Treatments

The main treatment for obesity consists of dieting and physical exercise.- Diet programs may produce weight loss over the short term,- but keeping this weight off can be a problem and often requires making exercise and a lower calorie diet a permanent part of a person's lifestyle.- Success rates of long-term weight loss maintenance are low and range from 2–20%.-
In a more structured setting, however, 67% of people who lost greater than 10% of their body mass maintained or continued to lose weight one year later.- An average maintained weight loss of more than 3 kg (6.6 lb) or 3% of total body mass could be sustained for five years. Some studies have found significant benefits in mortality in certain populations with weight loss. In a prospective study of obese women with weight related diseases, intentional weight loss of any amount was associated with a 20% reduction in mortality. In obese women without obesity related illnesses a weight loss of greater than 9 kg (20 lb) was associated with a 25% reduction in mortality. A recent review concluded that certain subgroups such as those with type 2 diabetes and women show long term benefits in all cause mortality, while outcomes for men do not seem to be improved with weight loss. A subsequent study has found benefits in mortality from intentional weight loss in those who have severe obesity.
The most effective treatment for obesity is bariatric surgery; however, due to its cost and the risk of complications, researchers are searching for other effective yet less invasive treatments.
Dieting-
Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.-A meta-analysis of six randomized controlled trials found no difference between three of the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram (4.4–8.8 lb) weight loss in all studies.- At two years these three methods resulted in similar weight loss irrespective of the macronutrients emphasized.-
Very low calorie diets provide 200–800 kcal/day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.-
Exercise-
With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat.- Exercise affects macronutrient balance. During moderate exercise, equivalent to a brisk walk, there is a shift to greater use of fat as a fuel>- To maintain health the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.
A meta-analysis of 43 randomized controlled trials by the Cochrane Collaboration found that exercising alone led to limited weight loss. In combination with diet, however, it resulted in a 1 kilogram weight loss over dieting alone. A 1.5 kilogram (3.3 lb) loss was observed with a greater degree of exercise. Even though exercise as carried out in the general population has only modest effects, a dose response curve is found, and very intense exercise can lead to substantial weight loss. During 20 weeks of basic military training with no dietary restriction, obese military recruits lost 12.5 kg (27.6 lb). High levels of physical activity seem to be necessary to maintain weight loss. A pedometer appears useful for motivation. Over an average of 18-weeks of use physical activity increased by 27% resulting in a 0.38 decreased in BMI.
Signs that encourage the use of stairs as well as community campaigns have been shown to be effective in increasing exercise in a population. The city of Bogota, Colombia for example blocks off 113 kilometers (70 miles) of roads every Sunday and on holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.
Weight loss programs-
Weight loss programs often promote lifestyle changes and diet modification. This may involve eating smaller meals, cutting down on certain types of food, and making a conscious effort to exercise more. These programs also enable people to connect with a group of others who are attempting to lose weight, in the hopes that participants will form mutually motivating and encouraging relationships.
A number of popular programs exist, including Weight Watchers, Overeaters Anonymous, and Jenny Craig. These appear to provide modest weight loss (2.9 kg, 6.4 lb) over dieting on one's own (0.2 kg, 0.4 lb) over a two year period. Internet-based programs appear to be ineffective.] The Chinese government has introduced a number of "fat farms" where obese children go for reinforced exercise, and has passed a law which requires students to exercise or play sports for an hour a day at school (see Obesity in China).
-Physical Activity
Similar to diets, most people start of with the best intentions by joining the local gym and even go as far as signing up for a deluxe 'gold' annual membership and going a few times before it gets into the 'chore' stage. Don't worry, many people do exactly that - oops and I nearly forgot... did you leave your direct debit going because you felt guilty in cancelling?

The reality is that there are no hard and fast rules to exercising apart from consistency. Keep things in perspective - make it a gradual process and build on your success. Celebrate milestones and achievements - and get the feel good factor before continuing. Once you get into a routine, you will probably find it hard to stop - and that's when you are half way home!

Keep an eye on your progress by weighing yourself - but don't get too disheartened or even give up because the weight isn't coming off after a few weeks - keep going and above all keep enjoying it.

Clinical protocols-
Much of the Western world has created clinical practice guidelines in an attempt to address rising rates of obesity. Australia, Canada, the European Union, and the United States have all published statements since 2004.
In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:
1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
2. If these goals are not achieved, pharmacotherapy can be offered. The person needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
4. In people with a BMI over 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The person needs to be aware of the potential complications.
5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.
A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected people in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.
Canada developed and published evidence-based practice guidelines in 2006. The guidelines attempt to address the prevention and management of obesity at both the individual and population levels in both children and adults. The European Union published clinical practice guidelines in 2008 in an effort to address the rising rates of obesity in Europe. Australia came out with practice guidelines in 2004.
anti-obesity medications
Anti-obesity medication or weight loss drugs refer to all pharmacological agents that reduce or control weight. These drugs alter one of the fundamental processes of the human body, weight regulation, by either altering appetite, metabolism, or absorption of calories. It is common for them to be tried and if there is little or no benefit from them to discontinue treatment. The main treatment modalities for overweight and obesity are dieting and physical exercise.
Because of potential side effects, it is recommended that anti-obesity drugs only be prescribed for obesity where it is hoped that the benefits of the treatment outweigh its risks.
Mechanisms of action
Anti-obesity drugs operate through one or more of the following mechanisms:
• Suppression of the appetite. Catecholamines and their derivatives (such as amphetamine-based drugs) are the main tools used for this. Drugs blocking the cannabinoid receptors may be a future strategy for appetite suppression
• Increase of the body's metabolism
• Interference with the body's ability to absorb specific nutrients in food. For example, Orlistat (also known as Xenical and Allī) blocks fat breakdown and thereby prevents fat absorption. The OTC fiber supplements glucomannan and guar gum have been used for the purpose of inhibiting digestion and lowering caloric absorption
Anorectics are primarily intended to suppress the appetite, but most of the drugs in this class also act as stimulants (dexedrine, e.g.), and patients have abused drugs "off label" to suppress appetite (e.g. digoxin).

1-Phentermine
Oral Uses
Phentermine is used along with a doctor-approved, reduced-calorie diet, exercise, and behavior change program to help you lose weight. It is used in people who are significantly overweight (obese) and have not been able to lose enough weight with diet and exercise alone. Losing weight and keeping it off can reduce the many health risks that come with obesity, including heart disease, diabetes, high blood pressure, and a shorter life.
It is not known how this medication helps people to lose weight. It may work by decreasing your appetite, increasing the amount of energy used by your body, or by affecting certain parts of the brain. This medication is an appetite suppressant and belongs to a class of drugs called sympathomimetic amines.
Take this medication by mouth, usually once a day 1 hour before breakfast or 1-2 hours after breakfast or as directed by your doctor. The tablet form may be taken at a lower dose (8 milligrams) up to 3 times a day 30 minutes before meals. Taking this medication late in the day may cause trouble sleeping (insomnia).
If you are using sustained-release capsules, swallow the medication whole. Do not crush or chew the sustained-release capsules. Doing so can destroy the long action of the drug and may increase side effects.
The dosage is based on your medical condition and response to therapy. Your doctor will adjust the dose to find the best dose for you. Use this medication regularly and exactly as prescribed in order to get the most benefit from it. To help you remember, take it at the same time(s) each day.
This medication is usually taken for only a few weeks at a time. It should not be taken with other appetite suppressants (see also Drug Interactions section). The possibility of serious side effects increases with longer use of this medication and use of this drug along with certain other diet drugs.
This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as depression, severe tiredness) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.
Rarely, abnormal drug-seeking behavior (addiction) is possible with this medication. Do not increase your dose, take it more frequently, or use it for a longer time than prescribed. Properly stop the medication when so directed.
This medication may stop working well after you have been taking it for a few weeks. Talk with your doctor if this medication stops working well. Do not increase the dose unless directed by your doctor. Your doctor may direct you to stop taking this medication.
2-Desoxyn
Oral Uses
Methamphetamine is a stimulant and is used to treat a certain attention disorder (attention deficit hyperactivity disorder-ADHD) in children older than 6 years. It is used as part of a total treatment plan, including psychological, educational, and social treatments. It may help increase the ability to pay attention, concentrate, and stop fidgeting.
This medication is also used along with a doctor-approved, reduced-calorie diet as an aid to help significantly overweight (obese) people lose weight. It should only be used for a short time (a few weeks) in patients who have not lost enough weight with other treatments (e.g., dieting, other drugs, group programs). It may work by decreasing your appetite.
This medication should not be used to treat tiredness or to hold off sleep in people who do not have a sleep disorder.
Read the Medication Guide provided by your pharmacist before you start using methamphetamine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.
For ADHD, take this medication by mouth with or without food, usually once or twice daily or as directed by your doctor. During treatment, your doctor may occasionally recommend stopping the medication for a short time to see whether there are any changes in your behavior and whether the medication is still needed.
For weight loss, take this medication by mouth, usually half an hour before each meal or as directed by your doctor. Take this medication exactly as prescribed.
Do not take this medication late in the evening because it may cause you to have trouble sleeping.
This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as extreme tiredness, mental/mood changes such as agitation) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.
Side Effects
Dry mouth, nausea, upset stomach, diarrhea, constipation, dizziness, trouble sleeping, or headache may occur. If any of these effects persist or worsen, notify your doctor promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur:
blurred vision
swelling of ankles/feet
rapid/unexplained weight loss
fast/irregular heartbeat
mental/mood/behavior changes (e.g., agitation, aggression, mood swings, depression, abnormal thoughts)
uncontrolled movements (e.g., muscle twitching/shaking)
outbursts of words/sounds
change in sexual ability/interest

Seek immediate medical attention if any of these rare but very serious side effects occur:
shortness of breath
chest/jaw/left arm pain
fainting
seizures
blurred vision
weakness on one side of the body
slurred speech
confusion

