Extreme Obesity

For extreme cases of obesity several pharmacological treatments and intervention are available. Pharmacotherapy is suggested for individuals with a BMI equal or greater than 30 kg/m2 or with a BMI equal or greater than 27 kg/m2 but with two or more weight related illnesses like coronary artery disease or diabetes or sleep apnea and who is not able to lose weight satisfactorily with the more conservative approaches (NHLBI, 1998). There are two drugs of choice either sibutramine (Meridia) or orlistat (Xenical), these are approved by the Food and Drug Administration for the induction and maintenance of weight loss (Yanovsky & Yanovsky, 2002)

Sibutramine or Meridia is a serotonin-norepinephrine combination reuptake inhibitor that is linked with information of increased satiation and fullness. A study by Lean (1997) shows that by using it with an LCD, sibutramine (10–15 mg/day) has produced a drastically greater loss of initial weight (7%) than an LCD plus placebo (2%) over the course of a year. Ten to fifteen percent reductions in weight has been observed in participants that combined intake with drastic lifestyle and behavior modifications of 10–15% have been observed in studies that combined sibutramine with intensive lifestyle modification.

(James et al, 2000; Wadden et al, 2001). However, sibutramine is not recommended for patients with uncontrolled hypertension or a history of CVD, arrhythmias, or stroke. It is also not recommended in combination with certain antidepressant agents, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors (Abbot laboratories, 2003). It is note though that the very individuals who is supposed to benefit from the use of the drug are noted to be the very same people who is not advised to use it.

On the other hand, Orlistat is a gastric lipase inhibitor that works by stopping the absorption of about one-third of the fat content of a meal (Sjostrom et al, 1998)that accounts for a loss of about 150 to 180 kcal per day. Patients are disapprovingly reinforced to eat a low-fat diet because the consumption of more than 20 grams of fat per meal, can induce an adverse gastro-intestinal measures that include oily stools, flatus with emancipation, and fecal urgency.

In randomized trials, participants who received placebo plus diet lost only 6 percent of their weight in 1 year, compared with 10 percent for those placed with orlistat plus diet therapies. (Davidson et al, 1999). It should also be noted that the biggest benefit of treatment with medications for obesity lies in weight maintenance rather than weight loss, studies by) and Sjostrom et al (1998) and Hanson et al (2002) for sibutramine treatments and Davidson et al (1999) and James et al (2000) for orlistat therapies shows that participants who persisted with the medication lost nearly two times as much as those who received placebo.

This findings indicates that medications used for weight maintenance is termed for long term use in the same manner of other maintenance medications used for hypertension or diabetes and hypercholesterolemia. There are several obstruction, however, with regards to the long-term use of weight loss medications, the most significant of which is the out-of-pocket expense burden for the patient for anti-obesity medications since these types of drugs are generally costly reaching over a hundred dollars per month (Bray, 1998).

Also in the most extreme case, surgical interventions like gastric bypass and other surgical procedures has been known to be of help to the obese person, a child in the strictest sense can undergo such if the child can be considered as morbidly obese and can only be helped by such extreme measures. Curing an obese child, more so the extremely to morbidly obese child is not easy, it will require a multi-faceted approach that will require more than one professional to help out.

Dieticians, psychologist, doctors and other medical professionals will be needed, but one of the most important factors that can help an obese child is the support of his or her loved ones. One might note that a child who feels loved by the parents, sibling and other significant figures in their lives will be more susceptible to treatment protocols rather than a child who undergoes treatment simply because the doctor asked the parent and no support structure is provided for the child or if the child is undergoing weight management programs because he feels that he is not accepted by the family due to his/her weight.

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