Weight Loss or Bariatric Industry Strategy Blog

Podcasts as a Tool to Aid in Weight Loss

2009-11-13T18:56:00.000-08:00

In order to lose weight and maintain the weight loss, one must almost, always modify his or her lifestyle to be successful long term. Lifestyle modification generally includes a change in diet, and engagement in regular exercise. Because achieving weight loss and maintaining weight loss present mental and physical challenges, counseling intervention can be a useful tool. And a study, discussed in an October 2009 American Journal of Preventive Medicine article, has shown that podcasts or pre-recorded audio (or video) files can be an effective counseling intervention tool.

To determine the effectiveness of using podcasts for weight loss, in 2008 a 12 week study was carried out in North Carolina. The study consisted of 24 participants that were randomly assigned to one of two groups. Both groups were subjected to 24 weight loss podcasts over the 12 week study period. However, one of the groups was exposed to an enhanced weight loss podcast, based on social cognitive theory (SCT).

This theory, by Albert Bandura, postulates that one can learn new behavior through observation without imitating the behavior. Further, a person is likely to adopt the new behavior, if the behavior leads to positive outcomes.

Therefore, offering podcasts on behavioral changes that lead to weight loss may motivate an individual to the adopt the changes, if the changes, indeed, lead to weight loss. In the above-mentioned study, the SCT podcast group lost up to three more pounds than the group not using the SCT podcast.

Hence, we think that podcasts might be a useful weight loss tool. The CDC (Centers for Disease Control and Prevention) appears to agree that podcasting for weight loss may be useful. The CDC Website presents a podcast to help women maintain a healthy weight.

We believe that if podcasts and other lifestyle modification techniques are combined, the appropriate combination may prove to be a powerful weight loss and weight management method. Weight loss or bariatric centers that make use of effective weight loss tools elevate the centers' competitive advantage. And podcasts may be such a tool.

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The Obesity Society Reports on Qnexa, Contrave and Lorcaserin

2009-11-04T10:27:00.000-08:00

Information Uncover was represented at last month’s TOS (The Obesity Society) annual meeting in Washington, D.C. And one of the most exciting bits of news coming out of the meeting was the prediction that three obesity drugs, we’ve talked about on this blog, will likely be on the market within two years. These drugs are Qnexa, Contrave and Lorcaserin.

Qnexa is manufactured by Mountain View, California based Vivus. Contrave is manufactured by La Jolla, CA based Orexigen. And Lorcaserin is manufactured by San Diego, California based Arena.

Qnexa is a combination of two drugs: Phentermine and Topiramate. Phentermine was used in the obesity drug combination Fen-phen, an obesity drug combining Fenfluramine and Phentermine. Fen-phen was taken off the market in the 90s because the drug caused severe side effects -- including serious cardiovascular issues.

However, Phentermine was the safer of the two drugs in the Fen-phen combination. Phentermine is often prescribed today for short term weight loss. Furthermore, while Phentermine is combined with Topiramate in Qnexa, the serious side effects associated with Fen-phen have not been observed in Qnexa. In addition, Qnexa surpasses the FDA obesity drug guidelines.

Orexigen’s Contrave is also the combination of two drugs. These drugs are Naltrexone and Bupropion. Naltrexone is FDA approved for the treatment of alcohol dependence. And Bupropion is FDA approved for the treatment of depression. Contrave appears to have no serious side effects, and the drug satisfies FDA obesity drug guidelines.

Finally, Lorcaserin, produced by Arena, does not produce the weight loss percentages achieved by Qnexa and Contrave. However, Lorcaserin appears to be well tolerated, while satisfying the FDA obesity drug guidelines.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers are closely monitoring Qnexa, Contrave, and Lorcaserin. We believe that if these three drugs do come on the market within two years, their presence will give a needed boost to the weight loss industry. And a number of speakers at The Obesity Society's annual meeting seemed to agree with this opinion.

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Learning How to Treat Obesity from a UK NHS Program

2009-10-22T13:06:00.000-07:00

In our October 14, 2009 blog post, we discussed the Chronic Care Model as a tool to treat obesity. The model was developed by the MacColl Institute for Healthcare Innovation. Since obesity is viewed as a chronic illness, the model might be used to fight obesity. In the model, the obese patient plays the central role in the model. Now, a UK program is confirming the importance of the role the patient must play in obesity treatment.

The UK program is about one year old. The program is an “NHS [National Health Service] nurses led service” program. As the description indicates, nurses lead the program. The program emphasizes patient education as a way for the patient to establish a strategy for losing weight. Indeed, in the UK program, as in the Chronic Care Model, an educated patient with assistance from trained professionals can lead to weight loss.

As we mentioned before, the Chronic Care Model consists of six elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management. And the self-management aspect of the Chronic Care Model is the most important element of the model.

It was pointed out in our Chronic Care Model blog post that some of the most important functions of the model are best carried out by trained non-physicians. And again, the UK program’s nurse leadership supports the belief that non-physician professionals can play a significant role in the treatment of a chronic illness such as obesity.

It appears that much is being learned about non-surgical, non-drug approaches to treating obesity. If research can continue to help improve these weight loss approaches, more obesity patients will be able to successfully deal with obesity on a long term basis. Of course, bariatric or weight loss centers should follow research in this area, and make use of applicable research results.

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Using the Chronic Care Model to Treat Obesity

2009-10-14T16:49:00.000-07:00

Obesity may be viewed as a chronic illness. Therefore, tools used to successfully treat chronic illnesses can be used to treat obesity. An effective tool for treating chronic illness is called the Chronic Care Model. The Chronic Care Model was developed by the MacColl Institute for Healthcare Innovation. The institute is based in Seattle, Washington. The institute developed the model to treat those illnesses that require an ongoing relationship between the ambulatory patient and the health care provider.