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including:
rash
itching/swelling (especially of the face/tongue/throat)
severe dizziness
trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
3-Clozaril
Side Effects
While clozapine can provide great benefits, it can rarely cause serious, possibly fatal side effects. For this reason, clozapine is used when other treatments have not worked or you cannot take them.
This medication can cause a serious immune system problem called agranulocytosis (low white blood cells). To make sure you have enough white blood cells, you will need to have a blood test before you begin taking clozapine and then have your blood tested regularly during your treatment. (See also How to Use, Side Effects, and Notes sections.)
Clozapine can also cause seizures, especially in higher doses. Let your doctor or pharmacist know if you have ever had seizures. While taking this medication, avoid driving or other activities during which a sudden loss of consciousness could be dangerous (e.g., operating heavy machinery, swimming).
This medication may rarely cause an inflammation of the heart muscle (myocarditis). Seek immediate medical attention if you have weakness, difficult/rapid breathing, chest pain, or swelling of the ankles/legs. Your risk is highest in the first month of treatment.
Clozapine can cause a big drop in blood pressure, which can make you dizzy or cause you to faint when you stand up. Be sure to get up slowly while taking this medication. This is more likely to occur when your dose of clozapine is increased or if you are also taking a benzodiazepine (e.g., clonazepam, lorazepam, diazepam).
There may be a slightly increased risk of serious, possibly fatal side effects (e.g., stroke, heart failure) when this medication is used in elderly patients with dementia. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with your doctor.
Drooling, drowsiness, dizziness, headache, shaking (tremor), vision problems (e.g., blurred vision) and constipation may occur. Many of these effects (especially drowsiness) lessen as your body gets used to the medication. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.
To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative (e.g., stimulant-type with stool softener).
4-Rimonabant
Rimonabant (Acomplia) is a recently developed anti-obesity medication. It is cannabinoid (CB1) receptor antagonist that acts centrally on the brain thus decreasing appetite. It may also act peripherally by increasing thermogenesis and therefore increasing energy expenditure.
Weight loss with Rimonabant however has not been shown to be greater than other available weight-loss medication. Due to safety concerns, primarily psychiatric in nature, the drug has not received approval in the United States or Canada, either as an anti-obesity treatment or as a smoking-cessation drug.
Sanofi-Aventis has received approval to market Rimonabant as a prescription anti-obesity drug in the European Union, subject to some restrictions, however, in October 2008, the European Medicines Agency (EMEA) recommended that Acomplia no longer be available in UK. One month later, Sanofi-Aventis decided it would no longer study rimonabant for any indication.
5-Metformin
In people with Diabetes mellitus type 2, the drug metformin (Glucophage) can reduce weight.
6-Exenatide
Exenatide (Byetta) is a long-acting analogue of the hormone GLP-1, which the intestines secrete inresponse to the presence of food. Among other effects, GLP-1 delays gastric emptying and promotes a feeling of satiety. Some obese people are deficient in GLP-1, and dieting reduces GLP-1 further. Byetta is currently available as a treatment for Diabetes mellitus type 2. Some, but not all, patients find that they lose substantial weight when taking Byetta. Drawbacks of Byetta include that it must be injected subcutaneously twice daily, and that it causes severe nausea in some patients, especially when therapy is initiated. Byetta is recommended only for patients with Type 2 Diabetes. A somewhat similar drug, Symlin, is currently available for treating diabetes and is in testing for treating obesity in non-diabetics.
7-Pramlintide
Pramlintide (Symlin) is a synthetic analogue of the hormone Amylin, which in normal people is secreted by the pancreas in response to eating. Among other effects, Amylin delays gastric emptying and promotes a feeling of satiety. Many diabetics are deficient in Amylin. Currently, Symlin is only approved to be used along with insulin by Type 1 and Type 2 diabetics. However, Symlin is currently being tested in non-diabetics as a treatment for obesity. A drawback is that Symlin must be injected at mealtimes.
The two most commonly used medications to treat obesity:
1-Orlistat
Orlistat (marketed as a prescription under the trade name Xenical by Roche in most countries, or over-the-counter as Alli by GlaxoSmithKline in the United Kingdom and the United States), also known as tetrahydrolipstatin, is a drug designed to treat obesity. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake. It is intended for use in conjunction with a physician-supervised reduced-calorie diet. Orlistat is the saturated derivative of lipstatin, a potent natural inhibitor of pancreatic lipases isolated from the bacterium Streptomyces toxytricini. However, due to simplicity and stability, orlistat rather than lipstatin was developed into an anti-obesity drug.
The effectiveness of orlistat in promoting weight loss is definite, though modest. Pooled data from clinical trials suggest that people given orlistat in addition to lifestyle modifications, such as diet and exercise, lose about 2–3 kilograms (4.4–6.6 lb) more than those not taking the drug over the course of a year. Orlistat also modestly reduces blood pressure, and appears to prevent the onset of type 2 diabetes, whether due to weight loss itself or to other effects; in a large randomized controlled trial, orlistat was found to reduce the incidence of diabetes by nearly 40% in obese people.
Orlistat is notorious for its gastrointestinal side effects (sometimes referred to as treatment effects), which can include steatorrhea (oily, loose stools). These decrease with time, however, and are the only significant adverse effects of the drug, which appears to be safe for long-term use. In the United States, the European Union, and Australia, orlistat is available for sale without a prescription. Over-the-counter approval was controversial in the United States, with consumer advocacy group Public Citizen repeatedly opposing it on safety and efficacy grounds. Generics of orlistat are available in India.
Pharmacology
Orlistat works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine. When lipase activity is blocked, triglycerides from the diet are not hydrolyzed into absorbable free fatty acids, and are excreted undigested instead. Only trace amounts of orlistat are absorbed systemically; the primary effect is local lipase inhibition within the GI tract after an oral dose. The primary route of elimination is through the feces.
At the standard prescription dose of 120 mg three times daily before meals, orlistat prevents approximately 30% of dietary fat from being absorbed, and about 25% at the standard over-the-counter dose of 60 mg. Higher doses do not produce more potent effects.
Efficacy
The amount of weight loss achieved with orlistat varies. In one-year clinical trials, between 35.5% and 54.8% of subjects achieved a 5% or greater decrease in body mass, although not all of this mass was necessarily fat. Between 16.4% and 24.8% achieved at least a 10% decrease in body mass. After orlistat was stopped, a significant number of subjects regained weight—up to 35% of the weight they had lost.
The incidence of type 2 diabetes in an obese population over four years is decreased with orlistat (6.2%) compared to placebo (9.0%). Long-term use of orlistat also leads to a modest reduction in blood pressure (mean reductions of 2.5 and 1.9 mmHg in systolic and diastolic blood pressure respectively).
Side effects
The primary side effects of the drug are gastrointestinal-related, and include steatorrhea (oily, loose stools with excessive flatus due to unabsorbed fats reaching the large intestine), fecal incontinence and frequent or urgent bowel movements. GlaxoSmithKline recommends that all users be cautious of the possible side effects until they "have a sense of any treatment effects". To minimize these effects, foods with high fat content should be avoided; the manufacturer advises consumers to follow a low-fat, reduced-calorie diet. Oily stools and flatulence can be controlled by reducing the dietary fat content to somewhere in the region of 15 grams per meal. The manual for Alli makes it clear that orlistat treatment involves aversion therapy, encouraging the user to associate eating fat with unpleasant treatment effects.
According to Roche, side effects are most severe when beginning therapy and may decrease in frequency with time; this is supported by the results of the XENDOS study, which found that only 36% of people had gastrointestinal adverse effects during their fourth year of taking orlistat, whereas 91% of study subjects had experienced at least one GI-related side effect during the first year of treatment. It has also been suggested that the decrease in side effects over time may be associated with long-term compliance with a low-fat diet.
The side effect profile of orlistat led US consumer group Prescription Access Litigation (PAL) to award its first 2007 "Bitter Pill Award" to GlaxoSmithKline—the 'With Allies Like This, Who Needs Enemas?' Award.
On May 26, 2010, the U.S. Food and Drug Administration (FDA) has approved a revised label for Xenical to include new safety information about cases of severe liver injury that have been reported rarely with the use of this medication.
Interactions
Orlistat may reduce plasma levels of ciclosporin (also known as "cyclosporin" or "cyclosporine", trade names Sandimmune, Gengraf, Neoral, etc.), an immunosuppressive drug frequently used to prevent transplant rejection; the two drugs should therefore not be administered concomitantly. Orlistat can also impair absorption of the antiarrhythmic amiodarone.
Contraindications
Orlistat is contraindicated in:
Malabsorption
• Hypersensitivity to orlistat
• Reduced gallbladder function (e.g. after cholecystectomy)
• Pregnancy and breastfeeding
• Use caution with: obstructed bile duct, impaired liver function, and pancreatic disease
2-Sibutramine
Sibutramine (usually available as sibutramine hydrochloride monohydrate) is an appetite suppressant that is administered orally for the treatment of obesity. Serious concerns have been expressed about its safety and has been suspended from use in the UK and EU
It is also under review by the FDA and the European Medicines Agency. It is a centrally-acting serotonin-norepinephrine reuptake inhibitor structurally related to amphetamines, although its mechanism of action is distinct.
Sibutramine was originally launched and marketed by Knoll Pharmaceuticals and is now manufactured and marketed by Abbott Laboratories, under brand names such as Reductil, Meridia and Sibutrex. It is classified as a Schedule IV controlled substance in the United States, despite having virtually no potential for misuse due to its lack of appreciable dopaminergic effects. It is likely that the compound's use as an anorectic is the sole reason is it classified as a controlled drug, as "overprescription" of anorectics (as a class) in the mid-20th century resulted in a number of cases of abuse or addiction.
Pharmacokinetics
Sibutramine is well absorbed from the GI tract (77%), but undergoes considerable first-pass metabolism, reducing its bioavailability. The drug itself reaches its peak plasma level after 1 hour and has also a half-life of 1 hour. Sibutramine is metabolized by cytochrome P450 isozyme CYP3A4 into two pharmacologically-active primary and secondary amines (called active metabolites 1 and 2) with half-lives of 14 and 16 hours, respectively. Peak plasma concentrations of active metabolites 1 and 2 are reached after three to four hours. The following metabolic pathway mainly results in two inactive conjugated and hydroxylated metabolites (called metabolites 5 and 6). Metabolites 5 and 6 are mainly excreted in the urine.
Pharmacodynamics
Sibutramine is a neurotransmitter reuptake inhibitor that reduces the reuptake of serotonin (by 53%), norepinephrine (by 54%), and dopamine (by 16%), thereby increasing the levels of these substances in synaptic clefts and helping enhance satiety; the serotonergic action, in particular, is thought to influence appetite. Older anorectic agents such as amphetamine and fenfluramine force the release of these neurotransmitters rather than affecting their reuptake.
Despite having a mechanism of action similar to tricyclic antidepressants, sibutramine has failed to demonstrate antidepressant properties in animal studies. It was approved by the U.S. Food and Drug Administration (FDA) in November 1997for the treatment of obesity.

Contraindications
Sibutramine is contraindicated in patients with:
• Psychiatric conditions as bulimia nervosa, anorexia nervosa, serious depression or preexisting mania
• Patients with a history of or a predisposition to drug or alcohol abuse
• Hypersensitivity to the drug
• Patients below 18 years of age
• Concomitant treatment with a MAO inhibitor, antidepressant or other centrally active drugs, particularly other anoretics
• History of peripheral arterial disease
• Hypertension that is not sufficiently controlled (e.g., > 145/90 mmHg), caution in controlled hypertension
• Existing pulmonary hypertension
• Existing damage on heart valves, coronary heart disease, congestive heart failure, serious arrhythmias, previous myocardial infarction
• Stroke or transient ischemic attack (TIA)
• Hyperthyroidism (overactive thyroid gland)
• Closed angle glaucoma
• Seizure disorders
• Enlargement of the prostate gland with urinary retention (relative C.I.)
• Pheochromocytoma
• Pregnant and lactating women (relative C.I.)
Side effects
A higher number of cardiovascular events has been observed in people taking sibutramine verses control (11.4% vs. 10.0%). In 2010 the FDA noted the concerns that sibutramine increases the risk of heart attacks and strokes in patients with a history of cardiovascular disease.
Frequently encountered side effects are: dry mouth, paradoxically increased appetite, nausea, strange taste in the mouth, upset stomach, constipation, trouble sleeping, dizziness, drowsiness, menstrual cramps/pain, headache, flushing, or joint/muscle pain.
Sibutramine can substantially increase blood pressure and pulse in some patients. Therefore regular monitoring needs to be performed.
The following side effects are infrequent but serious and require immediate medical attention: cardiac arrhythmias, paresthesia, mental/mood changes (e.g., excitement, restlessness, confusion, depression, rare thoughts of suicide).
Symptoms that require urgent medical attention are seizures, problems urinating, abnormal bruising or bleeding, melena, hematemesis, jaundice, fever and rigors, chest pain, hemiplegia, abnormal vision, dyspnea and edema.
Currently, no case of pulmonary hypertension has been noted, although related compounds (such as Fen-Phen) have shown this rare but clinically significant problem.
Interactions
Sibutramine has a number of clinically significant interactions. The concomitant use of sibutramine and monoamine oxidase inhibitors (MAOIs, such as selegiline) is not indicated, as it may increase the risk of serotonin syndrome, a somewhat rare but serious adverse drug reaction. Sibutramine should not be taken within two weeks of stopping or starting an MAOI. Taking both sibutramine and certain medications used in the treatment of migraines—such as ergolines and triptans—, as well as opioids, may also increase the risk for serotonin syndrome, as may the use of more than one serotonin reuptake inhibitor at the same time.
The concomitant use of sibutramine and drugs which inhibit CYP3A4, such as ketoconazole and erythromycin, may increase plasma levels of sibutramine. Sibutramine does not affect the efficacy of hormonal contraception.
Counterfeit weight-loss products
On December 22, 2008, the United States Food and Drug Administration issued an alert to consumers naming 27 different products marketed as “dietary supplements” for weight loss, that illegally contain undisclosed amounts of sibutramine. In March 2009, Dieter Müller et al. published a study of sibutramine poisoning cases from similar Chinese "herbal supplements" sold in Europe, containing as much as twice the dosage of the legally licensed drug.
An additional 34 products were recalled by the FDA on April 22, 2009, further underscoring the risks associated with unregulated "herbal supplements" to unsuspecting persons. This concern is especially relevant to those with underlying medical conditions incompatible with undeclared pharmaceutical adulterants. In January 2010, a similar alert was issued for counterfeit versions of the over-the-counter weight loss drug Alli sold over the Internet. Instead of the active ingredient orlistat, the counterfeit drugs contain sibutramine, and at concentrations at least twice the amount recommended for weight loss.
In March 2010 Health Canada advised the public that illegal "Herbal Diet Natural" had been found on the market, containing sibutramine, which is a prescription drug in Canada, without listing sibutramine as an ingredient.
-Herbal treatments
Obesity Natural Herbal Cure | Ayurvedic Treatment

According to both modern medicine, and ayurvedic studies, obesity occurs when excess fat builds up. This excess fat buildup is caused when a person consumes more calories in one day than that person is able to burn off. In men, the fats usually begins to form around the stomach area, and in women, the fat usually forms around the waste area.

