hCG Weight Loss Programs: What Is the Evidence?
Andrew Kaunitz, MD
Hello, I'm Andrew Kaunitz, Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville, Florida. Today I'd like to discuss hCG Weight Loss Programs: What Is the Evidence?
On a regular basis, patients are asking me about human chorionic gonadotropin (hCG) weight loss programs. Not being familiar with this, I looked into hCG as used in weight loss programs.
It turns out that the use of hCG for the treatment of obese and overweight patients has a long and controversial history. In the 1950s, a Dr. A. Simeons introduced the use of hCG injections combined with a strict 500-calorie-a-day, high-protein diet.[1]
By the 1970s, Simeons' method had become popular among those seeking weight loss, with advocates claiming that this approach indeed induced rapid weight loss with minimal hunger. While the program appeared to work, this approach to dieting fell out of favor after clinical trials noted that weight loss occurred because of the strict diet, not because of the hCG injections. A 1995 meta-analysis concluded that "...there is no scientific evidence that hCG is effective in the treatment of obesity..."[2]
Notwithstanding the lack of evidence supporting hCG's efficacy,[3] for profit weight loss programs are once again promoting hCG injections. A Google search turned up a number of programs advertising hCG-based weight loss right here in Jacksonville, as well as more than 7 million hits overall.
In a 2010 press release, the American Society of Bariatric Physicians indicates that it is "...officially not recommending..." hCG injections for weight loss, once again pointing to numerous studies that fail to demonstrate efficacy.[4,5]
This press release goes on to point out that the pillars of an effective approach to weight loss include:
* Diet modification based on safe caloric and nutrient guidelines;
* Exercise programs tailored to the capabilities and limitations of the patient; and
* Behavioral counseling, including development of proper eating habits, how to deal with stress-related eating, and how to address the diet and lifestyle of the whole family.
Seems like sound advice to me. Thank you.
My comment: A lot of my clients have paid no less than RM3000 for a month of hCG jabs to various clinics around Kuala Lumpur. Sure, they've lost weight, one even lost 10 kg in that month. It just goes to show that when you have someone nagging you to eat no more than 500 calories a day, you'll lose enough weight to model in Oprah's show.
Wow, if I implement this programme in my clinic, I could make a name as a weight loss guru & get me that BMW I always wanted. Ka-Ching!!
Wednesday, May 25, 2011
Sunday, May 22, 2011
Medical advice v. sales talk
I have copied & pasted something I wrote on this blog in September 2009 below as a reminder to new visitors to my clinic. My sentiments haven't changed. It still saddens me to see a lot of people who would rather get "free" consultation from a "consultant" who gets a 30-50% commission on successful referrals (to more often than not, dubious unregistered surgeons) than pay RM30 for decent medical advice from a registered doctor. Sales talk is free. Medical advice from a registered medical practitioner does cost a little bit of money - it might save you thousands in the long run. Do go to September 2009 of this blog for related stories.
Cosmetic medicine trade - story of friends & unscrupulous middlemen
NB: names have been changed to protect the privacy of the people involved.
Alice had just turned 50 & developed pigmentation she was desperate to get rid of. In her vulnerable state of feeling old & ugly (not uncommon with hormonal fluxes during the peri-menopausal period), she fell victim to a "friend" who pretended to do her a favour by introducing her to another friend (let's call her Meegan) who could introduce a doctor "highly skilled in removing pigmentation".
Alice was so happy to find a friend who would unselfishly introduce a good doctor to solve her problem, she immediately signed up for a RM800 "PRP/Fxl" treatment. However, after the RM800 treatment, her pigmentation was still there, as stubborn as ever.
She called the doctor to ask further but the good doctor was too busy. Instead, she got a call from Meegan. Meegan told Alice that the RM800 treatment was to "prepare her skin" for the superior SuperR (name changed) laser treatment that would remove all types of pigmentation & the cost would be RM3000 for a course of 6 sessions. Alice balked at the thought of spending so much beyond her initial budget but she was persuaded by Meegan & the good doctor that SuperR was the magic laser that removes all pigmentation & that there were only 3 such lasers in the whole of Malaysia. Alice was already uncomfortable with the idea of spending more but since SuperR was the latest & best laser, she argued that she wanted to pay half 1st i.e. RM1500 since she did not see any results so far.
