The Obesity-Diabetes Clinic

Anorexigenic Drugs in Perspective

“…In 60–70 per cent of women, a negative caloric intake well below that needed for maintenance; produces a reduction in scale‐weight for only the first few weeks or months (22, 23). Although the fat content of these women decreases, their retention of water counterbalances the fat loss, effectively masking it (23, 24). This metabolic abnormality, the cause of which is still unknown, is associated with the carbohydrate portion of the diet (25, 26).…”

Application of Newer Concepts in Diabetes*

“…In other words, latent, subclinical or even overt diabetes mellitus can be reversed through this means alone to the premellitic or prediabetic phase. It is the only treatment of diabetes which can produce a remission with any degree of consistency (24–27). The mechanism by which this is accomplished may be through the restoration of a state of compensation or sensitivity to impaired endogenous insulin action (10).…”

“…The clinical concept that the primary therapeutic target in the management of obesity‐diabetes is the obesity remains unaltered despite the reversal of obesity and diabetes as cause and effect. These patients should not be given oral hyperglycemic drugs until every effort to produce weight loss has been made for several weeks at least (23, 26) (Fig. 2) Immediate control is not urgent.…”

“…These drugs seem particularly useful in the obesity associated with diabetes (23, 26, 28) because this type of obesity appears to be mainly metabolic or genetic in origin and not based on psychogenic factors. In a recent clinical report it was suggested that the lower incidence of neurosis in the obese diabetic than in the obese nondiabetic is one of the reasons for attaining satisfactory weight loss in almost 80 per cent of that group of obese diabetics (26). Conversely, appetite suppressants are least effective in psychological obesity, notoriously the most difficult to treat and probably not as common as supposed.…”