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Vitamin D : Get Levels Checked Soon

In Health, Healthcare, Medicine on September 24, 2012 at 8:00 am

WHY WORRY ABOUT LOW VITAMIN D LEVELS?

The normal range is 30.0 to 74.0 nanograms per milliliter (ng/mL).

Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol

Lower than normal levels suggest a vitamin D deficiency. This condition can result from:

  • Lack of exposure to sunlight
  • Lack of adequate vitamin D in the diet
  • Liver and kidney diseases
  • Malabsorption
  • Use of certain medicines, including phenytoin, phenobarbital, and rifampin
Recommended Dietary Allowances (RDAs) for Vitamin D 
Age Male Female Pregnancy Lactation
0–12 months* 400 IU
(10 mcg)
400 IU
(10 mcg)
1–13 years 600 IU
(15 mcg)
600 IU
(15 mcg)
14–18 years 600 IU
(15 mcg)
600 IU
(15 mcg)
600 IU
(15 mcg)
600 IU
(15 mcg)
19–50 years 600 IU
(15 mcg)
600 IU
(15 mcg)
600 IU
(15 mcg)
600 IU
(15 mcg)
51–70 years 600 IU
(15 mcg)
600 IU
(15 mcg)
>70 years 800 IU
(20 mcg)
800 IU
(20 mcg)

* Adequate Intake (AI)

Immunity

Vitamin D appears to have effects on immune function. It has been postulated to play a role in influenza with lack of vitamin D synthesis during the winter as one explanation for high rates of influenza infection during the winter. For viral infections, other implicated factors include low relative humidities produced by indoor heating and cold temperatures that favor virus spread. Low levels of vitamin D appear to be a risk factor for tuberculosis, and historically it was used as a treatment. As of 2011, it is being investigated in controlled clinical trials. Vitamin D may also play a role in HIV. Although there are tentative data linking low levels of vitamin D to asthma, there is inconclusive evidence to support a beneficial effect from supplementation. Accordingly, supplementation is not currently recommended for treatment or prevention of asthma. Also, preliminary data is inconclusive for supplemental vitamin D in promotion of human hair growth.

Mortality

Low blood levels of vitamin D are associated with increased mortality, and giving supplementary vitamin D3 to elderly women in institutional care seems to decrease the risk of death. Vitamin D2, alfacalcidol, and calcitriol do not appear to be effective. However, both an excess and a deficiency in vitamin D appear to cause abnormal functioning and premature aging. The relationship between serum calcidiol level and all-cause mortality is U-shaped, Harm from vitamin D appears to occur at a lower vitamin D level in the black population than in the white population.

Bone health

Vitamin D deficiency causes osteomalacia (called rickets when it occurs in children). Beyond that, low serum vitamin D levels have been associated with falls, and low bone mineral density.

In 2012, the U.S. Preventive Services Task Force issued a draft statement recommending that there is not enough evidence to indicate that healthy postmenopausal women should use supplemental doses of calcium or vitamin D to prevent fractures.

Some studies have shown that supplementation with vitamin D and calcium may improve bone mineral density slightly, as well as decreasing the risk of falls and fractures in certain groups of people, specifically those older than 65 years. This appears to apply more to people in institutions than those living independently. The quality of the evidence is, however, poor. And there does not appear to be a benefit to bone health from vitamin D without sufficient calcium.

Cardiovascular disease

Evidence for health effects from vitamin D supplementation for cardiovascular health is poor. Moderate to high doses may reduce cardiovascular disease risk but are of questionable clinical significance.

Multiple sclerosis

Low levels of vitamin D are associated with multiple sclerosis. Supplementation with vitamin D may have a protective effect but there are uncertainties and unanswered questions. “The reasons why vitamin D deficiency is thought to be a risk factor for MS are as follows: (1) MS frequency increases with increasing latitude, which is strongly inversely correlated with duration and intensity of UVB from sunlight and vitamin D concentrations; (2) prevalence of MS is lower than expected at high latitudes in populations with high consumption of vitamin-D-rich fatty fish; and (3) MS risk seems to decrease with migration from high to low latitudes.” A clinical trial sponsored by ChariteUniversity in Berlin, Germany was begun in 2011, with the goal of examining the efficacy, safety and tolerability of vitamin D3 in the treatment of Multiple Sclerosis.