Obesity is known to be passed down from generation to generation. Symptoms of obesity are noted as follows:
• Enlarged stomach, waist, thighs, and/or buttocks
• Fatigue
• Saggy breasts (in women)
Long Term effects of obesity gone untreated include one or more of the following conditions:
• Diabetis
• Heart trouble
• Ulcers
• Clogged arteries
• High cholesterol
• Hypertension
• Lowered immune system
Change of Diet: Find an ayurvedic diet chart and follow it every single day. An ayurvedic diet would include increase of fresh fruits and vegetables and a decrease in white breads and other processed foods. Also, use vegetable oil in place of butter or margarine,drink 8-10 glasses of water a day, and use skim milk rather than whole milk. Futhermore, when cooking meats be sure to bake, roast or boil them.
Also, a person affect by obesity should make sure to consult an ayurvedic doctor for further information on what diet would be best for the body's overall physical condition. For example, some people will have to not eat any sugar at all to lower the blood sugar. Other people will have to lower the amounts of fatty foods taken in to reduce cholesterol levels. Whatever a person's case may be, it is important for that person to follows the doctor's orders regarding diet. This will be one of the most important factor which will contribut to an obese person's ability to lose weight.
It is also importan to remember not only what to eat, but how to eat. When deciding to eat, a person should make sure to eat 4-5 smaller meals in a day rather than 2-3 larger meals in a day. This will help the body digest more foods more thoroughly, as well as to better absorb necessary nutrients.
Exerize Regularly: Everyone, especially obese people should be sure to exercise for at least 30 minutes a day. Beginning the ruitine with stretching and walking is an excellent idea, and then proceeding to more vigorous aerobic exercizes. Instructions on how to do aerobic exersizes can be found at a local video store or library.
Also, one can take a dance class, or play in a team sport. All the above activities will help burn calories and aid in weight reduction.
Other Home Remedies
Honey: Mix one teaspoon of honey with two teaspoons of lime juice and some pepper. Drink this at least once a day.

Boiled Water: Drink a glass of boiled water every day after a meal.
Ginger Tea:Drink ginger tea 2-3 times a day.
Black Pepper:Seasoning foods with black pepper will decrease the need for salts and fats, and will still add flavor to foods. This will also help reduce weight.
Cinnamon:This spice can act as a low calorie sweetener to help reduce the amount of sugar needed in a recipe. It also adds a unique flavor to most cookie recipes.
Shudh Guggulu:Take Guggulu with a teaspoon of ginger and honey twice a day. This helps increase a body's metabolism.
Trifla:This is another diet aid that contains amalaki, bibbitaki, and haritaki. This should be taken at least once a day if one chooses to use this supplement.
Raw or Cooked Cabbage:The intake of cabbage reduces the conversion of sugars to fat. Therefore, eating plenty of this well help increase the body's ability to metabolize fatty foods.
Vitamin B-12:Take a vitamin B-12 tablet at least once daily. For further information on vitamin usage, read the directions on the vitamin bottle, and consult a doctor for more information. This vitamin comes also in leafy dark green vegetables, so eat many of these as often as possible.
Ayurvedic Medicines for Obesity
• Traphala Capsules
• Shuddha Guggulu Capsules
• Morslim-Z slimming Capsules of Obesity
When one follow the above diet recommendations and partake in one or more of the ayurvedic remedies, that person will be cured from obesity.

When not sure about how to apply herbal remedies or diet tablets, one should consult an ayruvedic specialist who is trained to help people in determining correct dosage. This is especially true for children inflicted with any disease, but is true for everyone. All medicines should be taken within the recommended guidelines.
Obenyl
Obenyl is an ayurvedic formulation of the pure herbs. Obenyl is a clinically proven, safe and effective polyherbal formulation that actually helps to regulate fat production and utilization. It also eliminates the craving for sweets, normalizes energy production and utilization into the body and helps you stay trim and healthy. It does NOT contain the Ephedra and is safe and effective as a weight regulator through specific ingredients and their unique herbal properties.
Benefits of Obenyl
• Obenyl brings the about efficient burning of fat.
• Obenyl inhibits fatty acid synthesis, thereby reducing the fat accumulation in the body.
• Obenyl reduces the cholesterol levels in the body, factors that are concerned with fat accumulation.
• Obenyl reduces the craving for food and sweets, by this means reducing the intake of fats and carbohydrates.
• Obenyl brings about effectual utilization of glucose in the body, which has a role to play in fat accumulation in the body.
• Obenyl leads to best utilization of nutrients and energy, thereby correcting the energy imbalances in the body that are responsible for fat accumulation.
Obenyl Ingredients Include:
Name of Ingredient Powders and Bhasmas: Latin/ English Name Quantity
Shuddha Gandhak - 15 mg
Jeeraka Vernonia antihelminica 15 mg
Kaishor Guggul - 15 mg
Triphala Guggul - 15 mg
Trayodashang Guggul - 15 mg
Kajjali - 30 mg
Yograj Guggul - 60 mg
Triphala - 90 mg
Punarnava Boerhaavia diffusa 195 mg

Extracts derived from

Katabhi Careya arborea 375 mg
Gorakhmundi Sphaeranthus indicus 195 mg
Maharasnadi kwath - 195 mg
Mahasudarshan churna kwath - 195 mg
Mahamanjistadi kwath - 195 mg
Ayurveda recommends a wide combination of these herbs in predetermined proportions for effective control of body weight. These herbs work synergistically to bring about the preferred effect.

Indications
Obenyl is good useful in controlling
• Obesity
• Hyperlipidemia
• Craving for sugar
Obenyl Use Directions
2 capsules twofold a day after breakfast and dinner, for a minimum period of 3 to 6 months.
Obenyl should be taken in combination with a reduced calorie diet and half an hour of exercise on a daily basis.
Obenyl Safety, Contraindications and Drug intractions:
No adverse effects have been reported with the good use of Obenyl Capsules, if taken as per the prescribed dose.

Contraindications:
• The use of Obenyl Capsules is well contraindicated in pregnancy. But it can be taken securely after lochia
• The use of Obenyl Capsules is contraindicated in patients with the jaundice and kidney failure.
• In patients who are previously suffering from problems like diabetes, heart problems and high blood pressure, it is much advisable to take Obenyl Capsules under good medical supervision.
Drug interaction:
• No drug intraction have been reported with the use of Obenyl Capsules.
Who can use Obenyl?
People whose body fat is more than the 25% and 30% of total body weight in men and women, correspondingly. Normal values of fat are 12-18% for men & 18-24% for women.
Dangers of being overweight
Being overweight can put you at risk for problems such as hypertension, diabetes, arthritis, back pain, coronary heart disease, gall bladder disease, cancer and sleep problems.

Diabetes
Obesity is a powerful risk for type II diabetes.

Osteoarthritis
Excessive weight can actually stress out the joints. Osteoarthritis is a disease that involves the weight-bearing joints. Excess weight speeds up the degeneration of the hips and knees.

Cardiovascular disease
Obesity is a risk for hypertension and atherosclerosis.

Cancer
An excess of dietary fat can so be a risk factor for cancer of the colon, prostate, breast and uterus.

Sleep apnea
Being overweight may cause the pauses in breathing in sleep.

