Hormonal drugs for weight loss and surgical liposuction
(III) Hormones
1. Thyroid hormones: Thyroid hormone drugs such as thyroxine (T₄), triiodothyronine (T₃), and desiccated thyroxine tablets are traditional drugs for treating obesity.
Mechanism of action: Thyroid hormones can increase metabolic rate, leading to weight loss.
However, in clinical practice, except for hypothyroidism-related obesity, the effect of using normal doses is not obvious.
For normal physiological doses, such as 10-60 mg of desiccated thyroxine tablets, taken orally once a day in the morning.
For obese patients with normal basal metabolism, a daily dose of 50 micrograms of T₄ and 30 micrograms of T₃ generally does not lead to weight loss. This may be because the secretion of endogenous thyroid hormones is inhibited and reduced after taking the medication, and the body's metabolic rate and energy consumption are not affected.
Transient hypothyroidism may occur after discontinuing the medication.
While pharmacological doses of thyroid hormones can increase metabolic rate and reduce weight, they also increase protein breakdown, bone calcium loss, and increase the risk of cardiovascular dysfunction. Furthermore, they may suppress normal thyroid function.
Therefore, it is not recommended for the treatment of simple obesity.
usage:
(1) Dry thyroxine tablets, orally, starting with 10 mg/time, once every morning.
If there is no adverse reaction, add 10 mg every 7 days, and the usual daily dose is up to 60 mg.
After significant weight loss, the dosage must be reduced to a maintenance dose of 30 mg/day. The reduction should be done slowly and maintained for several days to six months.
(2) T₄, orally, initially 10 micrograms once a day in the morning, then increase by 10 micrograms each week, and maintain at 50 micrograms per day.
(3) T₃, orally, start with 5 micrograms once a day in the morning, then increase by 5 micrograms each week until it reaches 30 micrograms or until the therapeutic effect or palpitations and excessive sweating are observed.
side effect:
(1) When using this type of hormone, after weight loss or when palpitations, excessive sweating, or tension occur, the dosage should be gradually reduced and adjusted to a suitable maintenance dose.
(2) Increase heart rate and oxygen consumption.
Use with caution in patients with coronary heart disease.
Start with a small dose to avoid inducing angina.
Generally, thyroid tablets are started at 10 mg/day. If there is no obvious discomfort, 10 mg is added every 7 to 10 days.
The usual daily dose is 30 mg.
If this dosage is ineffective after 3 months or if angina occurs, it should be discontinued.
(3) Liver function impairment.
Elevated SGPT levels can return to normal after reducing or stopping medication for 1–3 weeks.
When using this medication, liver function should be checked monthly. If there is a slight increase, liver-protective drugs can be given at the same time.
(4) Increased protein catabolism necessitates the addition of a high-protein and high-fiber diet.
2. Beta-adrenergic drugs
(1) BRL26830A: A new adrenergic agonist that can increase thermogenesis, raise the metabolic rate, and reduce body fat content.
This drug is used on specific adipose tissue areas, does not affect body density, can reduce nitrogen loss, and has no effect on heart rate or blood pressure. The usual dosage is 200-400 mg/day, with a course of treatment of 6-8 weeks. It does not cause liver or kidney damage.
(2) LAY104119 and LY79771: These drugs can competitively bind to H-dihydro-dlprenolol receptors, increase cAMP content in brown animal adipose tissue, stimulate lipid breakdown, and increase the release of norepinephrine from sympathetic nerve fibers in adipose tissue innervated by nerves, thereby enhancing thermogenesis. This norepinephrine tension only occurs in adipose tissue and not in organs such as the heart and liver. It is a weight loss drug with highly selective thermogenic and metabolic-promoting effects.
3. Growth hormone (GH): Clinically, it is often found that obese individuals have reduced growth hormone secretion.
Growth hormone primarily increases the mobilization of free fatty acids at fat storage sites during metabolism, accelerating the body's utilization of free fatty acids and thus reducing fat storage, thereby achieving the goal of weight loss.
Growth hormone increases the metabolic rate and the activity of 5'-deiodinase, promoting the conversion of T₃ to T₄, restoring serum T₃ concentration to normal during calorie restriction, alleviating negative nitrogen balance during dieting, and reducing protein loss.
Generally, 5 mg daily can increase the basal metabolic rate after 1 to 3 days of initial use.
However, the drug is difficult to source and is prone to producing antibodies, thus its application is not yet widespread.
4. Lipolytics: a freeze-dried protein product extracted from the anterior pituitary gland.
It can promote the consumption and burning of fat in fat stores, activate lipolytic enzymes in adipose tissue, promote fat decomposition, and reduce weight.
This product has side effects such as edema and allergic reactions.
Contraindications: This product is contraindicated in patients with cardiovascular disease, diabetes, liver or kidney dysfunction, or those allergic to it.
Dosage: Intramuscular injection, 50 mg each time, twice a day.
One course of treatment lasts 10 to 20 days.
(iv) Drugs that affect digestion and absorption
1. Dietary fiber; contains polysaccharides, lignin, hemicellulose, resins and alginate, which can resist hydrolysis by human gastrointestinal secretions.
Its functions are: ① prolonging gastric emptying; ② reducing energy and gastrointestinal absorption; ③ preventing fat from entering the terminal ileum and increasing satiety; ④ affecting the release of hormones in the gastrointestinal tract.
