Antiobesity drugs only work with lifestyle changes

By Clare E. Urwin

SURABAYA (JP): Obesity is not just about being too fat. Nor is it about looking nice and cuddly, attractively plump, or proud and portly. Obesity and being overweight is dangerous. It is a life-threatening health problem that we need to take very seriously.

To put it simply, it will kill you, sooner or later and one way or the other.

For instance, diabetes is rapidly becoming a worldwide epidemic. An alarming statistic is that 90 percent of people with Type 2 Diabetes are overweight.

Being too heavy is a significant risk factor in high blood pressure, heart failure, coronary disease, stroke, certain cancers, sleep apnea, thrombosis, orthopedic difficulties and numerous other medical problems.

Because obesity is so menacing to good health, any responsible new product, claiming it can help people lose weight, has got to be worth examining.

Living in Asia, it is easy to think that we are immune to the worldwide epidemic of increasing weight gain. After all, Asians do not look fat, at least not generally. And certainly, compared to the growing size of citizens in America, Australia and Europe, most Asian people seem positively thin.

However, in reality, this is not true. Unfortunately, the obesity-associated diseases appear at a lower body mass index (BMI) in Asia than in western countries. In other words, even though Asian people are generally smaller, they get more weight related disease and it starts earlier than it does for their European cousins.

Where the fat is situated in the body, is the problem. With most Asians, and men in particular, body fat tends to accumulate around the belly area, giving a rotund apple-shaped appearance. This abdominal fat is a clear warning sign of impending problems.

You can get a very good idea of your own weight situation and health risk factors by merely measuring the circumference of your waist. This easy method of predicting possible future difficulties is now widely used; either alone, or combined with the traditional BMI method.

At present, risks are associated with a waist measurement of 102 cm (40") for a male and 88 cm (35") for a female, if their BMI is over 25. A new proposed classification for health risks in Asians is 90 cm (36") for a man and 80 cm (32") for a woman if their BMI is over 23. After further study, it may go down even lower.

So, it is very important how big your waist is. Reduce that, and reduce your risk. Incidentally, an increased waist circumference can also be a marker for added risk, even in somebody of normal weight.

Visceral, or inner fat, rather than subcutaneous or outer fat, is the real danger. Visceral fat, the one that you cannot see, sits right up around all the vital organs like your kidneys and intestines. The more you have of that stuff, the more peril you are in.

However, some good news has come out of all this study. Losing even a little weight, brings a lot of benefits. For instance a 5 percent overall weight loss can result in a 30 percent reduction in visceral fat.

Furthermore, losing only six or seven kilos can reduce the risk of diabetes mellitus by 60 percent. It is easier on men too. When they lose weight it immediately goes from their belly area.

The obvious solution to permanent weight loss is behavioral modification. In other words, make changes to your lifestyle. Alter your eating habits by learning to love healthy food and combine this with some regular exercise that you really enjoy.

However, we all know it is not easy. Losing weight requires commitment and determination. It is hard work and takes a long time. In this case, Xenical, a lipase inhibitor - a fat blocker, might help. This new anti-obesity drug, introduced earlier this month by Roche, works on a particular enzyme in your stomach and reduces the enzyme's ability to absorb fat. This results in a third of the fat you eat, being passed straight through your body in your stools. Roche claims that, unlike the old-fashioned appetite suppressants, the new drug does not affect the brain, blood or heart and is nonaddictive.

Recent studies show that people who use this drug and combine it with some lifestyle changes, can lose about 10 percent of their initial weight over the course of a year.

However, Xenical is an aid, not a substitute for a weight-loss program. It will not work without lifestyle changes. Proper effort and personal responsibility are still required, especially by eating a low-fat diet and increasing exercise.

In a way, it is a self-learning drug. If you do reduce the fats in your diet to 30 percent of calorie intake, there are normally no, or very few, side effects. However, if you continue to eat a high-fat diet, some rather embarrassing ones happen. These can include oily spotting, flatulence with discharge, faecal urgency, fatty or oily stools and faeces incontinence. Not nice.

This prescription medicine is indicated for at-risk, overweight people only. It is not meant for those who want to lose two kilos before the bikini season. (clareu@attglobal.net)