Culture-Negative Fibrinous Peritonitis in a Postpartum Female
Want To Slim Down? Change Your Lifestyle, Not Your Medication
The newer oral and injectable weight loss drugs that are sweeping the developed world seem at first glance to be the long-sought answer to the ever-growing crisis of an overweight and obese population. As a physician with over 40 years of experience with patients and their illnesses, I am confident that — except in selected cases — these drugs are not the best approach to this problem.
To understand the scope of the problem itself, we need to look at the facts. In our own country, the prevalence of individuals who are either overweight or obese (defined as a body mass index of greater than 25 and 30, respectively) is approaching 75%. The average adult male in the United States weighed 166 pounds in the 1960s. Today that number is 200 pounds. One in three American adults is prediabetic, and 80% of them do not even know it.
Ultra-processed food, which makes up about 58% of our diet, is leading us down a path of chronic illness and disability. This, combined with a populace that is more sedentary than at any time in history, is creating a population of people at higher risk of developing chronic cardiovascular, autoimmune, joint, respiratory, sleep-related, neoplastic (cancer) and other diseases that will severely strain our already overburdened health care system. Within the next 10 years, there will be more people over the age of 65 than under the age of 18 in this country. These older and sicker Americans will suffer further from the looming shortage of doctors, nurses and other health care workers, and, as we continue to throw money at the problem (about 20% of our yearly federal budget goes to health care), the situation will eventually become untenable.
Yet we cling to medications, instead of lifestyle changes, for the answer to our ills. Twenty percent of Americans take five or more prescription medications, and 85% are on at least one prescription medication. We are a heavily dosed populace.
Now that certain oral and injectable drugs have been shown to take weight off quickly and dramatically in a large number of patients, people can't seem to get enough of them. But do we really know the long-term ramifications of these agents? What does the science show?
These newer medications, like Jardiance (empagliflozin), Monjauro (tirzepatide), Ozempic and Wegovy (both semaglutide) were originally designed to help people with type 2 diabetes and related co-morbidities (concurrent illnesses). But then doctors began using them off-label to take weight off and then things really got hot for them. Patients, whether 15 or 150 pounds overweight, clamored for them. And therein lies the problem.
In patients who are significantly overweight and have co-existing cardiovascular illnesses, these drugs have been proven to be beneficial, as evidenced by a November article in The New England Journal of Medicine that revealed a reduction in cardiovascular-related deaths when patients used the drug semaglutide versus placebo.
But in patients who desire to lose a small or moderate amount of weight, is it really worth the risks that have emerged in recent studies? There have been reports, such as the one from October published in the Journal of the American Medical Association from The University of British Columbia. It linked GLP-1 agonists (Monjauro and Zepbound are in this class) to a nine times higher incidence of pancreatitis, an over four times the risk of bowel obstruction and a 3.67 times the risk of gastroparesis (stomach paralysis) when compared to using weight loss treatment bupropion and naltrexone.
Then there's the cost, which can run to about $1,200 a month for these agents and is often not covered by insurance. Combine this with the fact that many patients must remain on the drugs indefinitely, because the weight just comes back on with a vengeance if the drugs are stopped.
Unless we have a cultural change regarding how we eat, how we use (or don't use) our bodies, and the way we approach medication as a crutch for our poor habits, we will never make a dent in the poorer health outcomes we have despite spending more money on health care than many other Westernized countries combined. The coming shortage of doctors and nurses, along with spiraling health care spending, will force us to a reckoning that will shock many in the near future.
Dr. David Sherer (www.Drdavidsherer.Com) is a retired physician and writer. His latest book is "Hunger Hijack, How Your Eating Habits are Changing Your Brain and Making You Sick" (Armin Lear Press, April 2024)
How To Lose Weight If You Have HIV
Key pointsAs for anyone, it's important for people with HIV to maintain a healthy body weight. Being overweight or underweight can cause problems for your health.
Maintaining a healthy weight is about balancing the energy you take in and use up. If you consume more energy (calories) than you use, you're likely to gain weight. On the other hand, if you burn more calories than you eat, the chances are you'll lose weight.
After starting HIV treatment, you may gain some weight as your health improves. Some people gain quite a lot of weight after starting or changing treatment. (See Weight gain and HIV treatment research briefing for further details of what is known.) This weight gain may increase your risk of diabetes, heart disease or cancer. Maintaining a healthy weight limits your risk of developing these conditions, especially if you are older.
