Obesity supplement pills and advice on diet and food selection, natural treatment
July 17 2017 by
Ray Sahelian, M.D.

Overall, about 30 percent of men and women in the United States are obese. The risk is higher as we age, and higher if we are under stress. The prevalence is about the same among black and white men, but much higher among black and Hispanic women than among white women. Obesity stats show about 60 percent of middle-aged black women are obese compared with 33 percent of white women. This is a health problem associated with higher rates of chronic medical conditions and worse physical health than a lifetime of smoking, poverty or problem drinking, making it the top health risk. Obesity can lead to high blood pressure and increase the risk for migraine headache, cancer, heart disease, diabetes, chronic fatigue, and gout. Those who live near fast food restaurants are more likely to put weight on. Obesity increases the risk of developing Alzheimer's and also speeds the onset.
   Is there a way to reduce the risks?
See weight loss for natural options such as food selection and dietary choices to deal with obesity including various types of diet such as low carbohydrate, high protein, high fat, etc. See diet for healthy suggestions, including how to increase fiber food intake.

Drinking about 16 ounces of water 30 minutes before meals can help with weight loss for obese adults. Published in the journal Obesity, 2015. Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity.

Natural supplements for obesity control, weight reducing products
These herbs and nutrients for obesity have been promoted through various advertisements, how effective are they?

Apple cider vinegar has not been proven to be effective even though many nutritional articles promote it.
Banaba leaf is used in Southeast Asia to lower blood sugar and promote healthy insulin levels that are related to appetite.
Bitter Orange is the same as citrus aurantium and often found in anti obesity pill products in health food stores.
Cayenne pepper is a thermogenic herb but I can't imagine consuming enough to make a marked difference. 
Cha de bugre is an herb used in South America.
Caralluma Fimbriata extract is being promoted as a weight loss herb, or specifically as a cactus or succulent.
Galactomannan has recently been promoted.
Hoodia is a cactus plant extract from the Kalahari desert in South Africa that has been getting a lot of attention lately.
Ephedra may be back on the market, but I do not recommend its use at this time.
Chitosan has not been found to be helpful in reducing obesity. You can find supplements here. Chitosan supplements may have a purpose in other health issues and medical conditions but it does not appear that

5-HTP is a nutrient that helps curb appetite in some individuals since it influences serotonin levels.
Acetyl-l-carnitine can sometimes help reduce appetite and it is also a potent brain enhancer.
Lipoic acid is not very effective by itself.

More than two-thirds of Americans are either overweight or obese. Mississippi has the highest incidence of obesity in the nation whereas Hawaii has the lowest incidence.

2013 review in J Diabetes Metabolism Disorders
Studies with Nigella Sativa, Camellia Sinensis, Crocus Sativus L, Seaweed laminaria Digitata, Xantigen, virgin olive oil, Catechin enriched green tea, Monoselect Camellia, Oolong tea, Yacon syrup, Irvingia Gabonensi, Weighlevel, RCM-104 compound of Camellia Sinensis, Pistachio, Psyllium fibre, black Chinese tea, sea buckthorn and bilberries show significant decreases in body weight. Only, alginate-based brown seaweed and Laminaria Digitata caused an abdominal bloating and upper respiratory tract infection as the side effect in the trial group. No other significant adverse effects were reported in all 33 trials included in this article.In conclusion, Nigella Sativa, Camellia Synensis, Green Tea, and Black Chinese Tea seem to have satisfactory anti-obesity effects.

Supplements that are of benefit in maintaining health in those who are obese
Complement Ther Clin Pract. 2016. Effects of pomegranate extract supplementation on inflammation in overweight and obese individuals: A randomized controlled clinical trial. Our study suggests that pomegranate extract consumption may reduce complications linked with obesity.

How you carry your fat influences health and mortality
It is not just overall obesity but also how body fat is distributed that determines a person's risk of dying over a given period. Both waist circumference and the waist-to-hip ratio are independent predictors of mortality.

