Overrated Medications Series: No.1 Weight Loss Medications
This is the first in my series on overrated medications. I am not trying for a definitive ranking of these medications, but rather I am simply trying to show my readers some of the most hyped and overrated drugs on the market. It will help people make better decisions, avoid waste and improve their health.
For number one I choose weight loss medications. The reasons are:
1. Weight loss medications are ineffective in the long run.
2. If they are ineffective, then by definition their therapeutic index (margin between safety and effect) is suspect.
3. Some are outright scams.
4. They are rarely needed (there are perhaps a few exceptions).
The most successful weight loss medications were fenfluramine and phentermine (Fen/Phen). This combination made a huge impact in the 1990s. Weight loss clinics sprang up and small fortunes made. I admit to taking the medications myself and to prescribing them. I bought into the hype.
The Fen/Phen studies were by Michael Weintraub and published in Clinical Pharmacology and Therapeutics. Initial results for some patients were astounding. Weight loss of 50 pounds the first year was fairly common. By year 3 of the study, study subjects were regaining lost weight and average weight lost was only 11 pounds. More than 50% of the patients had dropped out. I might add that this 11 pounds includes the medications plus diet and exercise. The United States Preventive Services Task Force guidelines for obesity cite 6 studies showing only diet and exercise resulting in up to 9.9 pounds of weight loss over 24 to 84 months. So medications add little to the small amount of weight lost by diet and exercise alone.
The Fen/Phen boom ended when fenfluramine patients developed valvular heart disease and pulmonary hypertension, both potentially lethal.
There are only two drugs currently approved for long-term use for obesity: Orlistat (Alli) and Sibutramine (Meridia). Neither of these drugs is more effective than the Fen/Phen combo. Orlistat is probably safe. It blocks the absorption of 25% to 30% of ingested fat in the intestine. Side effects are gas, bloating and loose oily stools to a degree that many users soil their underwear. You can decide if those side effects are worth it for the small weight loss effect.
Sibutramine is prescription only weight loss medication. I consider it unsafe. In this respect I disagree with the FDA, though they are conducting a safety review. The European Union has suspended Sibutramine stating risks do not outweigh benefits. It does not result in more effective weight loss than Fen/Phen and can raise blood pressure and increase cardiovascular risks.
Other weight loss medications include Phentermine alone. It is generally safe if patients are carefully selected and monitored. But why bother with this medication? It is approved only for short-term use. Weight is regained once the medication is stopped. The medication’s weight loss effects, just like those of Fen/Phen fade over the long run. It is of the amphetamine class and has some addictive and abuse potential. Side effects are high blood pressure, anxiety, palpitations, fast heart rate and in rare cases seizures.
Lastly I will mention the hormone Human Chorionic Gonadotropin (hCG). Marketed as Releana, it is a scam. Click the link to their slick site, scroll down and read the FDA disclaimer at the bottom of the page: FDA has not approved hCG for weight loss and there is no substantial published evidence hCG is effective in obesity treatment. Then click their “Help and Support” tab and then “Clinical Studies.” Open the second PDF file and go to page 5, under the results section you will read “Regarding weight loss, similar results (with/without hCG administration) were obtained.” You have to dig for it, but at least they are honest. The hCG does nothing. It is the 500 calorie per day that gets the job done. If you want to pursue a 500 calorie a day starvation diet, that’s your business. But you need medical supervision. It can be unsafe. It can rarely result in electrolyte abnormalities and sudden death. You will lose lean tissue, that is muscle as well as fat, and you will regain lost weight. Releana is a scam.
Do you need to lose weight? If your body mass index (BMI) is greater than 35 weight loss would probably improve your health. A BMI of 35 would put you in the fattest 3% of the population. A BMI from 18.5 to 24.9 is considered normal. Surprisingly, to those not well-informed on obesity, a BMI of 25 to 35 carries no increased risk of death. Until BMI exceeds 35 (and that includes 35 and up to 60+) there is simply no mortality risk associated with obesity. In fact, mortality is lower in the overweight until BMI exceeds 35.
There are several drugs in the pipeline for obesity. I will review them in the future. Preliminary reports show some promise, but weight loss is modest as it has been with all past drugs. Except for those rare patients that truly need to lose weight for health reasons I recommend healthy eating (not dieting) and exercise and for patients to accept their current weight. I recommend that my fat patients read Health at Every Size by Linda Bacon.