You may limit the amount of weight you gain by trying to eat a healthy balanced diet. Foods that are high in sugar, refined carbohydrates or fat will encourage weight gain. Instead, aim for half of each meal to be made from non-starchy vegetables such as greens, cauliflower, broccoli, tomatoes, onions, okra, and salad vegetables. To find out more about healthy eating, see the page on healthy eating for people living with HIV.
Finding the right balance over time allows you to achieve and maintain a healthy body weight. How and what you eat can help influence both your weight and the levels of fats and sugars in your blood.
Take part in Positive Fitness, our online fitness class for people living with HIV.
Your GP or HIV dietitian can help you to work out if your current body weight is healthy. You can also use an online calculator. Body mass index (BMI) is calculated to show whether you are underweight, normal weight, overweight or obese for someone of your height. A BMI between 25 and 29.9 is overweight. A BMI of 30 or above is obese and a body mass index above 40 is severely obese.
Your GP or HIV dietitian will also measure your waist line. Regardless of your BMI, you should try to lose weight if your waist is over 94cm (37 inches) for men or over 80cm (31.5 inches) for women. You're at very high risk of some serious health conditions if your waist is over 102cm (40 inches) for men or over 88cm (34.5 inches) for women. If this is the case, you definitely need to see a GP or dietitian.
This is because your risk of getting some health problems is affected by where you store your body fat, as well as by your weight.
People who carry more fat around the waist usually have increased fat deposits within the liver and pancreas. This leads to increased blood pressure and to increased levels of sugar and fats such as cholesterol in the blood. Losing weight around the middle results in reversal of excess fat deposits in the liver and pancreas and reduces your risk for stroke, heart attacks and diabetes. Losing just 5% of your body weight can reduce this health risk, although losing 10% will help significantly.
Basic steps towards weight lossIf you are overweight or obese there are some basic steps that you can follow to lose weight. These steps are the same for everyone, regardless of age or HIV status.
To get started, it will help you to know how much you are eating and how physically active you are in an average week. Keep a food and activity diary for a week.
You can download apps that can help track activity. Most smart phones come with activity monitors pre-loaded. Alternatively, you can wear an inexpensive pedometer to record how far you walk each day.
Get a weight loss plan. You can download a 12-week weight loss guide from the NHS website. The plan is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lb) each week by sticking to a daily calorie allowance.
Limit your calorie intake. For most taller people, this means sticking to a calorie limit of no more than 1900kcal a day, and 1400kcal for most shorter people. As we are all different, ideally see your HIV dietitian to have your own target calculated. A very low calorie diet (less than 1200 calories a day) should only be attempted after consultation with an HIV dietitian. Remember that some antiretroviral drugs need to be taken with food. Check which drugs need to be taken with food here.
Do physical exercise. Exercise increases the number of calories you burn and helps weight loss. Set yourself exercise goals and aim to increase the amount you do each week.
Glossary body mass index (BMI)Body mass index, or BMI, is a measure of body size. It combines a person's weight with their height. The BMI gives an idea of whether a person has the correct weight for their height. Below 18.5 is considered underweight; between 18.5 and 25 is normal; between 25 and 30 is overweight; and over 30 is obese. Many BMI calculators can be found on the internet.
diabetesA group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.
absorptionThe process (or rate) of a drug or other substances, such as food, entering the blood.
antiretroviral (ARV)A substance that acts against retroviruses such as HIV. There are several classes of antiretrovirals, which are defined by what step of viral replication they target: nucleoside reverse transcriptase inhibitors; non-nucleoside reverse transcriptase inhibitors; protease inhibitors; entry inhibitors; integrase (strand transfer) inhibitors.
drug interactionA risky combination of drugs, when drug A interferes with the functioning of drug B. Blood levels of the drug may be lowered or raised, potentially interfering with effectiveness or making side-effects worse. Also known as a drug-drug interaction.
Aim for 30 minutes of moderate intensity physical activity such as brisk walking, cycling, gardening, dancing or swimming, five times a week. Moderate intensity exercise raises your heart and breathing rate. Alternatively, aim for 75 minutes of high intensity exercise such as running or circuit training each week. High intensity exercise should make you breathe hard and your heart beat fast.
Some form of strength exercise twice a week will also help you lose weight. Lifting weights or carrying shopping bags for a distance count as strength exercise.
Your GP can refer you for exercise on prescription or to a local weight loss group.
Weight gain and pregnancyIt is normal to gain weight during pregnancy. Most women begin to lose some of this weight within a few months of having their baby. It is unclear if women who start HIV treatment during pregnancy gain more weight than other women. We don't know if women already on HIV treatment when they become pregnant gain more weight than other women.
