Monthly Archives: December 2012

TREATING DIABETES: RAPID CONTROL WITH WEIGHT LOSS

There is now a pandemic of obesity, and the problem is causing increasing levels of type 2 diabetes. Cooperation with effective pharmacy weight loss programmes can reliably provide rapid and potentially long-term clinical benefits from weight loss. Stephen Kreitzman and Valerie Beeson explain how Lipotrim can help

diabetes is a progressively debilitating disease, often requiring increasingly aggressive therapy. The treatment protocols with oral hypoglycaemics usually lead to increasing body weight. The increased weight degrades insulin sensitivity and can ultimately lead to a need for insulin. With insulin, a common outcome is yet further weight gain, and the disease gets increasingly worse. This entire cascade of events can be avoided.
There are really two basic facts to consider. The first is that type 2 diabetes is a disease that has a primary aetiology, which is close to 100% reversibility related to excess body weight. The second fact is that diabetic patients can lose enough weight within a few days to bring their blood sugars under control and enough further weight within weeks to crucially reduce cardiovascular risk factors and apparently keep the disease in remission, even with some weight regain.

Achieving a maximum safe rate of weight loss
Modest reductions in calories can theoretically result in weight loss. Of course, the modest reduction has to be from the equilibrium level, not from current intake. If a person is overeating by 2,000 calories a day (very common in the obese), a modest reduction in calorie intake will not cause weight loss.
There is a maximum rate of weight loss for any individual. A total fast provides zero calories and therefore requires that all the calories necessary for life come from the body fuel reserves. A total fast, however, provides no nutrients, and since an obese patient has a far greater reserve of calories than stores of other essential nutrients, a total fast is out of the question as a treatment. To be healthy, a diet has to supply adequate essential amino acids, essential fatty acids, vitamins, minerals and trace elements. A total fast cannot be a valid treatment for obesity. The simple idea of reducing fat levels in an enteral formula solves both the calorie and the nutrient problem. An ideal nutritional product with the absolute minimum of calories consistent with a healthy diet is achieved. Lipotrim is an example of such a product, providing a maximum safe rate of weight loss. The literature on safety and efficacy is massive. The time has really come to pay attention to it.
There is also extensive literature on the beneficial effects of weight loss on cardiovascular risk factors, on blood lipid profiles and on blood pressure. Managing weight in practice, however, can be time consuming. The beneficial results from substantial and rapid weight loss on the glycaemic control and the cardiovascular risk factors more than justify consideration of this approach. Cooperative efforts with local pharmacists, however, benefit patients, pharmacists and also the primary care
providers.
Weight is extremely important to patients and has a critical influence on the clinical course of type 2 diabetes. It would appear prudent and considerate to give diabetic patients an opportunity to lose weight using Lipotrim under your own care or encourage them to seek care from a local pharmacist.

Stephen Kreitzman PhD RNutr, Valerie Beeson Clinical Programme Director

PDF version: 4-TREATING-DIABETES-RAPID-CONTROL-WITH-WEIGHT-LOSS.pdf

WEIGHT MANAGEMENT IS A MEDICAL CONCERN

“Fat people are just greedy, says BMA chief” – www.telegraph.co.uk, 4 August 2007. “Doctor tells fatties to eat less” – www.thesun.co.uk, 3 August 2007. These kinds of headlines are avoidable

There is now close to a 30-year history of safe and effective worldwide usage of nutrient-complete total food replacements based upon the concept of low-fat nutrient-complete enteral feeds (VLCD). The enormous volume of scientific and medical literature has been thoroughly evaluated by expert committees and they have been recognised as safe and in some cases, such as type 2 diabetes, more effective than standard weight loss methods.

An expanding network of pharmacists are offering a range of treatments for weight problems. They have the training,
the respect of the public, the contact hours and the desire to offer weight management as a professional service. NICE
recommends that specialists be used for extended VLCD treatment. These pharmacists are trained and experienced specialists in the use of VLCD.
Weight loss is more than a cosmetic issue. Weight loss can lower blood pressure, normalise blood lipids, practically
eliminate type 2 diabetes, reduce the severity of asthma, bring relief to patients with arthritis, increase the fertility of women and relieve sleep apnoea. Weight loss can provide an opportunity for patients to be considered for elective surgery. It can decrease the need for antidepressants, make exercise more possible, thus improve cardiovascular
health, and can vastly improve the quality of life for patients in a prejudiced and intolerant world.
Minimal calorie gap diets are not always successful. For example, in the 1959 classic study of the published outcomes from the best weight loss programmes, Stunkard showed that regardless of the programme for weight loss, or the expertise of the clinic, after one year 95% had put back on all the lost weight.1 After two years 98% and by five years virtually all of the dieters had put the weight back on.
VLCD has a vastly better, well-documented, record for weight maintenance.
The idea that reducing calorie intake to a sufficiently low level to encourage a more rapid loss of weight, was somehow harmful, can be directly attributed to the fact that the distribution of essential nutrients in ordinary foods makes it very difficult to create a nutrient-complete diet under conditions of food restriction. It is impossible to achieve a nutrient-complete diet at intakes below 1,200 calories.

