Author: Paul Rivas, M.D.
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I read Dr. Rivas' books "Turn Off the Hunger Switch" and "Fat Nation, Skinny Pills" after I had gotten to a point in my career where I was questioning everything I had learned about nutrition in medical school. I had just finished my masters program, and was thinking about what type of job would be fulfilling for me. I couldn't see myself going back to the hamster wheel of primary care. I loved primary care in residency, but I wasn't fond of the "business" of medicine in the real world. I also knew that most of my patients in primary care needed to lose weight. Actually, many of them could stop their medications if they lost weight. I was also carrying an extra thirty pounds. I felt that the only way I could effectively help patients would be to help myself.
Rivas offered an idea that was controversial and wasn't covered in any medical school class I attended. He believed that obesity was a disease and should be treated like diabetes or hypertension in certain patients. This idea intrigued me because his book was written before the AMA declared obesity as a disease and before the FDA approved three weight loss medications for chronic use.
Moreover, he was advocating using appetite suppressing stimulants. Like most physicians, I rarely prescribed stimulants. Appetite suppressants are often frowned upon in the medical field because of the history of complications with prescription diet pills like Fen-Phen and Meridia. Despite the fact that Fenfluramine and Meridia were taken off the market, the fear has led medical professionals to condemn all medications labeled as "appetite suppressants" or "stimulants". The irony is that many of the appetite suppressants currently on the market have been available for over 50 years without enough concern to withdraw them from the market. We've seen many medications, like Vioxx, taken off the market when there was substantial cause for concern. Vioxx was on the market for approximately five years before it was withdrawn. Interestingly, the other members of the COX inhibitor family as a whole do not have the same stigma as weight loss drugs. Doctors continue to prescribe them. A partial explanation may be because weight loss is seen as something that can be accomplished if you aren't "weak-willed" or "lazy". Taking a medication to lose weight is viewed as cheating. No one blinks an eye at the number of children taking stimulants chronically for ADD or ADHD.
Rivas also wrote in "Turn Off the Hunger Switch" about the affect neurotransmitters have on appetite and cravings and how stimulants or supplements can alter these neurotransmitters. I had never heard this theory before. He explained the affects of three neurotransmitters in particular: dopamine, serotonin, and norepinephrine.
After finishing the book, I immediately started looking for research studies about the relationship between the neurotransmitters and appetite. They weren't hard to find with Dr. Google's assistance, but I was shocked that I had never learned this in my medical training.
I was still skeptical. I started perusing supplements online that would increase serotonin, dopamine, or norepinephrine. In particular serotonin, since I sometimes have a sweet tooth. I went to my local vitamin store and bought a supplement that was a precursor to serotonin to see if taking it would decrease my sugar cravings. My sugar cravings improved.
I was curious and ready to learn more. I decided to immerse myself in books on nutrition and weight loss. I also wanted to gain experience prescribing stimulants safely. Who better to work with than the man that wrote this book? I emailed Dr. Rivas and asked if he was hiring physicians. Three years later I've treated thousands of patients in his practice and learned a ton along the way. Dr. Rivas has definitely increased my understanding of prescription weight loss medications and my comfort prescribing them.
I continue to use stimulants with some of my patients. I consider them a useful tool, but I have found that many patients can often achieve their goals making lifestyle changes alone. Nutrition is definitely the cornerstone of weight loss and wellbeing.
Rivas offered an idea that was controversial and wasn't covered in any medical school class I attended. He believed that obesity was a disease and should be treated like diabetes or hypertension in certain patients. This idea intrigued me because his book was written before the AMA declared obesity as a disease and before the FDA approved three weight loss medications for chronic use.
Moreover, he was advocating using appetite suppressing stimulants. Like most physicians, I rarely prescribed stimulants. Appetite suppressants are often frowned upon in the medical field because of the history of complications with prescription diet pills like Fen-Phen and Meridia. Despite the fact that Fenfluramine and Meridia were taken off the market, the fear has led medical professionals to condemn all medications labeled as "appetite suppressants" or "stimulants". The irony is that many of the appetite suppressants currently on the market have been available for over 50 years without enough concern to withdraw them from the market. We've seen many medications, like Vioxx, taken off the market when there was substantial cause for concern. Vioxx was on the market for approximately five years before it was withdrawn. Interestingly, the other members of the COX inhibitor family as a whole do not have the same stigma as weight loss drugs. Doctors continue to prescribe them. A partial explanation may be because weight loss is seen as something that can be accomplished if you aren't "weak-willed" or "lazy". Taking a medication to lose weight is viewed as cheating. No one blinks an eye at the number of children taking stimulants chronically for ADD or ADHD.
Rivas also wrote in "Turn Off the Hunger Switch" about the affect neurotransmitters have on appetite and cravings and how stimulants or supplements can alter these neurotransmitters. I had never heard this theory before. He explained the affects of three neurotransmitters in particular: dopamine, serotonin, and norepinephrine.
After finishing the book, I immediately started looking for research studies about the relationship between the neurotransmitters and appetite. They weren't hard to find with Dr. Google's assistance, but I was shocked that I had never learned this in my medical training.
I was still skeptical. I started perusing supplements online that would increase serotonin, dopamine, or norepinephrine. In particular serotonin, since I sometimes have a sweet tooth. I went to my local vitamin store and bought a supplement that was a precursor to serotonin to see if taking it would decrease my sugar cravings. My sugar cravings improved.
I was curious and ready to learn more. I decided to immerse myself in books on nutrition and weight loss. I also wanted to gain experience prescribing stimulants safely. Who better to work with than the man that wrote this book? I emailed Dr. Rivas and asked if he was hiring physicians. Three years later I've treated thousands of patients in his practice and learned a ton along the way. Dr. Rivas has definitely increased my understanding of prescription weight loss medications and my comfort prescribing them.
I continue to use stimulants with some of my patients. I consider them a useful tool, but I have found that many patients can often achieve their goals making lifestyle changes alone. Nutrition is definitely the cornerstone of weight loss and wellbeing.
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