If you have a high body weight and you plan to have a baby, you will be encouraged to lose weight before becoming pregnant. Losing weight before becoming pregnant will benefit you and your baby, reducing the risk of complications during pregnancy and at the time of birth. Women who are obese are at higher risk of developing diabetes or high blood pressure during pregnancy.
Dieting during pregnancy or while you are breastfeeding is not recommended.
Medicine to help you lose weightYour doctor may prescribe you a medicine called orlistat if diet and exercise don't help you to lose weight and you have a BMI over 30 (or over 28 and diabetes or hypertension). A lower dose version of orlistat called Alli can be bought over the counter without a prescription.
Orlistat promotes weight loss by blocking fat absorption in the gut. It blocks absorption of about 30% of the fat you eat. Orlistat should be used with a balanced low-fat diet and exercise. Orlistat is not suitable for pregnant or breastfeeding women.
Orlistat is a short-term treatment and use for more than 12 months is rarely recommended.
It has not been studied as a weight loss aid in people living with HIV. There is a potential for a drug interaction that reduces levels of HIV drugs in the blood, leading to viral rebound. Orlistat should be taken 4-5 hours apart from antiretrovirals to avoid this risk.
Several other medicines to promote weight loss are not yet approved for prescription in the United Kingdom. Further evidence of effectiveness and value for money is needed before liraglutide (Saxenda) or naltrexone/bupoprion (Mysimba) could be offered by the NHS.
Changing HIV treatmentSome people put on weight after starting HIV treatment. However, there is no evidence that changing your HIV medication results in weight loss after weight gain. More research is needed to understand if specific antiretrovirals cause weight gain and if switching treatment has any effect on body weight. There's more information on another page.
Weight loss surgeryIf all other methods of weight loss have not worked and you are severely obese (BMI of at least 40, or 35 if you have a weight-related health condition, such as type 2 diabetes or high blood pressure), weight loss surgery may be an option. If weight loss surgery is suggested to you, it is because your weight places you at high risk of serious illness and shortened life.
Surgery to support weight loss is called bariatric surgery. Surgery may reduce the size of the stomach so that you feel full quicker or limit the absorption of calories from food. Bariatric surgery may lead to weight loss of 15 to 20% and weight loss is maintained when combined with exercise and a balanced diet.
Research suggests that people with HIV get the same benefits from bariatric surgery as everyone else and do not suffer a higher rate of complications. Bariatric surgery may lead to less absorption of antiretrovirals and more research is needed to understand its effects on drug absorption. You may need to take your antiretrovirals in a liquid formulation for a short time following surgery.
There's more information on the NHS website.
Hims Weight Loss Programs For Men Reviewed – What Are The Latest Customer Results Saying?
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Have you been questioning your physical abilities lately? As a man, do you feel your current workout routine isn't doing anything to sculpt your physique, let alone help shed pounds? Often, weight loss is a journey associated with women, and society has neglected to see whether men also require assistance. Most advice comes from the fitness community, where men generally believe going on a heavy bulk and then cutting will help them reach their goals. And, as most of us have seen on social media, the food that goes into the body during a bulk is far from healthy. This makes us wonder whether weight loss is one-size-fits-all for men.
One team that advocates quality, affordable care for all does not believe so. This team, offering necessary supplementary care, argues that the missing link in men's weight loss programs is the "right things" that are usually neglected. What are the right things? This is probably a good time to introduce Hims and their weight-loss programs for men.
What is Hims?Hims is a 100% telehealth company on a mission to normalize health and wellness challenges. This team acknowledges that no two people are the same and started this endeavor to offer personalized solutions. As per this team, their mission is personal, as each member is a customer in one way or another, adding that "this is the enduring power of Hims [and] Hers." For the longest time, dietary supplements, weight management programs, and other gaps needing filling were all developed with women's health in mind. Hims was introduced to the world to serve as the shoulder that men across America can lean on. Here are a few words from the Hims team on their journey and approach to wellness:
"We believe how you feel in your body and mind transforms your appearance. That's why we're building a future where nothing stands in the way of harnessing this power."
One thing that might be standing in the way of men's ability to harness their power is weight loss difficulties. So, how does Hims plan to help men overcome this hurdle? The following section will cover their personalized weight loss programs in detail.
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How do I get started with Hims weight loss programs?To get started with Hims, men are instructed to complete an assessment. This will help their medical professionals assess each individual's health history, lifestyle choices, health goals, and eligibility for the Hims weight loss programs. The right program includes prescribed weight-loss medication and a holistic meal plan, with free shipping for all prescriptions. Video or audio consultations are available if required by a specific state. This brings us to the possible options for prescription medications.
