Weight Management

Weight management adheres to a multi-faceted lifestyle model that’s comprised of several interrelated decisions and activities such as: eating healthy foods; understanding portion sizes, nutritional values, and macronutrient ratios; creating a holistic exercise regimen that works with your schedule, incorporates your interests, is dynamic enough to prevent burnout, and sets reasonable goals; and accessing the wealth of safe, clinically proven, prescription weight management medications that are currently available. Empower Pharmacy is dedicated to providing the resources health professionals need to aid their patients in achieving and maintaining ideal body weight goals, as they strive to improve their health-related conditions and overall quality of life.

Obesity and its many serious comorbidities exert a heavy toll in both human and economic terms. More than one-third of adults in the United States are obese, which exponentially increases their odds of hypertension, dyslipidemia, diabetes, and other cardiovascular disease risk factors.[1] Studies have demonstrated that weight loss of as little as 5% to 10% of baseline body weight, has been shown to result in lower triglyceride and blood pressure levels, and in as much as a 58% reduction in the risk of diabetes in pre-diabetic patients. [1] Unfortunately, the problem of obesity is typically exacerbated by aging, as this condition becomes even more difficult to control for older segments of the population. It is a mistake to merely think of obesity in relation to internal health conditions, because it impacts many other areas of one’s childhood, teen, adult, and especially senior life.  One study of individuals aged 65 years and older found that obese individuals had a 31% higher incidence of falling.1

Symptoms and Causes of Obesity

The definitions for being overweight and obese vary depending on the source. The National Heart, Lung, and Blood Institute describes some of the signs of being overweight and possibly obese as: clothes feeling tight and requiring larger size; the development of extra fat around the waist; and possessing a higher than normal body mass index and waist circumference.2

More specifically, with regard to defining obesity, the Mayo Clinic quantifies obesity as a body mass index (BMI) of 30 or higher. Your body mass index is calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared.3

Although there are genetic components and hormonal influences, obesity occurs when you take in more calories than you burn through normal daily activities and extracurricular exercise. The body stores these excess calories as fat, which if it continues to accumulate results in obesity that can be caused by a combination of contributing factors including:

• Inactivity - a sedentary lifestyle makes it easy to overeat.
• Unhealthy diet and eating habits - frequent: high calorie meals; fast food; breakfast skipping; late night eating; drinking high calorie beverages; and eating oversized portions all contribute to weight gain.
• Pregnancy - Many women view this as a time of overindulgence, which initiates obesity, whereas others simply find this weight difficult to lose after giving birth.
• Lack of sleep - getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite, and create cravings for high calorie foods.
• Certain medications - some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids, and beta blockers.
• Medical problems - specific medical diseases and conditions promote weight gain, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, metabolic syndrome, etc.

Dangerous Weight Loss Drugs

• Overweight and obese individuals have been seeking quick fixes for centuries. Called 'fat reducers', the first diet pills emerged in the late 1800's. Based on thyroid extract, which can increase metabolic rate, they were effective but had harsh side effects including abnormal heartbeats, increased heart rate, weakness, chest pains, high blood pressure, and fatalities. In the 1930s, a new medication (though technically a poison) called dinitrophenol became a popular for its thermogenic fat loss property (actually a symptom of phenol poisoning). Once its other poisonous symptoms (severe rashes, cataracts, peripheral neuritis, etc.) turned tragic it was removed from the market.
• A mid-1950s stimulant used in WWII to keep soldiers alert, amphetamines, promoted energy, suppressed appetite, and provided a slimming effect, but were neurologically and psychological addictive.
• 1965's obesity treatment, aminorex fumarate, triggered pulmonary hypertension.
• By the late 1960s a form of thyroid hormone was introduced, often used in conjunction with diuretics, laxatives, and amphetamines. These drugs proved too toxic.
• In the 1970s, a Danish physician used ephedrine in combination with caffeine to treat asthma, and eventually weight loss. It was soon banned by several states in the 1990s and finally the U.S. Food and Drug Administration (FDA) on December 31, 2003 for adverse cardiovascular and neurological problems, and implication in several deaths.
• Later phenylpropanolamine, an ephedra derivative, became popular as an appetite suppressant. It was also discontinued due to hemorrhagic stroke and increased hypertension.
• In 1973 the FDA approved weight loss drug fenfluramine gained popularity in 1992, when it was combined with another drug, phentermine and came to be known as Fen-Phen. Boasting over 18,000,000 sold bottles in 1996 alone, pulmonary hypertension, heart lesions, and valve abnormalities caused its removal...subsequently fenfluramine was voluntarily removed from the market in 1997.

