Obesity is now the most common nutritional disorder in western industrialized countries. Defined as a body mass index of greater than 30, it arises from the accumulation of excess fat in the body from over consumption of fatty foods. Prevalence of obesity in the US and Europe has reached epidemic levels.
Weight loss surgery may be an option for people with extreme obesity (BMI of 40 or greater) when other treatments have failed. It’s also an option for people with a BMI of 35 or greater who have life-threatening conditions such as:
• Severe sleep apnea (a condition in which your breathing stops or gets very shallow while you’re sleeping)
• Obesity-related cardiomyopathy (diseases of the heart muscle)
• Severe type 2 diabetes
Two common weight loss surgeries include:
• Banded gastroplasty. For this surgery, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold.
• Roux-en-Y gastric bypass. For this surgery, a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed. This surgery limits food intake and reduces the calories your body absorbs.
Weight loss surgery can improve your health and weight. However, the surgery can be risky depending on your overall health. There are few long-term side effects with gastroplasty; however, you must limit your food intake dramatically. Roux-en-Y gastric bypass has more side effects. These include nausea, bloating, diarrhea, and faintness (which are all part of a condition called dumping syndrome). After Roux-en-Y gastric bypass, multivitamins and minerals may be needed to prevent nutrient deficiencies.
Lifelong medical follow-up is needed after both surgeries. A monitoring program both before and after surgery also is advised to help you with diet, physical activity, and coping skills.
As a substitute for surgery in 2006 a new drug has been approved for human use that’s effective as obesity treatment. The drug is called Rimonabant. On 21 June 2006, the European Commission approved the sale of Rimonabant in the then 25-member European Union. Sales began in July 2006.
Rimonabant works by blocking endogenous cannabinoid binding to neuronal CB1 receptors. Activation of these receptors by endogenous cannabinoids, such as anadamide, increases appetite. It is the most advanced endocannabinoid receptor antagonist in clinical development and offers a novel therapeutic approach to appetite control and weight reduction.
After 1 year of treatment, patients receiving 20 mg Rimonabant lost an average of about 20 pounds of weight, compared to 5 pounds for patients on placebo. Further, patients receiving 20 mg Rimonabant had significant improvements (compared to placebo) in waist circumference, HDL levels, triglyceride levels, CRP levels, and insulin sensitivity. For patients with metabolic syndrome at baseline (which included about 50% of the study population), half of those taking 20 mg Rimonabant no longer had metabolic syndrome at the end of the study.
The drug was said to be well tolerated. The only relatively common side effects were mild GI side effects and dizziness, and these were said to be transient.