Despite countless diets, and sincere efforts at weight loss, Americans are getting heavier each year. Obesity is one of the leading causes of preventable death in the US, second only to tobacco.
Tired of seeing no results from the traditional diet and exercise regime, many people are looking to alternative methods to help them lose weight. Or, put another way, unable to do the hard work of diet and exercise, many people are looking to a drug to help them lose weight. Short of gastric bypass surgery, prescription weight loss medications may be the next best bet for some. But how effective are these medications? And how can you know if you are a good candidate for them?
There are over a dozen prescription and over-the-counter medications used in obesity treatment. Generally, these medications are only prescribed when diet and exercise changes fail to produce the desired results. This is because patients who take these drugs may experience unpleasant side effects or develop a tolerance or addiction to the drugs. However, for some, obesity is increasingly viewed and treated as a chronic illness. For these patients, medication therapy may be required indefinitely.
At present there are two main classes of weight loss medications: appetite suppressants and malabsorption enhancers. To date, only two have been approved for long-term weight loss by the US Food and Drug Administration (FDA): orlistat (Xenical) and sibutramine (Meridia). Another commonly prescribed drug is phentermine, however it’s only suitable for short-term use of a few weeks.
Unfortunately, there is no “magic pill” for weight loss, and like all medications, they come with the risk of side effects. Additionally, despite rigorous testing, these agents are still new and their safety and effectiveness has not been established beyond one year.
Moreover, weight loss medications generally result in a weight loss of 5-22 pounds per year, with maximum weight loss occurring six months after starting therapy. Of course, even a modest reduction in weight can translate into a significant reduction in obesity-related health risks, such as diabetes and cardiovascular disease. Most studies suggest that sibutramine or orlistat, combined with diet and exercise can enhance weight loss. And for many individuals, the benefits of losing any weight at all might outweigh the risk.
Research has focused on the effectiveness of orlistat and sibutramine. Here is a look at some research on these drugs:
In general, weight loss medications are most appropriate for people whose weight poses a health risk—not those looking to drop a few pounds for aesthetic reasons. Overweight individuals should talk to their doctor or dietitian to determine whether drug therapy is an option for them.
RESOURCES:
American Dietetic Association
http://www.eatright.org
American Obesity Association
http://www.obesity.org
References:
Bays H, Dujovne C. Pharmacotherapy of obesity: currently marketed and upcoming agents. Am J Cardiovasc Drugs. 2002;2(4):245-253.
Klem ML, Wing RR, McGuire MT, et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. AJCN . 1997;66:239-246.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA . 2004;291(10):1238-1245.
Orlistat. Medline Plus Drug Information. National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500006.html . Accessed April 20, 2004.
Padwal R, Li SK, Lau DC. Long-term pharmaotherapy for obesity and overweight (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester: Wiley. CD004094.
Phentermine. Medline Plus Drug Information. National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682187.html . Accessed April 20, 2004.
Prescription medications for treatment of obesity. Weight Control Information Network. NIDDK website. Available at: http://www.niddk.gov/health/nutrit/pubs/presmeds.htm . Accessed April 14, 2004.
Treatment: weight loss strategies. American Obesity Association website. Available at: http://www.obesity.org/treatment/weight.shtml . Accessed April 14, 2004.
Van Baak MA, Van Mil E, Astrup AV, et al. Leisure-time activity is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance (STORM trial). Am J Clin Nutr . 2003;78(2):209-214.
Wilding J. Clinical Evaluation of anti-obesity drugs. Current Drug Targets . 2004;5(3):325-332.
Last reviewed August 2006 by Lawrence Frisch, MD, MPH
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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