What is the Hims app?Individuals who would like quick access to their weight loss program and everything that comes with each program might want to consider downloading the Hims app. Currently, the app is available for iOS download in the Apple App Store. Here's a quick rundown of what individuals will find as they navigate the Hims app:
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What types of weight-loss kits are currently available through Hims?Hims currently offers five different medication kits. Listed below is a general overview of each one. The precise dosage of each component will undoubtedly vary from person to person. The purpose of this overview is to provide a sense of what men can expect in terms of medication intake.
Medication Kit 1The first medication kit consists of Metformin, Bupropion and Naltrexone, Topiramate, and Vitamin B12. Metformin is a type of prescription drug explicitly developed to treat high blood sugar levels caused by type 2 diabetes. It works by reducing the amount of glucose that the liver produces, decreasing how much glucose is absorbed by the body, and increasing the effect of insulin on the body. The latter is imperative for ensuring that glucose is efficiently utilized by our cells, tissues, and organs, lowering blood sugar levels. To add to the list of benefits, the Hims team claims to have selected Metformin for its ability to reduce cravings, which might promote weight loss.
The next duo is Bupropion and Naltrexone, where the former is an antidepressant medication, and the latter blocks the effects of opioids in people with addiction problems. The one thing that this duo has in common is their ability to suppress hunger pangs and random cravings. As a result, this duo is poised to help with weight management. Following suit, we have Topiramate, a medication intended mainly to treat epilepsy by managing manic seizures. In terms of weight management, this drug has been demonstrated in clinical studies to lower weight.
It works by changing the reward pathway associated with food, lowering leptin and blood sugar levels, and increasing the production of lipoprotein lipase. Furthermore, it might reduce the baseline BMP and improve glycemic control in obese people. This led the researchers to conclude that Topiramate has promising weight-loss effects; however, more research is still needed to understand its mechanism. To wrap up this kit, the Hims team is also throwing in vitamin B12, which they insist is essential for overall human health and to protect against deficiencies.
The rest of the kits are different combinations of the five components:
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How much does it cost to get started on Hims weight loss programs?To get started on the Hims weight loss programs, individuals will pay up to $79 per month. This does not include the medication. The exact breakdown is currently unavailable.
Q: Why do I have to complete the Hims weight loss assessment?
A: According to the Hims team, willpower is just one part of the equation for weight loss results. The other consists of the "right things," which can be broken down into underlying factors such as genetics and hormones. These are unique to each person and could serve as sources of setbacks. The Hims online assessment aims to identify the root causes of slowed weight loss results by asking a series of questions. This also allows medical specialists to determine one's eligibility for Hims' prescription-based weight loss programs.
Q: What types of questions will I be asked in the Hims weight loss assessment?
A: The Hims weight loss assessment asks questions about one's age, sex at birth, gender, height, and weight, state of residence, experience with weight loss plans, family history of weight management, weight distribution, relationship with food, and a series of factors that might limit weight loss success (e.G., stress levels, sleep quality, and cravings and hunger pangs).
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Q: Who should avoid Metformin altogether?
A: Metformin is not suitable for people with kidney problems, who are about to get an injection of dye or contrast agents for an x-ray, or who are about to get surgery.
Q: What are the side effects of Metformin?
A: Common side effects of Metformin include nausea, diarrhea, and an upset stomach.
Q: When should I stop taking Metformin?
A: If individuals start feeling weak and tired, have unusual muscle pain, have trouble breathing, or are experiencing unusual sleep patterns, diarrhea, or dizziness, then the Hims medical professional must be informed immediately, and the medication should be stopped until further notice.
Q: Who is at risk of developing lactic acidosis?
A: One of the more serious side effects of taking Metformin is the risk of developing lactic acidosis. This is more likely in people with kidney problems, liver problems, congestive heart failure, are prone to getting dehydrated, have a heart-related illness, are about to undergo surgery, or are 80 years of age or older.
Q: What do Hims medical professionals need to know before taking Metformin?
A: Once again, the Hims medical professionals need to know each individual's complete medical history. Metformin is not recommended for people with type 1 diabetes, a history of diabetic ketoacidosis, or who have kidney, liver, or heart problems.
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Q: Who should avoid Bupropion?
