Patients are naturally drawn to more comfortable and convenient treatment options. This may be particularly true for obese patients. Rather than going through long-term behavior and dietary corrections, they would rather choose a more effortless and immediately effective option such as surgery or procedures. Doctors are using medical devices more to meet such needs of patients. However, an easy option in the field of obesity treatment is the medication. Many specialists in the field of anti-obesity treatment believe that medication compensates for the shortcomings of surgery and device procedures. We met with Dr. Jang-bong Yoon of Nowbe Clinic, Dr. Min-su Park of ND Care Clinic, Dr. Ki-nam Kim of Eventme Clinic, and Dr. Jung-ah Koh of Digital Aesthetics Plastic Surgery & Dermatology to discuss the current status, limitations and future prospects of anti-obesity medication. Dr. Won-woo Choi of Wells Dermatology & Medical Spa and Dr. Young-dae Kwon of Gangnam Plastic Surgery Osan also shared their insights on obesity treatment in the fields of plastic surgery and dermatology.
Dr. Jang-bong Yoon of Nowbe Clinic Dr. Min-su Park of ND Care Clinic
Dr. Jung-ah Koh of DA Clinic Dr. Ki-nam Kim of Eventme Clinic
Dr. Young-dae Kwon of Gangnam Plastic Surgery Osan Dr. Won-woo Choi of Wells Dermatology & Medical Spa
Surgery and procedures are for body contouring rather than treatment of obesity
Dr. Jung-ah Koh commented, “The purpose of surgical and non-surgical procedures is contouring the target body area rather than systemic weight loss.”
Dr. Jang-bong Yoon believes, “Injections, device treatment or liposuction are not related to weight loss. These treatments are done for body shape correction or contouring and not for losing weight.”
Most obesity experts think surgery and other localized procedures are for fat reduction in a certain area of the body. However, the number of obesity patients are increasing rapidly and so is that of fat removing devices and procedures. Lipolytic injection, HPL, ultrasound, radiofrequency, cryotherapy, and liposuction, etc. offer relatively easy and convenient fat removal with minimal discomfort. However, these procedures require costly devices, space, and personnel, etc. as well as cause frequent side effects. They also often fail to bring overall weight loss. Most obesity experts would agree that the most effective way of weight loss is the patient’s voluntary control of their diet and regular exercise. Complementing such efforts with anti-obesity medications may be more effective. Let’s take a look at what the doctors with specialty in anti-obesity medications are saying about the benefits of using medication in treatment of obesity.
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Curbing appetite with medication
Dr. Min-su Park of ND Care Clinic treats 80% of his obesity patients with medication. The percentage is even higher with Dr. Jang-bong Yoon at 90% of his obesity patients. Dr. Jung-ah Koh also often combines medication in the treatment regimen. She emphasizes the importance of prescribing the right medication in each patient as each drug has different effects. Dr. Ki-nam Kim believes that the success of obesity treatment depends largely on drug selection and dose adjustment.
“Anti-obesity drugs can largely be categorized into appetite suppressant that help control the amount of food intake, satiety inducing drugs, inhibitor of fat or carbohydrate absorption, and stimulants that promote dissipation of energy through heat generation. Other drugs offer symptomatic relief of conditions caused by weight loss. The key to successful anti-obesity therapy is to select the right medication and adjusting the dose appropriately for each patient. Appetite suppressants may be said to be the most effective in calorie reduction. However, the recent trends favor combining appetite suppressants with intestinal lipase inhibitor, etc. rather than using high-dose single therapy to minimize dependency on appetite curbing drugs.”
Dr. Jung-ah Koh places priority in behavior correction and uses pharmacotherapy to help patients deal with behavior problems that are difficult to control.
