Diabetes Injection beats Xenical for weight loss

Here's an interesting new finding for people struggling with their weight, as reported on BBC News (link), and published in the latest issue of the medical journal The Lancet: in a randomized, controlled study, the injectable diabetes treatment Victoza (liraglutide) helped overweight people lose significantly more weight than prescription Xenical, which is one of the leading weight-loss medications. Victoza (liraglutide) is awaiting FDA approval here in the U.S.A.

This is actually an exciting, unexpected finding, and holds promise for treatment of diabetes, metabolic syndrome and obesity.

In this 20-week European study, 564 individuals with obesity were randomly assigned to one of four Victoza (liraglutide) doses, to placebo, or orlistat. All individuals were given a 500 kcal diet and increased their physical activity throughout the trial.

Participants on Victoza lost significantly more weight than did those on placebo or orlistat. Weight loss increased with the dosage of Victoza, and was 7·2 kg (15.8 lbs) in the high dose group, compared with only 2·8 kg with placebo and 4·1 kg with orlistat. The medication also reduced blood pressure, and reduced the prevalence of prediabetes in the 20 week trial.

If Victoza (liraglutide) does meet FDA criteria, it will be interesting to see whether people will accept the idea of a daily injection for weight loss treatment. With any new drug, it's also very important to fully understand the potential side effect profile, as well.

When Abdominal Fat can be deadly - "Metabolic Syndrome"

It's well known that America has an obesity epidemic, which affects both adults and children alike. But what's not as well known, even in the medical community, is the rapid rise in an obesity-related problem called "Metabolic Syndrome".

Metabolic Syndrome is diagnosed if you have 3 or more of:
- increased waist size (>40 inches for men, 34.6 inches for women
- elevated blood sugars or known Type II diabetes
- elevated blood pressure (> 130/85) or known hypertension
- decreased good cholesterol (HDL)
- increased triglycerides

Why is Metabolic Syndrome important? Because it causes a huge increase in the risks for heart attack and stroke. According to a 2002 article in the Journal of the American Medical Association ("JAMA"), middle aged men with Metabolic Syndrome are three to four times more likely to die of coronary artery disease, and have double the all-cause mortality rate. It affects women similarly, too.

About 47 million people in the United States are believed to have the syndrome, or about one-fourth of the population. It's common here due to our sedentary lifestyle and overall level of obesity.

It's probably more even common than that at my office, because the patients I see for liposuction and tummy tucks are often self-selected; they are seeing me specifically because they have an increased waist size, which is the most obvious part of the syndrome. I now routinely check these patients for the other parts of the syndrome.... Almost every month, we find men and women who never knew they had untreated diabetes, or cholesterol abnormalities, or the whole package -- Metabolic Syndrome. And let me tell you, are they ever thankful we discovered the problem early, rather than after a heart attack! "Doc, I came in for a tummy tuck, and you saved my life!"

It turns out that the fat inside the abdomen, the so-called "visceral fat" (as opposed to the fat that is immediately underneath the skin - "subcutaneous fat") is the chief culprit, together with insulin resistance. Visceral fat is not the harmless layer of insulation we used to think it was - it is metabolically active, giving off hormonal messenger compounds that affect our body. The thicker the visceral fat is, the more health problems are seen. Unfortunately, this internal fat can not be removed by way of liposuction or tummy tuck, so there's no quick fix.

There is an answer, though, and hope for those with the syndrome. Insulin sensitizing medications such as metformin can be used to help with the insulin resistance. Blood pressure and cholesterol medication can help, too, controlling those parts of the syndrome.

Probably the most important treatment, though, is the one that takes the most determination and effort - diet and excercise, particularly aerobic fitness. Several studies show that aerobically fit people with Metabolic Syndrome improve their odds substantially, reducing their risks by a factor of three. Furthermore, overweight people who are aerobically fit have a lower risk of cardiovascular mortality than those who are lean but unfit.

It's time to turn off the TV's and computers, America, and go get some exercise! (And that includes me, too!) Your heart will thank you for it.