Q: I've tried everything to lose weight. Is there any medication that can help? Help!
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A: As we speak (and read), 40 percent of women are on some type of diet to lose weight — so you're in good company. The unfortunate statistics, though, are that less than five percent of individuals who lose weight keep it off and only two percent of those who lose 20 pounds have kept it off two years later.
And to add pounds to insult, despite all this dieting, one third of U.S. women are obese (when we define obesity we now consider both BMI and waist circumference). I hate to tell you this, but women are now considered to have central obesity if our waist measures more than 35 inches. This is not only disastrous when it comes to fitting into your jeans, but it also puts you at risk for type 2 diabetes, hypertension, and heart disease. (If you want to measure your waist circumferences put the measuring tape around your abdomen, at the top of your hip bones, and don’t suck in your stomach.)
The good news is that whenever you lose “just” 10 percent of your initial body weight there are amazing subsequent benefits to your health. However, maintaining these weight and health benefits can be the challenge. Be realistic when you set your weight-loss goals. I'm not saying that after you lose that first 10 percent you can't try to lose another 10 percent — just do it gradually.
If you've decided to lose weight the next question is how to lose it. When you type "diet" into Google, 144 million results come up. Obviously when there are so many choices, none of them are perfect. Pharmaceutical companies have been searching for that magic diet pill for as long as this problem has existed, because they realize its potential for health and wealth.
Fen-phen and amphetamines (speed-like drugs that increase metabolism and decrease appetite) were thought to be the answers in the early 90’s, but the serious medical complications associated with these drugs brought this prescription drug combo to a drastic and legal halt in 1997. Medications that are similar in structure to amphetamines called sympathominetics are less addictive, but they are approved by the FDA for only three months of use and, in general, their effects are short lasting.
There are currently only two weight-loss medications that have been approved for use for up to 12 months by the FDA. The first is sibutramine (brand name Meridia). It suppresses appetite by inhibiting levels of certain neurotransmitters (the specific ones are norepinephrine, serotonin, and dopamine). When Meridia was combined with diet, exercise, and behavioral therapy (I want to stress the words "combined with"), it was found to be superior in helping overweight patients lose weight compared to these lifestyle modifications without the drug. But there's no drug without side effects and this medication can cause dry mouth, insomnia, constipation, headache, and even a small increase in blood pressure and heart rate. Your doctor might not want to give you this medication if you have hypertension or are taking a SSRI antidepressant.
The second drug approved by the FDA for weight loss is orlistat (brand name Xenical). This medication helps prevent the absorption of fat in the stomach and the small intestine. Since the drug blocks fat absorption, the fat you consume gets excreted in the stool which can be unpleasant (gas, odor and fecal staining). So it may also help you lose weight because you avoid consuming fatty foods. Using orlistat together with dietary modifications has been shown in over 10 trials to help patients attain weight loss of 2.7 kg (around 7 pounds), compared to just using the placebo. However, side effects occurred 16 to 40 percent more often on this drug than with the placebo, and included fatty oily stool, stool urgency, and oily spotting. This medication will become over-the-counter in July 2007. It works as long as you take it, but when you stop the previously lost weight can return.
There is also a medication that's been available in Great Britain since July 2006. It’s generic name is rimonabant and it’s brand name is Acomplia. This drug is a cannabinoid receptor antagonist; it can make you feel full and decrease your appetite… it blocks the pleasure centers in the brain that are stimulated by eating (and smoking). A two-year trial of the drug showed significant weight reduction that was maintained for two years. This trial included 3000 obese and overweight adults and their weight loss was at least as good as that seen when taking Meridia and Xenical and in some cases better. But the dropout rate in the study was high – only half of those in the treatment group stayed on the drug. Also, more than 80 percent of those on the drug had at least one side effect. These side effects were mostly gastrointestinal, but relatively mild. Acomplia is being reviewed by the FDA, and it's not clear whether it will be approved for weight loss or smoking cessation.
That's it for the meds that are either available or might be available soon. I can't tell you how many of my patients have tried alternative therapies as well. Some of these therapies have contained ephedra, which has significant side effects. All attempts have been made to remove products that contain ephedra and ma huang (a natural form of ephedrine) from the market. Avoid these products if you find them. In terms of other products that may help with weight loss, there is currently no clinical support for their use or usefulness based on peer-reviewed trials.
Finally, patients with morbid obesity (with a BMI of 40 or greater or 35 with other major medical conditions) who have tried everything else without success, should probably be referred to bariatric surgeons. There are now several very succesful surgical procedures that restrict food intake, cause mal absorption of food, or do both. Although these procedures have potential complications, there has been enormous improvement in surgical techniques and a decrease in the invasiveness of the surgeries (they're often done through a laparoscope). Recent studies have shown that much or the early weight loss and clinical improvements in blood pressure, diabetes control and lipid (cholesterol) values are also maintained years later.
Dr. Reichman’s Bottom Line: Yes, there are medications that can help with weight loss, but there's no magic bullet. If you want to use of weight loss drugs you should be carefully followed by your physician. If you want to lose weight and keep it off, you also need to be prepared to get on board with behavioral modification, appropriately limits of your food intake, and diligently follow an exercise program.
Dr. Judith Reichman, the TODAY show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.
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