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Which Diet Drugs Can Help Me Lose Weight?
Tribune photo by VICTOR JUNCO
The approved weight-loss drugs work for some people - but only if you also cut calories and exercise regularly.
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Published: July 3, 2008
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"Isn't there anything you can give me to help me lose some weight?"
As a primary care physician, I am routinely asked this question. Many patients desperately wish to lose weight for health reasons but are unsuccessful after several attempts. With the expansion and high-profile advertising of medical weight-loss clinics, more patients are seeking medications to help them shed pounds.
Three types of prescription medications (including one over-the-counter drug) are available to help promote gradual weight loss. These drugs should not be confused with unregulated dietary supplements, which do not undergo the same FDA approval process. The approved weight-loss drugs work for some people - but only if you also cut calories and exercise regularly.
The medications:
•Phentermine and phendimetrazine belong to a class of medications that act as stimulants to the central nervous system. These drugs - similar to those prescribed for attention deficit disorders - also decrease appetite. Significantly less expensive than the other major FDA-approved diet drugs, these widely used appetite suppressants are not appropriate for everyone, however. Because of their nervous system effect, they can elevate blood pressure and cause insomnia and nervous tics in susceptible individuals. Many physicians do not consider stimulants safe for patients with blood pressure or other cardiovascular problems. They are approved for short-term treatment (up to 12 weeks) of obesity.
•Xenical (orlistat), available over the counter in a lower-strength version as Alli, blocks fat absorption in the large intestine. This medication is safe for almost everyone, with none of the stimulant risks previously mentioned. However, because of decreased fat absorption, people taking orlistat may experience unpleasant side effects, including abdominal pain, excessive gas, bloating and diarrhea. Eating a low-fat diet limits the risk of these potential side effects. For maximum effectiveness, the drug needs to be taken before every meal, making it less convenient to use.
•Meridia (sibutramine), similar to many antidepressant medications, regulates naturally occurring neurotransmitters in the brain. It helps reduce hunger by working on the brain's appetite control center to increase feelings of fullness. Meridia should not be used by people with high blood pressure or other cardiovascular risk factors. Like Xenical, it is approved for longer-term use - one year or more - in appropriate patients.
Often, physicians will try to determine why a person cannot lose weight or continues to gain. Untreated depression or other mood disorders can certainly contribute to ongoing weight difficulties. Some physicians use antidepressants "off label" to help patients start a successful weight-loss program. The medications may help improve a person's mood enough so that he or she is motivated to become more active and work toward a realistic weight-loss goal.
In general, if combined with dietary restriction and an exercise program, medications such as Xenical and Meridia may result in a greater average weight loss than might be expected with nondrug treatments. However, I always emphasize to my patients that weight-loss medications are intended to supplement, not replace, healthy lifestyle choices. No diet pill will work without portion control, appropriate food choices and adequate exercise. Any weight lost while taking diet pills will be regained when the medication is stopped, if a healthy eating plan and exercise program are not in place.
Dr. Cannarozzi is an assistant professor of internal medicine and pediatrics at USF Health.
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