Back pain
The site where fat tissue is deposited is the waist. Due to the gravity, the vertebral column is pulled by increasing the curvature of the spine, causing pain
For best results with Obenyl
• To be effective, Obenyl should be taken that along with a reduced calorie diet and 20 mins. to 1 hour of moderate physical activity 3 times a week*.
• Eat small, normal meals. Dinner should be the smallest meal.
• Drink at least 8-10 glasses of water every day.
• Increase the amount of fresh fruit, green vegetables and juices in your diet.
• Cut down on sweets, fried food, cheese and lofty fat food.
• If there's a party, have a lesser lunch or schedule a longer exercise routine.
• Don't feel frustrated and give up the halfway. Keep at it.
• Help Obenyl to help you. While you should start to get seeing results after 4-6 weeks, allow at least 3 months for full reimbursement.
• After achieving the preferred weight loss, you may reduce the capsule intake to a maintenance dosage of 1 capsule twice a day.
An exercise routine* can include the following:
• Half an hour of brisk walking.
• Using the stairs twice on a daily basis rather than the lift, except after meals.
* Exercise should be done under the medical supervision for those with health risks.
A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity
Shirin Hasani-Ranjbar, Neda Nayebi, Bagher Larijani, and Mohammad Abdollahi
Shirin Hasani-Ranjbar, Neda Nayebi, Bagher Larijani, Endocrinology and Metabolism Research Center, and Faculty of Medicine, Tehran University of Medical Sciences, Tehran 1411413137, Iran
Mohammad Abdollahi, Faculty of Pharmacy, and Pharmaceutical Sciences Research Centre, Tehran University of Medical Sciences, Tehran 1417614411, Iran
Author contributions: Hasani-Ranjbar S completed the bibliography and drafted the paper; Nayebi N carried out the literature search and provided tables; Larijani B read the paper and commented; Abdollahi M supervised, reviewed and edited the paper.
Correspondence to: Mohammad Abdollahi, Professor, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran. mohammad.abdollahi@utoronto.ca
Telephone: +98-21-66959104
Fax: +98-21-66959104
Received March 17, 2009; Revised May 1, 2009; Accepted May 8, 2009.
This article has been cited by other articles in PMC.
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesAbstract
This review focuses on the efficacy and safety of effective herbal medicines in the management of obesity in humans and animals. PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases were searched up to December 30, 2008. The search terms were “obesity” and (“herbal medicine” or “plant”, “plant medicinal” or “medicine traditional”) without narrowing or limiting search elements. All of the human and animal studies on the effects of herbs with the key outcome of change in anthropometric measures such as body weight and waist-hip circumference, body fat, amount of food intake, and appetite were included. In vitro studies, reviews, and letters to editors were excluded. Of the publications identified in the initial database, 915 results were identified and reviewed, and a total of 77 studies were included (19 human and 58 animal studies). Studies with Cissus quadrangularis (CQ), Sambucus nigra, Asparagus officinalis, Garcinia atroviridis, ephedra and caffeine, Slimax (extract of several plants including Zingiber officinale and Bofutsushosan) showed a significant decrease in body weight. In 41 animal studies, significant weight loss or inhibition of weight gain was found. No significant adverse effects or mortality were observed except in studies with supplements containing ephedra, caffeine and Bofutsushosan. In conclusion, compounds containing ephedra, CQ, ginseng, bitter melon, and zingiber were found to be effective in the management of obesity. Attention to these natural compounds would open a new approach for novel therapeutic and more effective agents.
Keywords: Animal, Herbal medicine, Human, Obesity
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesINTRODUCTION
The prevalence of obesity is increasing worldwide[1] resulting in an association with major health problems such as type 2 diabetes, ischemic heart disease, stroke, and cancer. It is necessary to treat obese individuals by both lifestyle interventions and/or pharmacological therapy. Pharmacologic treatment and surgical interventions used in some circumstances are not always appropriate[2]. Unfortunately, drug treatment of obesity despite short-term benefits, is often associated with rebound weight gain after the cessation of drug use, side effects from the medication, and the potential for drug abuse[3]. Pharmacologic options include sibutramine, orlistat, phentermine, diethylpropion, and fluoxetine or bupropion. Phentermine and diethylpropion have potential for abuse and are only approved for short-term use. Approved medications for long term use in the treatment of obesity are sibutramine and orlistat, however, these agents should be used with caution in patients with a history of cardiovascular disorders[4]. The general public uses many other methods for weight loss including herbs, vitamins, nutritional supplements, and meal replacement preparations. Rigorous scientific studies have not been carried out on these products, and in many cases safety and efficacy take a back seat to marketing.
Complementary and alternative therapies have long been used in the Eastern world but recently these therapies are being used increasingly worldwide[5]. When conventional medicine fails to treat chronic diseases and conditions such as obesity efficaciously and without adverse events, many people seek unconventional therapies including herbal medicine[6]. Although the number of randomized trials on complementary therapies has doubled every 5 years and the Cochrane library included 100 systematic reviews of unconventional interventions[7], none of these studies specifically mentioned herbal therapy in obesity.
This review aimed to evaluate the current science on the efficacy and safety of herbal medicines in the management of obesity.
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesDATA SOURCES AND STUDY SELECTIONS
PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases were searched up to December 30, 2008 for all human and animal studies investigating the effects (both harmful and beneficial) of treating obesity with herbal medicines. The search terms were “obesity” and (“herbal medicine” or “plant”, “plant medicinal” or “medicine traditional”) without narrowing or limiting search elements. Only publications with available abstracts were reviewed. The main outcome measures sought at the end of treatments as anti-obesity effects, were body weight, body fat including fat mass/fat weight or fat percentage/visceral adipose tissue weight, triceps skin fold thickness, waist or hip circumference, and appetite or amount of food intake.
Herbal medicines are defined in this review as raw or refined products derived from plants or parts of plants (e.g. leaves, stems, buds, flowers, roots, or tubers) used for the treatment of diseases. The synonyms of herbal medicines are herbal remedies, herbal medications, herbal products, herbal preparations, medicinal herbs, and phytopharmaceuticals, etc.
All of the abstracts from human and animal studies with the main outcome of change in anthropometric measures such as body weight and waist-hip circumference, body fat (weight or mass of visceral adipose tissue, fat mass or percent), amount of food intake, and appetite in participants were included. Even studies on other relevant diseases such as diabetes were also reviewed and included if the appropriate outcomes were shown. In vitro studies, review articles, and letters to the editor were excluded. Unpublished data such as theses were also excluded. Two reviewers independently examined the title, abstract and references of each article meeting the inclusion criteria and eliminated duplications and those showing exclusion criteria.
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesFINDINGS
Of the publications identified from the initial database search, 915 results were identified and reviewed for inclusion or exclusion. A total of 77 studies were included (19 human and 58 animal studies). Human studies included 17 randomized clinical trials (RCTs) and two before-after clinical trials[8–26]. RCTs reported random allocation of humans to herbal medicines vs (placebo/another plant/combination of plants) with or without specific dietary and exercise programs outlined in Tables 1 and 2 as weight loss programs. Human subjects were healthy overweight, obese or with impaired glucose tolerance test volunteers. Animal studies included healthy, genetically or experimentally obese or diabetic mice, rats and other rodents. The route of administration of herbs in almost all studies was oral intake with the exception of some animal studies as indicated in Table 2.
Table 1
Human studies considering the anti-obesity effects of herbal medicines
Table 2
Animal studies on the anti-obesity effects of herbal medicines
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesHUMAN STUDIES
Change in human body weight
All studies showed loss of body weight except one[21] which seemed to have problems with the study design, and one other study[10] which showed a significant decrease only in body fat. Studies with Cissus quadrangularis (CQ)[26] or combined with Irvingia gabonensis (IG)[15], a combination of Sambucus nigra and Asparagus officinalis[16], calcium hydroxycitrate in Garcinia atroviridis[18], supplements containing ephedra and caffeine[9,13,20], and Slimax as an extract of several plants including Zingiber officinale[8] and Bofutsushosan[14] showed significant decreases in body weight.
Body fat
A significant decrease in body fat was shown with CQ[26], supplements containing ephedra and caffeine[9,13], a natural compound containing capsicum and some lipotropic nutrients[10], Bofutsushosan[14], and calcium hydroxycitrate in Garcinia atroviridis[18]. These phytopharmaceuticals showed a significant decrease in triceps skin fold thickness indicating significant loss of fat.
Waist and hip circumference
Efficient decreases in both waist and hip circumferences in trials with a supplement containing ephedra and caffeine[9] and Slimax (extract of several plants including Zingiber officinale[8] were shown whereas Caralluma fimbriata[19] and CQ with or without IG[15] significantly decreased waist size.
Food intake
Decreases in appetite or amount of food or energy intake with a supplement containing ephedra and caffeine[20] and Caralluma fimbriata[19] were shown (not significant) but hydroxycitric acid (HCA-SX) with or without Gymnema sylvestre[23] decreased the amount of food intake efficiently. A natural compound containing capsicum and other lipotropic nutrients[10] did not significantly change energy intake.
Other effects
Anti-hyperlipidemic, antihyperglycemic, and other relevant anti-obesity effects of medicinal plants in human studies are summarized in Table 1.
Adverse effects
No significant adverse effects compared to controls were mentioned and no mortality was reported, except in studies with supplements containing ephedra and caffeine[9,20] which caused minor adverse effects such as dry mouth, insomnia, nervousness, palpitation and headache. Bofutsushosan[14] caused loose bowel movements.
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Change in body weight and body fat
The majority of animal studies (41 out of 58) showed significant weight loss or inhibition of weight gain when supplemented with high fat diets containing extracts of plants, with or without an efficient decrease in fat mass[27–85] (Table 2).
Food intake
Clinical trials with Agave tequilana (TEQ) and Dasylirion spp (DAS)[30], Pomegranate leaf[43], Korean red ginseng[58], Tree peony[69], Gyeongshang angjeehwan containing a variety of plants including platycodongrandiflorum, Magnoliaceae and Ephedra[81], Parasitic loranthus[70], and Panax ginseng berry[85] showed significant reductions in food intake or appetite. In studies with Cucurbita moschata[40], Cyperus rotundus[42], Nomame Herba[66], Acanthopanax senticosus[57] PM-F2-OB (a traditional herbal medicine used for the treatment of obesity in Korea composed of Lycii Fructus), and several other plants[73], bofu-tsusho-san[79], Galega officinalis[77], and Oolong tea[67], no change in the amount of food intake or appetite was observed.
DISCUSSION
In many studies[8–10,12–16,20–23,27,39,73,74,79–81,83], a combination of plants or compounds containing minerals and or chemical extracts of plants were investigated and the scientific names are summarized in Tables 1 and 2. Most of these studies showed anti-obesity effects such as decreasing body weight in humans or body weight gain in animals with or without changes in body fat.
Currently available anti-obesity medications attack the body fat dilemma in three different ways. They can stimulate metabolism, suppress appetite, affect serotonin, or they can impede digestion of fat. In this review, we can categorize the target effects of herbal medicines in the same way.
Arachis hypogaea[50] decreased body weight gain, liver triglyceride content and liver size in association with increased fecal lipid excretion, suggesting an inhibitory mechanism on lipid absorption. Phillyrin[52], Allium victorialis[32], Pomegranate leaf[43], Kochia scoparia[46], Panax japonicus[55], Oolong tea[67], and Aesculus turbinata Blume[71] also had the same effect.
A decrease in food intake as a result of a decrease in appetite and an influence on hormonal status was observed with TEQ and DAS[30], Pomegranate leaf[43], Korean red ginseng[58], Tree peony[69], Gyeongshang angjeehwan containing a variety of plants including platycodon grandiflorum and Magnoliaceae and ephedra[81], and Parasitic loranthus[70], refined Rhubarb[34], Caralluma fimbriata[19] and Panax ginseng berry[85]. Possible stimulation of metabolism has been reported as a mechanism of action for compounds such as Slimax[8], supplements containing ephedra[9,13,14,20] and Terminalia arjuna Roxb[11] which showed modification of lipid metabolism and a reduction in serum lipid levels.
Ephedra known as Ma Huang is a well known natural product with amphetamine-like stimulation effects. Although it’s efficacy in weight loss need more investigations, its adverse effects are well established in the literature. In this review, nine studies investigated the effects of ephedra as one of the major components in the combinations with caffeine[9,13,22] or with several other plants[14,20,79,81,83] 5 of which were human studies[9,13,14,20,22].
In one study[13], efficient decreases in body weight and fat were observed with the administration of 210 mg caffeine and 72 mg ephedra per day for 12 wk with an improvement in lipid metabolism and blood pressure without serious adverse effects. In this study, the weight loss at 12-wk was -3.5 ± 0.6 kg with the test compound which was significantly (P < 0.02) higher than that of the placebo. The percentage fat loss shown by DXA was -7.9% ± 2.9% and -1.9% ± 1.1%, respectively (P < 0.05). In another study[20], ephedra at a dose of 40 mg/d and caffeine at a dose of 100 mg/d for a longer time (9 mo) was found to be more efficient than the previous study in lowering body fat and weight, improving lipid metabolism and blood pressure and had no serious adverse effects. The treatment group lost significantly more body weight (-7.18 kg) and body fat (-5.33 kg) than the control group (-2.25 and -0.99 kg, respectively). The difference in data from these two studies possibly resulted from the different dosages and duration of interventions.
In a human study[9], a significantly greater weight loss was observed (-4.0 ± 3.4 kg or 3.5% of baseline) in the test group vs (-0.8 ± 2.4 kg or 0.09% of baseline) in the placebo group. Changes were significantly greater for body fat and percentage of body fat in the active group (-3.5 ± 3.3 kg and -2.1% ± 3.0%) in comparison to the placebo group (-0.7 ± 2.9 kg and -0.2% ± 2.3%). The tested product also produced several untoward side effects, leading to some actively treated subjects withdrawing from the study. Additional long-term studies are needed to elucidate the effects of chronic treatment. Thus further examinations in healthy individuals using scientific combinations and dose/duration adjustments are required.
Four studies[58,59,65,76] investigated different doses and types of ginseng which is a very popular Chinese herbal medicine. Ginseng significantly decreased weight gain and efficiently improved glucose tolerance[59,76].
It has been reported[58] that hormonal influences can reduce food intake and decrease serum leptin and neuropeptide Y in the brain hypothalamus although not significantly. Thus the anti-obesity effect of this plant requires further investigation.
CQ, a succulent vine native to West Africa and Southeast Asia, has been used in traditional African and Ayurvedic medicine for more than a century. Although some studies have examined other uses for CQ, its role in fighting against obesity and for symptoms of metabolic syndrome has recently attracted interest in other parts of the world, because of its milder adverse effects comparing to ephedra. In this review, two studies focused on this herb[15,26]. CQ in combination with IG[15] induced marked reductions in body weight and fat. In addition, a reduction in waist size of 1.0 cm in the placebo group vs 21.9 cm in the CQ-IG group was observed.
As we focused on herbal medicines, all dietary interventions such as the consumption of fruits and vegetables, whole grains, different types of fibers, functional food components including omega three fatty acids or phytochemicals such as flavonoids were omitted. Lifestyle modification is still the safest and efficacious method of inducing a persistent weight loss. In this review, some of the studies were carried out on subjects who simultaneously received diet and exercise programs (mentioned as weight loss programs in Tables). These results demonstrated that specific phytochemical supplements increase the effectiveness of weight loss programs and additional significant anti-obesity effects are observed.
Although few studies mentioned adverse effects, it should be noted that many serious adverse events which would have stopped a trial of a pharmaceutical agent would likely not have been identified by the authors’ search methods. Moreover, important safety issues including significant adverse events or supplement-drug interactions relevant to many clinical populations may not be fully addressed by the trials available for review.
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o AbstractINTRODUCTIONDATA SOURCES AND STUDY SELECTIONSFINDINGSHUMAN STUDIESANIMAL STUDIESCONCLUSIONReferencesCONCLUSION
Compliance with conventional weight-management programs, which often include increasing energy expenditure via physical activity, is low. It is not surprising to see the marketing of many new dietary slimming aids aimed at satisfying the need for palatable (as well as safe, effective, and therapeutic) options. In accord with this approach there are numerous investigations on the effectiveness of medicinal plants as natural supplements to reduce body weight. In this paper a variety of herbal supplements had beneficial effects on obesity especially compounds containing ephedra, CQ, ginseng, bitter melon (Momordica charantia), and zingiber. Most of the introduced herbals (Tables 1 and 2) have also been shown to have antioxidant effects, and with regard to the role of oxidative stress in the pathophysiology of some diseases and conditions, their further positive effects may be very promising[86–95]. Attention to these natural compounds and further work on the isolation and characterization of their constituents is highly recommended.
Footnotes
Peer reviewers: Cheng Ji, Professor of Research, Department of Medicine, University of Southern California, 2011 Zonal Ave., HMR-101, Los Angeles, CA 90033, United States; Anders E Lehmann, PhD, Associate Professor, Senior Principal Scientist, Bioscience, AstraZeneca R&D Mölndal, Mölndal, Sweden
