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Query: UMLS:C0497406 (overweight)
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Very fat people die earlier than people of normal weight because hypertension, diabetes and coronary disease are more frequent among the markedly obese. Most obese subjects, however, are only slightly overweight and their mortality is not elevated. Reasons for dieting are more often psychological than somatic. 2. Reducing diets are ineffective because the obese rarely follow them. Total fasting and intestinal bypass may provide better results, but are more dangerous. 3. Atkins' diet eliminates carbohydrates from food without restricting protein and fat intake. Deprived of carbohydrates, the body uses fat for fuel. A small part of metabolized fat is eliminated in the urine as ketone bodies, and this is why such diets are called "ketogenic". They have been known at least since 1863. 4. Caloric loss due to ketonuria does not exceed 100 Cal/day in the non-diabetic. It is maximal during total fasting and cannot be increased by a ketogenic diet. 5. In the short run, such diets produce rapid weight loss due to polyuria. On the other hand, refeeding carbohydrates causes water retention and weight gain. 6. The diet decreases appetite: patients eat less without feeling severe hunger and without measuring their food intake. 7. Orthostatic hypotension, fatigue, and nausea are frequent, despite what Dr. ATKINS claims. 8. The diet increases plasma cholesterol and uric acid. It may be dangerous in diabetes (anorexia, acidosis) and in heart or kidney failure (hypokalemia). 9. The diet, though far from good, is better than the book. ATKINS' theories are at best half-truths, and the results he claims lack credibility. The obese subject's disappointment with traditional reducing diets and the book's hard-sell style account for ATKINS' success.
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PMID:[Dr. Atkins' dietetic revolution: a critique]. 89 45

Centrally acting appetite suppressant drugs used in the treatment of obesity fall into 2 broad pharmacological categories; those which act via brain catecholamine pathways and those which act via serotonin pathways. Of the former group, amphetamine and phenmetrazine are no longer recommended because of their stimulant properties and addictive potential. The remaining drugs in this class include amfepramone (diethylpropion), phentermine, mazindol and phenylpropanolamine. All have been shown to reduce appetite and lower food intake, thereby helping obese patients more easily keep to a low-calorie diet and lose weight. They all have some sympathomimetic and stimulant properties. Anorectic drugs which promote serotonin neurotransmission have no such stimulant or sympathomimetic properties. They are fenfluramine, together with its recently introduced dextrorotatory stereoisomer dexfenfluramine, and fluoxetine. They reduce appetite and food intake and are effective in the treatment of obesity. Anorectic drugs should be reserved for those who are clinically at risk from being overweight, and then only as part of a comprehensive weight-reducing programme including regular dietary counselling. Although current licensing regulations only allow their use over a relatively short period (12 to 16 weeks), clinical trials have shown them to be effective over longer periods, particularly in preventing weight regain. Of the compounds currently indicated for use in obesity, dexfenfluramine appears to have the most suitable pharmacological profile, although it should not be given to patients with a history of depression. When used appropriately, appetite suppressants can be of real therapeutic benefit, and pose little risk.
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PMID:Appetite suppressants. A review. 137 55

Persons who contacted the Anorexia/Bulimia Association of Norway for information and stated that they had an eating disorder were asked to participate in this questionnaire study. The answers from the 32 women who fulfilled the DSM-III-R criteria for bulimia nervosa are presented. Usually the women's eating problems had started in the teens after a period of voluntary dieting. The mean duration of bulimia nervosa was six years. 31% had a history of anorexia nervosa. At the time of the study almost all had normal body weight, but nevertheless felt overweight. 78% practised self-induced vomiting, 22% used laxatives and 16% used diuretics to reduce weight. Depressive and anxiety symptoms were common in connection with the overeating episodes, but also more generally, which interfered with everyday life. Somatic symptoms (abdominal pain, diarrhoea, constipation, dyspepsia, headache, dry mouth and eyes, parotid gland swelling, muscular symptoms, fatigue, and oligomenorrhoea) were also common.
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PMID:[Bulimia nervosa and self-reported symptoms. A questionnaire study among 32 women with bulimia nervosa]. 147 Nov 6

Anorectic agents constitute the most widely used supportive drug treatment in obesity as well as that most often prescribed. A large number of substances have been proposed for this purpose, and some have been found to be reasonably effective, while others exhibiting side effects which forbid their use, as thyroid hormones and diuretic agents. There are other substances with properties that might justify their use, such as ballast preparations, some antidepressive agents, and a few compounds acting principally on the gastrointestinal tract. Of current interest are substances furthering thermogenesis, but for the time being these remain in the realm of pure research. The anorectic agents usually available bring about a weight loss of about 0.5 lb (0.230 kg) per week more than prescription of a placebo, though only over a limited period of time. Once the drug is discontinued, weight regain is the rule and it appears even that association of an anorectic agent to behavioural therapy might have an unfavourable effect on maintenance of the weight loss. Their use is therefore difficult to justify except in the rare cases where a short-term reduction in weight is desired or in patients suffering from an illness linked to their overweight. Differences in eating habits observed with amphetamines compared with fenfluramine and its dextrorotatory isomer dexfenfluramine suggest that these compounds could play a supportive role in the management of obese patients along with the dietetic training and changes in eating habits which are still fundamental to the medical treatment of obesity.
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PMID:[Drug treatment of obesity]. 266 70