The model was developed more than a decade ago. In designing the model, the developers researched literature to uncover methods that could be used to improve the treatment of chronic illnesses. Over time, the model evolved to contain six key elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management.

The first of the six elements is community resources and policies. This means that the health care provider should make use of existing community resources. Further, the provider should work to institutionalize policies that improve care. In making use of community resources, for example, a bariatric center could partner with a gym in the community to provide exercise to patients.

The next item on the list is the provider’s health care organization. Among other things, this item stipulates that the provider’s health care organization should actively support improvements in health care. And the provider’s organization should emphasize the use of quality measures in the application of health care.

Case management, the next list item, is meant to indicate that the provider should work with the patient to enhance the patient’s self-management. Self-management will be discussed below. Case management also entails follow-up to make sure the treatment is working. Case management also includes an effort to help guide the patient through the health care system.

The delivery system design is the next element on the list. It is essential, for example, that the delivery system be designed so that necessary resources be made available to the patient. In fact, implementing the delivery system so that both the provider and the patient have access to resources is important. In the system, evidence based treatment methods should be used. And many of these treatment methods ought to be delivered by non-physician members of the provider team. Because in some cases, it has been found that non-physician members can deliver certain services better than the physician.

Next, we have decision support. Evidence-based guidelines must be part of the health care provider's organization. Established education methods should be employed. And treatment guidelines and clinical information should be shared with the patient.

Last on the list is self-management. Indeed, it has been found that self-management is a necessary part of the Chronic Care Model -- more so than any other element. In self-management, the patient must be viewed as the central player in the ongoing treatment of the chronic illness. And as part of the process, the provider must be agree to relinquish some control to the patient.

Since the introduction of the Chronic Care Model, efforts have been made to determine if the model improves health outcomes and is cost effective. Although more work needs to be done to determine the cost effectiveness of the model, published reports appear to indicate that by using the Chronic Care Model, health care organizations can improve the treatment of chronic illness.

Since overweight and obesity may be viewed as a chronic illness, The Chronic Care Model is applicable in the treatment of the illness. It has been shown that for long-term success, a strong ongoing relationship between the individual attempting to lose or control weight and the organization providing the weight loss or weight management service is of utmost importance. And the Chronic Care Model emphasizes this relationship.

Indeed for obesity treatment, weight loss centers should review elements of the Chronic Care Model, and try to implement as many of the model's elements as possible, with an emphasis on self-management.

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GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. to Look for Obesity-Cancer Link

2009-10-05T05:07:00.000-07:00

We now know that obesity is highly correlated with a number of illnesses, including some cancers. Therefore, efforts that might shed more light on the relationship between cancer and obesity can be useful. New York based GENova Biotherapeutics Inc, which has a research focus on cancer, will collaborate with the UK based company Bridge Bioresearch Plc., which has a focus on obesity. The two companies will try to find links between cancer and obesity by sharing their research results.

Obesity has been found to play a role in a number of ailments. It is well accepted that these ailments include high blood pressure and high cholesterol. Moreover, the The Mayo clinic did a study and determined that obesity contributes to the need for hip replacement. And some experts indicate that there is a link between obesity and Alzheimer’s disease.

Further, researchers in the UK suggest that obesity is a bigger health risk, today, than smoking. In the UK, it is estimated that there might be as many as 19,000 British cases of cancers per year resulting from obesity. Finding links between obesity and cancer is almost as important as the link discovered between smoking and cancer, since obesity is associated with a number of cancers.

According to the National Cancer Institute (NCI), a U.S. government organization, obesity is related to a number of cancers. These include: "colon, breast (postmenopausal), endometrial, kidney, and cancer of the esophagus." According to the NCI, the link between cancer and obesity is not known. In fact, the NCI goes on to say, the link might be different for different cancers. And the NCI has ongoing studies to determine what these links are.

The collaboration between GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. may add to results coming out of the NCI studies and other studies investigating the link between cancer and obesity. In fact, health care organizations that offer both weight loss treatment and cancer treatment might also add to the obesity-cancer link knowledge base.

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Weight Loss Through Lifestyle Modification Could Be Enhanced with Nutrisystem D

2009-09-27T07:22:00.000-07:00

Lifestyle modification, as a way to lose weight, is the most popular weight-loss method. It’s the most popular method because it's usually the easiest, least expensive, and safest way to lose weight. The main components of lifestyle modification for weight-loss generally include a modified diet and an exercise program -- diet being more important than exercise. And Nutrisystem has introduced a new program, called Nutrisystem D, that greatly improves a person's weight-loss chances, according to a recent study done at the Temple University School of Medicine.

The Nutrisystem D program is directed at overweight people, who have type 2 diabetes. As part of the program, a person receives 150 pre-packaged meals. The meals are portioned controlled. And the meals are designed to cause low rises in blood sugar.

The Nutrisystem D study done at Temple was led by Dr. Gary Foster. The study participants following the Nutrisystem program lost more than twice the weight as did participants who followed a diet designed for diabetics.

Using prepackaged meals as meal replacements has already been shown to lead to weight loss. Meal replacements include shakes, entrees and bars. And along with Nutrisystem's meals, pre-packaged meals include meals made by Lean Cuisine and Healthy Choice. With pre-packaged meals, a dieter can simply pick up a meal without having to worry about the calorie or nutritional content. And this can be quite convenient. Further, a 2003 Pub Med report indicated that meal replacements can be employed safely to enable one to lose weight and maintain the weight loss.

Nonetheless, staying on a diet long term -- even on a well designed diet -- can prove to be difficult. But modifying a lifestyle to follow a specific diet, long term, can be aided with external reinforcement from weight-loss counselors. And counseling is a part of the Nutrisystem D program. Since the Nutrisystem D program appears to be a good one, bariatric centers should take note of the program. Some of the procedures employed in the Nutrisystem D program may be adaptable to bariatric center programs.

