Obesity in patients – the importance of broaching the topic and the benefits of pharmacotherapy as an adjunct
The World Health Organization has found that more than 28% of adults in South Africa are obese, the highest obesity rate amongst sub-Saharan African countries. Obesity is widely acknowledged to be associated with many health risks and diseases including type 2 diabetes, heart disease, stroke, hypertension, joint pain and certain cancers.
Dr Daksha Jivan, an endocrinologist in the Division of Endocrinology at Charlotte Maxeke Johannesburg Academic Hospital, says that healthcare practitioners need to introduce the topic of obesity with their patients and make them aware of their BMI, tell them about the potential risks and problems associated with obesity, screen them for complications early and make them aware that there is medication available to assist them. “I can’t stress enough how important it is for HCPs to broach the topic with their patients,” she says.
Dr Jivan, who is very much in favour of the use of medically approved obesity treatments in suitable patients, says that these treatments are useful in appetite suppression, in increasing satiety and are beneficial in assisting the lifestyle changes that need to accompany weight loss.
She says that any patient that is motivated to lose weight and expresses some commitment to being compliant on the medication can benefit, especially those who are willing to make a change to their lifestyle. “The medications are especially beneficial in those patients that have been previously unsuccessful in lifestyle approach alone. It is important to realize that metabolic adaptations occur with weight loss that results in increased hunger and these can rapidly promote weight regain. These medications can thus also assist patients who have already lost weight to continue losing weight,” she says.
She says the most effective pharmacotherapy treatments are those that act on multiple areas. “For example, appetite suppression as well as increased satiety at the level of the gut as well as centrally on the brain are more likely to be successful,” she says.
There are currently three registered medications indicated for weight loss or as appetite suppressants in South Africa. One of which is Duromine.
Duromine, which is available in 15 mg and 30 mg capsules, is an anorectic agent used in the management of obesity. Its active ingredient is Phentermine resin, a sympathomimetic amine chemically related to amphetamine, which acts as an appetite suppressant. Duromine is indicated as a short-term adjunct to be used alongside a medically monitored comprehensive regimen of weight reduction which should include exercise, diet (caloric/kilojoule restriction) and behaviour modifications. Duromine is indicated for use by obese patients with a body mass index (BMI) of 30 kg/m2 or higher who have not achieved an adequate clinical response to an appropriate weight-reducing regimen alone.
Dr Jivan says that although obesity pharmacotherapy does have some side effects, which can include nausea, vomiting and upset stomachs and where centrally-acting agents are concerned, these can include insomnia, fast heartrate and increase blood pressure; the benefits far outweigh these side effects in correctly chosen patients.
When it comes to whether gradual or rapid initial weight loss is more beneficial for patients in the long term, researchers from the Department of Clinical and Health Psychology at the University of Florida in the United States have found that there were both short- and long-term advantages to fast* initial weight loss. The study, which looked at diet and behavioural therapy modifications without pharmacotherapy interventions, concluded that fast weight losers obtained greater weight reduction and long-term maintenance and were not more susceptible to weight regain than gradual weight losers.
Dr Jivan concurs. “The older thinking was that the slower weight was lost, the less likely it was to be regained. Newer evidence has shown us that the rate of weight loss actually has no bearing on weight regain. In fact, some studies show an association between more rapid weight loss and increased total weight loss and less weight regain,” she says.
To assist patients on their weight loss journey with Duromine, iNova Pharmaceutical’s iLiveLite program which is an online platform which patients can join and which offers tools to help them track their weight and measurements on a weekly basis while getting the necessary advice, tips, dietician developed eating programme and support to keep them motivated on their path to attaining and maintaining their goal weight. Treating physicians also have access to monitor and track the progress with their patients through this platform.
Go to www.ilivelite.co.za and register on the doctor site to access information that can assist you in managing your overweight patients.
*Fast weight loss is quantified as weight loss of >0.68 kg/week.
 Business Insider South Africa. South Africa has just been ranked the unhealthiest country on earth (2019) at https://www.businessinsider.co.za/most-unhealthy-countries-in-the-world-ranked-2019-3 (Website accessed March 2019)
 National Obesity Week: South Africa’s weighty problem – The Heart and Stroke Foundation 2016 (http://www.heartfoundation.co.za/media-releases/national-obesity-week-south-africa%E2%80%99s-weighty-problem) (Accessed on 15 August 2017).
 Q&A with Dr Daksha Jivan. 4 November 2019 (unpaid).
 eMIMS. Accessed 15 November 2019.
 Duromine package insert. July 2000.
 Nackers L, Ross K and Perri M. The Association Between Rate of Initial Weight Loss and Long- Term Success in Obesity Treatment: Does Slow and Steady Win the Race? Int J Behav Med. 2010 September; 17(3): 161–167. doi:10.1007/s12529-010-9092-y.