Appetite suppressants affect the appetite-regulating region of the brain called the hypothalamus; and work within the brain by blocking the re-uptake of the chemicals serotonin and norepinephrine to improve satiety.456789

Researchers and medical experts have worked for years to develop appetite suppressants - dietary supplements in the form of over-the-counter (OTC) and prescribed medications, which work by reducing your appetite for food, thereby helping you to lose weight. More specifically, the potential of treating obesity is enormous, bearing in mind that a volitional weight loss of 10 kg is associated with important risk factor improvement: blood pressure -10 mmHg; total cholesterol -10%; LDL cholesterol -15%; triglycerides -30%; fasting glucose -50%; and HDL cholesterol +8%.10

Appetite suppressants have a long history that dates back to the 1950s, when the German and Finnish militaries were reported to have issued amphetamines to soldiers for the enhancement of warfare during the Second World War.11 Following the war, amphetamines were redirected for use in the commercial marketplace, and sold as appetite suppressants until outlawed in most parts of the world by the late 1950s due to safety issues among which were addiction, tachycardia, and hypertension.12 Instantly appetite suppressing drugs became a rage among those who wanted to lose weight without effort, and such drugs were extensively prescribed by doctors all over the world. The industry then became flooded with OTCs, the most common of which was based on hoodia (which much later became a top selling product in its own right), a genus of 13 species in the flowering plant family apocynaceae, under the subfamily asclepiadoideae. Several appetite suppressants were based on a mix of natural ingredients, mostly using the natural diuretic green tea as the base, in combination with other plant extracts such as fucoxanthin found naturally in seaweed. Drugs of this class are frequently called stimulants and are members of the phenethylamine family, related to amphetamines for which the street name is ‘Speed’.

The market was later saturated with more appetite suppressants. Dexatrim is known generically as phenylpropanolamine a decongestant that works by constricting (shrinking) blood vessels (both veins and arteries) in your body. The constriction of blood vessels in your sinuses, nose, and chest allows drainage in these areas, which decreases congestion making it ideal for the treatment of allergies, hay fever, sinus irritation, and the common cold. However, phenylpropanolamine also causes a significant decrease in appetite, and is used in a variety of OTC diet products. Unfortunately, phenylpropanolamine has been associated with an increased risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain), and although the risk is low the U.S. Food and Drug Administration (FDA) recommends that consumers not use any products that contain phenylpropanolamine.

Later renamed fat-burners due to the addition thermogenic ingredients, appetite suppressants like Ephedra, Apidex, and Fen-phen could be purchased without prescriptions. It was during the 1990s that the side-effects, sometimes mild and sometimes life-threatening started showing up. Many such drugs were either suspected or proven to damage heart valves and lead to heart attacks. In the year 2000, these drugs were withdrawn from the market owing to their harmful effects.

FDA-Approved Appetite Suppressants

Appetite suppressants affect the appetite-regulating region of the brain called the hypothalamus. They work by blocking the re-uptake of the chemicals serotonin and norepinephrine, which create that feeling of satiety received after eating a big meal. With more of these chemicals circulating in the brain, a feeling of fullness can occur. Appetite suppressants are the cornerstone of the pharmacological approach to treating obesity.

