As six drugs containing sibutramine hydrochloride are banned in Egypt after fears of harmful side effects, what should people do who want to lose weight, asks Mai Samih People from all walks of life are obsessed with their weight, and there have been endless efforts to help overweight people get rid of those extra pounds. From British King Charles II's use of food supplements to similar practices employed by mediaeval monks to cut down on hunger pangs, people throughout the ages have sought the magic bullet that can reduce weight safely. However, such efforts have not come without occasional dangers, exemplified by the Ministry of Health's decision last month to ban six drugs containing the weight-loss drug sibutramine hydrochloride from the Egyptian market, after a report from the American Organisation for Nutrition and Drugs indicated that they could be linked to the development of blood clots and an increased risk of heart attacks. According to endocrinologist Ehab Abul-Yazid, "sibutramine hydrochloride can have side effects, including irritation, insomnia, increased blood pressure, and some types of arrhythmia, or irregularity of heart beat. However, the problem in this country is not necessarily the drug itself as much as the way it is used. Some 98 per cent of people advising patients on their diets are nutritionists, not physicians, and nutritionists are not allowed to prescribe medications." "Sibutramine hydrochloride is a drug that has side effects, and it should always be prescribed by a physician," Abul- Yazid said. The problem in Egypt, according to Abul-Yazid, is that too often the drug has been used without proper medical supervision. This means that it has been given to patients not able to take this type of medication, such as those with pre-existing hypertension, or nervous or neurological problems. While the drug assists in helping patients stick to their diets, it is also not necessary for patients following a diet to take it. In today's practice, Abul-Yazid adds, "we try to help patients avoid feelings of hunger," and there are other complementary therapies that may be able to assist patients as much as sibutramine hydrochloride can. Various forms of muscle-tightening therapies can be used that require little physical effort on the part of the patient, and there are also therapies that dissolve the fat in various parts of the body through the use of targeted injections, though these should not be used by people suffering from pre-existing heart, liver, or kidney problems, or by people with diabetes. Physicians have also recommended that people having a history of weight gain, especially children, should sleep more, as much as 10 hours per night, in an effort to lose weight. Research has shown that women who get least sleep are more than 30 per cent more likely to gain weight than those getting more. There are also special diets, often focussing on one food alone, that can help patients lose weight. One such diet is the "banana diet", in which the patient eats only bananas, though this diet, like other fruit-based diets, is dangerous, since it does not provide the body with essential carbohydrates. Some British scientists have detected "greed genes" responsible for weight gain in affected persons, speculating that one in six people may have such genes. More informal ways of losing weight include eating food slowly, as this may help a person feel full and eat less. Such methods can all substitute for medical ways of losing weight, some of which can have hefty price tags attached. Prescription weight-loss medication can cost from LE20 to LE350, while weight-loss herbs, not sold on prescription, can cost from between LE35 and LE250. Recent medical research has also investigated the substances in the body responsible for feelings of fullness in an effort to trick the body not to feel hunger pangs and thus to help patients lose weight. A DNA test has also made it possible to determine which kind of diet is suitable for each person, potentially helping people who have tried, and failed, to lose weight. Such people include Khairia Shaalan, a journalist, who has been struggling with weight-loss issues, particularly because of her job, which requires a good deal of travel. "It has been a long journey for me with dieting. It all began when I was a secondary school student. I discovered that my nutritional behaviour was wrong and was not helped by the traditional Egyptian family, which does not have a developed nutritional culture and is often only concerned with providing children with what fills their stomachs." When Shaalan got married and had children, she always put her home and children first, giving her little time to think about weight-loss issues. "It is a problem that many mothers face -- starting to neglect their appearance and weight because it is always the children who come first," Shaalan explains. It was only when Shaalan developed health problems that she decided she would have to tackle her weight. "I found that I was a prisoner in my heavy body. I couldn't do the kinds of things I used to like, such as jogging. Then my priorities changed from looking after my appearance to fighting to regain my health." There was nothing she did not try, though she never went the route of surgery or medication. "Although I went through many diets, I was always determined that I would not take pills to help me lose weight." She did try acupuncture, though without result, she says. One woman who did try dieting pills is Samah Abdel-Aziz, a housewife, who complains of their side effects. Could dietary herbs be the answer? Abdel-Aziz is sceptical, saying that "I don't believe that herbs can help someone lose weight. Some of them may even harm a person more than they benefit him," such as herbs that are used to prevent nutrition from reaching the body. Shaalan also does not believe in herbs. "I occasionally drink ginger and lemon, or green tea, but I do not depend on it for my diet." According to Abul-Yazid, such methods, essentially complementary therapies, "do not cause weight loss. The only way to lose weight is by reducing caloric intake, which means following a healthy diet. As for local obesity or localised areas of fat, there are different ways of dealing with this, including surgery, which is not easy for a patient to deal with." One recent substitute for more radical interventions