Cancer

Low vitamin D levels are associated with some cancers and with worse outcomes in other cancers, but taking supplements does not appear to help people with prostate cancer. Currently evidence is insufficient to support supplementation in those with cancer. Results for a protective or harmful effect of vitamin D supplementation in other types of cancer are inconclusive.

So, get your levels checked today. It is a simple test. Call your healthcare provider to get the test ordered. It will save you from a bad future of your health !!!

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HEALTHCARE MANGEMENT BUSINESS MODELING

In Health, Healthcare, Medicine on September 20, 2012 at 8:00 am

 

Current Healthcare situation is changing. Performance is awarded, not value.

HEALTHCARE MANAGEMENT ISSUES

1. Cost

One of the biggest issues in healthcare management is the cost of medical care services and insurance. Health insurance rates often increase faster than inflation, which means they consume a larger portion of an employer’s money or an individual buyer’s income. Some employers cut their health benefits to employees as costs rise or during a period of financial distress, forcing more people to pay for their own healthcare. Those who can’t afford to do so add to the number of uninsured Americans or receive benefits from a government-subsidized program such as Medicare or Medicaid.

2. Litigation

Litigation is a significant issue for medical practices and healthcare providers alike. The threat of malpractice suits forces doctors to spend a great deal on malpractice insurance, and practitioners must pass some of this cost on to patients. Legal disputes between patients, insurance providers and healthcare providers take time and money away from medical research and treating patients.

3. Access

Access to affordable, high-quality healthcare is far from a given for millions of people. Programs such as Medicare and Medicaid are only available to elderly and low-income individuals and families that qualify. Group insurance is only an option for members of groups that receive reduced rates, such as employees of a company or members of a social club.

4. Staffing

Staffing is an ongoing issue in hospitals, doctors’ offices, nursing homes and other facilities that needs trained specialists on hand to assist patients. The broad shortage of nurses means that many duties fall to untrained or inexperienced assistants, thereby driving up the likelihood of error. Discrepancies in pay draw medical students away from certain fields and into others, resulting in a lopsided distribution of doctors and a lack, or surplus, of options for patients.

5. Types of Care

Healthcare management seeks to offer different types of care to patients. For example, terminally ill patients may elect to receive end-of-life palliative care, which focuses on alleviating symptoms instead of aggressively combating disease. Preventative care takes place before symptoms appear and saves time and money in the long-term, but requires an early awareness and up-front spending by insurance providers or patients. Electing between different types of care requires healthcare providers to educate patients and also demands that individuals take control of their own healthcare needs.
Do we have the Right Models?

Health care is the country’s economic black hole, rising from about 13% of U.S. GDP in 1999 to 18% in 2009. By 2025, it is projected to soar to 25%. Legislation and regulation can only go so far in fixing the system, and new technology can’t do much on its own. To truly combat health care’s cost challenge, the focus must shift to disruptive business models–innovative ways of delivering existing treatments at a much lower cost.

While new business models are needed across the spectrum of healthcare, many impediments prevent new ideas from taking root. Barriers stem from the fact that health care in America doesn’t function like the free market. For instance, consumers rarely pay directly for their own care, so there is little incentive for making trade-offs such as choosing something cheaper that costs less. The regulatory environment often doesn’t allow inexpensive solutions to make it to market. Finally, there are mismatched incentives: hospitals want patients to get that operation, but insurance companies don’t.

Health care in America doesn’t function like the free market. Given all that’s standing in the way of enabling new business models, we must take note when promising ones appear ready to take off.

The lesson isn’t that healthcare companies should accept charging less and making lower profits. Instead, through business model innovation, companies need to examine their value chains and throw away assumptions about the way things are done. By reinventing business models we can dramatically reduce costs and greatly improve care.

 

What does this all mean?

Successful healthcare organizations have to excel in:

  • Forging Trusted Relationships: Between Management, Providers and Patients
  • Building Networked Business Models: Connecting value-exchanging entities
  • Realizing Sustainable Economies of Scale: On both a discrete and networked basis
  • Focusing on Core Competencies: Borrowing skills and assets where required

To perform well, a healthcare organization needs,

1. Strong Management

2. Healthcare Information Technology

3. Employee Satisfaction and Retention

4. Patient Satisfaction

5. Quality Improvement

6. Training

7. Data Tracking

Q: How can changes be made?    