There are a number of anorexiant medications approved by the FDA for weight management. Anorexiants work by changing the way neurotransmitters behave in the brain. Neurotransmitters are chemicals stored in nerve cells that are released when a nerve is stimulated. A neurotransmitter is released from the axon (or end) of a nerve fiber and crosses a very tiny gap between nerve cells (known as the synapse) to stimulate the adjacent cell. Thus, neurotransmitters are chemicals used to create communication between nerve cells, or between nerve cells and other tissues, such as fatty tissue.

The most effective and most commonly prescribed anorexiant medication is Phentermine. It and all other anorexiants available work largely by activating an adrenalin-like neurotransmitter, known as norepinephrine (NE), both within the central nervous system and the sympathetic nervous system. There is some evidence that overweight individuals suffer from diminished baseline sympathetic nervous system activity or sympathetic “tone”. This has the ramification of relatively decreasing the basal metabolic rate of overweight and obese individuals. Consequently, by utilizing sympathomimetic amines one can effectuate an increase in the basal metabolic rate, which can be hugely important for weight loss purposes.

Besides phentermine, this class of medications includes two other notable appetite suppressants known as phendimetrazine and diethylpropion. By using a combination of long- and short-acting compounds, appetite suppression can be effectively experienced for extended lengths of time. An example of such a combination would be the use phentermine in the morning, followed by phendimetrazine or diethylpropion in the late afternoon.

Researched-Based Evidence on Anorexiant Medications

Numerous peer-reviewed clinical studies and journal articles have confirmed the appetite suppressing and weight loss properties of these medications, including the following.

An 866 eligible subject study, which at weeks 52 and 108 found that phentermin/topiramate (PHEN/TPM CR) was associated with significant, sustained weight loss along with improved cardiovascular and metabolic variables, and decreased rates of incident diabetes in comparison with placebo. PHEN/TPM CR was well tolerated over 108 weeks, with reduced rates of adverse events occurring between weeks 56 and 108, compared with rates between weeks 0 and 56.13

A meta-analytic study of 20 English-language weight-reduction studies, reported on the effect of > or = 6 months of pharmacologic therapy on weight loss and its maintenance to determine the clinical benefits of extended treatment, propose of treatment guidelines, and to identify future research needs. The pharmacologic agents included phentermine, mazindol, fenfluramine, dexfenfluramine, and fluoxetine. This study concluded that the benefits of extended treatment appear to outweigh the risks for those patients who are unable to lose sufficient weight without pharmacologic therapy, but who maintain adequate weight loss with long-term pharmacologic therapy.14

Diethylpropion is a selective serotonin 2C receptor agonist that works by decreasing food intake with few side effects. Its outcomes on weight are modest, but may be helpful in certain selected patients. The phentermine/topiramate combination has proved to be highly effective, achieving a 10% reduction in weight in the majority of patients.15

Past therapies for the treatment of obesity have typically involved pharmacological agents usually in combination with a calorie-controlled diet. Meta-analyses support a significant though modest loss in bodyweight with a mean weight difference of 4.7 kg (95% CI 4.1 to 5.3 kg) for rimonabant, 4.2 kg (95% CI 3.6 to 4.8 kg) for sibutramine and 2.9 kg (95% CI 2.5 to 3.2 kg) for orlistat compared to placebo at ≥12 months. Of the Phase III pharmacotherapies, lorcaserin, taranabant, topiramate, and bupropion with naltrexone all demonstrated significant weight loss compared to placebo at ≥12 months.15

Vitamin B-12 aides in the growth of healthy blood cells, nerve cells, and bodily proteins; assist with the metabolism of fats and carbohydrates to release energy; help regulate appetite and mood (key factors in overeating); and are a great treatment for people who cannot absorb vitamin B-12. Vitamin B-12 is an essential water-soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meat, eggs, and dairy products. Important in DNA synthesis, vitamin B-12 is frequently used in combination with other B vitamins in what is known as a vitamin B-complex formulation. Vitamin B-12 is bound to the protein in food, and released by stomach acids during digestion. Once released, B-12 combines with a substance called intrinsic factor (IF) before it is absorbed into the bloodstream.