The daily dosage is 6 to 30 grams.
Mild bloating, increased flatulence and bowel movements indicate that this drug has great potential.
2. Sucrose Polyester: This product has the same processing and properties as ordinary oils and fats. It can replace dietary fats, but it cannot be digested and absorbed after consumption and is excreted in feces, thus reducing the source of calories.
Some researchers have suggested that if 40 grams of fat are replaced by this product in a diet of 5020.8 kJ (1200 kcal), dietary energy expenditure can be reduced from 7531.2 kJ (1800 kcal) to 5313.68 kJ (1270 kcal), and cholesterol absorption can be reduced by 67% and vitamin A absorption by 42%.
3. Digestive enzyme inhibitors
(V) Mobilizing local fat-decomposing drugs
Clinical observations have shown that stimulating β1-adrenergic neurons or inhibiting α2-adrenergic neurons can induce local fat mobilization and oxidation for heat production.
Injecting norepinephrine, yohimbine, or other substances into areas of fat accumulation can mobilize local fat, achieving effective weight loss.
II. Surgical weight loss
For patients who are excessively obese or who have failed with diet control, medication, and other weight loss methods, surgical weight loss may be considered.
In the past, weight loss surgery was mostly used to treat various complications caused by obesity or when obesity was life-threatening.
For conditions such as respiratory failure, heart failure, severe hypertension, and peripheral edema accompanied by ulceration, a jejunoileal bypass surgery is generally performed, which involves anastomosing the jejunum to the terminal ileum. This reduces the absorption of food in the intestines, causing malabsorption syndrome and thus reducing weight.
This is an indirect method of eliminating fat.
With advancements in medical research, people have begun to use surgical methods to directly remove fat from the abdomen and other areas.
However, surgical removal of excess skin and fat leaves obvious and long surgical scars. To avoid these drawbacks, in the 1960s, a German doctor first used a gynecological curette to scrape away excess fat tissue, and then used suction to remove fat tissue fragments to achieve the goal of weight loss.
Subsequently, various countries began to carry out this type of weight loss surgery-liposuction.
In the 1980s, some hospitals in major cities across my country began to perform this surgery. With continuous innovation and improvement in technology, and the gradual improvement of instruments and methods, it has become a relatively mature surgical weight loss method today.
Patients with refractory obesity can seek treatment at relevant hospitals.
To determine if they are a suitable candidate for weight loss through surgical treatment.
However, it is crucial to remember that this treatment must be performed at a reputable hospital, as there have been reports of individual practitioners accidentally removing a patient's small intestine during liposuction, leading to the patient's death.
The indications, methods, and postoperative precautions for this surgery are described below.
(I) What kind of obesity is suitable for liposuction?
Traditional liposuction improves body shape by removing excess skin and fat, but the surgery often leaves long, wide, or even raised and thickened scars, causing new problems for the patients.
Liposuction involves making only a small incision, through which fat is suctioned out under negative pressure.
It is suitable for people with excess local fat and good skin elasticity, such as those who are obese in the neck, waist, abdomen and thighs, and whose skin in the corresponding areas is not loose or sagging.
For those with sagging skin who require liposuction, partial abdominal wall resection should also be performed at the site of significant sagging. For those with obesity on the upper inner thighs, the two sides often rub against each other during walking, causing local skin erosion. Surgery can serve both therapeutic and cosmetic purposes.
The appropriate age for the procedure varies among scholars from country to country, but most believe that 18 to 60 years old is the ideal age, as development is basically complete by age 18 and self-control is already in place.
Obese people over 60 years of age generally experience a decline in health and reduced social activity. Given my country's national conditions, most of them do not have an urgent need for assistance.
For patients undergoing liposuction, the functions of vital organs such as the heart, liver, lungs, and kidneys should be normal, and there should be no coagulation disorders.
Liposuction, like other weight loss procedures such as abdominal wall liposuction, is a surgical procedure to remove excess fat from certain parts of the body. It cannot solve systemic obesity; surgical treatment can only address localized obesity. Even for localized treatment, a realistic estimate must be made.
(II) Instruments and equipment for liposuction
The instruments used for liposuction consist of three parts.
1. Suction tube: The suction tube is a specially made hollow tube, mostly made of stainless steel, but also sometimes made of hard plastic.
One end is a blind end shaped like a shark's mouth. Near the blind end, there is an oval side opening through which fatty tissue enters the lumen under negative pressure, is torn apart, and is sucked out.
Fat fragments vary in size, and the suction tube needs to have a certain diameter to suck them out; the inner diameter is generally 5 to 10 millimeters.
The other end of the straw is open and has a handle with markings indicating the position of the round hole. It connects to the tube at the back.
The length and curvature of the suction tube are made into various models depending on the location.
2. Catheter: It connects the suction tube and the suction device.
The catheter requires a certain degree of transparency and rigidity.
The transparency requirement is sufficient to see the nature and color of the attractant, and the hardness requirement is that the tube wall will not collapse under a negative pressure of one atmosphere.
3. Negative pressure source: Generally an electric suction device, which requires a suction speed of not less than 30 liters/minute under a negative pressure of 1.01×10⁵ Pa (1 atmosphere).