 A:  BY INNOVATION

Innovation of Management tools

1. Setting Goals

2. Value of Organizational Behavior

3. Develop workable business and IT infrastructure models.

4. Extending the patient-physician interaction beyond the office visit using telemedicine tools, as well as using health information exchange (HIE) to aggregate data from multiple sources.

5. Meaningful Use Guidelines:

  • Patients View, Download and Transmit Their Health Information
  • HIE Crossing Vendor and Organizational Boundaries
  • Secure Electronic Messaging
  • Summary of Care Documents
  • eMAR
  • Medication Reconciliation
  • CPOE
  •  Clinical Quality Measures

6. Applying Lean and Six sigma to current Management and workforce.

7. TELE-HEALTH: Being able to communicate using IT tools to help patients stay healthy and get rewarded well.

8. Transparency: Everyone should know what is happening in the organization.

Colors of OM: Relaxation and Meditation with Powerful OM Chants

In Health, Healthcare, Medicine on September 18, 2012 at 9:01 pm

Colors of OM: Relaxation and Meditation with Powerful OM Chants

“Om” is the primordial sound of the universe, the first vibration of creation, the eternal sound of the divine. “Om” in particular helps center and calm participants, bringing a sense of peace, focus and connection to ourselves, each other and the world. When chanted in repetition “om” is invigorating, strengthening and an effective way to release stress. Here are a number of the benefits of chanting “om.”

Physiological Effects:

1.slows the heart beat
2.relaxes muscles
3.calms the body
4.decreases blood pressure
5.oxygenates the blood
6.massages the spine, chest, core, throat and head through vibrations

Mental/Emotional Effects:

1. induces the relaxation response
2.improves task performance
3.increases clarity and concentrated focus
4.soothes the mind
5.increases effectiveness and motivation
6.deepens the connection to spiritual self
7.creates a sense of community (group chanting)

Seeking treatment for Eating Disorders

In Health, Healthcare, Medicine on September 18, 2012 at 8:00 am

Questions to Ask When Considering Treatment Options

 

There are various approaches to eating disorders treatment. It is important to find an option that is most effective for your needs.

Questions to Ask Your Treatment Provider
Once you have chosen a treatment provider, you may want to consider asking these questions in your first meeting.

Eating Disorders Survival Guide
Eating disorders can lead to significant physiological changes that require medical treatment in addition to psychiatric treatment and the reimbursement system does not allow for a holistic approach. For this reason, patients and families frequently have to fight to get the appropriate and necessary treatment.

Securing Eating Disorders Treatment: Ammunition for Arguments with Third Parties
Unfortunately, some patients and families frequently have to fight to get the appropriate and necessary treatment for eating disorders. Here are some arguments to use when trying to secure treatment from an insurance provider or another third party.

Substance Abuse and Eating Disorders
Research suggests that nearly 50% of individuals with an eating disorder (ED) are also abusing drugs and/or alcohol, a rate 5 times greater than what is seen in the general population according to the National Center on Addiction and Substance Abuse.

Suggested Medical Tests
A complete medical assessment is important when diagnosing eating disorders. Talk with your doctor about performing specific laboratory tests.

Sharing with EEEase
When you begin to notice that disordered eating habits are affecting your life, your happiness, and your ability to concentrate, it is important that you talk to somebody about what you’re going through.

Treatment of Eating Disorders
The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient’s individual problems, needs, and strengths.

What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder
If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders

Twelve Ideas for Negotiating the Holidays
The Holidays can be a time to spend with loved ones and a time to celebrate. They can also be a time when food and family can provoke anxiety and present triggers. This guide suggests a few ideas that may help you plan ahead and get your supports in place.

Source: http://www.nationaleatingdisorders.org/information-resources/general-information.php

 

Basics of Eating Disorders

In Health, Healthcare, Medicine on September 17, 2012 at 8:00 am

Terms and definitions:

 

Anorexia, Bulimia, & Binge Eating Disorder: What is an Eating Disorder?

Eating disorders such as anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding weight and food issues.

Anorexia Nervosa

Anorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.Binge Eating Disorder
Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Bulimia Nervosa
Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Eating Disorders Not Otherwise Specified (EDNOS)
A person does not have to be diagnosed with Anorexia, Bulimia or BED to have an eating disorder. An eating disorder can include a combination of signs and symptoms but not meet the full criteria. Read more about the individual signs and symptoms in this handout.

