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Discusses Women's Health

Since I tend to report on aspects of my personal life, I want to announce some personally exciting news: My daughter and her two small children moved to LA for a year. Not only are they living three minutes away…the children are in my temple school. I am delighted!

I have also become involved with a terrific organization, the National Breast Cancer Coalition (NBCC) which sponsors and supports the research that will help us prevent, diagnosis and effectively treat breast cancer. They are holding their annual event in LA on October 6. It will be a phenomenal French style review of dancing and singing titled “Les Girls” with performances by many of your favorite TV and theater stars and will be hosted by Allison Janney (who, I might add just won two Tonys). I am somewhat embarrassed to add that the NBCC board decided to present me with an award that evening and I am truly honored.

So if you think you would like to come to a fun evening and contribute to an important cause you can download details HERE.

Now onto the medical subject of this week’s website….Weight Loss

The September 3 issue of JAMA was dedicated to this weighty subject. As you know, one third of Americans are overweight or obese. It truly is an American epidemic. (And by the way, risk for a majority of cancers is significantly increased or just plain caused by obesity.) Multi billions of dollars are spent on branded weight loss programs, foods, diets, lifestyle recommendations and “come-on books” that suggest a secret way to lose pounds quickly, now and forever… A meta-analysis of 48 unique, randomized trials was published in that issue of JAMA and after many tables and graphs concluded that both low-carbohydrate and low-fat diets were associated with more weight loss than no dietary intervention over a 12-month period and that behavior support and exercise enhanced weight loss. (So far, I think we all knew this.) What made this article unique and caused it to create a stir was the fact that the statisticians found that weight loss differences between individual diets were small and likely of little importance. Their suggestion: if you want to lose weight adhere to any diet that you can stay on be it low-carb or low-fat.

The last article in the JAMA issue discussed two drugs, now on the market, that may aid and albeit weight loss: lorcaserin (Belviq) and Qsymia (Vivus). These new products are FDA approved for use in obese patients with body mass index (BMI) equal to or greater than 30 or overweight patients (BMI over 27) who also have at least one weight- related risk factor such as hypertension, abnormal lipids or type 2 diabetes.

In short: Belviq activates a serotonin receptor (type 2C to be exact) and is thought to suppress appetite. It can, however, cause headache, nausea and dizziness and in trials was discontinued 36 to 50% of the time. In the first year of one major trial, patients lost somewhat more that 5 % of their body weight but regained a quarter of it back during the second year of therapy. Qsymia combines phentermine and Topamax, a drug used for epilepsy. ( In the past phentermine was combined with fenfluramine (“phe-fen”) and caused heart valve problems…hence it was discontinued and now a new combination has been formulated, and felt to be heart valve safe.) Weight loss of 5% or more in the first year occurred in 45 to 70 % of patients depending on the dose and those who continued the medication for two years had an average weight loss of 10% compared to 1.8% in those on placebo. Side effects that occurred in more than 5% of patients included dry mouth, constipation, numbness and in the higher doses, insomnia. There were also reports of difficulties in concentration and memory.

In conclusion, the article states that either drug, taken as an addition to diet and exercise “may be affective in increasing weight loss in the first year of use, but much less so in the second year. Qsymia appears to be more effective than lovaserin, but may cause more troublesome adverse effects.”

A lot of information…I (or your other physicians) will be happy to discuss all of this in your next visit.

And I hope to see some of you (not in the office) October 6….

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