Article 95: Safety of Weight Loss Medication and Surgical Weight Loss

How should we understand the problem of obesity? What principles should we follow when trying to lose weight? Experts point out that in addition to causing inconvenience in life, obesity can also lead to a series of life-threatening diseases such as high blood pressure, abnormal blood lipids, and elevated blood sugar. The whole society should pay more attention to obesity, and weight loss should not be carried out blindly. We should strongly advocate the principle of "safety first in weight loss".

Body Mass Index (BMI) is calculated by dividing weight (in kilograms) by the square of height, and waist circumference is a commonly used standard for determining obesity. In China, a BMI greater than 24 is considered overweight, and greater than 28 is considered obese. A normal waist circumference for men should be within 85 centimeters, and for women, it should be below 80 centimeters; otherwise, it is considered obese.

Those with excessive body mass index (BMI) and waist circumference should consult a doctor at a hospital's weight loss clinic or endocrinology department for weight loss guidance. Currently, weight loss drugs on the market fall into two main categories: centrally acting drugs and non-centrally acting drugs. In China, fenfluramine and sibutramine are the most common examples of centrally acting drugs. Fenfluramine was banned in the United States as early as 1997 due to its potential to cause valvular heart disease, while sibutramine can cause increased blood pressure and heart rate. Therefore, the use of centrally acting drugs should be under the guidance of a doctor, and heart rate and blood pressure fluctuations should be monitored regularly. People with a history of cardiovascular disease and stroke should use them with extra caution. As for non-centrally acting drugs like orlistat, they mainly act on the gastrointestinal tract, blocking the absorption of some dietary fat; their adverse reactions are primarily gastrointestinal.

Currently, there are many misconceptions among the public regarding weight loss. It is very common for people to choose medications without asking about their ingredients and pharmacology or consulting with doctors. The safe use of weight loss drugs should be given widespread attention by society.

In the treatment of obesity, weight-loss drugs are only an adjunct, not the primary, method. Weight-loss drugs include Western and traditional Chinese medicine, and can be broadly categorized into two types based on their effects: appetite suppressants and metabolism boosters. However, all weight-loss drugs have certain side effects. Therefore, from a health perspective, clinical medicine does not advocate for weight-loss drugs. Even for moderate to severe obesity that requires medication, it should be used under the guidance of a doctor for a short period, and the following precautions should be taken: ① Pregnant women, the elderly, and children in their developmental stage should not use weight-loss drugs. ② People with hypertension, cardiovascular disease, or hyperthyroidism should avoid appetite suppressants. These drugs primarily stimulate the hypothalamus's satiety center, controlling the appetite center, thus reducing appetite and preventing cravings, thereby reducing food intake and weight. However, potential side effects include insomnia, anxiety, nervousness, dizziness, increased blood pressure, headache, palpitations, and dry mouth. Therefore, people with hypertension, cardiovascular disease, or hyperthyroidism should avoid using these drugs. ③ Metabolic acid boosters primarily work by promoting diuresis and sodium excretion, thus helping obese individuals lose weight while suppressing thirst, thereby achieving slimming effects. However, these drugs may cause side effects such as increased bowel movements, abdominal discomfort, dizziness, nausea, drowsiness, and increased nocturia. ④ Long-term use of weight-loss drugs may lead to drug tolerance and even addiction. Therefore, after short-term use, the dosage must be gradually reduced until discontinued, and all of this must be done under the guidance of a doctor.

A study commissioned by the U.S. Food and Drug Administration (FDA) has shown that ephedrine, a herbal stimulant used by many young Americans for weight loss and fitness, is actually harmful, potentially causing heart attacks, strokes, and the onset of some chronic diseases, and even death. According to researchers, since the mid-1990s, at least 54 deaths and more than 1,000 complications have been linked to ephedrine. Most of these patients were young people, some of whom had only taken ephedrine for a few weeks or even days. Two pregnant women also miscarried after taking it. Therefore, scientists believe that the risks associated with ephedrine may far outweigh its benefits.

Using diuretics to increase the excretion of water from the body is one of the clinical methods for weight loss. However, this is mostly used for obese patients with edema, such as obese patients with cardiac edema or renal edema, to increase urine output and eliminate sodium and water retention in the body. Commonly used diuretics in clinical practice include: hydrochlorothiazide, triamterene, spironolactone, and furosemide.

Excessive dosage or prolonged use of diuretics can lead to excessive water loss and electrolyte imbalance. Although the dosage of diuretics is small, prolonged use can lead to dependence. Upon discontinuation, withdrawal symptoms such as general malaise, fatigue, edema, decreased urine output, and nervousness may occur. Therefore, internationally, the abuse of diuretics for weight loss by athletes is prohibited. Similarly, obese individuals should never use diuretics without medical supervision.