 Prevention:

Eating Disorders can be Prevented!
Eating disorders arise from a variety of physical, emotional, social issues, all of which need to be addressed for effective prevention and treatment.

50 Ways to Lose the 3Ds: Dieting, Drive for Thinness, and Body Dissatisfaction
Individuals involved with youth and adolescents, such as educators, parents, health professionals, and physicians can prevent the further development of issues and concerns regarding weight through their own actions and words of encouragement toward healthful eating practices and attitudes.

Factors that may contribute to eating disorders:

Factors that May Contribute to Eating Disorders
While eating disorders may begin with preoccupations with food and weight, they are most often about much more than food. NEDA acknowledges there may be a difference of opinion among experts and the literature on this topic and we encourage readers to explore the topic further, using all means available to them. 

Body image issues:

Body Image
Body image is how you see yourself when you look in the mirror or picture yourself in your mind.

Every Body is Different
Genetics influence bone structure, body size, shape, and weight differently in every person.

Listen to Your Body
Eat what you want, when you are truly hungry. Stop when you’re full. And eat exactly what appeals to you. Do this instead of any diet, and you are unlikely to ever have a weight problem, let alone an eating disorder. Eat when you are truly hungry. Stop when you are full.

No Weight!
Signing this declaration of independence from a weight-obsessed world may help you accept your body’s natural shape and size.

Ten “Will-Powers” for Improving Body Image
Taking care of your body and doing things you enjoy will enable you to enjoy a happy, participatory life.

Ten Steps To Positive Body Image
One list cannot automatically tell you how to turn negative body thoughts into positive body image, but it can help you think about new ways of looking more healthfully and happily at yourself and your body. The more you do that, the more likely you are to feel good about who you are and the body you naturally have.

The Media, Body Image, and Eating Disorders
Eating disorders are complex conditions that arise from a variety of factors, including physical, psychological, interpersonal, and social issues. Media images that help to create cultural definitions of beauty and attractiveness are often acknowledged as being among those factors contributing to the rise of eating disorders.

Twenty Ways to Love Your Body!
Think of your body as the vehicle to your dreams. Honor it. Respect it. Fuel it.

Health concerns:

Eating Concerns and Oral Health
Dietary habits can and do play a role in oral health. Everyone has heard from their dentist that eating too much sugar can lead to cavities, but did you know that high intake of acidic “diet” foods can have an equally devastating effect on your teeth?

Health Consequences of Eating Disorders
Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.

 Dieting: Risks and Reasons to Stop
Americans spend more than $40 billion dollars a year on dieting and diet-related products. What do we get for our money?

Laxative Abuse: Some Basic Facts
Laxative abuse is serious and dangerous – often resulting in a variety of health complications and sometimes causing life-threatening risks.

Orthorexia

Orthorexia is a term coined by Steven Bratman, MD, to describe his own experience with food and eating.  It is not an officially recognized disorder, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being ‘thin’ and losing weight).
Diabulimia
Not a recognized medical diagnosis, diabulimia refers to the condition in which an individual with an eating disorder, who also has diabetes, manipulates insulin levels to manage weight. It carries serious health consequences.
For more information about diabulimia and where you can find help, please contact our toll free information and referral helpline at 800-931-2237Tests and Screening
Primary care providers may be the first person to recognize and offer assistance regarding a patient’s eating and weight concerns. These questions and tests can help doctors with initial screening and diagnosis.

 

Economic Costs Related to Overweight and Obesity

In Health, Healthcare, Medicine on September 14, 2012 at 8:00 am

As the prevalence of overweight and obesity has increased in the United States, so have related health care costs. The statistics presented below represent the economic cost of obesity in the United States in 2006, updated to 2008 dollars.

 

Q: What is the cost of obesity?

A: On average, people who are considered obese pay $1,429 (42 percent) more in health care costs than normal-weight individuals.

What is the cost of obesity by insurance status?

A: For each obese beneficiary:

  • Medicare pays $1,723 more than it pays for normal-weight beneficiaries.
  • Medicaid pays $1,021 more than it pays for normal-weight beneficiaries.
  • Private insurers pay $1,140 more than they pay for normal-weight beneficiaries.

What is the cost of obesity by the type of service provided?