Once traditional food diets were attempted below 1,000 calories, dieters were put at risk. When the need for dieting
was for a prolonged period, it was inevitable that nutrient stores were depleted. The result was some sort of health compromise.
The nature of the compromise and the consequences depended upon which nutrients happened to be depleted by the unique food choices of the dieter. Supplying the essential nutrients in a preprepared mixture, as in an enteral feed,
assures that nutrient deficiencies do not occur. As for energy, the dieter has ample stores of energy in the fat stores of the body – about 37,000 calories in each stone of excess fat weight. These calories are readily available. None are really required from the outside, with the exception of those nutrients in the formula that notionally have a calorie value (such as the essential aminoacids and the essential fatty acids). A proper calorie gap provides reliable and continuous weight loss, which is motivating in itself, but has also been shown to provide better glycaemic control in people with diabetes
than the same weight loss achieved more slowly.
The modern VLCD can be used with confidence, both in the reliability of the weight loss, and the safety of the monitored
programmes. There are contraindications and medical issues that need to be understood, but under the care of an experienced pharmacist, the weight loss needs of seriously overweight patients can be met.

reference
1. Stunkard A, McLaren-Hume M. Results of treatment for obesity. Arch Int Med 1959; 103:79-85.

PDF version: 5-3-medical-concern

WEIGHT MANAGEMENT: HELPING OBESE PATIENTS

Over 70% of the middle-aged UK population has a weight problem.Healthcare professionals cannot wait for new pharmaceutical solutions: action is needed now, if only to cope with “diabesity” – a very descriptive addition to the language

there is a lengthy list of common medical conditions that are either caused by or exacerbated by obesity. At the very top of that list is type 2 diabetes, which is virtually 100% reversibly related to excess weight. Treating the weight is treating the disease. Treating the weight could also be considered as preventing the disease. By 2010, three million people will be diagnosed as having diabetes, and 80% of them will die prematurely from cardiovascular disease.1 Type 2 diabetes is even increasing in children; the condition is considered serious enough by NICE that surgical intervention is being countenanced for children. Most of the agents used in diabetes treatment are known to cause an increase in weight.
Current treatment protocols often encourage immediate selection of treatments that invariably result in yet further weight gain and perpetuation of the disease.
Morbid obesity minus 5% is still pretty fat
What advice should we give to a 23-stone patient? Should the advice be different if this patient was 25 stone a year ago? There is a very high probability that clinical judgement would not recognise much difference. This patient is still dangerously fat, despite having lost the 5% of initial weight that may have been the treatment expectation.

Even worse, an obese patient will usually shift 5% of body weight or more of stored glycogen and water upon dieting. Fat loss at this level can be essentially nil. With repletion of glycogen stores upon termination of the “diet”, the lost weight can rapidly return. It can almost seem as though there is a “set point” for body weight.

Being effective with obese patients
Pharmacists are already proving that substantial weight loss and long-term weight maintenance can be an expected norm under pharmacy conditions. Weight loss will drastically reduce the advance of type 2 diabetes. It will help deal with hypertension. It will permit patients to gain access to elective surgery. Excess weight is a common and powerful constraint on quality of life. It is in the best interest of patients and the NHS as a whole to support and encourage
initiatives in managing body weight.
It is also reasonable to expect clinically meaningful results for obese patients. While any weight loss can be argued to improve relative risk of diseases or premature death, patients anticipate real help from medical professionals. Before selecting a course of treatment, determine whether the published results for the treatment or previous experience provide a realistic expectation that the patient really will lose sufficient weight and not be faced with the probability
of nutrient deficiencies. The need is to reduce food intake sufficiently; to use up enough previously eaten calories that
are now stored as fat, and at the same time prevent malnutrition – the human body requires a full complement of nutrients.

Patients need to accept a substantial reduction in calorie intake
Patients would love to find a way around some very simple laws of physics, but sadly it is impossible. In order to lose weight they really have to eat fewer calories than they are using, regardless of whether the calories are from carbohydrates, fats or proteins. It takes an enormous amount of physical effort to use up the calories (3,500kcal) in a single pound of body fat. Since a mile run only consumes about 100kcal, a 35-mile run is required. The only practical means of dealing with a substantial weight problem is by severely restricting intake. Increased activity levels are very important in the long term but are more possible as the patient achieves a reasonable weight.