Three studies have been undertaken to investigate why there are individual differences in the response to d-fenfluramine with respect to food intake and hunger in the short term and on body weight loss in the long term. Fenfluramine and norfenfluramine plasma levels have been used as probes to help detect and normalize these variances. In a single dose ranging volunteer study (0, 30, 40, and 60 mg), d-fenfluramine levels were significantly related to caloric intake and hunger rating scales when compared individually, and the slopes of the regression lines showed intersubject variation. These slopes, an index of each subject's response to fenfluramine, appear to be related to both the percentage underweight and more weakly to the percentage overweight. Those subjects at the extremes of weight showed a greater response to a given drug level. In two placebo-controlled 3 month studies (30 mg/day), the variances in weight loss were not explained by steady state drug levels, the percentage overweight, initial weight, duration of obesity, or caloric intake even when weight loss was normalized for differences in drug levels. Age, however, was significantly related to weight loss, with each additional 10 years increasing weight loss by approximately 1 kg. If confirmed, the sensitivity of fenfluramine anorexia may be an objective acute test of the central control of food intake. However, in long term clinical studies, drug levels were only weakly related to weight loss and other undefined factors seem to determine which patients responded better to fenfluramine treatment.
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PMID:Factors that may effect the reduction of hunger and body weight following d-fenfluramine administration. 305 14

A novel model of nutritionally induced hypertension in the rat is described. Dietary obesity was produced by providing sweet milk in addition to regular chow, which elicited a 52% increase in caloric intake. Despite 54% greater body weight gain and 139% heavier retroperitoneal fat pads, 120 days of overfeeding failed to increase systolic pressure in the conscious state (125 +/- 8 vs. 121 +/- 4 mmHg in chow-fed controls) or mean arterial pressure under urethan anesthesia (71 +/- 4 vs. 63 +/- 3 mmHg). In contrast, mild hypertension developed in intermittantly fasted obese animals (a 21-mmHg increase in systolic blood pressure measured in the conscious state and a 16-mmHg increase in mean arterial pressure under anesthesia relative to chow-fed controls). The first 4-day supplemented fast was initiated 4 wk after the introduction of sweet milk, when the animals were 47 g overweight relative to chow-fed controls. Thereafter, 4 days of starvation were alternated with 2 wk of refeeding for a total of 4 cycles. A rapid fall in systolic blood pressure (12 +/- 2 mmHg at 2 days) accompanied the onset of supplemented fasting and was maintained thereafter (2.7 +/- 2.6 mmHg further decrease during the latter half of the fast). With refeeding, blood pressure rose precipitously (13 +/- 3 mmHg in the 1st 2 days), despite poststarvation anorexia. Blood pressure tended to rise slightly over the remainder of the realimentation period (5.2 +/- 2.8 mmHg). After the 4th supplemented fast, hypertension was sustained during 30 days of refeeding. Cumulative caloric intake in starved-refed rats fell within 2% of that in chow-fed controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Refeeding hypertension in dietary obesity. 333 69

The accumulated amount of research studies on anorexia has not until now produced a clear understanding of its etiology, symptoms and treatment. In this paper we deal with one aspect of the symptomatology: the delusion on the part of the anorectic patient of being normal or overweight. This issue, which seems the most obnoxious, is dealt with and discussed through a psychological model of group therapy with the participation of 7 anorectic women. Implications and limitations of further psychological treatment are clarified and revised.
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PMID:Homogeneous groups as treatment modality for anorectics. 362 87

This review summarizes recent work that focuses on the role of endogenous opioids (EOs) and opiate receptors in the control of food intake. Although the anorexic effect of opiate antagonists are now well accepted, the exact EO, site(s), and mechanism(s) of action remain to be established. However, accumulating evidence suggests that dynorphin, an endogenous ligand for kappa-type opiate receptors, is an important regulator (stimulant) of appetite. The roles of other EOs, such as beta-endorphin, are less clear. EOs appear to be involved in maintaining normal feeding behavior and are likely responsible for the overconsumption of fat in genetically obese and stressed subjects. Opiate antagonists block overconsumption of palatable foods, thus offering a promising approach to weight reduction for some overweight individuals. Anorexias may follow from a deficiency of kappa-type opioid activity, and surprisingly, can also result from excess opioid activity. Indeed, opiate antagonists of the mu type (naloxone) can enhance eating and weight gain in certain anorexic conditions. Therefore, it appears that excess opioid agonist activity may result in hyperphagia or anorexia (depending on the opiate receptor type). Finally, opiate antagonists may help normalize both types of pathological feeding states.
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PMID:Opioids, feeding, and anorexias. 614 54

The relationship between anorectic drug (stimulant) treatment and subsequent drug abuse in overweight individuals has often been discussed but seldom systematically studied. One hypothesis is that anorectic treatment promotes the likelihood of drug-abuse patterns. The present study involved a group of overweight psychiatric patients (n = 91) who were compared on the basis of whether or not they had used anorectic drugs in the past year and also whether or not they were currently using any form of psychoactive drugs. It was found that the use of anorectic drugs was mainly associated with weight problems, such as dieting difficulties, but not with amount of overweight. Anorectic use and other weight-problem variables do not seem to be strongly related to the psychiatric patient's drug problems.
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PMID:Psychoactive drug use among overweight psychiatric patients: problem aspect of anorectic drugs. 692 77

The relationship between anorectic drug (stimulant) treatment and subsequent drug abuse in overweight individuals has often been discussed but seldom systematically studied. One hypothesis is that anorectic treatment promotes the likelihood of drug-abuse patterns. The present study involved a group of overweight psychiatric patients (n=91) who were compared on the basis of whether or not they had used anorectic drugs in the past year and also whether or not they were currently using any form of psychoactive drugs. It was found that the use of anorectic drugs was mainly associated with weight problems, such as dieting difficulties, but not with amount of overweight. Anorectic use and other weight-problem variables do not seem to be strongly related to the psychiatric patient's drug problems.
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PMID:Psychoactive drug use among overweight psychiatric patients: problems aspects of anorectic drugs. 722 87


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