The human body stores several years' worth of vitamin B-12 in the liver, so low levels in the body are rare. Decreases in vitamin B-12 levels are more common in the elderly, HIV-infected persons, and vegetarians. Vitamin B-12 deficiency is often defined by low levels of within the body stores of this vitamin, which can result in anemia – a lower-than-normal number of red blood cells wherein some of the symptoms include fever, excessive sweating, and soreness or weakness in the arms and legs. The inability to absorb vitamin B-12 from the intestinal tract can lead to various types of anemia, the most prominent of which is a type of megaloblastic anemia called pernicious anemia. However, this form of anemia is quickly remedied through vitamin B-12 supplementation.

Vitamin B-12 has a fascinating history, which rounds out over a decade of vitamin research as one of the last vitamins to be discovered. An essential daily nutrient, vitamin B-12 is needed to maintain healthy red blood cells, healthy nerve cells, and to make DNA. However, it was discovered as a cure to a condition known as pernicious anemia, which is directly related to a vitamin B-12 deficiency.

Pernicious anemia is a blood disorder in which red blood cells fail to develop normally, resulting in the steady decline of red blood corpuscles that was fatal until the 1920s. The disease was first described completely in 1849 by English physician Thomas Addison (1793-1860), who noted that the typical symptoms included increasing weakness and pallor, accompanied by obesity or weight gain rather than weight loss.161718

Numerous scientists played roles in helping to discover and isolate the causes and cure for anemia:192021

• Dr. Newcastle was never looking for a vitamin supplement, but rather a simple cure for pernicious anemia. He discovered that administering regurgitated gastric juices to his patients caused disease improvement.
• Dr. George Whipple's (1878-1976) studies showed that beef liver could improve the formation of red corpuscles in anemic dogs. He bled dogs to induce anemia and then set about to find out which foods would cause the dogs to recover the quickest. He discovered that feeding the dogs raw liver essentially cured anemia. Thus, raw liver, or raw liver juice became the treatment of choice for pernicious anemia. He recommended patients eat at least a 1/2 pound per day.
• George Minot and William Murphy were two researchers who set about to try to isolate the curative property of raw liver. They were successful in showing that the curative property was in the liver tissue. For their respective roles in the discovery of a cure of pernicious anemia Whipple, Minot, and Murphy all won the 1934 Nobel Prize in Medicine.
• Edwin Cohn created a liver extract that was substantially more potent than simply eating raw liver.
• American and British researchers Karl A. Folkers and Alexander R. Todd respectively, simultaneously discovered, isolated, and named cobalamin (vitamin B-12) in 1948.
• Dorothy Crowfoot Hodgkin with more sophisticated technology, using crystallographic data, was able to determine the molecular structure of vitamin B-12. This made it possible in the 1950s to produce large quantities from bacteria cultures leading to the modern form of treatment for the disease. She also won a Nobel Prize for her work.

Vitamin B-12 Deficiency

Pernicious anemia is a decrease in red blood cells that occurs when your intestines cannot properly absorb vitamin B-12, and presents a host of complications and symptoms. However, studies have shown that a deficiency of vitamin B-12 can also lead to abnormal symptoms. These symptoms may include ataxia (shaky movements and unsteady gait), muscle weakness, spasticity (stiff or rigid muscles), incontinence (lack of bladder and/or bowel control), hypotension (low blood pressure), vision problems, dementia, psychoses (abnormal condition of the mind), and mood disturbances. Giving vitamin B-12 by mouth, by injection, or by nasal inhalation is effective for preventing and treating dietary vitamin B-12 deficiency.