such as surgery is laser therapy, recently approved by the Ministry of Health. Laser light of a certain wavelength is shone on the area of the body needing treatment for about 35 minutes without any kind of anesthesia. According to Abul-Yazid, this "feels like soft massage", and results can appear after just one session, these being permanent as long as the patient does not then go on to put on more weight. The recent scare over the use of sibutramine hydrochloride has raised the more general issue of how consumers can know when a certain medicine or technique could be dangerous. According to Mohamed Ramzi of the World Health Organisation (WHO)'s Essential Medicines and Pharmaceutical Policies unit, the WHO has a procedure for following up such concerns. "One of the roles of the organisation is to follow medications on an international basis. If a drug is to be withdrawn, it issues a bulletin giving the details behind the withdrawal to member states, in this case in the Eastern Mediterranean region. If a drug is shown not to be safe for human use, the state making the withdrawal order will inform other countries. Their response is usually the immediate withdrawal of the drug." In the opinion of Abdel-Aziz, the only way to bring weight under control is persistence. "It is a matter of willpower," she says. "Once you have your heart set on something, you can do it." Shaalan agrees. "If there is no willpower, you won't get anywhere. A person's willpower is the important thing, and this determines the success or failure of any diet. Don't say, 'I'll do this or that tomorrow.' Say, 'I'll do it now.'" Her message is that "your willpower is your driving power. Your priority should be to maintain your health, not necessarily your figure. Change your eating habits. Work to achieve an image of yourself you can accept. If you are careless in your overall behaviour, there are things that a diet alone can't fix." She points to diseases that can accompany excessive eating, such as diabetes or heart disease. For Abul-Yazid, the most important thing is lifestyle modification. "Change your lifestyle, and you can maintain your weight. The most difficult task is to maintain what you have. Follow a proper diet. Avoid bad habits and start counting calories. Oh, and try to do regular exercise." 10 facts on obesity - Overweight and obesity are defined as "abnormal or excessive fat accumulation that may impair health". Body mass index (BMI) -- the weight in kilogrammes divided by the square of the height in metres (kg/m2) -- is a commonly used index to classify overweight and obesity in adults. WHO defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or more than 30. - One billion adults are overweight -- without action, this figure will surpass 1.5 billion by 2015. More than 300 million are obese. At least 2.6 million people die each year as a result of being overweight or obese. Once associated with high-income countries, obesity is now also prevalent in low- and middle-income countries. - Globally, over 42 million children under five years of age are overweight. Childhood obesity is one of the most serious public health challenges of the 21st century. Overweight children are likely to become obese adults. They are more likely than non-overweight children to develop diabetes and cardiovascular diseases at a younger age, which in turn are associated with a higher chance of premature death and disability. - Overweight and obesity are linked to more deaths worldwide than underweight. Sixty five per cent of the world's population live in a country where overweight and obesity kill more people than underweight. This includes all high-income and middle-income countries. Globally, 44 per cent of diabetes, 23 per cent of ischaemic heart disease and 7--41 per cent of certain cancers are attributable to overweight and obesity. - For an individual, obesity is usually the result of an imbalance between calories consumed and calories expended. An increased consumption of highly calorific foods, without an equal increase in physical activity, leads to an unhealthy increase in weight. Decreased levels of physical activity will also result in an energy imbalance and lead to weight gain. - Supportive environments and communities are fundamental in shaping people's choices and preventing obesity. Individual responsibility can only have its full effect where people have access to a healthy lifestyle, and are supported to make healthy choices. WHO mobilises the range of stakeholders who have vital roles to play in shaping healthy environments and making healthier diet options affordable and easily accessible. - Children's choices, diet and physical activity habits are influenced by their surrounding environment. Social and economic development as well as policies in the areas of agriculture, transport, urban planning, environment, education, food processing, distribution and marketing influence children's dietary habits and preferences as well as their physical activity patterns. Increasingly, these influences are promoting unhealthy weight gain leading to a steady rise in the prevalence of childhood obesity. - Eating a healthy diet can help prevent obesity. People can maintain a healthy weight, limit total fat intake and shift fat consumption away from saturated fats to unsaturated fats, increase consumption of fruit, vegetables, pulses, whole grains and nuts, and limit the intake of sugar and salt. - Regular physical activity helps maintain a healthy body. People should engage in adequate levels of physical activity throughout their lives. At least 30 minutes of regular, moderate-intensity physical activity on most days reduces the risk of cardiovascular disease, diabetes, colon cancer and breast cancer. Muscle strengthening and balance training can reduce falls and improve mobility among older adults. More activity may be required for weight control. - Curbing the global obesity epidemic requires a population-based multisectoral, multi-disciplinary, and culturally relevant approach. WHO's Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases provides a roadmap to establish and strengthen initiatives for the surveillance, prevention and management of noncommunicable diseases, including obesity. source: World Health Organisation (WHO) http:// www.who.int/features/factfiles/obesity/en/www.who.int/features/factfiles/obesity/en//p
