glucose, which is a necessary condition of ketosis.
A bit of medical history: Prior to the 1920's or so, ketogenic states were commonly encountered in two medical conditions: Epileptics, and Type I diabetics.
For epileptics, a ketogenic diet was one of the few methods of seizure control available, prior to the invention of anti-epileptics -- the whole goal was to run your brain mostly on ketone bodies. It's still used in some difficult cases, although it takes a great deal of discipline and attention, as the requirements are stricter than what a weight-cont
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They already have that, It's called gastric bypass and liposuction. you dont even have to wait to lose the weight.
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Wrong.
In medicine it is fully understood that you can pretty much bleed any patient's wallet dry.
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