Vivus Is Planning to Apply for FDA Approval for Its Obesity Drug Qnexa

2009-09-17T11:44:00.000-07:00

A few obesity drugs in the drug pipeline are continuing to show promise. The companies, developing obesity drugs, that have recently received attention include the California based companies, Vivus, Arena and Orexigen. Vivus manufactures the drug Qnexa. Arena makes the drug lorcaserin, and Orexigen produces the drug contrave. But Vivus, with its drug Qnexa, is currently dominating the news.

Qnexa is a combination of two drugs: phentermine and topiramate. Phentermine was used in the obesity drug combination fen-phen. Fenfluramine and Phentermine were fen-phen. Fen-phen was taken off the market in the 90s, at the request of the FDA, because of severe side effects, including cardiovascular problems. But phentermine was the safer of the two drugs.

Qnexa motivates weight loss by suppressing the appetite, and by making the user feel full. So far, the main Qnexa side effects are “dry mouth, tingling, constipation, altered taste and insomnia.”
And persons participating in Qnexa drug trials experienced an approximate 15 percent weight loss. This weight loss percentage greatly exceeds FDA guidelines. Further, Qnexa has the potential to reduce some risks associated with diabetes.

The market for obesity drugs is potentially lucrative, if an obesity drug is found that is safe and effective. “JMP securities recently projected Qnexa's annual sales would hit $1.5 billion by 2015.”

Based on trials results, Vivus expects to apply for approval from the FDA to market the Qnexa by the end of this year. The company is then planning to start marketing the drug by the end of 2010. Also, the company will start looking for collaborative opportunities to sell the drug.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers should closely monitor Qnexa and if reasonable, the companies should take advantage of collaborative opportunities.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post. SUBSCRIBE to this blog by scrolling to the bottom of this page and entering your email address.)

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An Update on the GI Dynamics Intestinal Liner

2009-09-12T18:15:00.000-07:00

Last year we wrote that the company, GI Dynamics of Lexington, Massachusetts, presented a report on the results of tests done using an intestinal liner that duplicates some of the functions of gastric bypass surgery. We went on to say that the liner, called the EndoBarrier, reduces the amount of calories that the body absorbs from food that is eaten.

Further, we indicated that the liner is inserted endoscopically through the mouth, and placed in the small intestine, covering about two feet of the intestine. Finally, we said that test results indicated that the liner could cause weight loss and produce beneficial effects for those with type 2 diabetes.

The intestinal liner mimics some of the malabsorptive characteristics of gastric bypass surgery. Gastric bypass surgery is a combination of two weight-loss surgical procedures that reduce calorie intake. In one of the procedures, called restriction, the surgeon creates a smaller stomach using a portion of the original stomach. This smaller stomach restricts the amount of food a person eats, thus reducing calorie intake. In the other procedure, called malabsorption, the surgeon reroutes the small intestine so that food bypasses a portion of the small intestine, reducing the amount of calories (and nutrients) absorbed by the body.

Persons participating in intestinal liner tests were able to lose an average of 30 pounds and there was a decrease in the blood sugar level in study subjects. Thus, there was a lessening of symptoms associated with type 2 diabetes.

Last month, GI Dynamics reported that they have improved the therapeutic effects of the Endobarrier Intestinal Liner by combining the liner with the company's Endobarrier Flow Restrictor. This device is used to delay the stomach's emptying of food into the small intestine. This is known as gastric emptying or GE. And this device appears to enhance the effects of the Endobarrier.

If ongoing tests of the Intestinal Liner plus Flow Restrictor prove successful, the combination might be a safe and effective method for weight loss and weight maintenance. And a weight loss or bariatric center may be able to employ the device and gain a competitive advantage.

Environmental Change: A Weapon to Fight Obesity

2009-08-30T13:36:00.000-07:00

Environmental change as an effective and low cost approach to weight loss appears to be gaining more attention. Environmental change can promote lifestyle modification, which is the leading method used in weight loss and weight maintenance. The two key elements of lifestyle modification are diet and exercise. And environmental change can enable a person to lose weight by causing the person to modify his diet and exercise.

Along with overweight and obesity comorbidities such as high blood pressure and high cholesterol, we are now learning that the brain shrinks with overweight and obesity. And as overweight and obesity increase in children, we will likely see more brain shrinkage as these children reach adulthood. So it is important to attack overweight problems in children as well as in adults. And lifestyle modification appears to be a good weapon.

It is now believed that heavy-handedness is not as effective in helping children fight overweight and obesity as a soft-touch approach. In essence, children should not be restricted from eating certain foods. They should be taught to regulate their food intake and eat healthy food. And parents can help their children by exposing them to healthy food in the home. Indeed, modifying the home environment to be conducive to healthy eating and exercise may lessen the amount of overweight and obese children.

Furthermore, changing the workplace environment may lessen the amount of overweight and obese adults. A study by Justin Trogdon, a consultant at RTI International, indicated that “environmental change interventions in work sites may be more likely to be cost saving than high-cost, individually targeted behavioral change interventions...” The interventions include nutritional programs, on-site gyms, and weight-loss competitions. The competitions include “contests that give overweight employees money if they succeed in shedding extra pounds ...”

So, environmental change may be an important component of lifestyle modification in the home, and a cost effective component of lifestyle modification in the workplace. Environmental change can be an aide in weight loss and weight maintenance which can reduce health care costs for employers.

So weight loss service and product providers should emphasize the importance of environmental change as an element in lifestyle modification. These providers should work with parents and employers to initiate environmental changes that motivate exercise and a healthy diet.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Lifestyle Modification with Medical Counseling Can Lead to Weight Loss

2009-08-21T05:50:00.000-07:00

Lifestyle modification — including diet and exercise changes — is known to be the most utilized weight loss method. However, lifestyle modification doesn’t lead to long term weight loss for many obese persons. But a recent study done at the University of Kentucky shows that lifestyle modification -- specifically diet change -- utilized with medical supervision can lead to quite respectable weight loss for obese persons. And there may be ways to maintain the weight loss long term.