Fast Food and Obesity
There is no doubt that high calorie foods, such as fast foods, increase adipose tissue size, cause obesity and often severe obesity. These fast foods include sandwiches with white bread, sweets, sodas with sugar, ice cream, and others. A fast-food restaurant within about 500 feet of a school leads to at least a 5 percent increase in the obesity rate at that school.

Candy, soda and other junk foods commonly sold at stores not traditionally associated with food may be contributing to the U.S. obesity problem. A study, of more than 1,000 non-food retail stores across the U.S., found that 41 percent sold candy, soft drinks, chips and other sweet and salty snacks. The foods were most commonly placed at check-out counters, where they were "within arm's reach" of impulsive buyers. This easy availability of snack foods may tempt many people into buying calories that they otherwise would not. And over time, those calories could add up to extra pounds. American Journal of Public Health, online December 17, 2009.

Causes of obesity - beyond genetic
Obesity results from consuming more calories than the body uses. Genetic and environmental factors influence body weight, but precisely how they interact to determine a person's weight is still unclear. One proposed explanation is that body weight is regulated around a set point, similar to a thermostat setting. A higher-than-normal set point may explain why some people are obese and why losing weight and maintaining weight loss are difficult for them.

    Reduced physical activity is probably one of the main reasons for the increase in obesity among people in affluent societies. Designing walkable communities is a cost-effective way to address the growing epidemic of obesity in the United States and cut down on harmful car emissions and pollution.
    Easy access to calorie-dense foods and drinks, along with a sedentary lifestyle in front of the TV tube are major factors. Rarely, hormonal disorders cause obesity. Depression and obesity are sometimes related. Depression could lead to excess caloric consumption, while obesity, with its resultant lack of physical activity and poor body image could lead to low mood or depression.
  
Waiting longer to start infants on solid food could lead to slimmer adults.

Is obesity socially contagious?
It appears to be socially contagious as it can spread among individuals in close social circles. The likely explanations: A person's idea of what is an appropriate body size is affected by the size of his or her friends. The types of foods eaten or restaurants visited could be similar, and activity level could become similar. For instance, if you hand out with obese friends who enjoys movies, along with popcorn and sodas, you are more likely to add on extra pounds than if you have friends whose idea of fun is to take long walks or bike rides.

Obesity may be contagious because most people feel good about themselves if they are about as heavy as the people around them. This could explain the rapid rise in the prevalence of overweight around the world. The norm that most people compare themselves to has become fatter and fatter, feeding a cycle of "imitative obesity."

Sodas and other sugar-sweetened drinks don't just go hand-in-hand, but actually cause it. Not that these drinks are the only cause -- genetics, exercise and other factors are involved -- but sodas are an important cause, perhaps the leading cause.

Emotions and obesity
Emotional disturbances, once considered an important cause, are now considered a reaction to the strong prejudice and discrimination against obese people. One type of emotional disturbance, a negative body image, is a serious problem for many young obese women. It leads to extreme self-consciousness and discomfort in social situations.

Cancer incidence increases
Among women, postmenopausal breast, endometrial and colon cancers accounted for nearly three-quarters (250,000 cases) of obesity-related cancers, while colon and kidney cancers account for more than two-thirds (nearly 90,000 cases) of obesity-related cancers in men.

Cell Metab. 2016. Obesity and Cancer: The Oil that Feeds the Flame. Although discussion of the obesity epidemic had become a cocktail party cliché, its impact on public health cannot be dismissed. In the past decade, cancer had joined the list of chronic debilitating diseases whose risk is substantially increased by hypernutrition. Here we discuss recent advances in understanding how obesity increases cancer risk and propose a unifying hypothesis according to which the major tumor-promoting mechanism triggered by hypernutrition is the indolent inflammation that takes place at particular organ sites, including liver, pancreas, and gastrointestinal tract. The mechanisms by which excessive fat deposition feeds this tumor-promoting inflammatory flame are diverse and tissue specific.

