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Doctors' Answers to "Frequently Asked Questions" - Weight


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/18/2000]
Question: Dear Dr. I have been told that my metabolism is very slow. I have a very slow heart rate about 50 beats per min. I am 215 pounds and five foot four inches tall. I have had a total hysterectomy and cannot seem yo lose any weight I have in the past been in excellent shape, but now that I am in my early thirties I just cannot seem to get rid of any weight. Will you please give me some information on matabolism so that I can try something to be healthy again.

Sincerly
Tina Garrison

Answer: There is no good measurement of metabolism, so whoever told you this did so mainly to placate you. Weight is a function of calories in and calories burned with exercise. There are clearly people who have trouble gaining/losing weight and we group this under metabolic headings, but no one has a measurement of this, so it isn't very accurate is it? Try changing your diet to one of the high protein diets, sugar busters or carbohydrate addicts diet.

[posted 04/14/2000]
Question: I AM CURRENTLY TAKING EFFEXOR 50 MG. AND TRAZADONE ONE-HALF OF A 50 MG. TABLET. I WOULD LIKE TO KNOW HOW THESE TWO DRUGS AFFECT YOUR METABOLISM. I HAVE BEEN TAKING PHENTERMINE FOR 4 MONTHS NOW AT 37.5 MGS A DAY. I HAVE NOT LOST ANY WEIGHT,AND SEEM TO BE GAINING.COULD ONE OF THESE TWO DRUGS BE PULLING MY METABOLISM DOWN TO THE POINT WHERE I'M NOT GOING TO LOSE ANY WEIGHT? I HAVE TAKEN PHENTERMINE BEFORE AND HAD GREAT SUCCESS,LOSING 30lbs IN 4 MONTHS,BUT THE ONLY DIFFRENCE IS I WAS NOT TAKING EITHER OF THESE TWO DRUGS.

Answer: They don't change your metabolism, but they do apparently change your appetite. About 30% of patients gain weight on this class of antidepressants.

[posted 02/28/2000]
Question: I am a 40-year female who is currently being treated for chronic bulimia, depression and obsessive-compulsive disorder. My doctors (an internist, a psychiatrist, and eating disorder psychologist/therapist) believe that the OBC behaviors are the result of my two-month abstinance from the bulimic binging and purging. Prior to the obc, I was prescribed 60 mg. of Celexa daily. Since developing obc, however, my psychiatrist has changed my meds to a daily combination of 50 mg. of desipramine AND 20 mg. of Prozac. My internist and my therapist have agreed to this change in medications, but have expressed different concerns relating to my weight. I am 5 feet 1 inch and have maintained a weight of 95 pounds for the past month. My internist cautioned that the new combination of meds may cause me to LOSE some weight and wants to see me twice a week to monitor my weight. My therapist, however, cautioned that these meds may cause me to GAIN some weight and does not want a weight gain to cause a bulimia relapse. I just want to feel better, but I'm now confused by my doctors having different opinions of how the new meds will affect my weight. I have tried to research the question myself, but have come up against the same contradictions regarding whether Prozac and Desipramine can cause weight gain or weight loss. I don't know if there is a definitive answer short of just taking the medications and "wait and see", but I would like to understand how my doctors can have such different opinions based on their individual experiences. Thank you.

Answer: Prozac is a funny drug regarding weight gain/loss. In my experience, about 20% lose weight, 40% gain weight and 40% are unchanged-hence the variable messages.

[posted 08/31/1999]
Question: Is there any information relating beta blockers and anti-anxiety drugs with weight gain. I had a significant weight gain (30-40 lbs.,) after starting these two medications. Also, I started Meridia on 5/3/99. Weight loss has been slow in comparison to others and my significant increase in physical activity. Can the Corgard and Ativan be affecting my weight loss and did it contribute to my weight gain? Thank You!

Answer: Not too much. Many patients however, have really decreased energy levels and decreased activity which would tend to lead to weight gain.

[posted 11/7/1999]
Question: hi i am 15 years old. I will 16 in 2 months. I have been weight training for aobut 2 years now. i also play hockey. Do you think I should supplement creatine? Will it cause any long term or harmful effects? thanks again

Answer: No, lift weights. Even Mark McGuire stopped using it.