S- Editor Li LF L- Editor Webster JR E- Editor Zheng XM
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1. World Health Organisation. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. World Health Organisation: Geneva; 1997.
2. Hardeman W, Griffin S, Johnston M, Kinmonth AL, Wareham NJ. Interventions to prevent weight gain: a systematic review of psychological models and behaviour change methods. Int J Obes Relat Metab Disord. 2000;24:131–143. [PubMed]
3. Abdollahi M, Afshar-Imani B. A review on obesity and weight loss measures. Middle East Pharmacy. 2003;11:6–10.
4. Mahan LK, Escott-Stump S. Krause's food, nutrition, and diet therapy. 12th ed. Vol. 11. WB Saunders: Philadelphia; 2008.
5. Hasani-Ranjbar S, Larijani B, Abdollahi M. A systematic review of Iranian medicinal plants useful in diabetes mellitus. Arch Med Sci. 2008;4:285–292.
6. Liu JP, Zhang M, Wang WY, Grimsgaard S. Chinese herbal medicines for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2004;4:CD003642. [PubMed]
7. Liu JP, Yang M, Du XM. Herbal medicines for viral myocarditis. Cochrane Database Syst Rev. 2004;4:CD003711. [PubMed]
8. Ignjatovic V, Ogru E, Heffernan M, Libinaki R, Lim Y, Ng F. Studies on the use of 'slimax', a chinese herbal mixture, in the treatment of human obesity. Pharm Biol. 2000;38:30–35.
9. Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon JL. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord. 2001;25:316–324. [PubMed]
10. Hoeger WW, Harris C, Long EM, Hopkins DR. Four-week supplementation with a natural dietary compound produces favorable changes in body composition. Adv Ther. 1998;15:305–314. [PubMed]
11. Ziauddin KS, Anwar M, Mannan A, Khan AB. Clinical efficacy of Terminalia arjuna Roxb. in the management of hyperlipidaemia. Hamdard Med. 2004;47:15–18.
12. Abidov MT, del Rio MJ, Ramazanov TZ, Klimenov AL, Dzhamirze Sh, Kalyuzhin OV. Effects of Aralia mandshurica and Engelhardtia chrysolepis extracts on some parameters of lipid metabolism in women with nondiabetic obesity. Bull Exp Biol Med. 2006;141:343–346. [PubMed]
13. Greenway FL, De Jonge L, Blanchard D, Frisard M, Smith SR. Effect of a dietary herbal supplement containing caffeine and ephedra on weight, metabolic rate, and body composition. Obes Res. 2004;12:1152–1157. [PubMed]
14. Hioki C, Yoshimoto K, Yoshida T. Efficacy of bofu-tsusho-san, an oriental herbal medicine, in obese Japanese women with impaired glucose tolerance. Clin Exp Pharmacol Physiol. 2004;31:614–619. [PubMed]
15. Oben JE, Ngondi JL, Momo CN, Agbor GA, Sobgui CS. The use of a Cissus quadrangularis/Irvingia gabonensis combination in the management of weight loss: a double-blind placebo-controlled study. Lipids Health Dis. 2008;7:12. [PMC free article] [PubMed]
16. Chrubasik C, Maier T, Dawid C, Torda T, Schieber A, Hofmann T, Chrubasik S. An observational study and quantification of the actives in a supplement with Sambucus nigra and Asparagus officinalis used for weight reduction. Phytother Res. 2008;22:913–918. [PubMed]
17. Udani J, Singh BB. Blocking carbohydrate absorption and weight loss: a clinical trial using a proprietary fractionated white bean extract. Altern Ther Health Med. 2007;13:32–37. [PubMed]
18. Roongpisuthipong C, Kantawan R, Roongpisuthipong W. Reduction of adipose tissue and body weight: effect of water soluble calcium hydroxycitrate in Garcinia atroviridis on the short term treatment of obese women in Thailand. Asia Pac J Clin Nutr. 2007;16:25–29. [PubMed]
19. Kuriyan R, Raj T, Srinivas SK, Vaz M, Rajendran R, Kurpad AV. Effect of Caralluma fimbriata extract on appetite, food intake and anthropometry in adult Indian men and women. Appetite. 2007;48:338–344. [PubMed]
20. Hackman RM, Havel PJ, Schwartz HJ, Rutledge JC, Watnik MR, Noceti EM, Stohs SJ, Stern JS, Keen CL. Multinutrient supplement containing ephedra and caffeine causes weight loss and improves metabolic risk factors in obese women: a randomized controlled trial. Int J Obes (Lond). 2006;30:1545–1556. [PubMed]
21. Garrison R, Chambliss WG. Effect of a proprietary Magnolia and Phellodendron extract on weight management: a pilot, double-blind, placebo-controlled clinical trial. Altern Ther Health Med. 2006;12:50–54. [PubMed]
22. Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes Relat Metab Disord. 2004;28:1411–1419. [PubMed]
23. Preuss HG, Bagchi D, Bagchi M, Rao CV, Dey DK, Satyanarayana S. Effects of a natural extract of (-)-hydroxycitric acid (HCA-SX) and a combination of HCA-SX plus niacin-bound chromium and Gymnema sylvestre extract on weight loss. Diabetes Obes Metab. 2004;6:171–180. [PubMed]
24. Udani J, Hardy M, Madsen DC. Blocking carbohydrate absorption and weight loss: a clinical trial using Phase 2 brand proprietary fractionated white bean extract. Altern Med Rev. 2004;9:63–69. [PubMed]
25. Bhatt AD, Dalal DG, Shah SJ, Joshi BA, Gajjar MN, Vaidya RA, Vaidya AB, Antarkar DS. Conceptual and methodologic challenges of assessing the short-term efficacy of Guggulu in obesity: data emergent from a naturalistic clinical trial. J Postgrad Med. 1995;41:5–7. [PubMed]
26. Oben JE, Enyegue DM, Fomekong GI, Soukontoua YB, Agbor GA. The effect of Cissus quadrangularis (CQR-300) and a Cissus formulation (CORE) on obesity and obesity-induced oxidative stress. Lipids Health Dis. 2007;6:4. [PMC free article] [PubMed]
27. Wang W, Wang WX, Sun BH, Zhao DZ, Gao P. [Effect of haidonghua powder(HDHP) on hypothalamic obesity in rats]. Zhongguo Zhongyao Zazhi. 2000;25:490–492. [PubMed]
28. Jeon WK, Kim JH, Lee HW, Ko BS, Kim HK. Effects of Rhus verniciflua Stokes (RVS) extract on diet-induced obesity in C57BL/6 mouse. Kor J Pharmacognosy. 2003;34:339–343.
29. Alarcon-Aguilar FJ, Zamilpa A, Perez-Garcia MD, Almanza-Perez JC, Romero-Nuñez E, Campos-Sepulveda EA, Vazquez-Carrillo LI, Roman-Ramos R. Effect of Hibiscus sabdariffa on obesity in MSG mice. J Ethnopharmacol. 2007;114:66–71. [PubMed]
30. Urías-Silvas JE, Cani PD, Delmée E, Neyrinck A, López MG, Delzenne NM. Physiological effects of dietary fructans extracted from Agave tequilana Gto. and Dasylirion spp. Br J Nutr. 2008;99:254–261. [PubMed]
31. Park YS, Yoon Y, Ahn HS. Platycodon grandiflorum extract represses up-regulated adipocyte fatty acid binding protein triggered by a high fat feeding in obese rats. World J Gastroenterol. 2007;13:3493–3499. [PubMed]
32. Jongwon C, KyungTae L, WonBae K, KwangKyun P, WonYun C, JinHa L, SangCheol L, HyunJu J, HeeJuhn P. Effect of Allium victorialis var. platyphyllum leaves on triton WR-1339-induced and poloxamer-407-induced hyperlipidemic rats and on diet-induced obesity rats. Kor J Pharmacognosy. 2005;36:109–115.
33. Kobayashi Y, Nakano Y, Kizaki M, Hoshikuma K, Yokoo Y, Kamiya T. Capsaicin-like anti-obese activities of evodiamine from fruits of Evodia rutaecarpa, a vanilloid receptor agonist. Planta Med. 2001;67:628–633. [PubMed]
34. Jin HM, Jiao DH. [Effect of jiang-zhi jian-fei yao on gastro-intestinal movement and adipose cell of abdominal wall]. Zhongguo Zhongxiyi Jiehe Zazhi. 1994;14:230–231, 198. [PubMed]
35. Kim SJ, Jung JY, Kim HW, Park T. Anti-obesity effects of Juniperus chinensis extract are associated with increased AMP-activated protein kinase expression and phosphorylation in the visceral adipose tissue of rats. Biol Pharm Bull. 2008;31:1415–1421. [PubMed]
36. Shih CC, Lin CH, Lin WL. Effects of Momordica charantia on insulin resistance and visceral obesity in mice on high-fat diet. Diabetes Res Clin Pract. 2008;81:134–143. [PubMed]
37. Pang J, Choi Y, Park T. Ilex paraguariensis extract ameliorates obesity induced by high-fat diet: potential role of AMPK in the visceral adipose tissue. Arch Biochem Biophys. 2008;476:178–185. [PubMed]
38. Bruno RS, Dugan CE, Smyth JA, DiNatale DA, Koo SI. Green tea extract protects leptin-deficient, spontaneously obese mice from hepatic steatosis and injury. J Nutr. 2008;138:323–331. [PubMed]
39. Lee J, Chae K, Ha J, Park BY, Lee HS, Jeong S, Kim MY, Yoon M. Regulation of obesity and lipid disorders by herbal extracts from Morus alba, Melissa officinalis, and Artemisia capillaris in high-fat diet-induced obese mice. J Ethnopharmacol. 2008;115:263–270. [PubMed]
40. Choi H, Eo H, Park K, Jin M, Park EJ, Kim SH, Park JE, Kim S. A water-soluble extract from Cucurbita moschata shows anti-obesity effects by controlling lipid metabolism in a high fat diet-induced obesity mouse model. Biochem Biophys Res Commun. 2007;359:419–425. [PubMed]
41. Huang HL, Hong YW, Wong YH, Chen YN, Chyuan JH, Huang CJ, Chao PM. Bitter melon (Momordica charantia L.) inhibits adipocyte hypertrophy and down regulates lipogenic gene expression in adipose tissue of diet-induced obese rats. Br J Nutr. 2008;99:230–239. [PubMed]
42. Lemaure B, Touché A, Zbinden I, Moulin J, Courtois D, Macé K, Darimont C. Administration of Cyperus rotundus tubers extract prevents weight gain in obese Zucker rats. Phytother Res. 2007;21:724–730. [PubMed]
43. Lei F, Zhang XN, Wang W, Xing DM, Xie WD, Su H, Du LJ. Evidence of anti-obesity effects of the pomegranate leaf extract in high-fat diet induced obese mice. Int J Obes (Lond). 2007;31:1023–1029. [PubMed]
44. Aoki F, Honda S, Kishida H, Kitano M, Arai N, Tanaka H, Yokota S, Nakagawa K, Asakura T, Nakai Y, et al. Suppression by licorice flavonoids of abdominal fat accumulation and body weight gain in high-fat diet-induced obese C57BL/6J mice. Biosci Biotechnol Biochem. 2007;71:206–214. [PubMed]
45. Oluyemi KA, Omotuyi IO, Jimoh OR, Adesanya OA, Saalu CL, Josiah SJ. Erythropoietic and anti-obesity effects of Garcinia cambogia (bitter kola) in Wistar rats. Biotechnol Appl Biochem. 2007;46:69–72. [PubMed]
46. Han LK, Nose R, Li W, Gong XJ, Zheng YN, Yoshikawa M, Koike K, Nikaido T, Okuda H, Kimura Y. Reduction of fat storage in mice fed a high-fat diet long term by treatment with saponins prepared from Kochia scoparia fruit. Phytother Res. 2006;20:877–882. [PubMed]
47. Goyal RK, Kadnur SV. Beneficial effects of Zingiber officinale on goldthioglucose induced obesity. Fitoterapia. 2006;77:160–163. [PubMed]
48. Kishino E, Ito T, Fujita K, Kiuchi Y. A mixture of the Salacia reticulata (Kotala himbutu) aqueous extract and cyclodextrin reduces the accumulation of visceral fat mass in mice and rats with high-fat diet-induced obesity. J Nutr. 2006;136:433–439. [PubMed]
49. Jayaprakasam B, Olson LK, Schutzki RE, Tai MH, Nair MG. Amelioration of obesity and glucose intolerance in high-fat-fed C57BL/6 mice by anthocyanins and ursolic acid in Cornelian cherry (Cornus mas). J Agric Food Chem. 2006;54:243–248. [PubMed]
50. Moreno DA, Ilic N, Poulev A, Raskin I. Effects of Arachis hypogaea nutshell extract on lipid metabolic enzymes and obesity parameters. Life Sci. 2006;78:2797–2803. [PubMed]
51. Galisteo M, Sánchez M, Vera R, González M, Anguera A, Duarte J, Zarzuelo A. A diet supplemented with husks of Plantago ovata reduces the development of endothelial dysfunction, hypertension, and obesity by affecting adiponectin and TNF-alpha in obese Zucker rats. J Nutr. 2005;135:2399–2404. [PubMed]
52. Zhao Y, Li F, Yang J, An X, Zhou M. [Effect of phillyrin on the anti-obesity in nutritive obesity mice]. Zhongyaocai. 2005;28:123–124. [PubMed]
53. Chen Q, Li ET. Reduced adiposity in bitter melon (Momordica charantia) fed rats is associated with lower tissue triglyceride and higher plasma catecholamines. Br J Nutr. 2005;93:747–754. [PubMed]
54. Han LK, Morimoto C, Yu RH, Okuda H. Effects of Coleus forskohlii on fat storage in ovariectomized rats. Yakugaku Zasshi. 2005;125:449–453. [PubMed]
55. Han LK, Zheng YN, Yoshikawa M, Okuda H, Kimura Y. Anti-obesity effects of chikusetsusaponins isolated from Panax japonicus rhizomes. BMC Complement Altern Med. 2005;5:9. [PMC free article] [PubMed]
56. Han LK, Gong XJ, Kawano S, Saito M, Kimura Y, Okuda H. [Antiobesity actions of Zingiber officinale Roscoe]. Yakugaku Zasshi. 2005;125:213–217. [PubMed]
57. Cha YS, Rhee SJ, Heo YR. Acanthopanax senticosus extract prepared from cultured cells decreases adiposity and obesity indices in C57BL/6J mice fed a high fat diet. J Med Food. 2004;7:422–429. [PubMed]
58. Kim JH, Hahm DH, Yang DC, Kim JH, Lee HJ, Shim I. Effect of crude saponin of Korean red ginseng on high-fat diet-induced obesity in the rat. J Pharmacol Sci. 2005;97:124–131. [PubMed]
59. Yun SN, Moon SJ, Ko SK, Im BO, Chung SH. Wild ginseng prevents the onset of high-fat diet induced hyperglycemia and obesity in ICR mice. Arch Pharm Res. 2004;27:790–796. [PubMed]
60. Junbao Y, Long J, Jiangbi W, Yonghui D, Tianzhen Z, Songyi Q, Wei L. [Inhibitive effect of Semen Cassiae on the weight gain in rats with nutritive obesity]. Zhongyaocai. 2004;27:281–284. [PubMed]
61. Kim SO, Yun SJ, Lee EH. The water extract of adlay seed (Coix lachrymajobi var. mayuen) exhibits anti-obesity effects through neuroendocrine modulation. Am J Chin Med. 2007;35:297–308. [PubMed]
62. Kwon CS, Sohn HY, Kim SH, Kim JH, Son KH, Lee JS, Lim JK, Kim JS. Anti-obesity effect of Dioscorea nipponica Makino with lipase-inhibitory activity in rodents. Biosci Biotechnol Biochem. 2003;67:1451–1456. [PubMed]
63. Lu J, Liu H. [Electron microscope observation on effect of kudingcha inspissation tea on small intestine villus in the adiposity rats]. Zhongyaocai. 1999;22:641–642. [PubMed]
64. Yoshikawa M, Shimoda H, Nishida N, Takada M, Matsuda H. Salacia reticulata and its polyphenolic constituents with lipase inhibitory and lipolytic activities have mild antiobesity effects in rats. J Nutr. 2002;132:1819–1824. [PubMed]
65. Xie JT, Zhou YP, Dey L, Attele AS, Wu JA, Gu M, Polonsky KS, Yuan CS. Ginseng berry reduces blood glucose and body weight in db/db mice. Phytomedicine. 2002;9:254–258. [PubMed]
66. Yamamoto M, Shimura S, Itoh Y, Ohsaka T, Egawa M, Inoue S. Anti-obesity effects of lipase inhibitor CT-II, an extract from edible herbs, Nomame Herba, on rats fed a high-fat diet. Int J Obes Relat Metab Disord. 2000;24:758–764. [PubMed]
67. Han LK, Takaku T, Li J, Kimura Y, Okuda H. Anti-obesity action of oolong tea. Int J Obes Relat Metab Disord. 1999;23:98–105. [PubMed]
68. Pusztai A, Grant G, Buchan WC, Bardocz S, de Carvalho AF, Ewen SW. Lipid accumulation in obese Zucker rats is reduced by inclusion of raw kidney bean (Phaseolus vulgaris) in the diet. Br J Nutr. 1998;79:213–221. [PubMed]
69. Nagasawa H, Iwabuchi T, Inatomi H. Protection by tree-peony (Paeonia suffruticosa Andr) of obesity in (SLN x C3H/He) F1 obese mice. In Vivo. 1991;5:115–118. [PubMed]
70. Wang Y, Deng M, Zhang SY, Zhou ZK, Tian WX. Parasitic loranthus from Loranthaceae rather than Viscaceae potently inhibits fatty acid synthase and reduces body weight in mice. J Ethnopharmacol. 2008;118:473–478. [PubMed]
71. Hu JN, Zhu XM, Han LK, Saito M, Sun YS, Yoshikawa M, Kimura Y, Zheng YN. Anti-obesity effects of escins extracted from the seeds of Aesculus turbinata BLUME (Hippocastanaceae). Chem Pharm Bull (Tokyo). 2008;56:12–16. [PubMed]
72. Ohkoshi E, Miyazaki H, Shindo K, Watanabe H, Yoshida A, Yajima H. Constituents from the leaves of Nelumbo nucifera stimulate lipolysis in the white adipose tissue of mice. Planta Med. 2007;73:1255–1259. [PubMed]
73. Kang M, Oh JW, Lee HK, Chung HS, Lee SM, Kim C, Lee HJ, Yoon DW, Choi H, Kim H, et al. Anti-obesity effect of PM-F2-OB, an anti-obesity herbal formulation, on rats fed a high-fat diet. Biol Pharm Bull. 2004;27:1251–1256. [PubMed]
74. Mary NK, Babu BH, Padikkala J. Antiatherogenic effect of Caps HT2, a herbal Ayurvedic medicine formulation. Phytomedicine. 2003;10:474–482. [PubMed]
75. Wu Y, Ou-Yang JP, Wu K, Wang Y, Zhou YF, Wen CY. Hypoglycemic effect of Astragalus polysaccharide and its effect on PTP1B. Acta Pharmacol Sin. 2005;26:345–352. [PubMed]
76. Xie JT, Wang CZ, Wang AB, Wu J, Basila D, Yuan CS. Antihyperglycemic effects of total ginsenosides from leaves and stem of Panax ginseng. Acta Pharmacol Sin. 2005;26:1104–1110. [PubMed]
77. Palit P, Furman BL, Gray AI. Novel weight-reducing activity of Galega officinalis in mice. J Pharm Pharmacol. 1999;51:1313–1319. [PubMed]
78. Oi Y, Kawada T, Shishido C, Wada K, Kominato Y, Nishimura S, Ariga T, Iwai K. Allyl-containing sulfides in garlic increase uncoupling protein content in brown adipose tissue, and noradrenaline and adrenaline secretion in rats. J Nutr. 1999;129:336–342. [PubMed]
79. Yoshida T, Sakane N, Wakabayashi Y, Umekawa T, Kondo M. Thermogenic, anti-obesity effects of bofu-tsusho-san in MSG-obese mice. Int J Obes Relat Metab Disord. 1995;19:717–722. [PubMed]
80. He GW, Qu WJ, Fan B, Jing R, He R. The protective effect of Yi-Qi-Yang-Yin-Ye, a compound of traditional Chinese herbal medicine in diet-induced obese rats. Am J Chin Med. 2008;36:705–717. [PubMed]
81. Jeong S, Chae K, Jung YS, Rho YH, Lee J, Ha J, Yoon KH, Kim GC, Oh KS, Shin SS, et al. The Korean traditional medicine Gyeongshingangjeehwan inhibits obesity through the regulation of leptin and PPARalpha action in OLETF rats. J Ethnopharmacol. 2008;119:245–251. [PubMed]
82. Park YS, Cha MH, Yoon YS, Ahn HS. Effects of low calorie diet and Platycodon grandiflorum extract on fatty acid binding protein expression in rats with diet-induced obesity. Nutritional Sciences. 2006;8:3–9.
83. Akagiri S, Naito Y, Ichikawa H, Mizushima K, Takagi T, Handa O, Kokura S, Yoshikawa T. Bofutsushosan, an Oriental Herbal Medicine, Attenuates the Weight Gain of White Adipose Tissue and the Increased Size of Adipocytes Associated with the Increase in Their Expression of Uncoupling Protein 1 in High-Fat Diet-Fed Male KK/Ta mice. J Clin Biochem Nutr. 2008;42:158–166. [PMC free article] [PubMed]
84. Kim YM, Jeong YK, Wang MH, Lee WY, Rhee HI. Inhibitory effect of pine extract on alpha-glucosidase activity and postprandial hyperglycemia. Nutrition. 2005;21:756–761. [PubMed]
85. Attele AS, Zhou YP, Xie JT, Wu JA, Zhang L, Dey L, Pugh W, Rue PA, Polonsky KS, Yuan CS. Antidiabetic effects of Panax ginseng berry extract and the identification of an effective component. Diabetes. 2002;51:1851–1858. [PubMed]
86. Hasani-Ranjbar S, Larijani B, Abdollahi M. A systematic review of the potential herbal sources of future drugs effective in oxidant-related diseases. Inflamm Allergy Drug Targets. 2009;8:2–10. [PubMed]
87. Mohseni Salehi Monfared SS, Larijani B, Abdollahi M. Islet transplantation and antioxidant management: a comprehensive review. World J Gastroenterol. 2009;15:1153–1161. [PMC free article] [PubMed]
88. Rahimi R, Mozaffari S, Abdollahi M. On the use of herbal medicines in management of inflammatory bowel diseases: a systematic review of animal and human studies. Dig Dis Sci. 2009;54:471–480. [PubMed]
89. Salari P, Rezaie A, Larijani B, Abdollahi M. A systematic review of the impact of n-3 fatty acids in bone health and osteoporosis. Med Sci Monit. 2008;14:RA37–RA44. [PubMed]
90. Rezaie A, Parker RD, Abdollahi M. Oxidative stress and pathogenesis of inflammatory bowel disease: an epiphenomenon or the cause? Dig Dis Sci. 2007;52:2015–2021. [PubMed]
91. Rahimi R, Abdollahi M. A review on the mechanisms involved in hyperglycemia induced by organophosphorus pesticides. Pestic Biochem Physiol. 2007;88:115–121.
92. Kajbaf F, Mojtahedzadeh M, Abdollahi M. Mechanisms underlying stress-induced hyperglycemia in critically ill patients. Therapy. 2007;4:97–106.
93. Rahimi R, Nikfar S, Larijani B, Abdollahi M. A review on the role of antioxidants in the management of diabetes and its complications. Biomed Pharmacother. 2005;59:365–373. [PubMed]
94. Abdollahi M, Larijani B, Rahimi R, Salari P. Role of oxidative stress in osteoporosis. Therapy. 2005;2:787–796.
95. Abdollahi M, Ranjbar A, Shadnia S, Nikfar S, Rezaie A. Pesticides and oxidative stress: a review. Med Sci Monit. 2004;10:RA141–RA147. [PubMed]
-Surgery
Bariatric surgery, or weight loss surgery, is a type of procedure performed on people who are dangerously obese, for the purpose of losing weight. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).
Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%.
The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities.