There exists a long list of other conditions, disorders, and complications related to vitamin B-12 deficiency, and on which the research remains unclear/inconclusive, but has shown some improvement during vitamin B-12 supplementation including:222324

Alzheimer's disease​, Angioplasty (opening narrowed/blocked arteries), Breast cancer, Canker sores, Cardiovascular disease/hyperhomocysteinemia, Cervical cancer, Claudication (leg pain from clogged arteries), Depression, Diabetic neuropathy (nerve damage), Diagnostic procedure, Facial spasm, Fatigue, Fractures (prevention), High cholesterol, Imerslund-Grasbeck disease, Joint pain (elbow), Mental performance, Poisoning (cyanide), Shaky-leg syndrome, Sickle cell disease, Sleep disorders (circadian rhythm)

Vitamin B-12 Sources and Treatments

Vitamin B-12 is necessary to produce an adequate amount of healthy red blood cells in the bone marrow, is available only in animal foods (meat and dairy products) or yeast extracts (such as brewer’s yeast). Vitamin B-12 is a water-soluble vitamin, which means it easily dissolves in water and is paradoxically stored in the liver (making it a good source). It is eliminated from the body through the urine, typically between 24 and 72 hours after consumption, depending on how active a person is and the amount of fluids they take in. Due to the rapid rate with which the body processes Vitamin B-12 frequent supplementation is needed to address deficiencies.

The stomach acids that aid in the natural breakdown of food also breakdown vitamin B-12 pill supplements, the body will only absorb a small amount when ingested orally. In addition, as a person gets older the body’s ability to absorb B-12 through digestion continually decreases. In fact, many adults are completely unable to absorb B-12. Injections provide a direct and concentrated method of supplying the body with the vitamin B-12, and are of particular value to older populations when normal absorption rates decrease, even in the absence of pernicious anemia. The conventional way of fixing a vitamin B-12 deficiency has been through intramuscular injections.23

Research findings show ample evidence to reveal that injections of 1 to 2 milligrams per day can quickly correct deficiencies. It is not apparent whether smaller amounts, such as the 25 micrograms or so found in multivitamins, are sufficient to cure deficiencies. Such a claim is substantiated by the fact that although oral supplementation with vitamin B-12 is safe, efficient, and inexpensive most multi-vitamin pills contain 100-200 micrograms of the cyanocobalamin or methylcobalamin forms of B-12. Furthermore, many multivitamins cannot be chewed, which is important for their thorough absorption.

Routine B-12 injections at a dosage of 1 milligram per month also helps to lower homocysteine levels in the blood, thereby reducing the probability of heart diseases and strokes. A vitamin B-12 injection acts as a stimulant for energizing the body, through cobalamin, which transmits its “anti-stress” elements to the human body. For example, the recommended effective cure for chronic fatigue syndrome (CFS) is 6 to 7 milligram dose of vitamin B-12 intramuscular injection per week for 3 weeks.

Methionine Inositol Choline (MIC) Injections, also referred to as Lipotropic Injections, or Lipo Injections, are used to help release fat throughout the body by specifically targeting its primary fatty deposits. Lipotropic, or fat burning substances include: inositol, which helps the liver remove fat; choline, which distributes cholesterol and prevents it from getting deposited in one part of the body; and methionine, which is similar to inositol, but also amplifies the combination. Injections can be administered up to twice a week, and vitamin B-12 is purported by practitioners and users to help accelerate metabolic processes, while creating a greater feeling of overall energy. Since lipotropics directly aid in the breakdown of fatty tissue, and are also closely related to B vitamins, when used together, they are thought to intensify each others' effects and are usually injected together as part of the same treatment injection cycle.

How Lipotropic Injections Work

The amino acids that are injected into the body stimulate the liver into optimizing the process of metabolism. These injections boost the body’s metabolic power by providing a highly effective temporary increase of normal metabolic functions. As soon as the effect of these substances wears off, the body begins to gradually return to its normal metabolic rate. When administered in combination with a low-calorie diet and regular exercise, our lipotropic formulas can help your body to rid itself of fat, while simultaneously increasing your energy levels both via the fat released energy and the energy promoting properties of vitamin B-12. The formula used in the MIC Injection specially blends the following important ingredients:

Methionine - The "M" in MIC Injection, is an essential amino acid, which means that it is not synthesized in humans. This amino acid acts as a lipotropic agent which: assists in the breakdown of fats within the liver; helps to lower cholesterol thereby preventing excess fat buildup in the liver and throughout your body’s circulatory system; is helpful in preventing and relieving fatigue; and is useful in some cases of allergies by virtue of its ability to reduce histamine release.252627