Diabetes
There is little doubt that obesity increases the risk for diabetes. Obesity leads to insulin resistance. Sugar in the blood is not able to leave the blood stream and enter tissues, thus leading to high blood sugar.
   Obesity is the most important modifiable risk factor for type 2 diabetes mellitus and most patients with diabetes are overweight or obese. It is well known that excess bodyweight induces or aggravates insulin resistance, which is a characteristic feature of type 2 diabetes. Thus, bodyweight plays a central role in the prevention and treatment of diabetes. Recent data suggest that lifestyle intervention in patients with impaired glucose tolerance results in an impressive reduction in the conversion to overt diabetes, which is greater than the effect of early intervention with drugs such as metformin or acarbose. The prevention of diabetes has been shown to be associated with the extent of weight loss. In patients with type 2 diabetes, weight loss by any means is followed by an improvement of metabolic control and associated risk factors. The most appropriate recommendation for obese patients with type 2 diabetes is a nutritionally balanced, moderately hypocaloric diet with a reduced intake of saturated fat and an increase in physical activity. If this standard approach is only partly successful or not at all, additional strategies such as weight-lowering drugs, very low-calorie diets for limited periods of up to 12 weeks, and, for severely obese patients, bariatric surgery should be carefully considered. A large body of data suggests that such measures can be very effective in this patient group by improving metabolic disturbances and blood pressure. However, it is extremely important for the long-term outcome that the treatment is tailored to the needs and wishes of the individual patient.

Obesity and Heart disease
Even in the absence of high blood pressure and other cardiovascular risk factors, obesity in midlife is associated with an elevated risk of hospitalization and death from coronary heart disease (CHD) in older age.

Amyloid, obesity, and Alzheimer's disease
As body fat increases, so do blood levels of a protein fragment linked to Alzheimer's disease, which may explain the reported association between obesity and the brain-wasting disease. Obesity by itself, even in otherwise healthy middle-aged people, is associated with elevated levels of the amyloid peptide that builds up and causes Alzheimer's. High levels of amyloid in the brain lead to amyloidosis.

Brain degeneration
Obese people have 8 percent less brain tissue than normal-weight individuals. Their brains look 16 years older than the brains of lean individuals. Those classified as overweight have 4 percent less brain tissue and their brains appear to have aged prematurely by 8 years.

Eye disease
Obesity is a key factor in sight loss. Obesity raises the risk of developing three major types of sight loss: Age-related macular degeneration (AMD), a condition affecting the retina; diabetic retinopathy, a progressive blurring of vision developed by 60 percent of type 2 diabetes sufferers; cataracts, a clouding of the eye lens responsible for one in four cases of sight loss in people over 75.

Obesity, pregnancy and fertility
Obesity decreases the chances that a woman will become pregnant, and the more obese she is, the worse her prospects of conception.
   Women who are obese before they become pregnant are at increased risk of having a baby with defects of the brain and spinal cord, especially if they tend to put on weight around the waist. The more obese a woman is when she becomes pregnant, the greater the likelihood that her baby will be born with a heart defect. American Journal of Clinical Nutrition, online April 7, 2010.

Plantar fasciitis
The risk for plantar fasciitis increases as a person becomes heavier.

Obesity and prostate cancer or enlargement
Obese men have an increased risk of prostate cancer recurrence and death after they have completed radiation therapy.
A very high body mass index (BMI) can be a confounding factor when evaluating a man's results from the prostate specific antigen PSA test.

Anti Obesity medications
Pharmacological therapy for obesity is in transition. Historically, there have been few effective agents, and many have been with-drawn because of unacceptable side effects. Current options include three medications approved by the FDA for the treatment of obesity: phentermine, sibutramine and orlistat. Phentermine and sibutramine suppress appetite and promote thermogenesis,and orlistat blocks fat digestion and absorption in the gut. Several drugs approved for other indications often promote weight loss, including bupropion, metformin, topiramate and zonisamide; they have been used empirically for treatment of obesity and to counter the weight-promoting effects of other medications.