The study-participants' diet was modified with the use of meal replacements. And medical supervision was combined with the meal replacements. This combination enabled obese-study participants to lose up to 16 percent of their initial body weight. The participants in the medically supervised program “lost an average 43.4 pounds in 19 weeks.” The meal replacements in the study were shakes, entrees, and bars.

Indeed, it has been shown before that the use of meal replacements can lead to weight loss. Among shakes, entrees and bars, specific examples of meal replacements include Lean Cuisine and Healthy Choice packaged meals. The packaged meals enable a dieter to simply pick up a meal without having to worry about the calorie or nutritional content. And this can be quite convenient. Moreover, a 2003 Pub Med report indicated that meal replacements can be employed safely to enable one to lose weight and maintain the weight loss.

Still, maintaining the weight loss -- even with meal replacements -- can prove to be difficult. But modifying a lifestyle so that appropriate meal replacements are selected and used for the long term can be aided with external reinforcement from medical weight loss counselors. Bariatric centers can provide ongoing counseling to help the obese person continue to make the best choices and stick with a diet program. And long term counseling can be an important offering for a weight loss or bariatric services provider.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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An Anti-Obesity Chewing Gum

2009-08-10T07:43:00.000-07:00

In the past, we have discussed lifestyle modification tools that can aid in weight loss. Now, the Switzerland based company, Ventana Biotech Inc, is working on another tool. The company is working on a chewing gum that might be an aid in weight loss. Of course, this wouldn't be the first time that chewing gum was employed to improve health.

Chewing gum is used to help smokers quit smoking. Chewing gum can serve as a substitute for smoking a cigarette, enabling a smoker to replace the smoking habit with chewing gum. Indeed, nicorette gum also gives the smoker a small amount of nicotine to reduce the effects of nicotine withdrawal.

And chewing sugar-free gum can help fight tooth decay. According to the American Dental Association (ADA), chewing gum containing the sugar substitute, xylitol, can prevent tooth decay.

Further, suggestions that chewing gum can be an aid in weight loss are not new. Contestants on the TV reality show, "The Biggest Loser," are told by the trainers and the nutritionists on the show to chew sugar free gum to help lose weight. And a 2007 Scotland study demonstrated that chewing gum can be an aid in weight management. Chewing gum can help as an aid in weight management because chewing gum can reduce hunger.

While chewing gum can reduce hunger, most chewing gum is not produced with an appetite suppressant as a key active ingredient. Ventana's gum contains an extract from the hoodia gordonii plant, and active ingredients in the plant can suppress appetite. Moreover, the gum is patented as an anti-obesity gum. The gum is currently in trials. And if the gum proves to be save and effective, Ventana hopes to license the gum to large pharmaceutical companies.

Indeed, if Ventana's chewing gum proves successful, it will be a useful tool for weight control. And the gum will be another weapon in the weight loss service provider' s arsenal.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Bariatric Surgery: An Option That Might Reduce Health Care Costs

2009-08-02T14:18:00.000-07:00

Most likely you've heard the following media report: Obesity accounts for $147 or almost 10% of the health care cost in the U.S. each year. You’ve also probably heard that the obesity market has unrealized potential. The potential is unrealized because most weight loss methods are not successful at providing long-term weight loss. However, since reducing obesity in the U.S. can reduce health care cost, finding ways to treat obesity is of the utmost importance. Perhaps, bariatric surgery could play a larger role in this treatment.

One obesity-related disease that has added to the increase in health care cost is diabetes. According to a 2008 Lewin Group study, the 2007 U.S. price tag for diabetes treatment was approximately $115 billion. And even when a diabetes patient has insurance, out-of-pocket cost for the patient can be significant.

For those with diabetes, losing weight can lead to a reduction in associated symptoms. Indeed, for morbidly obese persons with diabetes, appreciable weight loss can stop the progression of the disease in many cases. Therefore, weight loss methods that are safe and effective may be vital to reducing diabetes and health care costs.

There are three weight loss approaches. They are lifestyle modification, obesity drugs, and bariatric or weight loss surgery. Although bariatric surgery is probably the most effective method for treating obesity, patients receiving the surgery have experienced serious complications.

However, significant progress toward decreasing the bariatric surgery-complication rate has been made. For example, according to a HealthGrades study, patients who have bariatric surgery at five-star rated centers (as determined by HealthGrades) have a 67% lower chance of experiencing complications. And a new risk management system "presented ... at the 26th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS)" can reduce post surgical complications by 65%.

Therefore, bariatric surgery might play a more prominent role in the treatment of obesity -- and thus a more important role in the treatment of diabetes. This, in turn, could put a dent in health care costs.

Bariatric surgical providers should take note of the above-mentioned HealthGrades study and the above-mentioned risk management system. Adopting practices followed by five-star rated bariatric centers and following procedures related to risk management could improve surgical services, and give a weight loss surgical provider a competitive advantage.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Laparoscopic Vertical Gastroplasty

2009-07-23T06:20:00.000-07:00

A 2003 study, published in the Archives of Surgery, indicated that ‘vertical gastroplasty can benefit most patients with morbid obesity and should be more frequently used.’ And recently, the company, Power Medical Interventions(r), Inc. (PMI), introduced a medical device that facilitates a laparoscopic version of the surgery.

In vertical gastroplasty, a part of the stomach is stapled in such a way as to create a smaller stomach pouch. Vertical gastroplasty is a type of restrictive bariatric surgery which means that the patient’s food intake is limited by the surgery. Vertical gastroplasty is similar to sleeve gastrectomy.