Indications
A medical guideline by the American College of Physicians concluded:
• "Surgery should be considered as a treatment option for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gallbladder disease, and malabsorption."
• "Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery."
When determining eligibility for bariatric surgery for extremely obese patients, psychiatric screening is critical; it is also critical for determining postoperative success. In patients with a body mass index of 40 kg/m2 or greater, there is a 5-fold risk of depression, and half of bariatric surgery candidates are depressed.
Classification of surgical procedures
Procedures can be grouped in three main categories: Standard of care in the United States and most of the industrialized world in 2009 is for laparoscopic as opposed to open procedures. Future trends are attempting to achieve similar or better results via endoscopic procedures.
Predominantly malabsorptive procedures
Predominantly malabsorptive procedures, although they also reduce stomach size, these operatBiliopancreatic diversion
This complex operation is also known as biliopancreatic diversion (BPD), or Scopinaro procedure. This surgery is rare now because of problems with malnourishment. It has been replaced with the Duodenal switch, also known as the BPD/DS. Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum.
In around 2% of patients there is severe malabsorption and nutritional deficiency that requires restoration of the normal absorption. The malabsorptive effect of BPD is so potent that those who undergo the procedure must take vitamin and dietary minerals above and beyond that of the normal population. Without these supplements, there is risk of serious deficiency diseases such as anemia and osteoporosis.
Because gallstones are a common complication of the rapid weight loss following any type of bariatric surgery, some surgeons remove the gallbladder as a preventative measure during BPD. Others prefer to prescribe medications to reduce the risk of post-operative gallstones
Far fewer surgeons perform BPD compared to other weight loss surgeries, in part because of the need for long-term nutritional follow-up and monitoring of BPD patients.
ions are based mainly on creating malabsorption.
Jejunoileal bypass
Jejunoileal Bypass was a surgical weight loss procedure performed from the 1950s through the 1970s in which all but 30cm (12") to 45cm (18") of the small bowel were detached and set to the side.
Many complications that followed jejunoileal bypass operations performed for the relief of morbid obesity were caused by bacterial overgrowth in the excluded blind loop. The arthritis-dermatitis syndrome was one of the common distressing disorders. The pathogenetic mechanism was thought to be an immune-complex-mediated process related to bypass enteritis.
Problems with Jejuno-Ilial Bypass
Two variants of jejunoileal anastomosis were developed, the end-to-side[1] and end-to end (Scott, Dean et al. 1973) anastomoses of the proximal jejunum to distal ileum. In both instances an extensive length of small intestine was bypassed, not excised, excluding it from the alimentary stream.
In both these variants a total of only about 35 cm (18") of normally absorptive small intestine was retained in the absorptive stream, compared with the normal length of approximately 7 metres (twenty feet). In consequence, malabsorption of carbohydrate, protein, lipids, minerals and vitamins inevitably occur, Where the end-to-side technique was used, reflux of bowel content back up the defunctionalized small intestine allowed absorption of some of the refluxed material resulting in less weight loss initially and greater subsequent weight regain.
Bile is secreted by the liver, enters the upper small intestine by way of the bile duct, and is absorbed in the small intestine. Bile has an important role in fat digestion, emulsifying fat as the first stage in its digestion. Bypassing the major site of bile acid reabsorption in the small intestine therefore further reduces fat and fat soluble vitamin absorption. As a result, huge amounts of fatty acids, which are normally absorbed in the small intestine, enter the colon where they cause irritation of the colon wall and the secretion of excessive volumes of water and electrolytes, especially sodium and potassium, leading to diarrhea. This diarrhea is the major patient complaint and has characterized jejunoileal bypass in the minds of patient and physician alike since the procedure was introduced.
Bile salts help to keep cholesterol in solution in the bile. Following JIB, the bile salt pool is decreased as a consequence of reduced absorption in the small intestine and bile salt losses in the stool. The relative cholesterol concentration in gallbladder bile rises and cholesterol crystals precipitate in the gallbladder bile, forming a nidus for development of cholesterol gallstones in the gallbladder. Specific vitamin deficiencies also occur; Vitamin D and Calcium deficiencies lead to thinning of bone with bone pain and fractures as a result of osteoporosis and osteomalacia. Bypass of the terminal ileum, which is the specific site of vitamin B12 absorption, leads to Vitamin B12 deficiency with a specific peripheral neuropathy. Vitamin A deficiency can induce night blindness. Calcium oxalate renal stones occur commonly following JIB, along with increased colonic absorption of oxalate. The colonic absorption of oxalate has been attributed to:
• Exposure of colonic mucosa to excessive bile salts and possibly bile acids, increasing colonic permeability to oxalate, or
• Excessive quantities of fatty acids in the gut form soaps with calcium, reducing its availability to form insoluble calcium oxalate leading to the persistence of soluble and absorbable oxalate in the colon.
Patients with intestinal bypass develop diarrhea 4-6 times daily. The frequency of stooling varying directly with fat intake. There is a general tendency for stooling to diminish with time, as the short segment of small intestine remaining in the alimentary stream increases in size and thickness, developing its capacity to absorb calories and nutrients, thus producing improvement in the patients nutrition and counterbalancing the ongoing weight loss. This happy result does not occur in every patient, but approximately one third of those undergoing "Intestinal Bypass" have a relatively benign course. Unfortunately, even this group is at risk of significant late complications, many patients developing irreversible hepatic cirrhosis several years after the procedure.
Complications
JIB is the classic example of a malabsorptive weight loss procedure. Some modern procedures utilize a lesser degree of malabsorption combined with gastric restriction to induce and maintain weight loss. Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB. The multiple complications associated with JIB while considerably less severe than those associated with Jejunocolic anastomosis, were sufficiently distressing both to the patient and to the medical attendant to cause the procedure to fall into disrepute.
Listing of jejuno-ileal bypass complications:
Mineral and electrolyte imbalance:
• Decreased serum sodium, potassium, magnesium and bicarbonate
• Decreased sodium chloride
• Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis
Protein calorie malnutrition:
• Hair loss, anemia, edema, and vitamin depletion
• Cholelithiasis
Enteric complications:
• Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction
Extra-intestinal manifestations:
• Arthritis
• Severe pain issues that are not fully understood
• Liver disease, occurs in at least 30%
• Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery.
• Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2%
• Erythema nodosum, non-specific pustular dermatosis
• Weber-Christian disease
Some of these features may coincide in bowel-associated dermatosis-arthritis syndrome.
Renal disease:
• Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.
Miscellaneous:
• Peripheral neuropathy, pericarditis, pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia
The multiple complications associated with JIB led to a search for alternative procedures, one of which was gastric bypass, a procedure that is described in detail later. In 1983 Griffen et al. reported a comprehensive series comparing the results of jejuno-ileal bypass with gastric bypass. 11 of 50 patients who underwent JIB required conversion to gastric bypass within 5 years, leading Griffen to abandon jejuno-ileal bypass.
JIB can be summed up as having: a. Good Weight Loss, b. Malabsorption with multiple deficiencies, c. Diarrhea, d. Severe Pain Issues That are not fully understood, e.Possible Death
As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB, and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures.
Endoluminal sleeve