After the 1st session of SuperR laser, she went back to the doctor complaining that she still did not see any improvement in her pigmentation. During this 2nd consultation, there appeared to be 3 consultants, namely 1) Dr. Mickey himself 2) Karlos, the laser salesman & 3) Meegan, the friend who introduced. All 3 of them insisted that the pigmentation had lightened so Alice was outnumbered in her opinion. However, Dr. Mickey's naive clinic nurse walked in & commented that there was no improvement in Alice's pigmentation at all. The nurse got some "if looks could kill" stares but Alice had no choice but to proceed with the 2nd laser treatment. During the laser treatment, Dr. Mickey was receiving instructions from Karlos about what laser settings to use. At the time she said she felt uncomfortable with the whole situation but with 3 consultants hovering around in the treatment room, it was 3 against 1.
A week after the 2nd laser session, she found that to her horror, the pigmentation had actually got worse & she frantically tried to contact Dr. Mickey but the clinic nurse told her to call Meegan instead. She did not want to talk to Meegan but Dr. Mickey was uncontactable as well. Anyway, she received a call from Meegan who lashed out at her telling her she was an unreasonable client who complained too much & therefore Alice was no longer wanted as a client. As for the 3rd prepaid laser session, Meegan told her that the doctor had gone 2 rounds on her face during her 2nd laser visit so she was not entitled to any refund or further laser sessions.
At that point in time, Alice was referred to me by another client of mine.
This story ends here. Why am I telling this story & risking backlash from my own kind in my industry? I'm doing it to remind the consumer of the bad apples in this industry. And it's also an appeal to those in my industry & a reminder to myself that we're practising cosmetic medicine here - ultimately, it is still medicine & as doctors we're duty bound to look out for our patients, not rob clients of their wallets. We don't need laser salesmen & middlemen to interfere in our medical practice. If patients are losing trust in doctors, I don't blame them.
Cosmetic medicine is in huge demand & many non-medical entrepreneurs have jumped on the bandwagon to profit from this industry. I'm not saying free enterprise is bad, in fact, I encourage it BUT one should not profit through lies & deceit. For example, there is no such thing as "preparing skin for SuperR laser with a Frxel laser". If one wants to make money from another laser procedure then please just tell the client directly the benefits of that particular laser. Consumers want to look beautiful & are willing to pay top dollar for it - there is no need to pull the wool over their eyes.
As for friends who want to profit from their friends by making referrals, please tell the truth. There is nothing wrong with making a living but don't pretend to be doing it as a good Samaritan. If you are doing it as a business & receiving a commission - just please tell the truth.
As for marketing middlemen in the industry - do it ethically - don't go around recruiting people to lie to their friends & relatives.
As for consumers who don't want to pay doctors' consultation fees - Think for yourself if it's worthwhile saving $30 & falling into the traps of "friends" who will ultimately make you part with thousands you can't afford. Just as an example, Alice probably only needed to spend a few hundred on her pigmentation, instead she is already out-of-pocket $2300 & to make matters worse, her pigmentation is actually darker than when she first started with.
I'm just fed-up with the direction this industry is heading. As I've said before, much financial reward can be reaped in this industry but I know that it can be done in an ethical manner. Don't let bad apples tarnish the image of those who practise it ethically.
Cosmetic medicine trade - story of friends & unscrupulous middlemen
NB: names have been changed to protect the privacy of the people involved.
Alice had just turned 50 & developed pigmentation she was desperate to get rid of. In her vulnerable state of feeling old & ugly (not uncommon with hormonal fluxes during the peri-menopausal period), she fell victim to a "friend" who pretended to do her a favour by introducing her to another friend (let's call her Meegan) who could introduce a doctor "highly skilled in removing pigmentation".
Alice was so happy to find a friend who would unselfishly introduce a good doctor to solve her problem, she immediately signed up for a RM800 "PRP/Fxl" treatment. However, after the RM800 treatment, her pigmentation was still there, as stubborn as ever.
She called the doctor to ask further but the good doctor was too busy. Instead, she got a call from Meegan. Meegan told Alice that the RM800 treatment was to "prepare her skin" for the superior SuperR (name changed) laser treatment that would remove all types of pigmentation & the cost would be RM3000 for a course of 6 sessions. Alice balked at the thought of spending so much beyond her initial budget but she was persuaded by Meegan & the good doctor that SuperR was the magic laser that removes all pigmentation & that there were only 3 such lasers in the whole of Malaysia. Alice was already uncomfortable with the idea of spending more but since SuperR was the latest & best laser, she argued that she wanted to pay half 1st i.e. RM1500 since she did not see any results so far.