In sleeve gastrectomy, a smaller stomach is made by sealing off part of the stomach using staples, and the unused part of the stomach is removed from the body. While vertical gastroplasty also seals off part of the stomach, resulting in a smaller stomach pouch, no part of the stomach is taken from the body in the surgery.

The device that PMI introduced is called the i60 Mid Cut device. The device can enable a doctor to perform vertical gastroplasty, laparoscopically, in approximately 30 minutes. As we’ve said before, laparoscopic bariatric surgery exposes the patient to less trauma and lowers recovery time.

As indicated on its Website, PMI is working on instruments that may allow vertical gastroplasty to be performed using a natural body orifice, such as the mouth, anus or vagina. Surgery using a natural orifice is often called Natural Orifice Translumenal Endoscopic Surgery or NOTES.

Laparoscopic vertical gastroplasty -- even laparoscopic vertical gastroplasty performed using NOTES -- is more evolutionary than revolutionary. Still, laparoscopic vertical gastroplasty is an important step toward developing less invasive, effective forms of bariatric surgery.

Medical device providers, working on bariatric surgical instrumentation, may help increase bariatric surgical options. These device providers' efforts can increase the surgical options that bariatric surgical providers may offer, increasing the surgical choices for prospective bariatric patients. (Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

Opportunities to Fight Obesity May Become More Accessible

2009-07-13T06:45:00.000-07:00

Today, we talk a lot about the causes of obesity and the methods that may be used to treat obesity. However, we might be missing some important opportunities to combat the disease during its early stages. Moreover, accessing those opportunities may become easier to do.

A study, entitled “Adult Obesity and Office-based Quality of Care in the United States,” discussed in a recent issue of the journal, Obesity, indicates that opportunities to treat obesity during patient visits to health care providers are commonly missed. For example, when an obese patient goes in for a physician visit, the patient is often not provided counseling on weight loss methods. And this absence of counseling leads to poor health and higher health care costs.

We think that patient visits provide an opportunity for physicians, especially primary care physicians, to improve the health of many patients. But in order for primary care physicians to take advantage of this opportunity, barriers that inhibit weight loss counseling must be broken down. And these barriers exist from both the patients' and the physicians' perspective.

For example, a 2007 report asserted that many health care providers feel that patients are obese because patients don’t effectively use self-control. And many patients believe that it’s up to them to control their weight. Thus many patients don’t talk with their health care provider about methods to combat obesity.

Although these and other barriers do exist, we believe that rising health care costs will cause more people to recognize the importance of maintaining a healthy weight. And this will cause more people to talk with their health care providers -- especially primary care physicians -- about weight management. Further, more people will talk with their providers about weight management, because their employers will urge them to do so.

Indeed, a July 2009 Wall Street Journal article entitled, “When All Else Fails: Forcing Workers Into Healthy Habits,” reported that some companies are now compelling their employees to live healthier lifestyles, because if employees live healthier lifestyles, this will lower a company's health care costs. A healthy lifestyle includes getting periodic physicals, sticking to a healthy diet, and maintaining a healthy weight.

We believe that there will be an increasing focus on living a healthier lifestyle, by primary care physicians and by patients. And this increasing focus offers an opportunity for all weight loss providers, especially medical weight loss providers. These weight loss experts can form strategic alliances with primary care physicians and others who work with persons needing to lose or maintain a healthy weight.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Will the Demand Fall for Obesity Drugs?

2009-07-03T09:00:00.000-07:00

Obesity drugs are one of the three methods generally employed to fight obesity. And the obesity market is a huge market that may be worth more than 500 billion dollars in a few years. However, drugs that fight obesity, so far, have not been very successful. These drugs cause cardiovascular and mental problems. Moreover, the use of the drugs usually doesn’t lead to long-term weight loss. Therefore, some believe that the demand for obesity drugs may fall in coming years.

Experts in India have felt for some time that the demand for obesity drugs will be hampered by the failures associated with the drugs. Today, India experts believe that the obesity drug failures have already caused demand for the drugs to decline by 70%. Indeed, if the demand for these drugs is declining worldwide, it will be harder for drug makers to sell new drugs, even if the drugs safely lead to weight loss.

So, it is imperative that pharmaceutical companies engaged in obesity drug research concentrate on producing safe and effective weight loss drugs. Tesofensine and Qnexa are two obesity drugs, currently in the pipeline, showing promise, as we've mentioned in this blog before. Let's hope these drugs prove to be successful.

However, if they don't prove successful, this condition creates an opportunity for the other two areas of weight loss and weight management -- lifestyle modification and bariatric surgery. Efforts to enhance lifestyle modification methods are being studied. And minimally invasive weight loss surgical techniques are being developed.

So despite the obesity-drug pessimistic outlook, research is ongoing in all weight loss arenas that may improve our ability to fight the worldwide weight gain. And of course, weight loss facilities should be willing to play whatever role is necessary to enhance their ability to provide healthy weight loss programs.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Endoscopic Bariatric Surgery Offers Opportunities For Medical Device Providers

2009-06-24T13:34:00.000-07:00

It is estimated that by 2014, the weight loss market will be worth 586.3 billion dollars. Further, the United States is expected to be 43 percent of that market. However, to date, no weight loss method provides long-term weight loss without the potential of serious complications. So finding an effective long-term weight loss treatment is the goal of most of those in the weight loss industry.

Of course, the dearth of safe, effective weight loss treatments offers opportunities for medical device providers operating in the weight loss industry. This is especially true for that segment of the bariatric industry focusing on endoscopic bariatric surgery.

Indeed, there are companies working on medical devices for endoscopic bariatric surgery. One of the companies is BioEnterics. This company makes the Intragastric Balloon or BIB system. In this system, a balloon is filled with a saline solution after being placed in the patient's stomach. This balloon gives the patient a feeling of fullness. BioEnterics is based in Irvine, California.