Since food restriction has much in common with restriction in other manifestations of addiction, withdrawal is not simple, especially in an environment where there is continued presence of the substance of abuse. Customary approaches to weight management are failing worldwide, leading to much wringing of hands and apportioning
of blame. At the same time, many of your pharmacy colleagues are quietly having an impact. If there really are going to
be three million diagnosed cases of type 2 diabetes in the UK in 2010, they could really use some help.

reference

1. Practice: parentlal role in ending child obesity. GP Magazine 2005;11:38.

PDF version: 5-2-helping-obese-patients

TREATING WEIGHT IN THE PHARMACY: GETTING RESULTS

There is now a pandemic of obesity, and the problem is getting worse instead of better. Would you know how to offer help that is worth the time and effort? Or would you simply reiterate the same platitudes that have been so ineffective over the years? Stephen Kreitzman and Valerie Beeson explain how Lipotrim can help

Many weight loss programmes either fail outright or provide so little weight loss beyond glycogen and its associated water losses that cavalier attitudes to weight loss are commonplace. The loss of significant weight cannot be treated so lightly. A type 2 diabetic on oral agents, for instance, will need to stop medication, ideally prior to dieting, since the blood sugar will normalise within the first few days of treatment. Continued medication may induce a hypoglycaemic reaction. Some people should not diet at all; others should diet with only the closest monitoring. Virtually all medical discussions of obesity begin by listing the medical consequences of excess weight. When weight loss is real and significant, there are physiological changes and therefore monitoring and control are justified.
There are now more than 300 pharmacies in the UK and Ireland, offering monitored weight loss programmes using Lipotrim, joining the thousands of UK GPs and hospital consultants offering Lipotrim to their patients. You can offer your patients help with their excess weight by simply guiding them to a local, trained pharmacist.
Excessive weight is the cause of disease in almost all cases of type 2 diabetes. Weight loss is an effective treatment. Excessive weight is contributory to hypertension. Weight loss reduces blood pressure in these people. Weight loss improves blood lipid profiles, ameliorates pain in arthritic patients, improves respiratory problems from apnoea to asthma, increases fertility and improves quality of life immeasurably.
Modest reductions in calories could theoretically result in weight loss. Of course, the modest reduction has to be from the equilibrium level, not from current intake.

If a person is overeating by 2,000 calories a day (very common in the obese), a small reduction in calorie intake will not cause weight loss. A reduction of a single calorie per day from the level in equilibrium with expenditure, however, will, in theory, result in weight loss. The dieter will have to be patient, however, since it will take 3,500 days (10 years) to use up the calories in a single pound of body fat at the rate of one calorie a day.
At the other extreme, there is a maximum rate of weight loss for any individual. A total fast requires that all the calories necessary for life come from the body reserves. A total fast violates the principle of need for nourishment and therefore supplementation is required. A diet has to supply adequate essential amino acids, essential fatty acids, vitamins, minerals and trace elements, in order to keep the dieter healthy. A total fast therefore cannot be a valid treatment for obesity.
What is needed is a nutrient complete source, which guarantees nourishment but at the same time provides the least possible calorie levels so that a maximum rate of safe weight loss can be achieved. Liquid enteral feeds meet the nutrient criteria but are designed to cause weight stability or even weight gain. These high calorie levels are met by relatively high levels of fat. Enteral feeds are used for prolonged periods without problems.
The simple idea of reducing fat levels in enteral formulas solved the calorie problem. An ideal nutritional product with the absolute minimum of calories consistent with a healthy diet is achieved. Lipotrim is an example of such a product.
You can offer your patients real help with their excess weight. Get the facts, share them with your patients. Weight is a serious issue.

Stephen Kreitzman PhD RNut UK Registered Nutritionist
Valerie Beeson Clinical Programme Director
Howard Foundation Research Ltd Cambridge UK

PDF version: 5-1-getting-results

TREATING OVERWEIGHT PATIENTS: WHAT ARE THE OPTIONS?

People suffer terribly from the consequences of their excess weight and many expect help from the health service. Here are some options…

A 5’2 woman who weighs 100 kg (15 st 10) has a BMI of 40 and is morbidly obese. If she manages to lose 5% of her weight, she will weigh 95 kg (14 st 13), which is a BMI of 38.6. Can anyone honestly say that this has been a sufficient treatment? To get her down in weight to the top of the normal range (BMI 25) she will have to lose 38.5 kg (approximately 6 stone).

Tell her to exercise?

The calories used in exercise will make a difference only if the patient is in calorie balance. Most overweight people are routinely eating in excess of their daily needs. Around 2,000 calories can be consumed with very little recognition that the average daily expenditure has been matched. Assuming, however unlikely, that calorie balance has been achieved, the excess weight represents 296,400 calories below the calorie balance level that will have to be used up by increased activity. At 100 calories for a mile run, the patient will simply have to run 3,000 miles (without any additional overeating).

Cut back a little to lose weight slowly?

Modest reductions in calories could theoretically result in weight loss, although the best efforts of the Swedish healthcare system could not produce any.1,2 Of course, it can’t be emphasised often enough, the modest reduction has to be from the equilibrium level, not from current intake. Standard advice has been to limit the rate of weight loss by encouraging a small calorie gap. This most often assures failure to lose substantial weight. Arguing that slow weight loss somehow results in better weight maintenance (except perhaps maintenance of the prediet weight) was convincingly demonstrated
to be false as far back as 1959. Stunkard showed that regardless of the programme for weight loss, or the expertise of the clinic, after one year 95% had put back all the lost weight.3 After two years 98% and by five years virtually all of the dieters had put the weight back on.