After the 1st session of SuperR laser, she went back to the doctor complaining that she still did not see any improvement in her pigmentation. During this 2nd consultation, there appeared to be 3 consultants, namely 1) Dr. Mickey himself 2) Karlos, the laser salesman & 3) Meegan, the friend who introduced. All 3 of them insisted that the pigmentation had lightened so Alice was outnumbered in her opinion. However, Dr. Mickey's naive clinic nurse walked in & commented that there was no improvement in Alice's pigmentation at all. The nurse got some "if looks could kill" stares but Alice had no choice but to proceed with the 2nd laser treatment. During the laser treatment, Dr. Mickey was receiving instructions from Karlos about what laser settings to use. At the time she said she felt uncomfortable with the whole situation but with 3 consultants hovering around in the treatment room, it was 3 against 1.
A week after the 2nd laser session, she found that to her horror, the pigmentation had actually got worse & she frantically tried to contact Dr. Mickey but the clinic nurse told her to call Meegan instead. She did not want to talk to Meegan but Dr. Mickey was uncontactable as well. Anyway, she received a call from Meegan who lashed out at her telling her she was an unreasonable client who complained too much & therefore Alice was no longer wanted as a client. As for the 3rd prepaid laser session, Meegan told her that the doctor had gone 2 rounds on her face during her 2nd laser visit so she was not entitled to any refund or further laser sessions.
At that point in time, Alice was referred to me by another client of mine.
This story ends here. Why am I telling this story & risking backlash from my own kind in my industry? I'm doing it to remind the consumer of the bad apples in this industry. And it's also an appeal to those in my industry & a reminder to myself that we're practising cosmetic medicine here - ultimately, it is still medicine & as doctors we're duty bound to look out for our patients, not rob clients of their wallets. We don't need laser salesmen & middlemen to interfere in our medical practice. If patients are losing trust in doctors, I don't blame them.
Cosmetic medicine is in huge demand & many non-medical entrepreneurs have jumped on the bandwagon to profit from this industry. I'm not saying free enterprise is bad, in fact, I encourage it BUT one should not profit through lies & deceit. For example, there is no such thing as "preparing skin for SuperR laser with a Frxel laser". If one wants to make money from another laser procedure then please just tell the client directly the benefits of that particular laser. Consumers want to look beautiful & are willing to pay top dollar for it - there is no need to pull the wool over their eyes.
As for friends who want to profit from their friends by making referrals, please tell the truth. There is nothing wrong with making a living but don't pretend to be doing it as a good Samaritan. If you are doing it as a business & receiving a commission - just please tell the truth.
As for marketing middlemen in the industry - do it ethically - don't go around recruiting people to lie to their friends & relatives.
As for consumers who don't want to pay doctors' consultation fees - Think for yourself if it's worthwhile saving $30 & falling into the traps of "friends" who will ultimately make you part with thousands you can't afford. Just as an example, Alice probably only needed to spend a few hundred on her pigmentation, instead she is already out-of-pocket $2300 & to make matters worse, her pigmentation is actually darker than when she first started with.
I'm just fed-up with the direction this industry is heading. As I've said before, much financial reward can be reaped in this industry but I know that it can be done in an ethical manner. Don't let bad apples tarnish the image of those who practise it ethically.
Monday, May 16, 2011
Liposuctioned hip fat returns to belly
Publish date: May 12, 2011
By: Bill Gillette
Source: Cosmetic Surgery Times E-News
Denver — Women who undergo liposuction on their hips are likely to see the fat return — this time to the belly — within a year, Medical News Today reports.
Researchers at the University of Colorado, Denver, conducted a randomized, controlled trial of liposuction in 32 non-obese healthy women with disproportionate distribution of body fat, mostly in the lower abdomen, hips or thighs. After various measurements were taken, the women were randomly assigned to one of two groups — one of 14 women who underwent small-volume liposuction within two to four weeks; the other of those who were offered liposuction after the study was completed.
Measurements were taken again at six weeks, six months and 12 months afterward. Investigators found, among other things, that after a year, the thigh region of the liposuction participants remained reduced, but fat accumulated in the abdominal region, compared with those in the control group.