Another company focusing on endoscopic bariatric weight loss devices is BaroNova Therapeutics, Inc, headquartered in Forster City, California. This company is working on a pill that is swallowed or placed in the stomach using an endoscope. The pill expands to make the user feel full.

Power Medical Interventions, Inc. of Longhorne, Pennsylvania, has made a stabling device that can be inserted into the stomach, using the mouth as the entry point. The device can be used to shrink the stomach. And GI Dynamics, a Lexington, Massachusetts company, has developed a sleeve that can be placed in the upper part of the small intestine to mimic the "bypass" part of gastric bypass surgery. The sleeve is called the EndoBarrier™.

Endoscopic surgical methods hold great potential for bariatric surgery. The surgery is less invasive, creating less trauma to the body. If some of the methods described above prove effective, it will be good for the weight loss industry. Further, the surgery could be less costly, enticing more persons who need the surgery to have the surgery. This increased number of persons seeking bariatric surgery would be a boon for bariatric surgery providers, and bariatric surgical medical device providers.
(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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In the War on Obesity, Two Obesity Drugs Show Promise

2009-06-15T11:49:00.000-07:00

As we've said before on this blog, there are three approaches to weight loss and weight management. They are lifestyle change, including diet and exercise; weight loss surgery; and obesity drugs. Each approach has its pros and cons. The most important pro for each of the approaches is that each approach can lead to weight loss. However, the cons are quite troubling.

For example, lifestyle modification is difficult to adhere to on a long term basis. Bariatric surgery is only advocated for severe obesity, plus the surgery produces complications. And obesity drugs have engendered less than stellar weight loss results, while causing serious side effects, including cardiovascular problems and thoughts of suicide. However, there are at least two drugs now in the pipeline that show promise.

The two drugs are Qnexa and Tesofensine. These drugs have shown positive weight loss results. Both of these drugs motivate weight loss by suppressing the appetite. And Qnexa also makes the user feel full. Qnexa is made by Vivus, Inc., a U.S. biopharmaceutical company, and Tesofensine is made by Neurosearch, a Danish biopharmaceutical company.

Qnexa is a combination of two other drugs. One of the drugs is phentermine. Phentermine was the "phen" in the drug combination fen-phen, and Fenfluramine was the "fen." Fen-phen was taken off the market in 1997 because the drug caused severe side effects, including cardiovascular problems. So far, however, Qnexa does not appear to produce fen-phen like complications.

Recent phase ll results for Qnexa have been positive. The side effects seen, so far, include constipation, tingling and nausea. And while Qnexa gave positive weight loss results, the drug also reduced some indicators associated with type 2 diabetes.

Tesofensine was originally developed to treat Parkinsons and Alzheimer's diseases. Although the drug was disappointing in fighting those diseases, it proved helpful in weight loss. And Neurosearch has completed phase ll testing of the drug, and gained FDA acceptance for the drug's phase lll test plans.

Both of the drugs, Qnexa and Tesofensine, have made significant progress. And either one could be an impressive obesity drug. This is especially true for Qnexa, because this drug has the potential to fight both obesity and type 2 diabetes. Of course, we will need to wait for the completion of the planned tests.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers should closely monitor Qnexa and Tesofensine phase lll results.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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TOGA Incisionless Bariatric Surgery

2009-06-08T08:32:00.000-07:00

Bariatric or weight loss surgery receives media attention, from time to time, because the surgery has shown to be effective in fighting obesity. Recently, a relative new bariatric surgical procedure was highlighted by the ABC network morning show Good Morning America (GMA). The surgical procedure is called Transoral Gastroplasty or TOGA. The TOGA procedure was created by Satiety Inc, based in Palo Alto, California.

TOGA is an incisionless surgical procedure. This means that the surgery is done using natural body orifices and pathways to access organs within the body. The TOGA procedure accesses the inside-of-the-stomach via the mouth and esophagus.

In the procedure, flexible stabling devices are introduced into the stomach, and the devices are used to bring sides of the stomach together so that the sides can be stapled together to create a small stomach pouch. Surgeons, performing the surgery, view their surgical actions inside the stomach using a lighted scope or endoscope.

An early use of the TOGA incisionless procedure was carried out at Barnes-Jewish Hospital in St. Louis, Missouri, as we reported in one of our August 2008 blog posts. The application of the procedure profiled on GMA was done at Cedars-Sinai Medical Center, located in Los Angeles, California. The TOGA procedure is estimated to cost somewhere between thirteen and twenty thousand dollars. And the procedure appears to be similar, in effectiveness, to lap band surgery.

Indeed, Transoral Gastroplasty will prove to be useful if the procedure produces long-term weight loss, while causing fewer complications compared to other forms of bariatric surgery. As indicated above, some U.S. facilities have used the TOGA procedure. Further study, which is ongoing, will determine if the procedure is a viable option for surgical weight loss providers to offer. At any rate, weight loss product and service providers should monitor TOGA study results.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Simulation Can Improve Laparoscopic Bariatric Surgery

2009-05-30T15:43:00.000-07:00

We have always believed in employing simulation as a way to improve skills. The United States Space program has used simulation as an integral part of space mission planning for many years. And recent studies demonstrate the usefulness of simulation in training doctors -- including doctors that perform laparoscopic surgery.

A recent study at Yale University demonstrated how simulation can be useful in training doctors. Using simulation, student doctors were trained to successfully insert a “central line” or catheter into a major vein of the body. So employing simulation to train doctors can be a smart thing to do. Moreover, in the opinion of some experts, not using simulation to aid in training doctors is a mistake.

England's chief medical officer recently stated that because doctors don’t have enough simulators on which to practice, patients are subjected to harm. Airlines use simulators to train their pilots. And because of their regular training on simulators, pilots are better trained to fly planes than surgeons are to perform surgery.

