Weight-Loss Medications

Weight-loss medications of any type are only appropriate for people with a BMI of 30 or above, or a BMI of 27 or above accompanied by weight-related medical conditions such as diabetes mellitus or hypertension. Amphetamine drugs were formerly prescribed to combat obesity, but their well-documented side effects, including insomnia, anxiety, and tolerance (the need to take higher and higher doses to continue to produce the same effect), made them less popular by the late 1970s.

A renewed scientific and commercial interest in weight-loss medications was prompted by the approval by the Food and Drug Administration (FDA) of the appetite suppressant dexfenfluramine (sold under the brand name Redux) in 1996. Dexfenfluramine was the first weight-loss medication approved in the United States in over 20 years and the first ever approved for maintaining weight loss. Although never approved for long-term use by the FDA, a combination of two drugs, phentermine and fenfluramine, or phentermine and dexflenfluramine, popularly known as fen-phen, was used by millions of Americans to promote weight loss. Fenfluramine and dexfenfluramine were eventually associated with valvular heart disease, and the manufacturer withdrew these medications from the marketplace in 1997.

The FDA has approved two medications, sibutramine and orlistat, for long-term use in the treatment of obesity. Sibutramine (sold under the brand name Meridia) increases fullness, making the required dietary changes for weight loss and the maintenance of weight loss easier to accomplish. Unlike dexfenfluramine and fenfluramine, sibutramine does not appear to be associated with valvular heart disease, although a small number of patients may develop significant increases in blood pressure. Orlistat (sold under the brand name Xenical) works by blocking the absorption of fat. Scientists are also investigating the hormone leptin, which plays a role in obesity in mice, as a possible treatment for obesity in humans.

Over a six-month period, weight-loss medications may result in a 10-percent body weight reduction. Weight loss slows or stops after six months, and discontinuing medication usually causes weight regain. The continued use of medications keeps most of the lost weight from returning for two years. Many experts recommend that medications for weight control be used continuously, like medications for diabetes mellitus and hypertension. Unfortunately, few studies have examined the consequences of long-term use of weight-control medications.

Surgery

Surgery may be a weight-loss option for patients who are severely obese (with a BMI of 40 or above) and suffer from serious medical complications due to weight. While the number of people in the United States who qualify for surgery remains small, the percentage of Americans with a BMI of 40 or above increased from less than 1 percent in 1990 to 2.2 percent in 2000.

There are two accepted surgical procedures for reducing body weight: gastroplasty and gastric bypass. Although these two procedures use different surgical methods, they both reduce the stomach to a pouch that is smaller than a chicken’s egg, drastically limiting the amount of food that can be consumed at one time. Surgery produces 25 to 35 percent reductions in weight over the first year and most of this weight loss is maintained five years after surgery. More importantly, the serious medical conditions that accompany extreme obesity improve significantly. Surgery is not without risk and should be performed by skilled surgeons who also provide patients with a comprehensive program for long-term weight control.

The Seven Wonders of the World

The Seven Wonders of the World were works of art and architecture considered by the ancient Greeks and Romans to be the most fabulous creations of antiquity. They were the Pyramids of Egypt, The Hanging Gardens of Babylon, The Temple of Artemis, The Statue of Zeus, The Mausoleum of Halicarnassus, The Colossus of Rhodes, and The Pharos of Alexandria.

1. Temple of Artemis-The Temple of Artemis is depicted in a fanciful reconstruction based on an Italian Renaissance church in this hand-colored engraving by Dutch artist Maarten van Heemskerck. Built in Ephesus in Asia Minor in 356 bc, the Greek temple was considered to be one of the Seven Wonders of the World. It was destroyed by the Goths in ad 262.

2. Colossus of Rhodes-The Colossus of Rhodes, depicted in this hand-colored engraving by Maarten van Heemskerck, was built about 280 bc. Standing 30 m (100 ft) high, it was built to guard the entrance to the harbor at Rhodes. The ancient Greeks and Romans considered it to be one of the Seven Wonders of the World.

3. Pharos of Alexandria-The Pharos of Alexandria, an ancient lighthouse, is depicted in this hand-colored engraving by Maarten van Heemskerck. The lighthouse stood on an island in the harbor of Alexandria and was over 134 m (440 ft) tall. It was considered to be one of the Seven Wonders of the World.

4. Hanging Gardens of Babylon -This hand-colored engraving by 16th century Dutch artist Maarten van Heemskerck depicts the Hanging Gardens of Babylon, one of the Seven Wonders of the World. Technically, the gardens did not hang, but grew on the roofs and terraces of the royal palace in Babylon. Nebuchadnezzar II, the Chaldean king, probably built the gardens in about 600 bc as a consolation to his Median wife who missed the natural surroundings of her homeland.

5. Mausoleum of Halicarnassus-The Mausoleum of Halicarnassus, depicted in this hand-colored engraving by Maarten van Heemskerck, was built about 353 bc. The mausoleum was a huge marble tomb built for King Mausolus of Caria in Asia Minor. It was considered to be one of the Seven Wonders of the World.