Researchers concluded that after liposuction, body fat “was restored and redistributed from the thigh to the abdomen.”
The authors noted that despite being informed of the study’s results, more than half of the women in the control group chose to have liposuction after the study was completed.
The study appeared online in the journal Obesity.
By: Bill Gillette
Source: Cosmetic Surgery Times E-News
Denver — Women who undergo liposuction on their hips are likely to see the fat return — this time to the belly — within a year, Medical News Today reports.
Researchers at the University of Colorado, Denver, conducted a randomized, controlled trial of liposuction in 32 non-obese healthy women with disproportionate distribution of body fat, mostly in the lower abdomen, hips or thighs. After various measurements were taken, the women were randomly assigned to one of two groups — one of 14 women who underwent small-volume liposuction within two to four weeks; the other of those who were offered liposuction after the study was completed.
Measurements were taken again at six weeks, six months and 12 months afterward. Investigators found, among other things, that after a year, the thigh region of the liposuction participants remained reduced, but fat accumulated in the abdominal region, compared with those in the control group.
Researchers concluded that after liposuction, body fat “was restored and redistributed from the thigh to the abdomen.”
The authors noted that despite being informed of the study’s results, more than half of the women in the control group chose to have liposuction after the study was completed.
The study appeared online in the journal Obesity.
Evidence for stem cells still 'limited'
Publish date: May 12, 2011
By: Bill Gillette
Source: Cosmetic Surgery Times E-News
Boston — Scientific evidence for the safety or efficacy of stem cell therapies in aesthetic medicine is very limited, and marketing is pushing too far ahead, according to a joint statement issued this week by two leading plastic surgery associations.
A joint task force of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released the position statement during the ASAPS Aesthetic Meeting 2011.
The task force said the conclusion was based on a systematic review of the peer-reviewed literature.
Led by plastic surgeon and stem cell expert J. Peter Rubin, M.D., of the University of Pittsburgh, the task force was convened to address concerns in the plastic surgery community about advertising claims and clinical practices that have not been substantiated by scientific evidence.
“There are encouraging data from laboratory and clinical studies to suggest that the use of adult stem cells is a very promising field,” Dr. Rubin said in the statement, “but as our comprehensive review of the current scientific literature shows, the data available today do not substantiate the marketing claims being made to patients seeking aesthetic surgery and aesthetic medical treatments.”
Recommendations and statements of the task force to ASAPS and ASPS members and patients include:
• Terms such as “stem cell therapy” and “stem cell procedure” should only be used to describe treatments or techniques where the collection, concentration, manipulation or therapeutic action of stem cells is the primary goal, rather than a passive result, of the treatment.
• The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time.
• While stem cell therapies have the potential to be beneficial for a variety of medical applications, a substantial body of clinical data to assess plastic surgery applications still needs to be collected. Until further evidence is available, stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval, including compliance with all guidelines for human medical studies.
By: Bill Gillette
Source: Cosmetic Surgery Times E-News
Boston — Scientific evidence for the safety or efficacy of stem cell therapies in aesthetic medicine is very limited, and marketing is pushing too far ahead, according to a joint statement issued this week by two leading plastic surgery associations.
A joint task force of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released the position statement during the ASAPS Aesthetic Meeting 2011.
The task force said the conclusion was based on a systematic review of the peer-reviewed literature.
Led by plastic surgeon and stem cell expert J. Peter Rubin, M.D., of the University of Pittsburgh, the task force was convened to address concerns in the plastic surgery community about advertising claims and clinical practices that have not been substantiated by scientific evidence.
“There are encouraging data from laboratory and clinical studies to suggest that the use of adult stem cells is a very promising field,” Dr. Rubin said in the statement, “but as our comprehensive review of the current scientific literature shows, the data available today do not substantiate the marketing claims being made to patients seeking aesthetic surgery and aesthetic medical treatments.”
Recommendations and statements of the task force to ASAPS and ASPS members and patients include:
• Terms such as “stem cell therapy” and “stem cell procedure” should only be used to describe treatments or techniques where the collection, concentration, manipulation or therapeutic action of stem cells is the primary goal, rather than a passive result, of the treatment.
• The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time.
• While stem cell therapies have the potential to be beneficial for a variety of medical applications, a substantial body of clinical data to assess plastic surgery applications still needs to be collected. Until further evidence is available, stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval, including compliance with all guidelines for human medical studies.