[posted 11/15/1999]
Question: I have just started a weight loss program with the drug ionomin. I also take 20mg of Prozac every other day for depression, and have occassional migraines that I treat with midrin at night, or imitres injections during the day. I have read about phen-fen and antidepressents, but I am having a difficult time figuring out if ionomin is in the same category. Thank you!

Answer: Wouldn't be my first choice.

[posted 10/30/1999]
Question: I am 32 and have always had a weight problem. My weight fluctuates (can't keep it off.) Three yrs ago I was diagnosed with hypothyroidism. I take .2 mg in Levoxyl (generic). I also take Flouresmeide for water retention, and Meridia to try to control my appetite. After infertility treatments, the birth of 3 children, and yrs of female problems, I had a hysterectomy (left ovaries) due to endrometriosis. At that time (2mnths ago.) I developed high blood pressure and now take Accupril 10mg. also. I cannot get my weight below 180. I practically kill myself to get it there. I get tired during the day and especially early evening. I thought levoxyl would help boost metabolism or do I need something else? Can there be some medical reason concerning the weight and all the above that is being missed. I am so sick of hearing " Oh you have thyroid problems thats why your fat" I don't want to be overweight i want to understand and be able to help myself.

Answer: Your thyroid has little to do with your weight. Your inheritance, exercise and intake do. Changing your diet might help. If you haven't tried a high protein diet, Adkins, Sugarbusters, Carbohydrate Addicts and the like-worth a try.

[posted 08/10/1999]
Question: I'm sorry - I have to add to my previous email - I am considering changing antidepressants. My doctor and I are looking up the weight-gain possibilities for Celexa vs. Effexor. The reason I wrote originally was because in your FAQs, there wasn't anything conclusive as to whether one antidepressant has less of an effect on weight than others. Thanks again for your time.
Christie

Answer: I'm not impressed that there is much difference.

[posted 08/10/1999]
Question: I realize many others have asked questions on weight gain and antidepressants, but I'm hoping that since the time that those questions have been asked, more information has come out. I'm currently on Effexor and have been for over 2 years now. I've tried a couple of times to go off of it because of weight gain, but the resulting emotional problems have caused me to start up again. The problem is, since going oin the Effexor, I have gained 70 pounds, and was already 30 pounds overweight when I started. Here I am 100 pounds overweight and "desperate" to find an alternative. I'm also currently on the new drug Xenical to help reduce weight and it's doing absolutely nothing for me. I'm exercising daily and eating only low-fat food and losing nothing. The weight gain is causing even more depression. I can't express enough how important it is to me to find "something" that can help me to lose the weight and keep a reign on my depression. Please help me.
Thank you for your time.

Answer: Well, it won't be the anti-depressants in your case. I'd switch diets and use a relatively high protein diet(Adkin, Sugar Busters, Carbohydrate Addicts etc.).

[posted 08/7/1999]
Question: I have a friend who wants to take a diet drug. However the subject has a normal weight for age. The subject has taken diet drugs in past. During this past use of diet drugs it may or may not haven caused the subject who is an avid runner, to loss consciousness during a race. Subject wishess to start retaking diet drugs. Because of what subject thinks as benifts from it such as loss of appetite, increased energy, and less need for sleep. Medically speaking can this subject who is around 18 years of age and female use any type of diet drugs safely? And are diet drugs in general safe for anyone?

Answer: To gain energy and decrease sleep need-none of the diet pills will work. It doesn't sound like a md would prescribe diet pills for this individual. We only do it for patients with excessive body mass/weight. Is this person anorexic?

[posted 08/7/1999]
Question: Since starting on Metoprolol I've been gaining weight. I've quit smoking since 02/99 and have changed other habits as well. I went to skim milk, I'm drinking more water and juices as well as low cholesterol meals. I feel more tired but I think it's from the weight gain. I'm up to 238 now and I was 225 when I had a mild heart attack on 02/19/99. Any opinions or help would be appreciated.