Pharmaceuticals (Basel). 2010 . Combinations of drugs in the Treatment of Obesity. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. KEYWORDS: 5-hydroxytryptophan; antidepressants; bupropion; caffeine; carbidopa; drug combination; ephedrine; fenfluramine; glucagon-like peptide-1; leptin; metformin; metreleptin; naltrexone; noradrenergic drugs; orlistat; peptide YY; phentermine; pramlintide; sibutramine; topiramate; zonisamide.

Drugs that Cause Obesity
A number of commonly used drugs cause weight gain. They include corticosteroids such as prednisone and many antidepressants, as well as many drugs used to treat psychiatric disorders.

Drugs used to treat obesity
As of 2016, five drugs are approved in the United States for managing obesity. But little has been known about how they stack up against one another. New findings -- based on more than 29,000 people in total -- show all five drugs can work. But people on certain drugs tended to be more successful, at least over one year. Specifically, people using Qsymia (phentermine-topiramate) or Victoza (liraglutide) had the highest odds of shedding at least 5 percent of their initial weight. Those taking Xenical (orlistat) had the lowest odds. Many obesity drugs have side effects.

BMI
Obesity is calculated using the body mass index (BMI) -- dividing weight in kilograms by height in meters squared. A BMI of more than 30 is considered obese, more than 40 is very severe.

Obesity in America - Environmental Factors
Americans are getting taller on average but they are much heavier too. On average, adult men and women are about an inch taller than they were in 1960 and 25 pounds heavier. The average body mass index (BMI), a weight-for-height formula used to measure obesity, has tipped across the overweight point from 25 in 1960 to 28 in 2002. The government's latest report on height and weight shows that the average height of a man aged 20 to 74 went from just over 5 feet 8 inches in 1960 to 5 feet 9 inches in 2002. The average height of a woman has gone from 5 feet 3 inches to 5 feet 4 inches. Weights, however, have ballooned. The average weight of an adult man was 166.3 pounds in 1960 and 191 pounds in 2002, while the average weight for women went from 140.2 pounds to 164.3 pounds.
   Obesity must be recognized and treated as a disease with deadly complications. Up to 8 percent of total healthcare costs in some Western countries are attributable to obesity and related problems. It is a leading cause of preventable death -- so shedding excess weight is not just about looking good. Obesity is not an aesthetic problem. It is a very complex problem tightly connected to diabetes, atherosclerosis (blocked arteries) and other major health problems and causes of death.
   Obesity is an end result of the intricate interactions of biology, behavior, and environment. Recent hypotheses in the scientific community suggest the current obesity epidemic in the USA is being driven largely by environmental factors (e.g., high energy/high fat foods, fast food consumption, television watching, "super-sized" portions, etc.) rather than biological ones. Individuals are bombarded with images and offers of high fat, high calorie, highly palatable, convenient, and inexpensive foods. These foods are packaged in portion sizes that far exceed federal recommendations. Furthermore, the physical demands of our society have changed resulting in an imbalance in energy intake and expenditure. Today's stressful lifestyles compound the effects of environmental factors by impairing weight loss efforts and by promoting fat storage. Combating the obesity epidemic demands environmental and social policy changes, particularly in the areas of portion size, availability of healthful foods, and promotion of physical activity.

United States
The rate of obesity is highest in the Southeast and Appalachia. High rates of obesity and diabetes are reported in more than 80 percent of counties in the Appalachian region that includes Kentucky, Tennessee and West Virginia. The same problem was seen in about 75 percent of counties in Alabama, Mississippi, Louisiana, Georgia and South Carolina. The five counties with the highest rates are Greene and Dallas counties in Alabama and Holmes, Humphreys and Jefferson counties in Mississippi. All are small, rural counties in the west central areas of each state, and each report obesity rates of around 44 or 43 percent. The national adult obesity rate is roughly 26 percent. Mexico Rate Surpasses The United States' in 2013, making It fattest country In The Americas