Simulation may be even more important in laparoscopic surgical training, since laparoscopic surgery requires a higher level of skill than open surgery. And laparoscopic bariatric surgery, performed by a skilled surgeon, generally produces less trauma for the patient. As reported in a Health Grades study, for those bariatric surgeries requiring hospital stay, the patient receiving laparoscopic surgery spends less time in the hospital than the patient receiving open surgery. Further, the complication rate for laparoscopic bariatric surgery is less than the complication rate for open bariatric surgery.

A recent study has shown that simulation can help a doctor acquire the necessary skills to gain laparoscopic surgical proficiency. Therefore, more medical device providers might want to consider building and making cost-effective simulators for laparoscopic surgical practice. The provider that creates the most useful, economical simulators for practicing laparoscopic bariatric surgical procedures will likely gain a competitive advantage.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Organizations Are Collaborating in the Fight Against Worldwide Obesity

2009-05-22T05:06:00.000-07:00

Obesity is a serious problem in the world. And experts throughout the world are trying to come up with ways to fight obesity. Organizations in the U.S. and in Europe are bringing knowledgeable groups together to find ways to combat the disease, because obesity increases the incidence of illness and strains a country’s health care budget. Bariatric or weight loss service or product providers could play an important role in this fight, since these providers have a grasp of what works and what doesn't.

In the US, the organization, Strategies to Overcome and Prevent (STOP) Obesity Alliance, is joining with consumers, health care providers, the government, businesses and others to come up with ways to fight obesity. And in Europe, “the UK National Obesity Forum (NOF) and the Belgian Obese Patients organization (BOLD) will” use results from a survey to gather information on fighting obesity.

Determining how to fight obesity is important since obesity is associated with a number of serious illnesses. For example, in the UK it is estimated that there might be as many as 19,000 British cases of cancers per year resulting from obesity.

That there is a high number of obesity-related diseases throughout the world is probably pretty much accepted now. However, maintaining a healthy weight as a way to prevent diseases is something we should focus on more. We have evidence to support the belief that losing weight and maintaining a healthy weight may enable an individual to avoid some diseases.

It is estimated, for example, that weight reduction through bariatric surgery has lowered by one-quarter the number of cases of diseases linked to obesity. So successfully combating obesity will increase health. And according to an Australian study, if we don’t successfully combat obesity, health care costs will rise worldwide.

To emphasize the importance of the obesity fight, some in the US believe that the US should “establish an End the National Obesity Epidemic (ENOE) task force.” It would probably be reasonable for this task force to collaborate with other organizations that are trying to find ways to fight obesity. Moreover, bariatric or weight loss service and product providers could join forces with obesity-fighting originations to try to find solutions to the worldwide obesity epidemic.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Food Played the Larger Role in America's Thirty Year Weight Gain

2009-05-13T10:22:00.001-07:00

We often say that lifestyle change is necessary for weight reduction. Lifestyle change usually includes diet modification and exercise. Diet and exercise are both important in weight reduction and weight control. However, some experts conclude that the number of calories we consume is more important than the exercise we get, when it comes to weight loss and weight control.

Of course, exercise is important for keeping the body in shape, and we should all engage in frequent exercise. Still, for weight loss or weight control, calorie intake appears to be the most significant factor. And a recent Australian study confirms the importance of calorie intake in weight gain.

We’ve all heard that the American sedentary lifestyle is a large contributor to the weight gain in American. We’ve heard that over the past few decades, Americans have spent more time working in offices than on farms and in factories. And leisure activities that include watching television and using a computer have replaced physical activity. Thus, sedentary activities have contributed heavily to Americans’ weight gain.

But according to the above mentioned Australian study, the weight gain in America over the past 30 years was due to an increase in calorie intake more so than a lack of physical activity. In fact, for American adults, there may even have been an increase in physical activity over the past 30-year period compared to previous years.

Therefore, the past 30-year American weight gain must be attributed to increased calorie intake. Moreover, according to the study, adults need to reduce their daily calorie intake by 500 calories to return the 1970 body weight numbers. And children should decrease their daily calorie intake by 350 calories.

These specific numbers should give weight loss centers calorie intake targets around which to design diets. Centers ought to design and market healthy diet programs that can reduce an adult’s calorie intake by 500 calories per day, and a child’s calorie intake by 350 calories.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Does Bariatric Surgery Volume Make a Difference In the Number of Surgery Related Complications?

2009-05-03T19:28:00.000-07:00

A resent study done by Dr. Edward H. Livingston, of the University of Texas Southwestern School of Medicine and Department of Veterans Affairs in Dallas, indicates that the complication rate for patients undergoing bariatric surgery is essentially the same at Center of Excellence (COE) facilities as at non-COE facilities. The study concludes that ‘Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volumes.’

A 2008 Health Grades bariatric study concluded that volume is very important in reducing the complication rate in bariatric surgery. The Health Grades study found that those facilities that had done at least 125 surgeries during a year had fewer complications than those facilities that had done 25 or less surgeries.

A 125-surgery-per-year minimum is an important element in the COE criteria established by both The American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). Moreover, Medicare will consider paying for bariatric surgery only if the surgery is performed at a COE facility, certified by the ASMBS or the ACS. So, there is support for the 125 per year bariatric surgical minimum as a basis for achieving surgical proficiency.

Based on the Livingston study, facilities performing less than 125 surgeries per year -- actually, an average of 79 surgeries -- have a complication rate similar to facilities performing 125 surgeries or more per year. Although this conclusion may reflect an accurate assessment of the study results, we don’t feel that the results necessarily mean that volume doesn’t count. The results may indicate that performing 79 surgeries per year is a good number from which to gain bariatric surgical proficiency.