A: Bupropion is not suitable for people with a history of a seizure disorder or epilepsy, eating disorders, are addicted to alcohol, take a monoamine oxidase inhibitor (MAOI), or are allergic to any ingredients in this prescription drug. Like in the case of Metformin, this medication is not intended for people with kidney and liver problems, who take insulin or other medications to control blood sugar, or who have had a head injury, among other conditions.
Q: What are the side effects of Bupropion and Naltrexone?
A: Common side effects of Bupropion and Naltrexone include trouble sleeping, feelings of anxiousness, and nausea and vomiting, respectively.
Q: What should I know about taking Bupropion?
A: Bupropion might increase the odds of experiencing seizures, high blood pressure, manic episodes, unusual thoughts or behaviors, visual problems, and skin-related effects.
Q: What are the side effects of Topiramate?
A: Common side effects of Topiramate include a tingling sensation in the arms and legs, a change in taste, difficulty sleeping, memory problems, kidney stones, and impacted alertness.
Q: What else is included in the Hims weight loss programs?
A: Besides the medication kit, the Hims weight loss programs include access to customized lessons and recipe ideas, which this team pledges are evidence-based and hand-selected for each individual's weight loss profile. Hims also provides a simple tool that reminds everyone to take their medications and log their sleep, movement, water intake, and nutrition.
Q: What type of support can I expect from the Hims team?
A: The Hims team will conduct regular follow-ups to assess individuals' feelings and determine whether they are progressing toward their goals. Should individuals have any questions or concerns, a medical professional will always be available for chat via unlimited provider messaging. This must be available during their hours of operation, and customer support must confirm this.
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Q: Who are the Hims medical professionals?
A: Hims team of medical professionals is comprised of industry-leading, board-licensed physician advisors and healthcare providers who value "safe, high-quality, evidence-based treatment and care," argues the team. They are all licensed to provide service in all 50 states and DC. Most of all, they have experience with men's healthcare, which is imperative. They even have an extensive medical advisory board with experts on urology, dermatology, obesity medicine, dermatology, gastroenterology and digestive health, menopause and primary care, psychology and sex therapy, and cardiometabolics.
Q: How long will it take for Hims shipments to arrive?
A: According to the team, delivery times vary based on the shipping carrier and destination. To keep everyone in the loop, the Hims team will email a link to track their respective packages.
Q: Does Hims offer money-back guarantees?
A: Due to the nature of their products and services, Hims does not accommodate returns.
Q: How do I get in touch with the Hims team?
A: At the time of writing, the only way to contact the Hims team is through their chat bubble at the bottom left of the official website.
Final VerdictUltimately, the Hims Weight Loss Programs are tailored specifically for men's health. It consists of prescription medication, healthy eating habits, and possibly exercise components. According to the Hims team, as much as motivation and willpower matter, so do genetics and hormones. No plan can directly influence one's genetics; however, it can be accounted for in a plan. Knowing that there is a family history of a particular condition that affects weight loss progress allows individuals to understand their effects and see whether medication can come in handy.
A lack of balance in hormones can also negatively impact results, which will either need to be controlled using prescription medications or a proper diet. Put differently, the Hims Weight Loss Programs aim to find a method that works individually, making each program as unique as possible for maximum results. Initially, our editorial team assumed that the prescription component focused on the administration of Ozempic, but this doesn't appear to be the case. Instead, their medication kits include prescription medications known to regulate blood sugar levels, suppress hunger and cravings, directly influence weight and body fat percentage, and promote overall well-being.
This strategy is more comforting because most of their selected medications have been around for a long time, with strong clinical evidence for their effectiveness. This is not to say that side effects aren't possible, but at least we know most of them. This can help the Hims healthcare providers assess results and any potential issues that might arise along the way and make recommendations or changes to prescriptions as required. Speaking of medical professionals, Hims invested heavily in board-licensed physicians with a wide range of health expertise, especially emphasizing men's health.
Our editorial team was equally impressed by their medical advisory board and executives, all of whom contribute to Hims' clinical excellence. If this wasn't enough, each of their Savoir Faire blogs serves as an educational resource for those seeking more clarity on their respective health goals. These blogs, backed by science, have been reviewed by a medical expert on the team to ensure that there is no misinformation or deception, another reassuring point to be mindful of. How can anyone overlook the mere fact that there is now a prescription-based weight loss program that factors in men's health? For these reasons, we see value in the Hims Weight Loss Program.
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The news and editorial staff of the Santa Cruz Sentinel had no role in this post's preparation. This is a paid advertisement and does not necessarily reflect the official policy or position of the Santa Cruz Sentinel, its employees, or subsidiaries.
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