Answer: Weight gain is a function of getting more calories in than you burn. Finding the right diet for you is the trick. Many cardiac patients substitute carbohydrate for fat in their diet. This is good for your cholesterol-but, only if your weight doesn't rise. I'd look at things like the Adkins diet or the Carbohydrate Addict's Diet. The metaprolol might be part of the problem(fatigue) but, the best drug for post MI patients.

[posted 08/6/1999]
Question: Hi, I am taking phentermine for weight loss and it works well but doctors don't usually like to prescribe it for more than a month or two. Why does that scare them so much? Also, is Meridia as effective? What about the drug Xenical? Also, I am taking Prozac, too but had to double the dose after a month of Phentermine...do these types of drugs commonly cause depression or personality changes? Thanks.

Answer: You'd have to ask your md about their prescription practices, most mds wouldn't have this problem. Merida works but is slow and expensive. It achieves about 2 pounds a month at a cost of 60-70$. Xenical works better but tends to cause some diarrhea-especially with high fat meals. There is some concern about vitamin metabolism with xenical-especially A,D,E,K. I've had better luck with xenical and don't use meridia much.

Weight Gain and Medications [posted 1/14/99]
Question: Can Claritin or Flonase cause weight gain or prohibit weight loss? I am 5' 3" 42 year old female. In January 1998 I started taking claritin and flonase for year round allergies to mold. I started gaining weight and joined a gym in May. When I joined I weighed 155 - 160 lbs. My fat percentage was measured at 29%. The end of July I weighed 155 and my fat % was measured at 31% despite my increased activity level. I was visiting the gym 3 times a week and trying to eat low fat. At this time I started keeping a daily food journal and I visit the gym 3 - 4 times a week and play volleyball once a week. My weight is now 150 and fat content 32%! My food journal shows I average less than 2000 cal most days and between 20 - 40 grams of fat per day. My trainer is stumped. I feel I should be losing weight not gaining or staying steady. Could the medications be causing this? Several years ago I took Hismanal for my allergies and gained 10 lbs. I quit taking it and lost most of the extra weight. At the time the doctor said it could not be from the Hismanal, but I see now that weight gain is listed as an adverse affect of Hismanal. Is Claritin or Flonase the same?

Answer: Not a usual reaction, but stop them and see. Flonase is more likely to be the culprit, but if you have had this "reaction" with antihistamines I'd stop both for a while.

Problematic Weight Loss [posted 1/13/99]
Question: My wife has had a recent (2 months) problem with lack of appetite. She has been on different antidepressants (prozac, zoloft) up until 8 months ago. She changed to St. John's Wort because of lack of libido and high prolactin levels thought to be due to SRI's and oral contraceptives (Triphasil 28). Her libido did not return, so after 4 months she tried Effexor for about 3 weeks at a low dose and then Tryptan at a low dose for 1 week where she became nauseated and stopped all medication for 3 weeks and then went back on her birth control pill. Since then her doctor put her on Maxgran to reduce nausea and about 2 weeks ago she started on Wellbutrin for depression. I am concerned because she is unable to eat any amount without nausea and wonder if it could be drug related? She now gets most of her nutrition through a few diet bars and shakes that she can keep down. She has lost over 12 kg and cannot afford to loose much more. Barium tests have not revealed anything.

Answer: Stop all the medications and recheck her prolactin level. is she hypothyroid or having pituitary dysfunction? Certainly possible.

Weight loss [posted 1/12/99]
Question: I have been on Lipitor l0mg for 2 months now. It has greatly helped lower my LDL from l70 to l23 and my cholesterol from 248 to l92 in just six weeks (had the blood tests two weeks ago). I also lowered my triglycerides from l76 to ll9. I was wondering if there has ever been any indication of this drug causing some weight loss? I have lost, what seems to be, 2-3 lbs in 3 l/2 weeks. (Obviously, I'm not on a diet or I'd be happy!). I've had some significant stress of late, but I'm just wondering if there is any correlation between the drug and the weight loss. My doctor and I are very pleased with these results, however. (I am a 50 year old woman and I am also on the Climara .05 mg patch and Provera.)

Answer: Not a usual problem.

Weight Gain Products [posted 1/8/99]
Question: I would like to gain weight. Could you tell me what product I could ask the pharmacist for?