Faster weight loss is actually better

Very low calorie diet (VLCD) treatment has a well-documented, vastly better, record for weight loss and weight maintenance.4 The fallacy that reducing calorie intake sufficiently low to encourage a rapid loss of weight was harmful, resulted from the fact that the poor distribution of essential nutrients in ordinary foods makes it very difficult to create a nutrient-complete diet under conditions of food restriction. It is actually impossible to achieve an unsupplemented nutrient complete diet at intakes below 1,200 calories. When traditional food diets were attempted below 1,000 calories, dieters were put at risk. When the need for dieting was for a prolonged period, it was inevitable that various nutrient stores were depleted. The result was some sort of health compromise. The nature of the compromise and the consequences depended upon which nutrients happened to be depleted by the unique food choices of the dieter. What was required was a nutrient-complete source, which guaranteed nourishment and at the same time provided the least possible calorie levels so that a maximum rate of safe weight loss could be achieved. Liquid enteral feeds meet the nutrient criteria, but are usually designed to cause weight stability or even weight gain. These high-calorie levels are generally met by relatively high levels of fat. Simply reducing fat levels in enteral formulas solved the calorie problem. An ideal nutritional product with the absolute minimum of calories consistent with a healthy diet is achieved. The modern VLCD can be used with confidence, both in the reliability of the weight loss, and the safety of the monitored programmes. There are contraindications and medical issues that need to be understood, but under proper care the weight loss needs of seriously overweight patients can be met.

Help is available and simple to use

An expanding network of pharmacists are offering a range of treatments for weight problems. They have the training, the respect of the public, the contact hours and the desire to offer weight management as a professional service. NICE recommends that specialists be used for extended VLCD treatment.5 These pharmacists are trained and experienced specialists in the use of VLCD. Suggest a pharmacist to offer your patients real help with their excess weight. This will even reverse the ever increasing prevalence of type 2 diabetes.

References

1. Sjöström D, Peltonen M, Wedel H, Sjöström L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36:20-5.

2. Karlsson J, Taft C, Rydén A, Sjöström L, Sullivan M. Ten-year trends in health related quality of life after surgical and conventional treatment for sever obesity: the SOS intervention study; Int J Obesity 2007;31:1248.

3. Stunkard A, McLaren- Hume M. Results of treatment for obesity (a review of the literature and report of a series). AMA Arch Intern Med 1959;103:79-85.

4. Saris WH. Very-lowcalorie diets and sustained weight loss. Obes Res 2001;9:295S-301S.

5. MIMS. NICE publishes guidance on overweight and obesity. London: MIMS; 2007.

PDF version: 4-4-Treating-overweight-patients

TYPE 2 DIABETES: SUGGEST A PHARMACIST INSTEAD OF A PHARMACEUTICAL

Type 2 diabetes is no longer an adult onset disease. Obesity is being seen in younger and younger people. There is a causal connection so people are calling it “diabesity”

It is time to stop wringing our collective hands about type 2 diabetes and do something about it. In a well researched editorial in this issue of Nursing in Practice (page XX-XX), Dr Song points out the frightening prevalence of type 2 diabetes and the terrible consequences of the disease. His comments add another page of literature to the existing pile, pointing out that this lethal disease is being seen in younger and younger age groups and treatment with a vast array of drugs does not appear to be solving the problem. He recognises the relationship to excess weight, but typically, really treating the weight is not one of the options considered. Why not? What could be the excuse? Could it be a lack of confidence in the means for treating obesity?
Obesity is not only treatable in theory, it is currently being treated effectively by more than 500 pharmacists in the UK and Ireland. Many of the cases being treated were patients with insulin resistance and/or type 2 diabetes. In patients with diabetes, it was necessary to get the prescribing doctor to stop the hypoglycaemic medication prior to dieting, because the blood sugar comes down very quickly, generally in about three days, and with continued weight loss, it seems to stay down, even with some weight regain. That’s it. No further story.
We are not in favour of the Atkins diet for many sound biological reasons, but when you consider the massive amount of money from vested interests and the well orchestrated expert opinion massed against the Atkins diet, you realise why the only tolerated solution will ultimately be pharmacological. But pharmacology cannot yet deal with obesity. A few kilograms of weight loss over an extended period has little impact on either the weight or disease. Fat people need to lose a lot of weight and playing with a few kilograms of glycogen and water loss is a waste of time and certainly not worth the risk of the side-effects.

Excessive weight

Excessive weight is the cause of 95–98% cases of type 2 diabetes and is contributory to hypertension. Weight loss is an effective treatment as it reduces blood pressure in most overweight people. Weight loss improves blood lipid profiles, ameliorates pain in arthritic patients, improves respiratory problems from apnoea to asthma, increases fertility and improves quality of life immeasurably.

Modest reductions in calories could theoretically result in weight loss. Of course, the modest reduction has to be from the equilibrium level, not from current intake. There is a maximum rate of weight loss for any individual. A total fast requires that all the calories necessary for life come from the body reserves, there can not be any greater rate of weight loss for any individual.

