What’s New in Weight Loss

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Kenneth Fujioka, MD
We used to have just diet and exercise and then surgery, but nothing in between. Now, we have medications. So there’s two that have recently been approved and there’s probably two more that will get approved within three to six months. So things are really moving rapidly in a very good way. So the biggest difference is how they were studied. So the old medications, if you look at say something, phentermine, which is still a very commonly used weight loss medication. This was studied in the ‘50s. So long ago that it was just studied for a very short period of time, they didn’t look at cardiovascular parameters. A lot of things are very important to look at in the overweight patient. These newer ones are studied for years, thousands of patients looking at every potential problem that come up and study to the N’th degree. So any medication that gets out right now is going to be pretty darn safe.

Kenneth Fujioka, MD (Continued)
When I started back in the early ‘90s on what is the cause of obesity, why do people struggle with weight? Is it just calories in and calories out? And that’s what we thought it was. That’s what we are all taught as docs in the ‘90s. Well, in the last 10 years, we’ve learned a lot. It’s not. It’s not simple math. It’s actually rocket science. In that, as someone gets heavier, the body knows how many fat cells are around and it does everything it can to keep those fat cells big and healthy, it thinks healthy. So in other words, if you go from 150 to 200 pounds, the body now thinks, “That’s the normal weight.” It wants to weigh that forever and it will defend against weight loss. So in other words, let’s say you’re 200 pounds, you lose just 20 pounds, 10% of your weight. The body makes adjustments to fight the weight loss by one, lowering the metabolism more than 10%. Should just be loss 10% of your weight, it should go down 10%. No, it goes down more than that. Two, the hormones will tell you, “You’re full,” that you should stop eating. Don’t go up to where they’re supposed to.

Kenneth Fujioka, MD (Continued)
In other words, somebody just loss some weight even through it could a year later, when they eat a meal, they’re not as satisfied or not as satiated as a person next to him who’s never been overweight but is the same weight. So in other words, our hormones now adjust to tell you to eat more. That’s you're fighting biology now. It is really tough. I mean, losing weight is by far the most difficult thing, and it makes sense because so many Americans struggle with it. When you have one-third of the U.S. population clinically obese or in other words heavy enough that we know that their lifespan is shortened, and another third that’s overweight, that’s a lot of Americans and it’s not because they want to be there.