Answer: There really isn't any particular drug that is effective. Some patients will gain weight with the SRI antidepressants, but some will lose weight also.

Bulking Agents & Weight Loss Drugs [posted 10/15/98]
Question:Which are the best naturally occuring bulking agents used in the control of obesity? Which synthetic drug as a single drug or combinations are safe & approved by USFDA after the recent ban on Fenflurbiprophen ?

Answer: There isn't compelling evidence that any of the bulk agents helps a great deal in preventing obesity. Any of the available agents would be fine. Some produce less abdominal gas than others. Meridia has just been released and is moderately effective without the side effects seen previously with the Phen-fen regimen. Many other combinations of antidepressants and other drugs have been tried. I haven't been too impressed with their efficacy.

Elderly Weight Loss [posted 9/29/98]
Question: My mother is a 70 yrs old with known heart disease. She is currently taking coumadin, lanoxin, premarin and recently prilosec. My mother started noticing that the pill lanoxin was coming out whole in her stool. I'm wondering if this should be expected.? She has asked both her pcp and cardiologist and received different information. She had been taken this medication for two years and never noticed this before. Consequently, her pcp discontinued the lanoxin and prescribed nitroglycerine patches. This started about two months ago and she has now developed acute pain in her abdomen with severe bloating after eating a meal. She has dropped six pounds in the last month and is weighing in at 100 pounds. Her chem panel along with amylase and lipase were normal. Recently, she had an upper GI series and CT of her abdomen proved to be normal. The cardiologist and gastroenterologist seem to think the symptoms are due to her heart and have scheduled an elctrocardio scan. Could there be other reasons beside her heart that are causing her symptoms? If it is her heart, then what chemical process is happening that would cause her such abdominal pain?

Answer: Weight loss from any source in an elderly person is bothersome. Many patients get toxic on lanoxin(digoxin) causing nausea and occasional pain. I suspect this is why the lanoxin was discontinued however, this would abate after a week or so off the medication. Time for a lower gi and possibly a gi consult. It sounds like they are focusing on atherosclerosis of the abdominal arteries-certainly possible-but, not much can be done to correct this problem.

Weight Loss Drugs - Phen-Fen, Redux Manufacturers [posted 8/4/98]
Question: I need to contact the companies who made the above drugs both generic and branded. I can't seem to find the manufacturers. Please let me know names and how to get into contact with them.

Answer: Phenteramine is made by Bristol-Myers-Squibb: 800-426-7644, Redux by Wyeth-Ayerst: 800-934-5556, and Fenfluramine by Robins: 800-934-5556.

Weight Loss Drugs [posted 7/31/98]
Question: I would like to know the name of the drug that is combined with phentermine for weight loss. I am concerned as a friend of mine has been prescribed these for weight loss and I'm not sure they're right for him. Weren't these drugs recalled?

Answer: Yes, they were recalled, so the drug you refer to could be any of about 50. Many physicians combined different drug protocols - with little data generally on effectiveness - in an attempt to capture the patients who they would have lost due to the recall. I'll need some more information however.

Weight Gain and Drug Interactions [posted 7/27/98]
Question: I am currently taking the following drugs: Premarin 2.5 mg, Paxil 20 mg (once a day) Synthroid 50 mcg (once a day) and Lodine XL 400 mg (once a day). I have gained about thirty pounds in the past 18 months and seemingly can not lose the weight no matter what I try. Is there any connection between the array of medications I am presently taking in your opinion? Also, if I happen to go without one of the medications in a two to three day period, I began having serious dizzy spells, lightheadedness, can not carry a train of thought, can not concentrate properly. I know I shouldn't miss any of my medications, but I have been attempting to wean myself off the Paxil and this same feeling happens within a 24-48 hour period. I would also like to know if there is any type of appetite suppressants that I could take while taking these medications? I would desperately like to get my weight problem under control and haven't been able to on my own. I am looking for suggestions. I am presently on the Paxil for depression and my weight problem is a very major part of the depression.