Nutritional products

A total fast provides no nourishment and therefore is not acceptable. A diet has to supply adequate essential amino acids, essential fatty acids, vitamins, minerals and trace elements, in order to keep the dieter healthy. What is needed is a nutrient complete source, which guarantees nourishment, that at the same time provides the least possible calorie levels so that a maximum rate of safe weight loss can be achieved. Liquid enteral feeds meet the nutrient criteria, but are designed to cause weight stability or even weight gain. These high calorie levels are generally met by relatively high levels of fat. Simply reducing fat levels in enteral formulas solves the calorie problem. An ideal nutritional product with the absolute minimum of calories consistent with a healthy diet is achieved. Lipotrim is an example of such a product.
There are now over 500 pharmacies in the UK and Ireland offering monitored weight loss programmes using Lipotrim, joining the many UK GPs offering Lipotrim to their patients. Suggest a pharmacist to offer your patients real help with their excess weight and reverse the scandal of an ever increasing prevalence of type 2 diabetes.

PDF version: 4-2-not-a-pharmaceutical

FREEING PATIENTS FROM THE TYRANNY OF FOOD DURING WEIGHT LOSS

When drug therapy is discontinued. When the counsellor moves on. When the patient is “cured” of excess weight. This is the point at which a dieter requires the maximum attention and assistance. Lipotrim weight maintenance programmes assist your patients in long-term weight management

Weight maintenance requires control of eating behaviour over a sustained period of time. While willpower can often help people lose weight over a short defined period, control for the months, years or even decades required for maintenance is quite a different story. Loss of weight by any means confers absolutely no lasting gift for weight maintenance. Weight
loss, however achieved, is only the beginning of the treatment, not the end point.
A person who has lost weight has to cope with the fact that he calorie requirement to maintain a lighter body is lower than they had become accustomed to eating. Returning to prediet eating behaviour will result in an early return to prediet weight. There is no “set point”. There is only a prolonged habitual approach to food choices and portion sizes that satisfy.
What usually surprises Lipotrim dieters, is the sudden freedom from food tyranny in conjunction with the appearance of urinary ketones, which are induced by a very low calorie, low carbohydrate intake and sustained long enough to deplete body stores of glycogen and force the utilisation of stored fat. Weight loss with Lipotrim is certain due to the large calorie
gap between intake and any level of expenditure. What allows the dieter to lose substantial weight, however, is the
prolonged freedom from the desperate drive to eat. This freedom is lost as soon as food is reintroduced.

 

Lipotrim weight maintenance formulas are not simply meal replacements
One of the most dramatic metabolic consequences of substantial weight loss is an improvement in insulin resistance.
In the immediate post-diet condition there is usually a continued excessive secretion of the now normally functioning
insulin, which can lead to mild hypoglyceamia. This is interpreted by the patient as a strong signal to eat.
Unless this is blocked, the dieter will overeat and regain weight. Maintenance requires calming these food cravings. Slowing the absorption of glucose from the gut into the bloodstream is the surest way to minimise the insulin response and reduce the recurrence of cravings subsequent to a meal.

Using what is well known to solve a major problem
Reliable and controlled slowing of the absorption of glucose from the gut is achieved by the addition of soluble fibre to a meal. Nourishment is still important, however, especially when food intake will become restricted. The addition of a complete micronutrient mix to the potent soluble fibre assures the provision of the complete complement of essential amino acids, fatty acids, trace elements, vitamins and minerals that one would expect to be provided by a full meal. The result is a greatly enhanced record of post-diet weight stability.
Weight management is enhanced in pharmacies
Many practices treat their own patients with Lipotrim, and the weight loss successes with their major clinical benefits more than justifies the practice time. The difficulty comes with justifying practice time and resources for patients who have achieved weight loss and are now both healthier and trying to maintain a normal weight. The expectation that this patient will sustain the weight loss without considerable help is naïve. Pharmacy-based programmes are ideal for the varying needs of patients. Obesity prevention, treatment and long-term management is a pharmacy health promotion service. Care of patients during weight loss, is ideal when carried out by the pharmacist who understands the implications of diseases or drug treatments that may interact with the weight loss programme. But, it is in the postdiet stage that the pharmacist is best placed to provide the essential longterm guidance, support and education that will increase the length of time that the weight loss is maintained. Pharmacists armed with the Lipotrim programme can assist your overweight patients cope with long-term weight management.

PDF version: 4-1-freeing-patients

COULD LIPOTRIM VLCD TREAT YOUR OBESE DIABETIC PATIENTS AND REDUCE YOUR PRESCRIBING COSTS?

The NHS is reported to be spending £9 billion a year treating diabetes ineffectively File on Four. BBC Radio 4 21 February 2012.)

3-2imgPerhaps the most important contributory cause to the rise in diabetes in recent years is overweight and obesity, yet a cost-effective, evidence-based option for treating the condition appears to be being overlooked. Rapid weight loss using a very low calorie diet (VLCD) regime has been shown to normalise blood sugar levels within a few days, requiring withdrawal of hypoglycaemic medication. 1,2 VLCD also lowers the risk factors for cardiovascular disease.