At the same time, those trying to lose weight should be reminded not to trust the so-called "ancestral secret recipes" or "miracle weight loss drugs" sold by street pharmacists, as these so-called weight loss drugs often contain laxatives and diuretics.

A female middle school student in Guangzhou, after failing to lose weight through dieting and consuming slimming teas, resorted to ingesting laundry detergent water to perform an intestinal cleansing, a harmful practice that has drawn widespread attention. Some pediatricians and nutrition professors have pointed out that adolescents and children in their growth and development stages should never attempt to lose weight through dieting or taking diet pills.

Teenagers and children first need to know if they need to lose weight, and determining whether they are obese also requires knowing their ideal weight. She provides a simple calculation method: Ideal weight (grams) for infants (1-6 months) = birth weight + age in months × 600; ideal weight (grams) for toddlers (7-12 months) = birth weight + age in months × 500; ideal weight (kilograms) for children and adolescents over 1 year old = age × 2 + 8. Generally speaking, a weight exceeding the ideal weight by 10% is considered overweight; only those exceeding the ideal weight by more than 20% are considered obese and need to lose weight.

Many weight-loss drugs are appetite suppressants and have side effects such as dizziness, nervousness, palpitations, and dry mouth. Because adolescents and children are in a period of rapid growth and development and need a balanced nutritional foundation, they cannot lose weight through dieting or taking weight-loss drugs like adults, otherwise it will seriously affect their intellectual and physical development.

The most popular slimming health products on the pharmaceutical market currently contain three chemical substances that have side effects.

First, there's fenfluramine. This is an appetite suppressant, often mixed into weight-loss drugs to make people feel neither hungry nor thirsty. If fenfluramine is processed into a leavening agent, a small amount can fill the stomach, thus reducing food intake and achieving weight loss. However, increasing clinical research shows that fenfluramine may be a heart-damaging stimulant, causing damage to heart valves and various adverse reactions such as diarrhea and dizziness.

Secondly, diuretics. Some weight-loss products contain the diuretic furosemide, which can rapidly reduce weight through excessive urination. Experts point out that clinical evidence shows furosemide has very significant side effects, including dry mouth, irregular heartbeat, fatigue, nausea, and vomiting.

Thirdly, ephedrine. Many slimming products contain ephedrine, a stimulant that works by affecting the central nervous system to accelerate metabolism and achieve weight loss. However, it can damage human organs because insufficient nutrient intake increases the burden on the body, leading to anxiety, insomnia, and tachycardia.

Experts point out that if weight loss is primarily achieved through laxatives, it can cause water and electrolyte imbalances in the body, triggering heart disease and directly endangering life. If dehydration is the only method used, in addition to weight rebound, it can also cause nutritional interruption, leading to exhaustion, hypoglycemia, and other consequences, endangering life.

Experts emphasize that obesity is a complex disease caused by the interaction of genetic and environmental factors. It is a chronic disease characterized by excessive accumulation of body fat, threatening health. To reduce the adverse effects of obesity and decrease its prevalence, it is essential to increase physical activity in daily life and take medication under the guidance of a doctor for effective results. Health supplements with unknown ingredients, unclear mechanisms of action, and whose efficacy and safety have not been clinically studied and verified by authoritative hospitals can indeed cause extremely serious harm to the body if ingested by mistake.

Since the 1990s, doping abuse has become increasingly prevalent in Europe and America, drawing widespread international attention. Because doping acts on the central nervous system, causing excitement and suppressing appetite, its withdrawal symptoms are not as severe as heroin's, but rather include mental depression, apathy, and sleep disorders. Therefore, many people use it for weight loss.

Some weight-loss drugs contain a significant amount of stimulant substances. In Europe and America, many beauty salons sell weight-loss drugs, which are readily available. Therefore, weight-loss drugs are now subject to strict monitoring by governments worldwide, as their abuse is one of the causes of amphetamine-type stimulant abuse. Furthermore, long-term use of weight-loss drugs is detrimental to the cardiovascular and digestive systems. Therefore, weight-loss drugs should not be taken casually; whether or not you can take them must be determined by consulting a doctor.

my country has classified the weight-loss drug amphetamine as a controlled substance, and its unauthorized production and distribution are illegal. Currently, the abuse of weight-loss drugs is a serious problem in Europe and the United States, while my country has not yet experienced such abuse; however, Chinese regulatory authorities are constantly monitoring the situation.

Clinical practice shows that taking antipsychotic drugs can easily cause weight gain, which is difficult to reverse even after discontinuation of the medication. This not only harms the patient's physical health but also has a significant impact on their mental health. Therefore, this issue must be taken very seriously.