One of the sulfur-containing amino acids (along with cysteine and cystine), methionine is important (essential) to many bodily functions and must be directly consumed through supplementation or methionine-containing proteins. Foods which contain high levels of methionine include cheese, eggs, fish, meats, spinach, potatoes, Brazil nuts, sesame seeds, and select other plant seeds. However, by injecting methionine into your muscles you can rapidly achieve high concentrations which many researchers and physicians believe results in more effective mobilization and elimination of abnormal fatty deposits. Other reported benefits of methionine include improvement of: liver disease; skin tone and elasticity; nails; hair; and cardiovascular and muscular functions, through its role in the production of creatine. It has also been used to treat premature ejaculation, chronic depression, pancreatitis, Parkinson’s disease, and AIDS myelopathy. More specifically, clinical research has clearly demonstrated methionine’s ability to “…strongly improve the alcohol-induced histological changes in the liver. Triglyceride content of the liver was found to decrease in a dose-dependent manner with increasing methionine ingestion.28

Inositol - The "I" in MIC Injection, is a B-vitamin that promotes: the health of cell structures and nerve synapses; aids in the metabolism of fats; helps reduce blood cholesterol; and participates in the action of serotonin, a neurotransmitter known to control mood and appetite.293031

Also known as myo-inositol, inositol is best described as a carbocyclic polyol, which forms the basis for many signaling and secondary messenger molecules. As such, it is involved in many biological processes, including the breakdown of fats, the reduction of serum cholesterol, serotonin activity modulation, gene expression, and insulin signal transduction. It is not considered a vitamin because your body is unable to synthesize it. However, it has been shown to be helpful for the treatment of depression, panic disorder, polycystic ovarian syndrome, and fatty liver. It also important for optimal brain function.3233

Inositol deficiency may manifest as symptoms of constipation, high cholesterol, vision problems, and hair loss. Although it is naturally found in certain foods such as nuts, beans (especially red beans and kidney beans), grains, cantaloupe melons, and oranges, it is more effective in breaking down fat when given as an intramuscular injection. 

Choline - The "C" in MIC Injection, is an essential nutrient that helps to support the liver in its processing and excretion of chemical waste products. Moreover, it is required for the transport and metabolism of fats and cholesterol, which is important for the healthy support of the endocrine, cardiovascular, and hepatic systems.

A few specific studies have clearly demonstrated:

Cyanocobalamin (Vitamin B-12) - This form of B-12 vitamin is used in our Lipo-B injection and plays a significant role in the replication of DNA, the normal functioning of the nervous system, and the formation of blood cells. The vitamin B-12 injection has been shown to provide these key benefits: boosts energy and overall metabolic rate; assists in the burning of stored body fat; detoxifies the body; increases red blood cell production; maintains a healthy liver; helps regulate sleep, mood, appetite and energy; works synergistically with other nutrients to improve health; and slows aging.394041

Vitamin B-12 is frequently used in combination with other B vitamins in a vitamin B-complex formulation. Important in DNA synthesis, vitamin B-12 is bound to the protein in food, and is released by stomach acids during digestion. Once released, B-12 combines with a substance called intrinsic factor (IF) before it is absorbed into the bloodstream. Essentially water-soluble this vitamin is commonly found in a variety of foods such as fish, shellfish, meat, eggs, and dairy products. Read more about Vitamin B-12 Injections.

L-Carnitine - Carnitine is an amino acid which is required for the transport and breakdown of body fat for the generation of metabolic energy. Studies show that oral L-Carnitine supplementation can decrease fat mass, preserve muscle during exercise, and reduce muscle fatigue.42 Further research over the last decade has shed new light on the importance of L-carnitine as a regulator of skeletal muscle fuel selection, which means it is needed to determine whether muscle tissue utilizes carbohydrates or fat for energy.43 When taken orally, L-Carnitine requires a high dose to promote fat tissue breakdown.4445 This is because only a fraction of carnitine is absorbed during oral digestion. When administered by injection, nutrients like L-Carnitine are completely absorbed by the body.