Bariatric surgery is another recognised method of weight reduction for obese patients with diabetes. However, the effect
on blood sugar is stronger with VLCD than with bariatric surgery as post-surgical nutrition includes a significant amount of carbohydrate, thus preventing the rapid utilisation of blood sugar and glycogen stores fundamental in a ketogenic VLCD. Furthermore, while there are around three quarters of a million patients who meet the NICE criteria for eligibility for bariatric surgery, the health system barely begins to meet the demand and last year less than 9000 operations, NHS and private combined, were performed.

Lipotrim is a well-established VCLD programme, supervised by GPs or pharmacists, which has been running successfully for over 25 years. GPs can monitor their patients on the programme themselves, although the monitoring task is usually provided by pharmacists who also supply the Total Food Replacement products. The programme has the additional advantage of being cost neutral to the NHS as the products are not ordinarily prescribed, while the cost to patients is usually more than compensated by the reduction in their food bills. Lipotrim refeeding and maintenance programmes are available for patients to maintain their weight at the reduced level once a target has been achieved.

Abundant evidence is available of the success of Lipotrim VLCD programmes run in UK pharmacies. More than 2000 pharmacies offer the service and many record their patients’ progress using Patient Tracker software, which produces
detailed audits providing substantial evidence of efficacy across a wide spectrum of patients and medical conditions. For example, audit results from 400 patients treated in one pharmacy have recorded an average weight loss of 11% across all clients after three or more weeks on the Lipotrim programme. 3
Percentage of initial weight lost by patients in this group reached as high as 37%. Average percentage weight loss rose with increasing BMI at outset, from 9% loss in clients with a BMI of 25-30, to 13% with starting BMI of 35-40 and 21% for those with starting BMI of 45-50. The figures also show that weight losses were maintained during refeeding and maintenance after dieting. There is also evidence from the Tracker that an average weight loss of around 14% can be
achieved on the Lipotrim programme by hypothyroid patients, who generally experience great difficulty with weight
management. And average weight losses of 12-13% in patients with hypertension and depression, conditions to which
excess weight can be a contributory factor, have also been shown.

For further information, contact Valerie Beeson, Clinical Programme Director, Howard Foundation Research Ltd. Cambridge UK. E-mail: obesity@lipotrim.demon.co.uk. Phone:01223 812812.

References
1. Paisey RB, et al. An intensive weight loss programme in established type 2 diabetes and controls: effects on weight and
atherosclerosis risk factors at 1 year. Diabet Med.1998; 15:73-9.
2. Paisey RB, et al. Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. J Hum Nutr Diet. 2002;15:121-7.)
3. Pharmacist Gareth Evans, Waistaway Ltd. Data on file.

PDF version:3-2-BMJ-May-2012

DIABETES AND OBESITY: HAVE YOU THOUGHT ABOUT LIPOTRIM?

“New NHS research has revealed the shocking toll of preventable deaths caused by just one medical condition – diabetes -which is causing 24,000 needless deaths a year in England alone. It’s not just the old and middle-aged who are at risk. Young women with diabetes are 6 to 9 times more likely to die than their age group overall. And many more young people who don’t die will develop life threatening diseases later due to failure to manage their blood sugar. Badly controlled diabetes can lead to kidney disease, heart conditions, or blindness. It’s also the cause of 5,000 amputations a year, mainly of legs or feet. With around 3 million diagnosed sufferers known to the health service, diabetes is said to be costing the NHS £9 billion a year, about a tenth of the total health budget.” File on Four. BBC Radio 4, 21 February 2012

 

GPs already know this and that diabetes, fuelled by an epidemic of overweight and obesity, is undermining the nation’s health. But it has been shown that with the aid of a very low calorie formula diet (VLCD), rapid weight loss leads to rapid remission of type 2 diabetes. A one-year study showed that BMI of obese diabetic patients was reduced by 5kg/m2 and that patients were able to discontinue insulin and oral hypoglycaemic agents for the whole year. 1 A five-year follow-up study confirmed that VLCD treatment was safe and effective in overweight diabetic subjects.2 It has also been shown that normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes is achieved by VLCD dietary energy restriction.3
Very low calorie diets and bariatric surgery are demonstrably the most effective weight loss methods for diabetic patients. Ultimately, it is the loss of the excess weight that leads to long

term improvement in insulin sensitivity and blood sugar control. With both VLCD and surgery, there is an immediate substantial reduction in the oral consumption of either carbohydrates or substances that can be readily converted to carbohydrates and, as a result, the metabolic response is rapid. Circulating glucose and mobilised glycogen stores are rapidly consumed and generally depleted within about 3-4 days, reducing blood glucose to normal levels. The reduction is so dramatic that oral hypoglycaemic agents must be withdrawn prior to the start of a VLCD programme. Rapid weight loss, with reasonable long term weight management, can put diabetes into long term remission. Both VCLD and bariatric surgery are approved by NICE as options for the treatment of obesity, but the advantages of a VLCD such as Lipotrim are often overlooked. A Lipotrim regime is not accompanied by the problematic aspects of bariatric surgery: high morbidity and mortality risk, prohibitively high cost, possible post operative complications and, in consideration of the large numbers of severely overweight people with or without diabetes, extremely limited availability. Lipotrim is not available on the NHS so treatment costs the NHS nothing, but patients are not out of pocket as the costs of the diet are no more, and can be less, than the costs of the food it replaces.