A: For each obese patient:

  • Medicare pays $95 more for an inpatient service, $693 more for a non-inpatient service, and $608 more for prescription drugs in comparison with normal-weight patients.
  • Medicaid pays $213 more for an inpatient service,$175 more for a non-inpatient service, and $230 more for prescription drugs in comparison with normal-weight patients.
  • Private insurers pay $443 more for an inpatient service, $398 more for a non-inpatient service, and $284 more for prescription drugs in comparison with normal-weight patients.

 

How physically active is the U.S. population?

In Health, Healthcare, Medicine on September 12, 2012 at 1:05 pm

 How physically active is the U.S. population?

 

 Only 31 percent of U.S. adults report that they engage in regular leisure-time physical activity (defined as either three sessions per week of vigorous physical activity lasting 20 minutes or more, or five sessions per week of light-to-moderate physical activity lasting 30 minutes or more). About 40 percent of adults report no leisure-time physical activity.

About 35 percent of high school students report that they participate in at least 60 minutes of physical activity on 5 or more days of the week, and only 30 percent of students report that they attend physical education class daily. As children get older, participation in regular physical activity decreases dramatically.

In contrast to reported activity, when physical activity is measured by a device that detects movement, only about 3–5 percent of adults obtain 30 minutes of moderate or greater intensity physical activity on at least 5 days per week. Among youth, measured activity provides information on younger children than is available with reports and highlights the decline in activity from childhood to adolescence. For example, 42 percent of children age 6–11 obtain the recommended 60 minutes per day of physical activity, whereas only 8 percent of adolescents achieve this goal.

What are the benefits of physical activity?

Research suggests that physical activity may reduce the risk of many adverse health conditions, such as coronary heart disease, stroke, some cancers, type 2 diabetes, osteoporosis, and depression. In addition, physical activity can help reduce risk factors for conditions such as high blood pressure and blood cholesterol. Researchers believe that some physical activity is better than none, and additional health benefits can be gained by increasing the frequency, intensity, and duration of physical activity.

 

Medications for the Treatment of Obesity

In Health, Healthcare, Medicine on September 5, 2012 at 11:43 am

 

Weight-loss medications should always be combined with a program of healthy eating and regular physical activity.

Obesity is a chronic disease that affects many people. To lose weight and maintain weight loss over the long term, it is necessary to modify one’s diet and engage in regular physical activity. Some people, however, may require additional treatment. As with other chronic conditions, such as diabetes or high blood pressure, the use of prescription medications may be appropriate for some people who are overweight or obese.

Prescription weight-loss medications should be used only by patients who are at increased medical risk because of their weight. They should not be used for “cosmetic” weight loss. In addition, patients should have previously tried to lose weight through diet and physical activity.

Prescription weight-loss drugs are approved only for those with:

  • A body mass index (BMI) of 30 and above.
  • A BMI of 27 and above with an obesity-related condition, such as high blood pressure, type 2 diabetes, or dyslipidemia (abnormal amounts of fat in the blood).

BMI is a measure of weight in relation to height that helps determine if your weight places your health at risk. A BMI of 18.5 to 24.9 is considered healthy. A BMI of 25 to 30 is considered overweight, and a BMI over 30 is considered obese. (See WIN’s brochure Weight and Waist Measurement: Tools for Adults for more information.)

Although most side effects of prescription medications for obesity are mild, serious complications have been reported. Also, few studies have evaluated the long-term safety or effectiveness of weight-loss medications. Weight-loss medications should always be combined with a program of healthy eating and regular physical activity.

The information in this fact sheet may help you decide if and what kind of weight-loss medication may help you in your efforts to reach and stay at a healthy weight. It does not replace medical advice from your doctor.

Table 1 provides an overview of medications that may be prescribed for weight loss.

Table 1
Generic Name Food and Drug Administration Approval for Weight Loss Drug Type Common Side Effects
Phentermine Yes; short term (up to 12 weeks) for adults Appetite Suppressant Increased blood pressure and heart rate, sleeplessness, nervousness
Diethylpropion Yes; short term (up to 12 weeks) for adults Appetite Suppressant Dizziness, headache, sleeplessness, nervousness
Phendimetrazine Yes; short term (up to 12 weeks) for adults Appetite Suppressant Sleeplessness, nervousness
Orlistat Yes; long term (up to 1 year) for adults and children age 12 and older Lipase Inhibitor Gastrointestinal issues (cramping, diarrhea, oily spotting), rare cases of severe liver injury reported
Bupropion No Depression Treatment Dry mouth, insomnia
Topiramate No Seizure Treatment Numbness of skin, change in taste
Zonisamide No Seizure Treatment Drowsiness, dry mouth, dizziness, headache, nausea
Metformin No Diabetes Treatment Weakness, dizziness, metallic taste, nausea

Because weight-loss medications are used to treat a condition that affects millions of people, the possibility that side effects may outweigh benefits is of great concern.