Answer: First, you might try to reduce your Premarin dosage. This is a strong stimulus to eat in most patients. The lower the dosage, the lower the stimulus. Secondly, you are on a very small dosage of thyroid replacement. Ensure that your TSH is in the normal range or even slightly low to ensure that you are not under replaced (note, low TSH not high, this is a reverse test). Lastly, Paxil causes about 60% of patients to gain weight. I don't have any great answers for this problem other than try other classes like Wellbutrin, etc. There are other drugs coming out for weight loss which should be available in 2-3 months.

Weight Loss Drug - Metabolyte [posted 7/22/98]
Question: I am interested in a drug I have heard about on the radio called Metabolyte (to increase metabolism and suppress hunger). Is it healthy, does it work, and why?

Answer: I'm not aware of this drug, but to date there is no drug that works by increasing metabolism. Exercise does, not medically.

Weight Control
Question: I have had a hysterectomy and presently taking an estrogen supplement. Trying to loose weight is almost impossible. Do you have any suggestions, or even something safe I could take to help with losing weight?

Answer: Since Redux and Phen-fen have been removed from the market, no.

Hysterectomy and weight gain
Question: I'd like to find out why women on estrogen gain weight. I'm 41 years old and had a hysterectomy a year ago. I was put on 2 mg of Estrace right away and continue to take that. I am very physically fit but need to lose about 20 pounds. I've been watching my diet very closely to try and lose the weight and after 8 weeks I've only lost 4 pounds. Is this because I'm taking the Estrace? If so, isn't there anything to combat this?

Answer: Good question. Steroids, of which estrogen is, affect the appetite and the way that calories are metabolized. For example, steroids like prednisone will cause a shift of fatty tissue to the abdomen and away from the legs. We have no idea why this is the case, nor any way to block the effect. One could make a lot of money if there were.

Rapid Weight Loss
Question: I am 42 years old and I have just lost about 50 lbs. However, I have to lose least 70 more lbs. I am on the Atkins diet and doing well at it. My only problem is that my skin is not conforming well to my body. There are loose flaps of skin. What can I do?

Answer: After you reach and maintain target weight, you will need a plastic surgeon to "tuck" the excess skin. There is no other option.

Premarin and Weight gain
Question: I have tried to find information on any relationship between premarin/provera and weight gain. I gained approximately 40 pounds within 6 months after beginning premarin. No matter what I try, I can't seem to lose this weight. Can you cite me any research that shows a connection between the premarin and weight gain. What can I do about it?

Answer: Premarin/provera is known to stimulate weight gain and appetite. This is one of the main reasons that it is administered to livestock. Weight gain on the birth control pills is the best researched and tends to be about 10-20 pounds, but with some women markedly more. I'm not sure what research will accomplish. It is certainly part of and maybe all of the stimulus for your weight gain. Unfortunately, there is little to be done to reverse this effect other than decrease or stopping the steroids. There is no medicine which will block the weight gain effect. There is no medicine that has the overall advantages of estrogen.

Weight Loss
Question: I am 5’ 7” and currently weigh 160 pounds. I lost weight and kept it off for a while, but unfortunately I have gained all of it back. Is there any help you should suggest with ideal weight, diet, and any of the medications that can be taken for weight loss would be right for me?

Answer: Unfortunately, the trick to weight loss is keeping it off. All the current drugs in use (fen-fen, Redux, etc.), as well as any weight losing regimen have the same problem. Stop the diet and the weight slowly returns. The only way around this is to change your exercise levels or your eating habits permanently. Try to find a diet that you can live with forever and that is not such a big sacrifice. This kind of diet usually yields smaller weight losses, but sustained ones. The carbohydrate addicts diet works for some. Weight watchers for others. Focus on how you lost weight and keep with the parts that are not objectionable in the long term.

Weight Gain
Question: I am a 60 year old, 5' 8'' male weighing only 134 lbs. I have had to watch my cholesterol, but it has made me thin. How can I gain weight without affecting my cholesterol?

Answer: In general, gaining weight will increase your cholesterol. I know of no way to gain weight without raising cholesterol. Some patients are very weight sensitive while others are less. Consequently, the amount of rise will vary dramatically. Regular exercise will raise the amount of good or HDL (high density lipoprotein) and may compensate for the rise in overall cholesterol.