Obesity in child - Childhood
More than half a million children in Europe may be suffering from a cluster of obesity -related risk factors that will increase their odds of developing diabetes, heart disease and stroke. New research presented at the 14th European Congress on Obesity in May 2005 shows that youngsters in Europe are catching up with their obese counterparts in the United States, where 2 million children are affected by metabolic syndrome. Its symptoms include a large waistline, high blood pressure, raised insulin levels, excess body weight and abnormal cholesterol levels. If someone has three or more symptoms they have the syndrome and a higher risk of suffering from life-threatening illnesses.
   The more soda kids drink, the more likely they are to be obese. However, soft drinks are not the only cause of the ongoing childhood obesity crisis, which is also fueled by a lack of physical activity, and too much TV, high fat and simple carbohydrate foods, among other problems.
   Obese people, particularly those who became obese during childhood, may have up to five times more fat cells than people of normal weight. Because the number of cells can't be reduced, weight can be lost only by reducing the amount of fat in each cell.
   Obese children who lose weight through diet and exercise become stronger and more agile in the process. A program that focuses on physical activity and diet education is able to not just help obese children shed pounds, but to also improve their endurance, strength, balance and coordination.
   Replacing sugar-laden drinks with water has a dramatic impact on the amount of calories kids consume and helps the fight against childhood obesity.
   Overweight and obese children have more aches and pains in their muscles and bones than their normal-weight peers. Annals of Family Medicine, 2009.
  
Obese children who watch a lot of television are more likely to have high blood pressure than heavy children who don't spend as much time in front of the tube.

Screening
In an update to their 2005 recommendation, the US Preventive Services Task Force recommends that clinicians screen children and adolescents ages 6 to 18 years old for obesity. For patients who are obese based on body mass index (BMI) percentile for age and gender, the Task Force advises referral to a comprehensive program that includes dietary, physical activity, and behavioral counseling components to promote weight loss. Skyrocketing rates of obesity have reached approximately 12% to 18% in 2- to 19-year-olds, increasing up to 6-fold since the 1970s. In addition to dietary and physical activity counseling, effective programs included behavioral management techniques such as self-monitoring, stimulus control, eating management, contingency management, and cognitive-behavioral techniques. Pediatrics 2010.

Obesity and risk of diabetes and heart disease in children
American children and teens are growing ever-fatter tummies, a bad sign that means they are at even more risk of heart disease and diabetes, U.S. researchers reported in November, 2006. They found that the belly fat of children and teenagers had increased by more than 65 percent since the 1990s -- directly in line with rising obesity rates. Belly fat is more dangerous than general weight gain, because abdominal and visceral fat -- found surrounding the internal organs -- is more clearly and strongly linked with disease than general body fat.

Premature puberty and obesity
Childhood obesity in the United States appears to be causing girls to reach puberty at an earlier age, for reasons that are not clear but could be related to excess estrogen production by fatty tissue.

Obesity Management
During the last two decades, the prevalence of adults in the higher body mass index (BMI) categories in the US has increased the most, as much as 300% for those with a BMI above 40kg/m2. In children and adolescents, a doubling of the prevalence of severe obesity poses a serious health risk to future generations of young adults who may develop chronic diseases normally associated with aging. The simple definition of obesity, an imbalance between energy intake and energy expenditure, ignores the complexity of, and largely unknown interactions between, genes, food intake and physical activity, which together determine bodyweight and fat distribution. Although the etiology and manifestations of overweight and obesity are complex, the assessment of overweight and obesity requires only an accurate measurement of bodyweight, height and abdominal circumference, as well as a history and physical examination attuned to the morbidities that commonly accompany overweight and obesity such as diabetes mellitus, hypertension, dyslipidemia and sleep apnea. The treatment of patients with overweight and obesity continues to be based on changes to diet and physical activity. Simple behavior modification techniques are within the reach of busy clinicians. The additional use of available bodyweight reduction medications can reliably lead to a 5 to 10% reduction from initial bodyweight, a loss that has been shown to provide significant health benefit. The use of meal replacements has also been shown to be effective and is probably an under-appreciated treatment resource. Surgery is the most successful treatment for those with severe obesity and should be discussed as an option for those in the appropriate bodyweight categories.