Most of the Food and Drug Administration (FDA)-approved weight-loss medications are approved for short-term use, meaning a few weeks, but doctors may prescribe them for longer periods of time—a practice called “off-label” use. (See the below for more information about off-label use.) Orlistat is the only weight-loss medication approved for longer-term use in patients who are significantly obese. Its safety and effectiveness have not been established for use beyond 2 years, however.

Appetite Suppressants. Most available weight-loss medications approved by the FDA are appetite-suppressant medications. These include phentermine, phendimetrazine, and diethylpropion. Appetite-suppressant medications promote weight loss by decreasing appetite or increasing the feeling of being full. These medications make you feel less hungry by increasing one or more brain chemicals that affect mood and appetite. Phentermine is the most commonly prescribed appetite-suppressant in the United States.

NOTE: Amphetamines are a type of appetite suppressant. However, amphetamines are not recommended for use in the treatment of obesity due to their strong potential for abuse and dependence.

Lipase Inhibitors. In 1999, the FDA approved the drug Xenical (orlistat) as a prescription weight loss drug. Orlistat reduces the body’s ability to absorb dietary fat by about one-third. It does this by blocking the enzyme lipase, which is responsible for breaking down dietary fat. When fat is not broken down, the body cannot absorb it, so it is eliminated and fewer calories are taken in.

In early 2007, orlistat was approved for over-the-counter (OTC) sale for adults age 18 and over. This means that the drug may be purchased without a prescription. The OTC version of orlistat is sold under the brand name alli. Alli is meant to be taken with a reduced-calorie, low-fat diet, exercise, and a daily multivitamin. Its side effects are similar to those for prescription orlistat. Anyone considering taking alli should read information about side effects, drug interactions, and usage recommendations on the drug’s packaging or website, http://www.myalli.com

The following types of medication(s) are not FDA-approved for the treatment of obesity. However, they have been shown to promote short-term weight loss in clinical studies and may be prescribed off-label.

Drugs to treat depression. Some antidepressant medications have been studied as appetite-suppressant medications. While these medications are FDA-approved for the treatment of depression, their use in weight loss is an off-label use . Studies of these medications have generally found that patients lose modest amounts of weight for up to 6 months, but that patients tend to regain weight while they are still on the drug. One exception is bupropion. In one study, patients taking bupropion maintained weight loss for up to 1 year.

Drugs to treat seizures. Two medications used to treat seizures, topiramate and zonisamide, have been shown to cause weight loss. Whether these drugs will be useful in treating obesity is being studied.

Drugs to treat diabetes. The diabetes medication metformin may promote small amounts of weight loss in people with obesity and type 2 diabetes. How this medication promotes weight loss is not clear, although research has shown reduced hunger and food intake in people taking the drug.

Drug combinations. The combined drug treatment using fenfluramine and phentermine (known as “fen/phen”) is no longer available due to the withdrawal of fenfluramine from the market after some patients experienced serious heart and lung disorders. (See the “Potential Risks and Concerns” section.) Little information is available about the safety or effectiveness of other drug combinations for weight loss, including fluoxetine/phentermine, phendimetrazine/phentermine, herbal combinations, or others. Until more information on their safety or effectiveness is available, using combinations of medications for weight loss is not recommended, except as part of a research study.

What is “off-label” use?

Although the FDA regulates how a medication can be advertised or promoted by the manufacturer, these regulations do not restrict a doctor’s ability to prescribe the medication for different conditions, in different doses, or for different lengths of time. The practice of prescribing medication for periods of time or for conditions not FDA-approved is known as off-label use. While such use often occurs in the treatment of many conditions, you should feel comfortable about asking your doctor if he or she is using a medication or combination of medications in a manner that is not approved by the FDA. The use of more than one weight-loss medication at a time (combined drug treatment) is an example of an off-label use. Using weight-loss medications other than orlistat for more than a short period of time (i.e., more than “a few weeks”) is also considered off-label use.