No longer only performed on mice, this surgery involved placing a 10 cm long impermeable sleeve into the mouse's intestine to block absorption of food in the duodenum and upper jejunum. A study at Massachusetts General Hospital Weight Center and Gastrointestinal Unit found that mice who had the surgery ate 30% less food and lost 20% more weight than counterpart mice, while blood glucose levels returned to normal levels in all mice who had the surgery.
Clinical trials began in South America and Europe in 2009. GI Dynamics inc, is testing a new surgery-free medical device called the EndoBarrier Gastrointestinal Liner. It may offer the effective surgery free weight loss. Lining part of the small intestines from the duodenum and into the first part of the jejunum. This mechanical bypass may alter hormonal responses in the body. Resulting in metabolic changes that lead to weight loss and a potential solution for type 2 diabetes.
Clinical studies show losses 20 percent of excess weight within three months, and 30 percent of excess weight within six months. The exact nature of the link between an Endoluminal sleeve and diabetes is unknown. One theory is it may change the hormone levels originating in the intestines.
Since the preceding paragraphs, the procedure's won the European CE Mark of Approval, and is available there now. At this time no information is available about clinical trials or approval in the United States.
Predominantly restrictive procedures
Predominantly restrictive procedures primarily reduce stomach size.
Vertical banded gastroplasty surgery