Exercise, regardless of the amount or intensity, produces similar reductions in abdominal obesity.

Growth Hormone and Obesity
The bulk of studies indicate little or no beneficial effects of HGH treatment of obesity despite the low serum HGH concentrations associated with obesity.

Obesity Surgery as a last resort
Surgery for obesity is called bariatric surgery. There is no one operation that is effective for all patients. Gastric bypass operations are the most common operations currently used. Because there are complications from surgeries, bariatric surgery should be performed in a multidisciplinary setting. The laparoscopic approach is being used by some surgeons in performing the various operations. The success rate--usually defined as >50% excess weight loss that is maintained for at least five years from bariatric surgery--ranges from 30% in the simple to 70% in the complex operations. The weight loss from surgical treatment results in significant improvements and, in some cases, resolution of comorbid conditions associated with obesity. Patients undergoing surgery for obesity need lifelong nutritional supplements and medical monitoring. However, obesity surgery complication are common.
     Obesity surgery has high complication rates. An HHS Agency for Healthcare Research and Quality (AHRQ) study has found that about 40% of 2,522 patients who had obesity surgery at 308 hospitals developed a significant complication during the six months after they left the hospital. The five most common complications were dumping syndrome, which includes vomiting, reflux, and diarrhea (nearly 20%); leaks or strictures resulting from the joining of the intestine and stomach (12%); abdominal hernias (7%); infections (6%); and pneumonia (4%).

Obesity Research
The hypothalamus and obesity.
Curr Drug Targets. 2005.
Obesity, a condition already at epidemic proportions in the developed world, is largely attributable to an indulgent lifestyle. Biologically we feel hunger more acutely than feeling "full-up" (satiety). The discovery over a decade ago of leptin, an adiposity signal, revolutionised our understanding of hypothalamic mechanisms underpinning the central control of ingestive behaviour. The structure and function of many hypothalamic peptides (Neuropeptide Y (NPY), Melanocortins, Agouti related peptide (AGRP), Cocaine and amphetamine regulated transcript (CART), Melanin concentrating hormone (MCH), Orexins and endocannabinoids) have been characterised in rodent models. The pharmacological potential of several endogenous peripheral peptides released prior to, during and/or after feeding are being explored. Short-term signal hormones including Cholecystokinin (CCK), Ghrelin, Peptide YY (PYY(3-36)) and Glucagon-like peptide 1 (GLP-1) control meal size via pathways converging on the hypothalamus. Long-term regulation is provided by the main circulating hormones leptin and insulin. These systems among others, implicated in hypothalamic appetite regulation all provide potential "drugable" targets by which to treat obesity.

In the United States, roughly 10 percent of all cancers -- more than 100,000 cases a year -- could be avoided if overweight and obesity did not exist. The new projections stem from a review of published studies, updates to the International Agency for Research on Cancer (IARC) report from 2002, and data from the Nurses' Health Study II, which includes 116,686 women, Dr. Graham Colditz explained at a press briefing at the American Association for Cancer Research's international conference on Frontiers in Cancer Prevention Research underway in Baltimore.

The tongue may indeed have a taste for cheesecake, french fries and butter cookies. In experiments with rodents, French scientists identified a receptor on the tongue that appears to detect dietary fat. This counters the traditional view that the taste buds pick up only five basic flavors: sweet, sour, salty, bitter and "umami," -- a flavor associated with the food additive monosodium glutamate (MSG). The fact that the tongue harbors receptors for fatty acids could shed new light on appetite control and obesity.

Questions
Q. Does the herb pinellia ternata help with weight loss?
   A. I am aware of one rodent study that showed it to have possible anti obesity effect.