“During consultation, I emphasize to my patients that medication does not bring weight loss by itself but helps their voluntary efforts to lose weight. I tell them that it is important to voluntarily reduce their food intake and increase physical activity for effective weight loss. However, most patients find it very difficult to control their eating. Appetite regulation with pharmacotherapy helps these patients control their food intake. Intestinal lipase inhibitor helps patients who eat fatty foods often to remove the excess fat by blocking intestinal absorption. Although medication is less financially burdensome for patients compared to surgery or other procedures, it can cause side effects such as dry mouth, sleep disturbance, palpitation, mood change, dependency, and cardiovascular complications, etc. Therefore, it is important to plan the appropriate duration of treatment before prescription.”
Dr. Min-su Park also believes that the patient’s personal determination to be the most important for the success of treatment. He recommends non-medication options of weight loss in the early phase.
“Non-medical regimens such as a dietary adjustment and exercise, etc. are tried for the first 3-6 months. If the weight loss is less than 10% of the original weight, I start medication. As medication should be administered long-term, I only select drugs with proven safety and efficacy. I have seen reports that combining various drugs has the same efficacy as monotherapy but higher risk of side effects. I think the doctor should be careful of this.”
Clinical experience and research are crucial as combining many drugs can cause problems. Dr. Min-su Park has established his own prescription knowhow from years of his efforts to minimize side effects.
“Currently, the safest and most effective drug is phentermine. It is allowed for only three months, as long-term use can cause safety issues. I prescribe it for 6-8 in most cases but up to 12 weeks in some cases. Intermittent use also brings good effect and can be used with a pause if long-term use is not feasible. Phentermine is affordable with excellent weight reduction. Despite its good efficacy, however, it often builds tolerance and may even lead to poor response when switching to other drugs. Caution needs to be taken with use. Phendimetrazine is administered 3 times daily at 1 tablet (35mg) dosing (up to 2T tid approved). At this dose, however, tolerance builds up and tendencies toward hypertensive tachycardia can develop. I recommend lower doses of 1Tqd or bid. It has amphetamine-like actions and should be used only up to 6-8 weeks. Great caution should be taken with use after this period. It is advisable to not use phendimetrazine for longer than the above period as it is highly habit-forming.”
Dr. Jung-ah Koh also prescribes phentermine class drugs often.
“I prescribe 37.5mg of phentermine hydrochloride once daily before or 1-2 hours after breakfast. Individualized approach is important as the dose of 18.75mg once daily may be more suitable in some patients and 18.75mg twice daily in others. As phentermine has the risk of addiction and abuse, short-term use is recommended. Patient response to therapy should be checked regularly after therapy initiation as there is a risk of side effects including cardiovascular and gastrointestinal diseases. Intestinal lipase inhibitors are also beneficial in patients with type 2 diabetes and hypertension. The recommended dosage is 1 capsule taken 3 times daily but I often prescribe once or twice daily to reduce financial burden.”
Dr. Jang-bong Yoon also uses similar choices of medication.
“Appetite suppressant, absorption inhibitor and metabolic accelerator can all be combined or used individually depending on the patient. I often use lorcacerine and phentermine for appetite curbing, orlistat for lipase absorption inhibition and ephedrine + caffeine for metabolic acceleration.”
Dr. Ki-nam Kim says that finding the most effective drug for each patient and basing the therapy on that drug increases the effectiveness.
“I find researching the most appropriate drug for the patient and adding other drugs to be very effective. I most frequently prescribe Panbesi SR Capsule (extended-release phentermine) and Oliet Capsule which is an intestinal lipase inhibitor. Panbesi SR Capsule is an extended-release formulation and the appetite suppression lasts to the afternoon when administered in the morning. I also add Topiramate, Fluoxetine, etc. depending on the patient’s appetite. Oliet Capsule is available in 60mg formulations, half the dose of Xenical Capsule. The lower dose can be taken during the day and 120mg at night to minimize the discomfort during daily activities. An intestinal lipase inhibitor also has laxative effect and can be particularly beneficial in obesity patients who often suffer constipation. However, the doctor should clearly explain the risk of steatorrhea, etc.”
-To be continued-