6. Statue of Zeus -The Greek sculptor Phidias created the 12-m (40-ft) tall Statue of Zeus in about 435 bc. The statue, depicted in this engraving by 16th-century Dutch artist Maarten van Heemskerck, stood in Olympia and was perhaps the most famous sculpture in ancient Greece. Phidias made the god’s robe and ornaments from gold and carved the body out of ivory.

7.Pyramids of Egypt-Of the Seven Wonders of the World, the famous pyramids located in Giza, near the city of Cairo, Egypt, are the only ones remaining nearly intact. They are depicted here in an engraving by 16th-century Dutch artist Maarten van Heemskerck.

Mona Lisa

Mona Lisa (1503-1506), painted by the Italian artist Leonardo da Vinci, was also known as La Gioconda, possibly referring to the subject’s husband, banker Zanobi del Giocondo. The artist’s use of very deep space in the background with a close-in portrait is typical of Renaissance painting style. The painting hangs in the Louvre, Paris.

Statue of Liberty

The Statue of Liberty, a symbol of freedom for many, was one of the first sights to welcome immigrants arriving in the United States. The statue stands 93 m (305 ft) tall on Liberty Island in New York Harbor. It was designed by French sculptor Frédéric-Auguste Bartholdi and is a gift from France commemmorating the first centennial of U.S. independence from Britain.

Acne

Acne, eruptive skin disease. It is primarily a disorder of the sebaceous follicles of the skin and appears most often on the face, neck, and back. The natural secretion, or sebum, of the follicles accumulates and mixes with dust and dirt. The follicles and surrounding tissue become inflamed and blackheads appear. If the follicle opening completely closes, the accumulated sebum is degraded by bacteria and forms a cyst.

Acne vulgaris, the most common form, is usually associated with adolescence but may also occur in adults. A severe form of the disorder is known as acne conglobata. Other forms of acne are also observed, such as the chloracne caused by chlorinated compounds. In acne rosacea, the capillaries in the cheeks, forehead, and nose are swollen with blood and the oil glands in the skin become infected.

Acne in adolescence results primarily from hormonal changes taking place in the body; the hormones stimulate sebum production. Outbreaks cannot be prevented by a controlled diet and are not a sign of uncleanliness. Good hygiene should be observed, however, to prevent more serious infections. Severe acne may be treated by antibiotics, benzoyl peroxide, or vitamin A derivatives. Severe acne in adults may be a sign of an underlying endocrine disorder.

Mesothelioma-Pneumoconiosis

Mesothelioma- tumor of body cavity lining: a benign or malignant tumor of the lining of the lungs, heart, or abdomen, often caused by asbestos exposure.

Pneumoconiosis , a general term for any one of several lung diseases caused by breathing dust from industrial occupations like coal mining, sand blasting, and stone cutting (see Occupational and Environmental Diseases). Years of continual exposure to industrial dust can cause the formation of spots (macules), lumps (nodules), or fibrous growths in lung tissue, causing permanent damage or destruction of these tissues. Smoking can complicate or worsen the conditions. Symptoms of the disease include shortness of breath, labored breathing, coughing, and production of phlegm (mucus secreted in the respiratory system when infections are present). Other, often fatal, illnesses such as cancer, tuberculosis, emphysema, or heart disease may also develop.

Both inorganic dust (from minerals) and organic dust (from plants) can produce pneumoconioses. For example, inhalation of inorganic irritants such as coal dust, particularly from mining hard coal, or anthracite, causes the condition known as black lung disease, coal worker’s pneumoconiosis, or anthracosis. Silica dust from quarrying, mining, or sand blasting causes the disease silicosis. The fine particles and dust from asbestos, a fibrous material commonly used in construction and insulation until its use was curtailed by the Environmental Protection Agency in 1989, causes asbestosis and mesothelioma, a cancer of the chest lining. The inhalation of organic irritants most often found in textile mills such as the dusts of cotton, flax, hemp, and jute causes byssinosis, or brown lung disease. Another type of pneumoconiosis takes the form of hypersensitivity to irritants, fumes, and vapors in the workplace from substances like cadmium, beryllium, chlorine, and fluorine.

Treatment can only relieve the symptoms of pneumoconiosis. Treatment options include medication, removal of the patient from the workplace, providing dust control through added ventilation, or the use of personal protection devices like dust masks.

Asbestos

Asbestos (Greek a-,“not”; sbestos, “extinguishable”), the fibrous form of several minerals and hydrous silicates of magnesium. The name may also be applied to the fibrous forms of calcium and iron. Asbestos fibers can be molded or woven into various fabrics. Because it is nonflammable and a poor heat conductor, asbestos has been widely used to make fireproof products such as safety clothing for fire fighters and insulation products such as hot-water piping. The first recorded use of the word asbestos is by Pliny the Elder in the 1st century ad, although the substance itself was known as early as the 2nd century bc. The Romans made cremation cloths and wicks from it, and centuries later Marco Polo noted its usefulness as cloth.

Asbestos is of two principal classes, the amphiboles and the serpentines, the former of relatively minor importance. Chrysotile, in the serpentine class, constitutes about 95 percent of the world supply of asbestos, of which three-fourths is mined in Québec. Other large deposits exist in South Africa. In the United States, California, Vermont, and Arizona are the leading asbestos-producing states; however, the majority of United States deposits are of no commercial value.