Weight Gain
Question: I have a history of SLE, Sjogrens and COPD. I have gained about 4 pounds per week since the first of January and my stomach is very swollen. My doctor does not seem to be concerned, but it is really bothering me. Any suggestions as to where to start looking?

Answer: Your history isn’t sufficiently detailed for me to help. For example, are you taking any medicines? What is your last labs, and has the SLE or COPD had any end organ damage?

Overweight
Question: I'm a 29 year old female, 5'8" tall, and I weigh 245 lbs. In the past 5 years I have gotten to this present weight, from weighing about 160 lbs. I do not want to take phen fen because it looks too risky to me. But I am interested in finding out more information on Redux. I'd like to get this information and talk to my doctor about whether or not this may be an option for me. My husband and I have been on the low-fat, no-fat diet, for nearly two years now, and I've managed to lose only 10 pounds in all that time. I am obese, and I would like to at least get back down to 150 or 160. So I need to lose nearly a hundred pounds.

Answer: Redux(dexfenfluramine hydrochloride) and phenteramine/fenfluramine are appetite suppressants. They have been used for the past several years to aid in weight reduction after publication in JAMA of an article and subsequent follow-up articles detailing the weight loss potential of this drug with very few side effects. These drugs are indicated for weight loss necessary to correct or improve the treatment of hypertension, diabetes mellitus, elevated cholesterol, with a body mass index of 27 or no risk factors and a body mass index of 30. Body mass index is arrived at by dividing your weight in pounds by your height in inches. These drugs should not be taken with MAO inhibitors, Imitrex (used for migraines), while pregnant, with anti-depressant drugs of any variety, especially SRI inhibitors, if glaucoma is present, or if under 18. Usual dosage of Redux is 15 mg twice a day. Ionomin's dosage is 15 mg once a day, and 30 mg if the individual is unresponsive. Pondomin's dosage is 15 mg three times a day, but this can be increased to 30 mg three times a day (t.i.d.). These drug regimens do not appear to be addictive currently. The biggest risk appears to be pulmonary hypertension. This is increased with taking these drugs and can lead to death, so it is not taken lightly. This appears to be an unusual but serious side effect. Common side effects for most patients are dry mouth, constipation, diarrhea, and drowsiness.

I have had a lot of success with these drugs. Redux is easier to take, but may not be as effective. Ionomin and Pondimin are a little more effective, but less convenient and slightly more costly. The weight loss tends to return after the medicines are discontinued. They are usually effective in about 80% of my patients. I have major concerns about pulmonary hypertension and I do not prescribe these drugs until all the risks are laid out and only for high risk patients.

Weight loss medications
Question: I am currently on a weight loss program using ionomin and pondamin. I also noticed that my concentration level is more intense and more centered after being on these drugs. I think a lot more clearly and I can usually make more precise decisions. I was wondering if the medicinal values of these drugs might cause this ability to focus more clearly? I was also wondering if there is any other drugs that can be purchased over the counter to achieve the same effect of clear thinking and better thought processing. I don't want to be on these drugs forever, but I do like the medicinal effects of thinking clearer.

Answer: Usually, patients complain of sleepiness on these drugs and not more alertness. I really don't know why you should be having this effect unless it is related to your weight loss. Sorry, I can't be of more help.

Prozac and Weight Loss
Question: I am taking 30 mg Prozac daily and would like to lose weight but my doctor will not consider Redux or Phen-phen because I am on Prozac. Would it be "safe" for me to take the OTC herbal weight reduction pills Citrimax or Chromium Picolanate? Would any of these interfere with the chemicals in my brain?

Answer: I'm not really aware of the medical effects of these herbal remedies. Unfortunately, many herbal remedies or treatments are poorly researched in terms of basic science (lack of financial incentive since there is no patent possible).

Weightloss Surgery
Question: I saw a story on a news show about an alternative surgery to stomach stapling, but I have not been able to find any more information. It is a banding surgery where they put a rubber band around the stomach and adjust it so that you lose weight. It sounds like a better option because it is less invasive. Do you have any information on this surgery?