Lipotrim is supplied in more than 2000 pharmacies nationwide. Overweight or obese patients taking medication for diabetes can only start on the Lipotrim programme with the cooperation of their GP. Potential dieters undergo an initial assessment by the pharmacist. The dieters must return to the pharmacy each week to collect their supplies, when the pharmacist monitors their progress and to check compliance with the diet. Once the target weight is attained, patients can elect to use specially formulated Lipotrim maintenance products along with healthy eating , which effectively assists post diet calorie control. Pharmacists also provide lifestyle advice and support to help prevent the lost weight from being regained. Each patient’s progress is recorded and many pharmacists use the Lipotrim Pharmacy Patient Tracker software, which audits the results of patients’ dieting and illustrates the patient’s progress in graphic form. Pooled audits from pharmacies have demonstrated their outstanding success in helping patients to lose weight and achieve remission from diabetes.
There is really no excuse for the situation reported by the File on 4 programme. Many patients can be helped to escape diabetes permanently by following a VLCD regime, and while not every diabetic patient may be able to defeat the addictive lure of a subsequent return to overeating, many can. But even for those who cannot, the time away from the condition allows for dealing with other medical problems and an improved quality of life. So, it is surely worth giving the patients a chance and Lipotrim a try.
For further information, contact Valerie Beeson,
Clinical Programme Director, Howard
Foundation Research Ltd. Cambridge UK.
E-mail: obesity@lipotrim.demon.co.uk.
Phone:01223 812812.

References
1. Paisey RB, et al. An intensive weight loss programme in established type 2 diabetes and controls: effects on weight and atherosclerosis risk factors at 1 year. Diabet Med.1998; 15:73-9.
2. Paisey RB, et al. Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. J Hum Nutr Diet. 2002;15:121-7.
3. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54:2506-14.

OBESITY PANDEMIC – DIABETES DETERRENCE BY WEIGHT LOSS: PHARMACY BENEFITS PRIMARY CARE

It should be reasonable to justify practice time and resources to assist overweight and obese patients lose their weight. The link to type II diabetes alone is sufficient. With rapid weight loss, normalisation of blood sugar levels is achieved in days and with further weight loss, the disease can be held in remission. Better long term glycaemic control is achieved with rapid weight loss, even after some weight regain, than is achieved with the same weight lost more slowly. About 50% of hypertensive patients can reduce drug treatments with weight loss. Surgical interventions can be scheduled when substantial weight is lost. Fewer anti-depressants are required and overall, the frequency of GP visits is significantly
lower for leaner patients.

There is no shortage of choice to meet the weight loss needs of individual patients. Drugs, both current and promised for the future, dietetic referral, exercise on prescription, and pharmacy based treatment programmes are all needed in order to deal with the massive problem of obesity. Each has a place depending upon the specific clinical needs of the patient. An exercise prescription may not be the best choice for a 40 stone patient who may struggle simply to walk, which at this weight is considerable exercise. Weight loss has been advocated as an adjunct to treatment for patients with
conditions such as diabetes type 2, hypertension, osteoarthritis and a catalogue of other disabilities. Generally, little attention is paid to this option because of the difficulty patients have experienced in losing adequate amounts of weight and keep it off. The widespread availability of effective weight loss programmes in UK and Irish pharmacies, however, argues strongly for offering overweight patients, especially type 2 diabetics, an opportunity to try a course that leads to less dependence on drugs and frequently leads to long term remission of disease.

For diabetes, there are really two basic facts to consider. The first is that type II diabetes is a disease that has a primary
etiology which is close to 100% REVERSIBLY related to excess body weight. The second fact is that diabetic patients can lose enough weight within a few days to bring their blood sugars under control and enough further weight within weeks to
crucially reduce cardiovascular risk factors and apparently keep the disease in remission, even with some weight regain.

WEIGHT SPIRAL:

Standard treatment for type 2 diabetes, with emphasis on using drugs to lower the blood sugar levels, often results in a
relentless vicious circle. High blood sugar leads to drug intervention, which results in increased body weight, which in turn elevates the blood sugar, which increases the requirement for more potent drugs, which spirals to obesity and possible insulin dependency. Patients are getting fatter as a result of treatment and this necessitates more aggressive drug usage. With significant weight loss, drug usage can be reduced and in many cases stopped permanently.

LONG TERM WEIGHT MANAGEMENT

While willpower can often help people lose weight over a short defined period, control for the months, years or even
decades required for stability is quite a different story. Loss of weight by any means confers absolutely no lasting legacy for weight maintenance. Weight loss, however achieved, is only the beginning of the treatment, not the end point. When the drug therapy is discontinued.
When the counsellor moves on. When the patient is “cured” of excess weight. This is the point at which a dieter requires the maximum attention and assistance. Weight management requires control of eating behaviour over a sustained period of time and the implementation of lifestyle changes. Justifying practice time and resources for a patient who has achieved weight loss and is now both healthier and at a normal weight is difficult. The expectation that this patient will sustain the weight loss without considerable help, however, is naïve. Pharmacy based programmes are ideal for the varying long term weight management needs of patients.