Tuesday, May 3, 2011
Scientists turn "bad fat" into "good fat"
3 May 2011 Last updated at 16:24 GMT
Scientists turn 'bad fat' into 'good fat'
By Michelle Roberts Health reporter, BBC News
Scientists say they have found a way to turn body fat into a better type of fat that burns off calories and weight.
The US Johns Hopkins team made the breakthrough in rats but believe the same could be done in humans, offering the hope of a new way to treat obesity.
Modifying the expression of a protein linked to appetite not only reduced the animals' calorie intake and weight, but also transformed their fat composition.
"Bad" white fat became "good" brown fat, Cell Metabolism journal reports.
Brown fat is abundant in babies, which they use as a power source to generate body heat, expending calories at the same time.
But as we age our brown fat largely disappears and gets replaced by "bad" white fat, which typically sits as a spare tyre around the waist.
Experts have reasoned that stimulating the body to make more brown fat rather than white fat could be a helpful way to control weight and prevent obesity and its related health problems like type 2 diabetes.
Various teams have been searching for a way to do this, and Dr Sheng Bi and colleagues at the Johns Hopkins University School of Medicine believe they may have cracked it.
They designed an experiment to see if suppressing an appetite-stimulating protein called NPY would decrease body weight in rats.
When they silenced NPY in the brains of the rodents they found their appetite and food intake decreased.
Even when the rats were fed a very rich, high-fat diet they still managed to keep more weight off than rats who had fully functioning NPY.
The scientists then checked the fat composition of the rats and found an interesting change had occurred.
In the rats with silenced NPY expression, some of the bad white fat had been replaced with good brown fat.
The researchers are hopeful that it may be possible to achieve the same effect in people by injecting brown fat stem cells under the skin to burn white fat and stimulate weight loss.
Dr Bi said: "If we could get the human body to turn bad fat into good fat that burns calories instead of storing them, we could add a serious new tool to tackle the obesity epidemic.
"Only future research will tell us if that is possible."
Dr Jeremy Tomlinson, an expert at the University of Birmingham's Centre for Obesity Research, said: "This is exciting, novel and interesting.
"We will need a lot more work to tease this out, but it could offer a feasible way to develop new treatments for obesity."
Scientists turn 'bad fat' into 'good fat'
By Michelle Roberts Health reporter, BBC News
Scientists say they have found a way to turn body fat into a better type of fat that burns off calories and weight.
The US Johns Hopkins team made the breakthrough in rats but believe the same could be done in humans, offering the hope of a new way to treat obesity.
Modifying the expression of a protein linked to appetite not only reduced the animals' calorie intake and weight, but also transformed their fat composition.
"Bad" white fat became "good" brown fat, Cell Metabolism journal reports.
Brown fat is abundant in babies, which they use as a power source to generate body heat, expending calories at the same time.
But as we age our brown fat largely disappears and gets replaced by "bad" white fat, which typically sits as a spare tyre around the waist.
Experts have reasoned that stimulating the body to make more brown fat rather than white fat could be a helpful way to control weight and prevent obesity and its related health problems like type 2 diabetes.
Various teams have been searching for a way to do this, and Dr Sheng Bi and colleagues at the Johns Hopkins University School of Medicine believe they may have cracked it.
They designed an experiment to see if suppressing an appetite-stimulating protein called NPY would decrease body weight in rats.
When they silenced NPY in the brains of the rodents they found their appetite and food intake decreased.
Even when the rats were fed a very rich, high-fat diet they still managed to keep more weight off than rats who had fully functioning NPY.
The scientists then checked the fat composition of the rats and found an interesting change had occurred.
In the rats with silenced NPY expression, some of the bad white fat had been replaced with good brown fat.
The researchers are hopeful that it may be possible to achieve the same effect in people by injecting brown fat stem cells under the skin to burn white fat and stimulate weight loss.
Dr Bi said: "If we could get the human body to turn bad fat into good fat that burns calories instead of storing them, we could add a serious new tool to tackle the obesity epidemic.
"Only future research will tell us if that is possible."
Dr Jeremy Tomlinson, an expert at the University of Birmingham's Centre for Obesity Research, said: "This is exciting, novel and interesting.
"We will need a lot more work to tease this out, but it could offer a feasible way to develop new treatments for obesity."
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