hCG: On the Front Line in the ‘Battle of the Bulge’

More and more physicians are turning to hCG and other drug therapies (e.g. B6 and B12 injections, appetite suppressants, lipase inhibitors, etc.), as part of their arsenal in the fight against fat.  However, incorporating pharmaceuticals into a tailored Medical Weight Loss Program requires a comprehensive understanding of the myriad of ingestable or injectable interventions that are available to doctors.  Furthermore, wading through the proliferation of studies, research, and peer reporting on the use of these agents can take a physician’s valuable time away from treating patients.  Therefore, many physician associations, such as the International Association for Physicians in Aesthetic Medicine (IAPAM) are incorporating the latest research on medically supervised weight loss products into their educational symposiums.

The Robert Wood Johnson Foundation reports that “more than two-thirds of adults and one-third of children in America are obese or at risk for obesity.”  Equally, the fifth annual 2008 F as in Fat report, from the Trust for America’s Health (TFAH), found that obesity rates rose for a second consecutive year in 24 states and for a third consecutive year in 19 states, and “no state saw a decrease” in its rates of obesity. Finally, adding insult to injury, in March 2009, Richard Hamburg, Government Relations Director of the TFAH testified before a U.S. House Committee on Nutrition stating that, “nutritionists are now worried that Americans will put on ‘recession pounds,’ pointing to studies linking obesity and unhealthy eating habits to lowering incomes.”

So, in response to this growing epidemic, doctors are increasingly being asked by patients for possible pharmacological agents to assist in their weight loss efforts, and physicians are responding to their patients needs.  Whereas before the 1940’s, obesity was considered simply the result of overeating, today physicians appreciate obesity is a multifaceted disorder.  As a result, physicians are offering patients tailored weight management programs that incorporate pharmacological solutions paired with diet, exercise, cutting edge nutritional intelligence, and the latest advances in weight loss technology.  And on the leading, and sometime controversial, edge of the pharmaceutical offerings is the use of human Chorionic Gonadotrophin (hCG) in weight management programs.

The use of hCG has a storied past. hCG is a hormone naturally occurring in the urine of pregnant women, however, today, most hCG on the market, such as Pregnyl, is synthetic.  Christmas Jones explains how hCG works.  In layman’s terms, hCG is said “to perform a metabolic recovery, where the hypothyroid is said to be reset, boosting the metabolism and increasing the person’s ability to burn fat at a much higher rate. hCG is also said to break down body fat, causing rapid weight loss by mass even before registering on a scale. Simultaneously, it is said to protect the endogenous fat and muscle which the body needs to stay healthy, but also avoiding sagging and loose skin known of excessive of weight loss.” (C. Jones, hCG and The Weight Loss Cure , 2007)

In 1954, with the publication of Dr. A.T.W. Simeons’ study in the British medical journal, The Lancet, hCG was introduced widely to the world as a weight management drug.   Dr. Simeons’ study and subsequent publication, Pounds and Inches: A New Approach to Obesity,  “discovered that a small quantity (125 to 250 I.U.) of hCG administered once daily for a short period of time (23 to 46 days) in combination with a very low calorie diet (VLCD) consisting of 500 calories, produced an average weight loss of 1 pound per day.”  Also, Simeons work with hCG began the dialogue around the issue of obesity.  Subsequently, weight management began to be characterized as “a disorder of energy metabolism,” and in response to a growing market for drugs to remedy this “disorder,” by the late 1950’s, the FDA had approved the use of several prescription appetite suppressants to assist in weight management.

Interestingly, appetite suppressants and hCG protocols flourished in parallel during the 1960’s, and then in the early 1970’s, following a series of unfavorable studies refuting the effectiveness of hCG in weight loss, hCG use fell from credibility.  Equally, the use of appetite suppressants in the class of amphetamines also fell from favor.  Proponents of hCG in weight management, such as Dr. Daniel Belluscio, cite the excessive proliferation of disreputable “fat clinics” and the over prescribing of this agent, which resulted in an increased rate of clinical complications.

Today hCG is experiencing a renaissance.  According to the editor of the hCG Diet Info website, their “traffic levels have gone from a few dozen hits a week to several thousand a day.” hCG is the hottest topic in online weight loss chat rooms and in doctor’s wait rooms.

However, hCG is not without its detractors and its controversy. The FDA only approves the use of hCG for the treatment of certain problems of the male reproductive system and in stimulating ovulation in women who have had difficulty becoming pregnant. The FDA is adamant that “no evidence has been presented, however, to substantiate claims for hCG as a weight-loss aid.”  Moreover, the FDA requires all labeling and advertising of hCG used in a weight management program, to include the following notice:

“THESE WEIGHT REDUCTION TREATMENTS INCLUDE THE USE OF hCG , A DRUG WHICH HAS NOT BEEN APPROVED BY THE FOOD AND DRUG ADMINISTRATION AS SAFE AND EFFECTIVE IN THE TREATMENT OF OBESITY OR WEIGHT CONTROL. THERE IS NO SUBSTANTIAL EVIDENCE THAT hCG INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR “NORMAL” DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTIVE DIETS.”

Equally, the endorsement of hCG in Kevin Trudeau’s controversial book, The Weight Loss Cure they don’t Want You to Know About, drew venomous attacks from medical researchers who challenge the efficacy of hCG in weight loss.  These clinicians concur with the FDA, that hCG is not effective in weight loss, and caution patients about the possible side effects of the use of hCG, ranging from blood clots to ovarian hyper-stimulation.

In the end, both proponents and critics alike are in agreement that hCG is not “a magic wand.”  Proponents emphasize that a “daily injection of hCG gives optimum results only when used in a rational weight reduction program, including a VLCD, and strict observation to the complete protocol is mandatory” for success.  Critics challenge that a VLCD and 3 trips a week to your doctor will result in substantial weight loss, without the use of hCG.  So the story of hCG continues; marvel or mystery, it certainly warrants a dialogue.

The content for this article was taken from part of the IAPAM’s new Medical Weight Loss Program presented at its renowned series of Aesthetic Medicine Symposiums in Scottsdale, Arizona.  This and more will be covered in the IAPAM’s upcoming Aesthetic Medicine Symposiums.  The IAPAM Symposium offers a balanced discussion of medical weight loss pharmacology options including hCG, B6/B12 injections, appetite suppressants, and lipase inhibitors. For more information on the IAPAM’s Medical Weight Management Program at the upcoming Aesthetic Medicine Symposium, please contact Jeff Russell, Executive Director, IAPAM, at 1-800-219-5108 ext. 705, or visit http://www.aestheticmedicinesymposium.com

by Leslie Marshall, Specialist, Online Media and Research for the International Association for Physicians in Aesthetic Medicine (IAPAM)
July 2, 2009