Answer: Most of the surgical techniques to reduce weight have lost much credence in the medical community. That is because they either produce potential serious side effects or just don't have lasting effects - That is, the patients will begin to gain weight again. My personal feeling is that the hunger center in the brain is the way to go to lose weight. Redux and the Fen-Fen combination work fairly well. They have some potential side effects and aren't cheap, but neither is surgery. There is always some new mechanical approach to losing weight, although I'm not a fan of any of them.

Ionamin and Pondamin
Question: What exactaly are the drugs Ionamin and Pondamin? When prescribed together how do they assist in weight loss? What are the side effects of the drugs and under what guidelines can it be prescibed to someone?

Answer: Ionamin(phentermine) and pondamin(fenfluramine hydrochloride) are relatively new in the ongoing saga of weight loss remedies. This follows fairly good research published in JAMA and a couple of other repubable journals showing good effectiveness and minimal side effects. I have used this combination extensively after reading about it a great deal and find that it works about 60 % of the time very well and 20 - 30 % somewhat well. The side effects tend to be dry mouth, drowsiness and diarrhea. There have been reports of pulmonary hypertension with this combination. This is a potentially severe problem which can lead to death and/or heart or lung transplantation. This is a major problem if the early reports pan out. It should only be taken for correction of hypertension, diabetes, etc., until this can be further researched. It should not be used in glaucoma prior to surgery or in patients with hypertension or depression.

Weight
Question: My question involves normal weight. I am a twenty-three year old female. I have always been under weight. I am 5'3" and presently 95 lbs. I have been told that I should weigh approximately 110 to 115. I do not believe I suffer from an eating disorder. I pretty much eat anything I want. I do not concern myself with fat content or calories. My problem is I just cannot gain weight. Doctors have told me that I have high metabolism, and this will change when I have a baby. I would like to know if it is safe to try to change my metabolism, or should I just wait and see. I am very healthy and do not feel this causes any health problems for me. I would like to gain weight, but I cannot figure out a way to put it on. Any suggestions?

Answer: There is a wide spectrum of weights for each height. This is usually a function of the body distribution patters and metabolic parameters inherited from your parents. The government has published "normal" height/weight charts. These are always argued vehemently when they are revised. Being "underweight" is usually of less concern than being "overweight" as long as there are no medical problems leading to the weight level. There does not appear to be any simple way to change one's metabolism. There is indirect evidence that more exercise increases metabolism and less exercise decreases metabolism. However, this has never been shown by experimental technique. As long as your physician has established that there is no medical reason to be "underweight" I would not concern myself too much.

Underweight
Question: My question deals with "normal" metabolism; I am a 22 year old male 5'9" and 134 lbs. This has always been a problem and I have tried everything to gain weight. I have seen Nutritionists, Doctors, Acupucturists, Weight Trainers, but nothing has worked. I have thought about taking growth hormones or steroids, but am afraid that it might inflict permanent damage to my body. If you also agree that there is no other possible treatment, I will begin the implementation of a "CYCLE" (four week dosages of steroid injections) and take it from there. Perhaps you might think that I have a psychological problem. I have seen a psychotherapist and his prescription, weekly "discussion sessions" with other mental cases, and anti-depressants: PROZAC and TRAZODONE.

Answer: Body size and conformation is an area of medicine that is poorly understood. It is fairly clear that the size and shape of your parents is the best predictor of size and shape. The size and shape of your parents and grandparents at every 10 years of life is also predictive of what your shape and size will be at each decade of life. Changing one's habitus with drugs is a possibility. However, it is likely to cause long term side effects including different types of cancers, strokes, etc. Major mood swings are also common while one is taking these drugs. These effects plus the fact that it is an illegal use of these drugs would counsel against their use. It is of interest that you have been on Prozac. These drugs have been used to change people's appetite centers - an approach that might be of benefit. A different aspect of the problem is your perception of your size and shape. Focusing on one's size and shape as an explanation of emotional and psychological troubles is usually misdirected. Leading a "normal" life will have little to do with one's habitus. I would recommend further sessions with your therapist tp explore different aspects of your belief system.