However, we don’t believe that the Livingston study results mean that a bariatric center that performs 15 surgeries per year is likely to have a lower complication rate than a center that performs 125 surgeries per year. We do believe that volume counts. Further, we believe that emphasizing a high volume is a good marketing tool for a weight loss center to use as part of an overall marketing strategy.
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The NIH May Offer an Opportunity for Bariatric Centers

2009-04-22T06:48:00.000-07:00

The National Institutes of Health (NIH), a U.S. governmental agency, pays a lot of attention to obesity among groups of lower socio-economic status -- with good reason. Studies done by the NIH indicate that a disproportionate number of persons in lower socio-economic groups are likely to be obese. Further, research programs, focusing on obesity in lower socio-economic groups, are important to the whole society, since the whole society pays for obesity in health care dollars. Because solving the obesity problem is so important to our society, the NIH offers obesity related research grants that some weight loss centers may be able to obtain.

Although important to society as a whole, reducing obesity in lower socio-economic groups is also important to persons in the groups. But reducing obesity in these groups is difficult, since persons in these groups typically live and work in environments not conducive to healthy diets and exercise. Healthy food such as fruits and vegetables are often not readily available to persons in these groups. Places to exercise are also hard to come by for these persons. Therefore, these problems need to be addressed to improve the health of individuals in lower socio-economic groups.

Now while a reduction in obesity is important for good health, a reduction in obesity may also be important for increasing economic status. In the workplace, people who are obese are less likely to get promoted than people of normal weight. And people in the workplace who are obese are less likely to get support from their colleagues than people of normal weight.

So while it may improve health, overcoming obesity may also raise the socio-economic status of persons in lower socio-economic groups. And because socio-economic status may be more important to many people than health, emphasizing the socio-economic status-raising benefits of weight reduction rather than the health benefits may be a better motivator for weight loss. Of couse, research could determine if this is true.

The NIH sponsors community programs that enable researchers to learn more about obesity among ethnic minority groups, since occupants of these groups make up a large portion of the obese in the U.S. And many obese persons in ethnic minority groups have a lower position on the socio-economic ladder.

Therefore, some bariatric centers could play a role in research focusing on obesity within lower socio-economic groups. Moreover, there may be NIH grants that could aid the centers in this endeavor. Engaging in obesity research could enhance a center's reputation, add to the obesity body of knowledge, and give a bariatric center a competitive edge.
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The Use of Health Coaches May Create an Opportunity for Medical Weight Loss Centers

2009-04-13T04:55:00.000-07:00

For some time, companies have offered wellness programs to company employees. Wellness programs often stress a healthy diet and frequent exercise. Companies have sponsored these programs in an attempt to keep employees healthy, and possibly reduce health care costs. Now, a modification to company wellness programs may be creating an opportunity for medical weight loss centers.

Companies are now beginning to use health coaches in the wellness programs. Moreover, the companies are targeting specific diseases with the coaches. The targeted diseases include diabetes, cardiovascular disease, asthma, and depression. In some way, each of these ailments can be exacerbated by obesity. This is especially true for diabetes.

Recently, Service Corporation International (SCI) began focusing on diabetes in its health coaching program. And SCI expects to save $500,000 during the first year of its program's operation, because of the program's focus and the use of health coaches.

Other companies are also using health coaches to assist employees with wellness issues. UPS is one of these companies. With its program, UPS targets employees afflicted with heart disease and diabetes. And the coaches encourage the employees to stay on their diets or prescription drug regimens.

We believe that providing employees access to health coaches is relatively new for most companies. But providing this benefit may reduce a company's overall health care costs. And this reduction will help a company's bottom line.

We think that the growing use of health coaches by companies creates an opportunity for medical weight loss centers. We believe this to be the case, since weight loss centers focus on weight loss. And weight loss is a key factor in the illnesses targeted by company wellness programs.

Medical weight loss centers may have a competitive advantage in this area, because medical weight loss centers are more likely to have a medically supported program. Thus, health coaches from these centers are more likely to be using medically based procedures, which may make the procedures more credible to a company.
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Using Collaboration to Fight Obesity and Improve a Competitive Position

2009-04-01T08:22:00.000-07:00

Making use of collaboration can be an important component of an organization's business strategy. In this blog, we have often advocated collaboration between weight loss centers and other organizations as a way to improve a competitive position, while fighting overweight and obesity. A relationship formed between The National Institutes of Health (NIH) and the Subway Restaurant Franchise illustrates this kind of collaboration. NIH, Subway, and other organizations, have come together, under an NIH program called “We Can!,” to work with parents and children to fight childhood obesity.

The NIH is a component of an agency within the federal government. That agency is the Department of Health and Human Services. And the agency has the primary responsibility for medical research in the U.S.

The NIH is based in Bethesda Maryland. The organization, which had its start in 1887 in Staten Island, NY, works to determine the cause and treatment of rare and common diseases. The organization carries out investigations within every state in the U.S. and in other countries.

The We Can! program is education oriented. The program helps children who are 8 to 13 years old maintain a healthy weight. As indicated above, a number of organizations have joined the We Can! program. However, in our opinion, Subway stands out as a member of the program because of the organization's attention to weight loss.

Subway restaurants sell mostly sandwiches and salads. And the restaurant franchise is rapidly growing. Much of the growth is no doubt due, in part, to the marketing of low calorie sandwiches. Adhering to a low calorie diet can lead to weight loss success. Jared Fogle followed a low calorie diet heavily dependent on low calorie Subway sandwiches. Fogle lost over 200 pounds by eating Subway sandwiches and engaging in frequent exercise. His weight loss success is highlighted in Subway TV commercials.

We believe that the collaboration between the NIH and Subway will serve a number of useful purposes. The collaboration may entice more restaurants to vigorously market low calorie meals. And the federal government’s involvement with Subway -- and other organizations -- shows that the government views overweight and obesity as major problems.

Weight loss centers might want to consider getting involved with the NIH program. Moreover, weight loss organizations should always be on the lookout for collaborative opportunities that may help the centers fight obesity while strengthening a competitive position.
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