Conflict of Interest and Weird Science Lead to a Major Medical Recommendation

NAPLES, Fla. - Jan. 22, 2015 - PRLog -- The following article is from MedpageToday (January 19, 2015). Medpage boasts an 85% credibility rating.  I’m sure that this "research" will be quoted everywhere, even by your physician as he pulls out his prescription pad.

        (My comments are written within the original article in indented,          parentheses- bound paragraphs, Diane Kress, RD CDE)

Focus on Weight over Comorbidities, obesity guide says
Job one: Get obese patients to lose excess fat.  by Kristina Fiore, staff writer, Medpage Today

Dr. Apovian (the lead author of this new guideline for obesity) disclosed financial relationships with the following drug and weight loss surgery companies:
amylin, merck, johnson and johnson, arena, nutrisystem, zafgen, sanofi, orexigen, enteromedics, lilly, aspire bariatrics, giodynamics, pfizer, metaproteomics, and the atkins foundation.

“The old paradigm was to treat each comorbidity with medications … then manage obesity, which caused most of the original problems in the first place, “The new paradigm is to manage the obesity first, with lifestyle change and medications, then manage the remainder of the comorbidities that have not responded.”

       ( Dr. Apovian, steeped in  financial ties to the pharmaceutical industry,          made sure to set guidelines that focus on prescribing pharmaceuticals as          the first line treatment for obesity.)

Those drugs, coupled with extensive lifestyle counseling and clinician visits, are poised to help patients who’ve struggled to lose weight for years by enhancing their ability to make behavioral change, Apovian said.

Several obesity experts contacted by Medpage Today said they agreed with the new guidance, that treating overweight and obesity could resolve many of the conditions that commonly occur with it.

     (Medpage did not contact this obesity expert.  I have no affiliations with          pharmaceutical companies.

Four new obesity drugs have been approved in the last few years: belviq, qsymia, contrave, and saxenda. Many of these medications work by amplifying the effects of behavioral changes, apovian said, and they have the greatest effect when they’re reinforced with face-to-face visits — the literature says at least 16 visits per year, a figure that federal insurers reimburse for.

     (So, the drugs need to be added to lifestyle change, exercise, diet, and at          least 16 face to face clinician visits per year.)

“Adding the medications to a diet and lifestyle program leads to a greater enhancement of their effects,” she said. “and we recommend that if you’re going to treat weight management patients that you see them frequently.”

Apovian noted that the endocrine society still stands by the AHA/ACC/TOS guidelines on weight management, and that the current guidelines simply fill a gap that wasn’t addressed in the 2013 guidance.

The new guidelines are the first to mention specific obesity drugs and give some guidance on how to prescribe them.

     (And these new guidelines are funded by pharmaceutical companies)

Patients should be put on the drugs for a 3-month trial period, starting at the lowest dose and titrating up, the guidelines state. If they don’t lose at least 5% of their body weight in that time, they should be switched to another drug.

       (I wonder why the first choice if the patient "doesn't succeed"  would be to         switch medications.  perhaps this patient is having difficulty with his or          her diet,exercise, lifestyle, or is failing to attend all those clinician          visits….yet, without assessing the situation, the directive is to write          another prescription for another drug for another 3 months.)

         (A 5% weight loss after 3 months is insignificant for an obese person…A          300 pound patient would only need to lose 16 pounds in 3 months to be          considered a success.)

“You have to give your best guess as to which drug the patient should go on based on their lifestyle characteristics that make them amenable to that particular drug,” Apovian said. “unless you have a very clear idea of what drug you think the patient will do best on, it’s going to be trial and error.”

     (The message is to prescribe drug after drug….with four new drugs, that will       take up an entire year and $6000.00 for the drugs alone.  the patient will          more than likely end up more obese than he/she was at the beginning of the      year.)

The guidelines also offer specifics on dietary recommendations — taking down saturated fats and trans fats for those with lipid problems, lowering salt and going on the dash diet if they have hypertension — and calling for 150 minutes per week of moderate-intensity exercise.

        (A low fat diet is, by nature, high in carbohydrate. A high carbohydrate diet         stimulates insulin release. High levels of insulin cause fat growth on the          body, in the liver, and in the blood. Higher body fat and circulating fat          leads to hypertension, hyperlipidemia, obesity, type 2 diabetes, cancer.          A low fat, low calorie diet prescription is 100% ineffective for weight loss          for over 150 million Americans with insulin imbalance.)

The question remains whether insurance will cover these medications, Zonszein said. They can cost between $4,000 and $6,000 per year.”

     (Insurance companies choose not to reimburse for ineffective medications          with a high level of side effects.)

     (The "take away" from this study and article: get all the MD's on the          bandwagon to prescribe expensive, high risk, ineffective drugs to their          overweight patients! More money for the MD and medical associations,          more money for Big Pharma...and no real health or weight improvements          for the patient)

Read more by Diane Kress, RD CDE at http://www.dianekress.wordpress.com.