Obesity prevention can also be part of the pharmacy contribution to health promotion services; dealing with excess weight before it reaches obese levels and exacerbates comorbidities. The care of patients during weight loss, is advantageous when monitored by a pharmacist, who understands the implications of other drug treatments that may interact with the weight loss programme.
But it is at the post diet stage that the pharmacist is best equipped to provide essential long range guidance, support and education that will increase the length of time that the weight loss is maintained.
Both the new GP and the pharmacy contracts strongly encourage interactive efforts to deal with a range of health problems, most of which have weight related implications. Weight loss is vital for management of, cholesterol,
blood lipids, diabetes, hypertension or asthma. It even impacts programmes for smoking cessation.

ACHIEVING A MAXIMUM SAFE RATE OF WEIGHT LOSS

Modest reductions in Calories can theoretically result in weight loss. Of course, the modest reduction has to be from the
equilibrium level, not from current intake. If a person is overeating by 2000 Calories a day (very common in the obese), a modest reduction in Calorie intake will not cause weight loss.
There is a maximum rate of weight loss for any individual. A total fast provides zero calories and therefore requires that all the Calories necessary for life come from the body fuel reserves. A total fast, however, provides no nutrients and since an obese patient has a far greater reserve of calories than stores of other essential nutrients, a total fast is out of the question as a treatment.
To be healthy, a diet has to supply adequate essential amino acids, essential fatty acids, vitamins, minerals and trace
elements. A total fast cannot be a valid treatment for obesity. The simple idea of reducing fat levels in an enteral formula
solves both the Calorie and the nutrient problem. An ideal nutritional product with the absolute minimum of Calories consistent with a healthy diet is achieved. Lipotrim is an example of such a product, providing a maximum safe rate of weight loss. The literature on safety and efficacy is massive. The time has really come to pay attention to it.

BENEFITS OF WEIGHT LOSS

There is also an extensive literature on the beneficial effects of weight loss on cardiovascular risk factors, on
blood lipid profiles and blood pressure. Managing weight in general practice is time consuming. The beneficial results from reliable weight loss on the glycaemic control and the cardiovascular risk factors more than justifies pharmacy cooperation. It benefits patients and makes good use of pharmacists’ training and facilities.
Weight is extremely important to patients generally and has a critical influence on the clinical course of many medical conditions. Uniquely, however, with type II diabetes, because the blood sugar can normalize so quickly under conditions of rapid weight loss, it is essential that hypoglycaemic medications are stopped prior to dieting. This requires an understanding, on the part of the prescribing GP, of the need to stop drug treatment and follow up of the patients.

THE IMPORTANCE OF PHARMACY IN WEIGHT MANAGEMENT

The need to deal with excess weight is no longer simply a cosmetic issue. Obesity has become pandemic. The serious consequences of excess weight are being acknowledged as type 2 diabetes rates soar in children as well as adults. There is
probably no other service that a pharmacist can provide that will prove to be as valuable to the needs of general practice as weight management. When effective self-funding programmes are available that do not require allocation of scarce resources from PCTs, it is hard to imagine any pharmacy failing to cooperate with a weight management programme. The problem has become so pervasive, that it will take a wide variety of treatments, drugs and public education to have any impact. Hospital programmes for weight management are overwhelmed. Pharmacy is the best community resource
and pharmacists’ training ideal for providing professional assistance in dealing with the major health issue of the decade.

REFERENCES

Wing RR, Blair E et al. Calorie restriction per se is a significant factor in improvement in glycemic control and insulin
sensitivity during weight loss in obese NIDDM patients. Diabetes Care 17:30- 36,1994.
Wing RR, Marcus M & Bononi P. Glycemic control after weight loss is affected by how weight loss is achieved. Diabetes, 39: suppl 1, 50A,1990.
Wing RR, Marcus MD, Salata R, Epstein LH, Miaskiewicz S & Blair EH. Effects of a very low calorie diet on long term glycemic control in obese type II diabetic subjects. Arch Int Med, 151: 1334-1340, 1991.
Weck M, Hanefeld M & Schollberg K. Effects of VLCD in obese NIDDM (noninsulin dependent diabetes) on glucose,
insulin and C peptide dynamics. Internat J Obes, 13: suppl 2, 159-160, 1989.
Uusitupa M, Alaakso M et al. Effects of a very-low-calorie-diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulindependent diabetes. Amer J Clin Nutr. 51:768-773,1990.
Shaper AG, Wannamethee SG & Walker M. Body weight: implications for the prevention of coronary heart disease, stroke and diabetes mellitus in a cohort study of middle aged men. Brit Med J, 314: 1311-1317, 1997.
Reports on tasks for scientific cooperation (EU SCOOP) Report of experts participating in Task 7.3, September 2002
Collection of data on products intended for use in very-low-caloriediets Directorate-General Health and Consumer Protectionz

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