Weight Gain
Question: I am a 26 year-old male. I'm 6'1" tall, medium frame and weigh about 135 pounds. I would like some information about any therapies (i.e. hormones, anti-depressants, etc.) to help me gain weight. I have a better-than-average diet which is high in proteins, carbohydrates and fiber. I exercise often and my job is somewhat labor-intensive. I am in good health and have no major physical medical problems. However, a few years ago I suffered from panic attacks and major anxiety. I was prescribed Tofranil and Klonopin and during this period of time I weighed as much as 143 pounds. A small miracle in my book. Any information and/or opinions you could offer would be greatly appreciated.

Answer: Gaining and losing weight seem to be two of the bigger dilemmas in human existence. Most people have difficulty losing weight; but, about 10% of the population has difficultly putting weight on. In reality, your weight is mainly determined by inherited characteristics front your parents. If one compares your height and weight at ten year intervals with your parents you will find an amazing correlation. This is even more so if your parents resemble each other. There are numerous regimens and commercial products to add weight. I haven't been impressed that any of them work. If you have had a good physical and ensured that your thyroid is not over-active I doubt that there will be much you can do to alter your physique.

Hormones and Weight Gain
Question: Why is it that in one years time after a hysterectomy and taking hormones I gained 40 lbs., never any previous weight problem before that, I'm 42 years old.

Answer:Hard to put one answer on this problem Gaining and losing weight is still a medical black box. It is pretty clear that women tend to put on weight with excess extrogen. This hormone is also occasionally given to chickens to fatten them prior to market I'd discuss it with your doctor and see if a different formulation might be helpful.

Xenical
Question: I have been reading about the drug xenical, which blocks action of enzymes that normally breakdown fat. I am about 150 pounds overweight and would like to consider the drug when it becomes available in September. My question is: Are there any side affects or reasons I should not take it since I am on the drug Paxil for depression. I want to discuss this with my Doctor next month during my physical and I would like some information regarding any adverse affects.

Answer: I am not currently familiar with this drug.

Unaccounted for Weight Gain
Question: Why have I gained weight when I have dieted and started an exercise program

Answer: Initially, in some exercise regimens patients will add muscle mass to accomplish the exercise regimen. This is particularly true of male patients; but, also true of females. If you cut your calories and exercise you will lose weight.

Synthroid for Weight Gain
Question: I am taking .025 daily of synthyroid for weight gain, bad constipation and all of the other hypo side effects. I also recently started taking orthotri-cyclen..is there enough estrogen in these pills to cancel out the value of the .025 synthyroid ?

Answer: If you are taking 0.025 mg per day you either are underdosed or don't need to be taking thyroid. The estrogen will have little effect on the thyroid. It will increase the binding proteins; but, have little effect on the free thyroid available. I'd find out what your TSH level is. If normal, stop the thyroid if elevated, you'll need additional thyroid.

Prinivil
Question: My husband is about 100 lbs overweight. Primary MD put him on 20 mg Prinivil in Jan 97. He's also on allupurinol for gout(300 md/day back then reduced to 200 mg in Jan 97 then down to 100 mg in Aug 97 since liver function tests were not normal in Jan) He began feeling depressed last year and began Zoloft but had to discontinue in Mar 97 due to side effects. Psy changed med to wellbutrin and after time began to increase dose R/T poor results. Finally changed med to effexor in Aug 97 hoping for better results.Problem: libido has continued to decrease since Jan and testosterone level dropped from 297 in Jan to 153 in Aug. Depression worse, no energy, unable to get motivated at work, tired all the time(takes daily naps) tender lump under right nipple and prolactin level found high in last weeks blood test. MRI scheduled in two days. Could any of these meds have contributed to potential pituitary tumor? Please supply any info on Prinivil or other meds he is or had taken.

Answer: None of these drugs should have caused a endocrine dysfunction. Especially of the pituitary. Prinivil is an ACE inhibitor and is extremely well tolerated with minimal side effects other than occasional cough. There should be no interaction with the endocrine axis. I know of no drugs that one could take after gestation which would have this effect.

Joint Pain
Question: Can being overweight cause even wrist, elbow, neck, etc joints to ache?

Answer: Not usually unless there is associated carpal tunnel syndrome.

Proper Weight
Question: What is the proper weight for a girl, age 16, 5'3"?

Answer: Depends on your build stocky or thin; but the range is from 80-115 lbs-depending on your source.



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