Vertical banded gastroplasty (VBG), also known as stomach stapling, is a restrictive operation for weight control. Both a band and staples are used to create a small stomach pouch. In the bottom of the pouch is an approximate one-centimeter hole through which the pouch contents can flow into the remainder of the stomach and thence onto the remainder of the gastrointestinal tract.
Stomach stapling is a restrictive technique for managing obesity. The pouch limits the amount of food a patient can eat at one time and slows passage of the food. Stomach stapling is more effective when combined with a malabsorptive technique, in which part of the digestive tract is bypassed, reducing the absorption of calories and nutrients. Combined restrictive and malabsorptive techniques are called gastric bypass techniques, of which Roux-en-Y gastric bypass surgery (RGB) is the most common. In this technique, staples are used to form a pouch that is connected to the small intestine, bypassing the lower stomach, the duodenum, and the first portion of the jejunum.
This type of weight loss surgery is losing favor as more doctors begin using the adjustable gastric band. The newer adjustable band does not require cutting into the stomach and does not use any staple lines, thus making it a much safer alternative.
VBG is known in the medical community as a very serious and dangerous procedure. It has been classified by the AMA as a "severely dangerous" operation.
VBG Advantages & Disadvantages
VBG advantages
• No dumping syndrome
• No nutritional deficiencies/malabsorption
VBG disadvantages
• Needs strict patient compliance to diet
• High fibre foods and foods with a more dense, natural consistency can become very difficult to eat, while highly refined foods cause little discomfort. Most people who regain any weight lost after surgery do so because choosing "healthier" foods are harder to digest, while "junk" food pass easily.
• VBG is in no way a magic bullet or pill. It must be emphasized that lifestyle changes, i.e. diet and exercise, are absolutely imperative for weight loss to occur and be maintained. Realistic expectations are imperative.
• Reversal of a VBG requires a much more complex and intensive surgical process than getting the VBG. When removal of a polyurethane band is involved (polyurethane was predominantly used in the 1980s and 90s), it likely has built substantial scar tissue that must also be removed, depending on how long ago the VBG took place. Removal of the staples involves stitching the previously separated parts of the stomach back together. For these reasons, a reversal should only be considered if there are serious medical complications.
• Vomiting and severe discomfort if food is not properly chewed or if food is eaten too quickly.
• Not adjustable (as with the Adjustable gastric band (aka "Lap band")).
VBG alternatives
• Selective vagotomy (Snipping the Vagus Nerve, effectively stopping hunger sensations)
Risks
One of the possibility is that the pouch could stretch and expand to the original size of the stomach. The food pouch grows to twice its capacity in just two months and it’s possible that it might stretch further. The stomach stapling could come apart, having the same effect: stomach expansion to original size. If there are leakages, the acid content from the stomach could leak onto other organs, damaging them seriously. Also, if the contents of the stomach move too quickly through the small intestine, you might find yourself reeling from nausea, perspiration, diarrhea and so on. Patients sometimes develop gall stones and develop complications such as hernia which need further follow-up operations; remember that corrective procedures come with their own risks.[1]
Adjustable gastric band
The restriction of the stomach also can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin. This operation can be performed laparoscopically, and is commonly referred to as a "lap band." The first non-adjustable gastric band was patented in 1979 and successfully applied in animal experiments. An American company, INAMED Health, later designed the BioEnterics LAP-BAND Adjustable Gastric Banding System (based on the design by Kuzmak in 1986), which was introduced in Europe in 1993. Neither of these bands was initially designed for use with laparoscopic surgery. The LAP-BAND System received U.S. Food and Drug Administration (FDA) approval in June 2001. In 2000, a lower pressure, wider, one-piece adjustable gastric band called the MIDband was introduced by Medical Innovation Development of Lyon France.[11] In 2002, a lower pressure, wider, one-piece adjustable gastric band called the Bioring designed specifically for laparoscopic insertion was introduced in France by Cousin-Biotech, and swiftly become one of the leading bands in that country. There are now a number of band manufacturers including Ethicon (Realize Band), A.M.I. (Soft Band) and Bariatric Solutions (Mini Mizer Extra).http://www.hospimedical.com/wDeutsch/for-surgeons/minimizer-extra.php?navid=2 [2]
Sleeve gastrectomy
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients, even when the risk of the two surgeries is added. Most patients can expect to lose 30 to 50% of their excess body weight over a 6 - 12 month period with the sleeve gastrectomy alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 – 18 months.
- Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts. - Removes the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin), although the durability of this removal has yet to be confirmed [4]. - No dumping syndrome because the pylorus is preserved. - Minimizes the chance of an ulcer occurring. - By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced. - Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2). - Limited results appear promising as a single stage procedure for low BMI patients (BMI 35–45 kg/m2). - Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
Intragastric balloon
This surgery involves endoscopic placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5-9BMI over half a year. While not yet approved by the FDA the Intragastric balloon is approved in Australia, Canada, Mexico, India and several European and South American countries.
Mixed procedures
Gastric Bypass Surgery
A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.
The gastric bypass had been the most commonly performed operation for weight loss in the United States, and approximately 140,000 gastric bypass procedures were performed in 2005, dwarfing the number of Lap-Band, duodenal switch and vertical banded gastroplasty procedures. The gastric bypass operation is considered the "gold standard" in the U.S. A factor in the success of any bariatric surgery is strict post-surgical adherence to a gastric bypass diet. healthier pattern of eating.
Sleeve gastrectomy with duodenal switch
A variation of the biliopancreatic diversion includes a Duodenal switch. The part of the stomach along its greater curve is resected. The stomach is "tubulized" with a residual volume of about 150 ml. This volume reduction provides the food intake restriction component of this operation. This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the upper part of the small intestine are reattached to the rest at about 75–100 cm from the colon.
Implantable Gastric Stimulation
This procedure where a device similar to a heart pacemaker is implanted by a surgeon, with the electrical leads stimulating the external surface of the stomach, is being studied in the USA. Electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of satiety, or fullness. Early evidence suggests that it is less effective than other forms of Bariatric Surgery.
Eating after bariatric surgery
Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts. This diet is continued until the gastrointenstinal tract has recovered somewhat from the surgery. The next stage provides a blended or pureed sugar-free diet for at least two weeks. This may consist of skimmed milk, cream of wheat, a small pat of margarine, protein drinks, cream soup, pureed fruit and mashed potatoes with gravy.
Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery from surgery depend in part on the type of surgery. Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in fats and alcohol.
Effectiveness of surgery
Weight loss
In general, the malabsorptive procedures lead to more weight loss than the restrictive procedures however, have a higher risk profile. A meta-analysis from University of California, Los Angeles reports the following weight loss at 36 months:
• Biliopancreatic diversion - 53 kg
• Roux-en-Y gastric bypass (RYGB) - 41 kg
o Open - 42 kg
o Laparoscopic - 38 kg
• Adjustable gastric banding - 35 kg
• Vertical banded gastroplasty - 32 kg
In terms of percentage of excess weight lost, following are aggregated study results for the range of each procedure (number of studies; total patients in all studies):
• Biliopancreatic diversion with duodenal switch – 65% to 75% (4; 3,266)
• Roux-en-Y gastric bypass (RYGB) – 50% to 70% (5, 6,234)
• Adjustable gastric banding – 25% to 80% (9; 2,672)
• Vertical banded gastroplasty – 50% to 60% (4; 1,114)
• Sleeve gastrectomy – short-term results – 65% to 75% (5; 384)
More recent studies have demonstrated that the medium (3–8 years) and long term (>10 years) weight loss results for RYGB and LAGB become very similar [6].However, the range of excess weight loss for LAGB patients (25% to 80%) is much broader than that of RYGB patients (50% to 70%). Data (beyond 5 years) for Sleeve Gastrectomy is not yet available (as of 12/09).
Reduced mortality and morbidity
Several recent studies report decrease in mortality and severity of medical conditions after bariatric surgery. But long term effects are not clear. In the Swedish prospective matched controlled trial, patients with a body mass index (BMI) of 34 or more for men and 38 or more for women underwent various types of bariatric surgery and were followed for an average of 11 years. Surgery patients had a 23.7% reduction in mortality (5.0% vs. 6.3% control, adjusted hazard ratio 0.71). This means 75 patients must be treated to avoid one death after 11 years (number needed to treat is 77).
In a Utah retrospective cohort study that followed patients for an average of 7 years after various types of gastric bypass, surgery patients had 0.4% mortality while control patients had 0.6% mortality. Death rates were lower in the gastric bypass patients for all diseases combined, as well as for diabetes, heart disease and cancer. Deaths from accident and suicide were 58% higher in the surgery group.
A randomized, controlled trial in Australia compared laparoscopic adjustable gastric banding ("lap banding") with non-surgical therapy in 80 moderately obese adults (BMI 30-35). At 2 years, the surgically-treated group lost more weight (21.6% of initial weight vs. 5.5%) and had statistically significant improvement in blood pressure, measures of diabetic control, and high-density lipoprotein cholesterol. Post surgical complications included 1 patient with an infected surgical site, 4 with lap band malpositioning requiring laparoscopic revision, and 1 patient with cholecystitis. In the non-surgical group, 12 patients declined or did not tolerate orlistat or diet restrictions, and 4 patients developed acute cholecystitis.
Bariatric surgery in older patients has also been a topic of debate, centered on concerns for safety in this population. One study of elderly patients undergoing laparoscopic bariatric surgery at Mount Sinai Medical Center, however, reported 0% conversion to open surgery, 0% 30-day mortality, 7.3% complication rate, and average hospital stay of 2.8 days. post operative mortality from 0.1 - 2 %
Laparoscopic bariatric surgery requires a hospital stay of only one or two days. Short-term complications from laparoscopic adjustable gastric banding are reported to be lower than laparoscopic Roux-en-Y surgery, and complications from laparoscopic Roux-en-Y surgery are lower than conventional (open) Roux-en-Y surgery.
Adverse effects
Complications from weight loss surgery are frequent. A study of insurance claims of 2522 who had undergone bariatric surgery showed 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months. This was more common in those over 40 and led to increased health care expenditure. Common problems were gastric dumping syndrome in about 20% (bloatedness and diarrhoea after eating, necessitating small meals or medication), leaks at the surgical site (12%), incisional hernia (7%), infections (6%) and pneumonia (4%). Mortality was 0.2%.
As the rate of complications appears to be reduced when the procedure is performed by an experienced surgeon, guidelines recommend that surgery is performed in dedicated or experienced units.
Obesity Surgery can Cause Serious Neurological Condition
Ivanhoe Newswire) -- If you have obesity surgery, it is crucial for you to take your prescribed vitamin supplements and watch for symptoms such as vomiting, confusion, lack of coordination and visual changes.
These could be signs of a serious neurological condition called Wernicke encephalopathy. The syndrome affects the brain and nervous system when patients don't get enough vitamin B1, also known as thiamine.
A new study reveals the syndrome most often occurs in patients who vomit frequently after weight loss surgery, like gastric bypass surgery, usually within one to three months after the procedure. It can develop when patients stop taking their vitamins or when frequent vomiting keeps them from absorbing the supplements.
Researchers reviewed scientific literature for the 32 reported cases of Wernicke encephalopathy occurring after bariatric surgery. They found many of the patients also had neurological symptoms not typical of the syndrome, like seizures, deafness, psychosis, muscle weakness, and pain or numbness in the feet or hands.
The authors say if you have any of these symptoms after weight loss surgery, you need to see a doctor immediately.
"There are more than 170,000 obesity surgeries performed annually in the United States, and this neurological condition, known as Wernicke encephalopathy, is increasingly being reported after the operation," reports lead author Sonal Singh, M.D., from Wake Forest University School of Medicine in Winston-Salem, N.C.
Patients are usually given vitamin B1 through an IV or injection to treat the condition. Of the 32 reported cases of Wernicke encephalopathy, researchers report 13 made a full recovery. Many patients kept having symptoms like memory problems, weakness, or difficulty coordinating movement.
While some doctors prescribe thiamine supplementation after bariatric surgery, Dr. Singh recommends national standards be set for all doctors to follow.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/.
SOURCE: NEUROLOGY, 2007;68:807-811