Asbestos is obtainable by various underground mining methods, but the most common method is open-pit mining. Only about 6 percent of the mined ore contains usable fibers.

The fibers are separated from the ore by crushing, air suction, and vibrating screens, and in the process are sorted into different lengths, or grades. The most widely used method of grading, the Québec Standard Test Method, divides the fibers into seven groups, the longest in group one and the shortest, called milled asbestos, in group seven. The length of the fibers, as well as the chemical composition of the ore, determines the kind of product that can be made from the asbestos. The longer fibers have been used in fabrics, commonly with cotton or rayon, and the shorter ones for molded goods, such as pipes and gaskets.

Asbestos has been used in building-construction materials, textiles, missile and jet parts, asphalt and caulking compounds and paints, and in friction products such as brake linings. Exposure to asbestos fibers and dust, however, can cause asbestosis, a disease of the lungs caused by the inhalation of asbestos particles, and, after a latent period of up to 30 years and more, various cancers, especially lung cancer and mesothelioma, which is an inoperable cancer of the chest and abdominal lining . At present no wholly satisfactory substitutes are available for asbestos in many of its applications; because of health risks posed by asbestos use, however, research into replacements has been accelerated. In 1986 the Environmental Protection Agency proposed an immediate ban on the major uses of asbestos and a complete ban on all asbestos products within the next decade. This proposal was partially overturned by the U.S. Court of Appeals, which limited the ban to asbestos flooring and new products using asbestos.

Blue Cross

Blue Cross And Blue Shield, network of companies that provide health insurance to people in the United States and Puerto Rico. The Blue Cross and Blue Shield Association, based in Chicago, Illinois, governs the various health insurance organizations that carry its name. Member health insurance companies are operated locally, but they must abide by standards established by the national association. Historically, Blue Cross and Blue Shield insurers have been nonprofit organizations that receive tax-exempt status.

More than 71 million people are members of Blue Cross and Blue Shield health insurance plans. Most Blue Cross and Blue Shield organizations negotiate contracts with local hospitals and physicians to offer services to individuals who have paid premiums (fees) individually or through their employers.

Blue Cross and Blue Shield health insurance plans offer a broad spectrum of coverage options, including fee-for-service plans (also known as indemnity plans) and managed care plans. Fee-for-service plans allow members to visit any doctor or hospital for medical services. Managed care plans require members to visit designated physicians and include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (POSs) (see Health Insurance: Types of Plans in the United States). Blue Cross and Blue Shield organizations also administer services for Medicare, a government program that provides coverage for elderly people and for people with certain disabilities

Throughout the 1990s Blue Cross and Blue Shield organizations faced financial difficulties due to the spread of for-profit health-care organizations. Blue Cross and Blue Shield chapters remained nonprofit groups that enrolled subscribers regardless of their individual risk of illness. Its competitors, which used experience rating, were able to recruit more members by charging lower premiums to people with a low risk of illness. Enrollment in Blue Cross and Blue Shield plans dropped drastically in the early 1990s, and many chapters closed.

In 1994 the Blue Cross and Blue Shield Association abolished its requirement that its member groups remain nonprofit organizations. In 1996 Blue Cross of California merged with a for-profit managed care company, WellPoint Health Networks, becoming the first chapter to relinquish its tax-exempt status. During the late 1990s a number of Blue Cross and Blue Shield chapters followed suit and merged with for-profit insurance providers or created new for-profit subsidiaries.

Environmental and Occupational Diseases

Environmental and Occupational Diseases, illnesses caused by exposure to disease-causing agents in the environment, as opposed to illnesses related primarily to an individual's genetic makeup or to immunological malfunctions. In everyday use, the term environmental disease is confined to noninfectious diseases and to diseases caused largely by exposures beyond the immediate control of the individual; the latter restriction eliminates diseases related to personal habits such as smoking or to the use or abuse of medications or drugs such as alcohol. Occupational disease, a major category of environmental disease, refers to illness resulting from job-related exposures.

Historically, awareness of environmental diseases began with the recognition of occupational illnesses, because exposures are usually more intense in work settings than in the general environment and therefore can more readily produce overt illnesses. Examples include silicosis, a lung disease of miners, industrial workers, and potters exposed to silica dust; scrotal skin cancer in chimney sweeps exposed to soot; neurological disease in potters exposed to lead glazes; and bone disease in workers exposed to phosphorus in the manufacture of matches. Many such diseases first gained public attention during the Industrial Revolution in the 19th century.

Environmental diseases

Environmental diseases are caused by chemical agents, radiation, and physical hazards. The effects of exposure, in both natural and work settings, are greatly influenced by the exposure routes: primarily air pollution and water pollution, contaminated food, and direct contact with toxins. Synergistic effects—two or more toxic exposures acting together—are also important, as illustrated by the greatly increased risk of lung cancer in asbestos workers who smoke cigarettes. The potential interaction of multiple hazardous chemicals at toxic waste dumps poses a current public health problem that is of unknown dimensions.