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Matusow: Dr. Trinh, what are the current methods people can choose to help them with severe weight issues?

Dr. Trinh: In addition to caloric burning exercise, the most basic approach to weight loss is simply to cut caloric intake by eating less. Here is a quick review of our current weight loss approaches:

The surgical approach to weight loss:

Treatments such as gastric bypass surgery, gastric banding, etc lead to a smaller stomach. Having a smaller stomach leads to the mental sensation of "being full" earlier with a smaller meal content. This sense of fullness (satiety) is driven by the vagal nerve that provides communication between the stomach and the brain. The vagal nerve is the information highway between the stomach and the brain. When the vagal nerve is "inhibited," it tells the brain "hey I am full now, stop eating." Having a smaller stomach through surgery means the stomach is distended by a smaller amount of food (less caloric intake), which in turns tells the vagal nerve to inform the brain that you are full. The downside of anatomically changing the stomach through surgery includes possible problems with digestion and malaborption as well as possible need for repeat surgeries in the future.

Prescription Weight loss medications:

Two weight loss drugs were approved by the FDA last year; Qsymia by VIVUS, Inc. and Belviq by Arena Pharmaceuticals, Inc. Both medications have documented weight loss benefits as well as side effects. The approvals come after a 13-year dry spell of any new weight loss medications due to issues with safety with previous weight loss medications (i.e. "fen-phen").

Vivus patients on average lose 10% of their weight after a year of treatment while Arena's patients lose 5% of their weight. Qsymia has potential risk of birth defects and has a fairly strict prescribing label. Arna's Belviq appears safer than Qsymia but achieves only modest weight loss of 5% in clinical trials. Neither drug is meant to be taken "forever."

There is also a company named Orexigen Therapeutics, Inc. that is currently testing an obesity drug in clinical trials called Contrave. Contrave is a combination of two medications already on the market for many years, bupropion SR and naltrexone SR. Bupropion is currently FDA approved for depression and naltrexone used primarily for the management of alcohol dependence. Bupropion's side effect profile includes "weight loss" and naltrexone's common potential side effects include non-specific GI complaints (nausea, abdominal cramping, etc). Apparently the documented side effect profiles of these two medications lead to the weight loss indication Orexigen is seeking approval for. Orexigen may have an advantage over both Qsymia and Belviq which were approved a few months ago. Both Qsymia and Belviq are currently tightly controlled by the FDA (requiring "special prescriptions") whereas Contrave's medications used are not as highly regulated, allowing easier access to prescribing and refills at local pharmacies.

Weight loss Programs:

Over the years many types of weight loss programs have come and gone. We've been exposed to many of the weight loss programs and diets out there through the experiences of my patients; Weight Watchers, Jenny Craig, Slim Fast shakes, Lendora, Adkins diet, Zone diet, South Beach diet, etc. The shakes and meal plans all have the same underlying goal: Reduce caloric intake with the attempt to "not feel hungry." These diet plans again rely on the vagus nerve physiologic function by eating low caloric foods while expanding the stomach and inhibiting the vagus nerve (connects stomach to brain). This sends a message to the brain, "I'm no longer hungry, stop eating."