By Qing Yang and Kevin Parker| State Journal-Register
Weight loss is one of the most popular New Years resolutions. However, it often fails, due to a lack of motivation, poor planning and not enough support. Even after achieving a weight loss goal, keeping the weight off is hard. Wouldnt it be nice if there was a magic pill you could take and the excess fat would just melt away forever?
Theres a huge demand for weight loss agents. Forty-two percent of American adults and 19% of children are obese based on the body mass index (BMI), which calculates whats the appropriate weight for a given height. Climbing obesity rates is a boon for pharmaceutical companies. In fact, several new prescription weight loss drugs have been introduced recently. Are they right for you? Before you decide, lets review what these pills are and how they work.
Six prescription weight loss medications are currently approved by the FDA. All are indicated for people with BMI > 30 or BMI > 27 and suffering from diseases such as high blood pressure, diabetes and high cholesterol.
Orlistat (brand name Xenical) inhibits the enzymes that break down fat in the stomach, reducing fat absorption. A lower dose formulation is available over-the-counter (Alli). Side effects are oily stools, diarrhea and gas, which can be alleviated by adopting a low-fat diet. You must also take supplements for fat-soluble vitamins (A, E, D and K). Rare instances of liver injury and kidney stones have been reported.
Liraglutide (Saxenda), originally created for treating diabetes, mimics a naturally-occurring hormone called GLP-1 to enhance satiety; you feel full, so you stop eating. It's injected once a day under the skin. Gastrointestinal side effects are common. It carries a small theoretical risk of inducing thyroid cancer.
Naltrexone + bupropion (Contrave) modulates signals in the brain to suppress appetite. Headache, dizziness, nausea and constipation are common. Exercise caution if you also take other agents that alter your nervous system such as seizure medicines, antidepressants and opioids.
Phentermine (various brands and generics) is an amphetamine derivative that decreases appetite. Once shunned by doctors for being part of the fen-phen (fenfluramine-phentermine) combo that was withdrawn in 1997 for causing deadly heart diseases, phentermine has gradually regained popularity and become the most widely prescribed weight loss medicine today. Similar to other stimulants, it can affect your blood pressure and heart rate, cause insomnia and problems with attention and memory.
Phentermine + topiramate (Qsymia) exploits synergistic appetite control. Side effects include dry mouth, anxiety, depression and worsening of glaucoma, in addition to whats associated with phentermine alone. Stopping the medicine suddenly can cause seizures.
Amfepramone is an older stimulant not commonly used nowadays.
Weight loss medications have a notorious track record of safety issues. In the 1960s, people died from amphetamine diet pills. Then came the fen-phen scandal. In 2004, the FDA banned ephedra for elevating blood pressure and causing stroke. In 2010, sibutramine (Merida) was withdrawn from the market for increasing heart attacks. Last year, lorcaserin (Belviq) was withdrawn due to cancer risks. Importantly, all weight loss medications should be avoided in women who are or want to be pregnant because of adverse effects on the fetus.
Ironically, these medications are clearly labeled only effective as adjuncts to caloric restriction and physical activity. In other words, they only work when used together with diet and exercise the two ultimate pillars of weight management. Also, dont expect immediate, dramatic results. Typically, people lose 3-7% of their starting weight after several months.
They arent cheap, either, costing hundreds of dollars per months, and not always covered by insurance.
Lastly, a word of caution about non-prescription weight loss agents marketed as herbal extracts or nutritional supplements they arent regulated by the FDA, so theres no way of knowing whats actually in them and no stringent clinical experiments to demonstrate their effects.
In conclusion, weight loss medications are not magical at all. Theres no shortcut to building a healthy body sorry! These pills can lend you an extra hand, but only if youve already built a foundation of moderation and discipline with diet and exercise. Given their side effects, they may not be worth the expense to your wallet and your overall health.
Qing Yang and Kevin Parker are a married couple and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy at various city and state governments around the country. He is formerly the group chief information officer for education with the Illinois Department of Innovation and Technology. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.
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Health Matters: Thinking about weight loss pills? Heres what you should know - The State Journal-Register