Commonly used drugs that easily cause weight gain: (1) Clozapine: The average weight gain after 2.5 months of treatment is 4.5 kg, and after 6 months of treatment it is 7.7 kg, and the weight gain will continue. (2) Olanzapine: The average weight gain after 1 year of treatment is 11.8 kg. (3) Thioridazine: The average weight gain after 2.5 months of treatment is 3.2 kg. (4) Chlorpromazine: 85% of patients treated with chlorpromazine will experience weight gain. (5) Risperidone: The incidence of weight gain after taking risperidone is 52%, and the incidence of weight gain increases and the magnitude of weight gain increases with the duration of treatment. (6) Other drugs: Haloperidol, fluphenazine and other drugs can also cause weight gain in patients, but the effect of these drugs is much weaker than the drugs mentioned above.

Adverse consequences of weight gain: For patients with anorexia nervosa and emaciation, weight gain is a good thing. However, if it develops into obesity, it becomes associated with the occurrence and development of many physical diseases. For example, it easily leads to hypertension, type 2 diabetes, coronary heart disease and ischemic stroke, breast cancer and endometrial cancer in postmenopausal women, gallbladder disease, osteoarthritis, colon cancer, etc. The occurrence and development of these diseases directly increase the mortality rate of obese individuals. Weight gain not only harms the patient's physical health but also seriously damages their mental health. Obese individuals experience less happiness and positive emotions than those of normal weight, while experiencing relatively more negative emotions, often exhibiting anxiety and depressive tendencies due to obesity. Therefore, it is evident that weight gain (especially obesity) caused by medication has significant adverse effects on patients.

Leg cramps after taking diet pills are caused by metabolic changes resulting from long-term use of these drugs, leading to an imbalance of sodium, potassium, and calcium, usually a sign of calcium deficiency.

Treatment for calf cramps mainly involves supplementing with calcium, vitamin E, and vitamin C. Of course, it's also important to differentiate it from restless legs syndrome.

Whether it's restless legs syndrome or calcium deficiency caused by diet pills, you can try the following traditional Chinese medicine: 15 grams of white peony root, 10 grams of licorice root, 30 grams of raw dragon bone (decocted first), 10 grams of yam, and 3 grams of cinnamon twig. Decocted in water and taken orally.

Obese people can achieve some weight loss through dieting, taking diet pills, or exercising. However, in some areas, such as the upper and lower abdomen and the outer thighs, the fat may not decrease significantly. Once they return to a normal diet or stop taking diet pills, they will become obese again.

Surgical slimming works by reducing the number of fat cells in areas of obesity, thereby reshaping the body's shape. Since the number of fat cells is reduced and will not increase again, the possibility of gaining weight again is avoided.

Currently, the main surgical methods for weight loss internationally include negative pressure liposuction, ultrasonic liposuction, and electronic liposuction. The latter two methods have not become mainstream due to the high cost of equipment, long operation time, limited understanding of their performance, and the ease with which they can cause certain complications.

The main process of negative pressure liposuction is as follows:

(1) Injecting tumescent local anesthetic eliminates pain sensation in the skin, softens fat, and constricts blood vessels, thereby facilitating fat aspiration and reducing bleeding. At the same time, tumescent anesthesia prolongs the duration of anesthetic action, so patients experience no significant pain after surgery and can generally maintain their independence in daily life.

(2) Suctioning subcutaneous fat with a suction tube. The doctor makes 1-2 incisions about 0.5 cm long in the obese area and uses a special suction tube to aspirate the fat. During the fat aspiration process, yellow fat particles can be seen continuously emerging.

Thanks to advancements in liposuction technology, the amount of fat that can now be removed has been greatly increased, and safety has been enhanced, allowing the procedure to be performed on outpatients (i.e., without hospitalization). The latest superficial liposuction techniques can also allow loose skin to naturally retract, resulting in a smoother skin surface.

Almost all subcutaneous fat can be removed by a surgeon's cannula, allowing doctors to reshape the body according to each individual's needs. However, liposuction is not a panacea; it is only effective for obesity caused by subcutaneous fat accumulation. It is ineffective for body shape problems caused by intra-abdominal fat accumulation, large muscles, and skeletal factors. It is also unsuitable for people with high blood pressure, diabetes, or heart, liver, or kidney diseases.

Liposuction is a relatively new procedure in my country. This surgery requires doctors to have anatomical knowledge, an understanding of human proportions and aesthetics, and skillful hands. Choosing the right doctor is crucial for successful liposuction.

In addition, liposuction can cause some complications such as postoperative difficulty in movement, bleeding, dizziness, nausea, subcutaneous hematoma, numbness of the skin, infection, and scarring. Serious complications include hemorrhagic shock, fat embolism, and even death.

Patients should fully understand the possible complications and their management before surgery, and strictly follow postoperative instructions. In case of any special circumstances, they should contact their doctor promptly to avoid delaying treatment.