People respond differently to weight-loss medications, and some people experience more weight loss than others. Weight-loss medications lead to an average weight loss of about 10 pounds more than what you might lose with nondrug obesity treatments. Maximum weight loss usually occurs within 6 months of starting the medicine. Weight then tends to level off or increase during the remainder of treatment.

Over the short term, weight loss in individuals who are obese may reduce a number of health risks. Studies have found that weight loss with some medications improves blood pressure, blood cholesterol, triglycerides (fats), and insulin resistance (the body’s inability to use blood sugar). New research suggests that long-term use of weight-loss drugs may help individuals keep off the weight they have lost. However, more studies are needed to determine the long-term effects of weight-loss drugs on weight and health.

Potential Risks and Concerns

Research has yet to determine the long-term health effects of weight-loss drugs. To date, the longest study is a 4-year investigation of orlistat. Most other studies have lasted 6 to 12 months or less. In addition, research has not examined rare side effects (those occurring in less than 1 per 1,000 patients), and the optimal duration of treatment is unknown.

When considering long-term weight-loss drugs to treat obesity, you should consider the following areas of concern and potential risks.

Potential for abuse or dependence. Currently, all prescription medications to treat obesity except orlistat are controlled substances, meaning doctors need to follow certain restrictions when prescribing them. Although abuse and dependence are not common with nonamphetamine appetite-suppressant medications, doctors should be cautious when they prescribe these medications for patients with a history of alcohol or other drug abuse.

Development of tolerance and weight regain. Most studies of weight-loss drugs show that a patient’s weight tends to level off after 6 months while still on the drug. Although some patients and doctors may be concerned that this shows tolerance to the medications, the leveling off may mean that the maximum amount of weight loss that the drug can produce has been achieved.

Studies examining the effects of weight loss drugs showed that after one year, patients receiving a weight loss drug lost more weight than patients in the placebo group. Findings also indicated that patients who continued treatment regained less weight compared with those who stopped treatment.

Reluctance to make behavioral changes while using prescription medications. Patients who are overweight or obese should be able to seek medical treatment to prevent health risks that can cause serious illness and death. Weight-loss drugs, however, are not “magic bullets” or a one-shot fix for this chronic disease. They should always be combined with a healthy eating plan and increased physical activity.

Side effects. Because weight-loss drugs are used to treat a condition that affects millions of people, many of whom are basically healthy, the possibility that side effects may outweigh benefits is of great concern. Most side effects of these drugs are mild and usually improve with continued use. Rarely, serious and even fatal outcomes have been reported. Some of the common side effects of the drugs are explained in this section.

Orlistat. Some side effects of orlistat include cramping, intestinal discomfort, passing gas, diarrhea, and leakage of oily stool. These side effects are generally mild and temporary, but may be worsened by eating high-fat foods. Rare cases of severe liver injury have been reported in patients using either Xenical or alli. Both drugs contain different strengths of orlistat. Xenical contains 120 mg, while alli contains 60 mg. Also, because orlistat reduces the absorption of some vitamins, patients should take a multivitamin at least 2 hours before or after taking orlistat. More information about orlistat (marketed as Xenical or alli) and liver injury is available at http://www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ucm213038.htm

Other appetite suppressants. Phentermine, phendimetrazine, and diethylpropion may cause symptoms of sleeplessness, nervousness, and euphoria (feeling of well-being). People with heart disease, high blood pressure, an overactive thyroid gland, or glaucoma should not use these drugs.

Two appetite-suppressant medications, fenfluramine and dexfenfluramine, were withdrawn from the market in 1997. These drugs, used alone and in combination with phentermine (fen/phen), were linked to the development of valvular heart disease and primary pulmonary hypertension (PPH), a rare but potentially fatal disorder that affects the blood vessels in the lungs. There have been only a few case reports of PPH in patients taking phentermine alone, but the possibility that phentermine use is associated with PPH cannot be ruled out.

NOTE: In 2010, the FDA asked Abbott Laboratories to voluntarily remove Meridia (sibutramine) from the U.S. market. Abbott Laboratories agreed to remove the drug from the market. Sibutramine is a weight-loss drug that works to reduce one’s appetite. Data from clinical trials showed an increased risk of heart attacks and strokes among patients using the drug. More information about sibutramine is available athttp://www.fda.gov.

Commonly Asked Questions About Weight-Loss Drugs

Q: Can drugs replace physical activity or changes in eating habits as a way to lose weight?

A: No. Studies show that weight-loss medications work best when combined with a weight-control program that helps you improve your eating and physical activity habits. Ask your doctor about ways you can improve your eating plan and become more physically active.

Q: How do I decide which drug is right for me?

A: Choosing a weight-loss drug is a decision between you and your health care provider. You will consider the drug’s side effects, your family’s medical history, and your current medical conditions and medicines.

Q: What medical history, conditions, or medications might influence my decision to take a weight-loss drug?

A: Let your doctor know if any of the following applies to you, as these factors may affect which weight-loss drugs you can take, if any:

  • History of drug or alcohol abuse.
  • History of eating disorders.
  • History of depression or manic depressive disorder.
  • Pregnancy or breast-feeding.
  • Migraine headaches requiring medication.
  • Glaucoma.
  • Diabetes.
  • Heart disease or heart condition, such as an irregular heart beat.
  • High blood pressure.
  • Use of blood-thinning medication.
  • Use of monoamine oxidase (or “MAO”) inhibitors or antidepressant medications.
  • Plan to have surgery that requires general anesthesia.

Q: How long will I need to take weight-loss medications to treat obesity?

A: The answer depends upon whether the medication helps you to lose and maintain weight and whether you have any side effects. Because obesity is a chronic disease, nondrug treatment including diet changes and regular physical activity may need to be continued for years, and perhaps a lifetime, to improve health and maintain a healthy weight. However, like many other types of drugs, there is still little information on how safe and effective weight-loss medications are for many years of use. At least one study has shown that intermittent use (1 month on medication and 1 month off medication) may help some people lose and maintain weight, but more research is needed.

Q: Will I regain some weight after I stop taking weight-loss medications?

A: Probably. Most studies show that the majority of patients who stop taking weight-loss medications regain the weight they lost. Maintaining healthy eating and physical activity habits may help you regain less weight or keep it off.

Q: Can children or teens use weight-loss medications?

A: Prescription orlistat is currently approved for use in teens age 12 or above. Other weight-loss drugs are not approved for use in children under age 16, although studies in children and teens are ongoing. Metformin is a drug being studied in clinical trials. Early reports show it to be safe and effective, but more research is needed and it has not been FDA-approved for children or adolescents.

Q: Will insurance cover the cost of weight-loss medication?

A: Currently, many insurance companies will not pay for weight-loss drugs, but this is changing as insurers begin to recognize obesity as a chronic disease. Contact your insurance company to find out if prescription weight-loss medication is covered under your plan. A 1-month prescription can cost from 60 dollars to more than twice this amount. Ask a staff member at your pharmacy what a 1-month supply of the medication you are considering taking will cost.

Most patients should not expect to reach an “ideal” body weight using currently available medications. However, even a modest weight loss of 5 to 10 percent of your starting body weight can improve your health. Together, you and your doctor can make an informed choice as to whether medication can be a useful part of your weight-control program.

 

Understanding Heartburn: Day 5

In Health, Healthcare, Medicine on September 3, 2012 at 8:00 am

What are the long-term complications of GERD?
Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures— narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its compli­cations should be monitored closely by a physician.
Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.

Understanding Heartburn: Day 4

In Health, Healthcare, Medicine on September 2, 2012 at 8:00 am

 

What if GERD symptoms persist?
If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.

• Barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esopha­gus. With this test, you drink a solu­tion and then x rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.

• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a
doctor’s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin,
flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny
camera, the endoscope allows the doc­tor to see the surface of the esophagus and search for abnormalities. If you
have had moderate to severe symp­toms and this procedure reveals injury to the esophagus, usually no other
tests are needed to confirm GERD. The doctor also may perform a biopsy. Tiny tweezers, called forceps, are
passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus.
The tissue is then viewed with a micro­scope to look for damage caused by acid reflux and to rule out other prob­
lems if infection or abnormal growths are not found.

• pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny
device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary— recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symp­
toms, including wheezing and cough­ing, are triggered by reflux.

A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.

Surgery
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be
a reasonable alternative to a lifetime of drugs and discomfort.

 

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