Drugs not likely to be solution to obesity

Summer has long been a time of renewed efforts to lose excess pounds that are hard to hide under skimpy hot-weather clothing. Some people (rarely those significantly overweight) manage to shed 5 or even 10 pounds before the Fourth of July.

Having just driven from New York to Minnesota and back, at every rest stop I saw evidence of what health experts are calling a national crisis - an epidemic of obesity, especially health-robbing morbid obesity.

No doubt most of the overweight people I encountered, had tried and ultimately failed to keep their weight under control before tipping the scales at 300-plus. In recent years, they had hundreds of diets to choose from, and many probably lost a number of pounds, only to regain the weight and more when they tired of the diet of the day.

Now some experts are saying that bariatric surgery to shrink the stomach and to bypass part of the intestines is the most effective solution for such people. But even this radical, risky and costly operation sometimes fails to keep people trim.

Enter - or I should say, re-enter - drugs that promote weight loss. You may recall the many desperate souls who sought to curb their appetites with amphetamines, drugs that caused extreme nervousness, insomnia and addiction. Or other diet-drug fiascos such as thyroid hormone, which caused hyperthyroidism, and ephedra and phenylpropanolamine, associated with heart problems.

Now other medications, on the market or in the pharmaceutical pipeline, are being cited as safer alternatives. However, these too have limitations.

In the June issue of The Journal of the American Dietetic Association, Susan B. Moyers of the University of South Florida College of Medicine reviewed drugs that had been studied as weight-loss aids. Moyers’ bottom line: “Whereas the evidence may support the use of medications to enhance weight loss, medication alone without diet/lifestyle change is not effective.”

In other words, there is no drug available or likely to be available soon that helps in weight loss without also cutting back on calories consumed, and no drug can help people maintain a weight loss unless they continue to limit calories or increase exercise.

Furthermore, no drug enables the morbidly obese, even with a reduced-calorie diet, to lose 100 or more pounds.

The two leading prescription weight-loss aids are Meridia (sibutramine) and Xenical (orlistat). Meridia acts on the brain to reduce hunger and enhance satiety. Typical weight losses of 5 percent to 10 percent (10 to 14 pounds in six months) have been reported. The drug should not be used by those with a history of heart disease or stroke, or people who take antidepressants called MAO inhibitors or SSRIs.

Xenical interferes with the enzyme that digests fat and can reduce by a third the amount of dietary fat a person absorbs. In a four-year study, one-quarter of patients kept off 10 percent of their initial body weight (about 13 pounds in a year), compared with 16 percent of patients on a placebo. Xenical is not a drug for fat lovers. If more than 20 grams of fat a day are consumed, the drug can cause oily stools, flatus with discharge and fecal urgency. It also interferes with the absorption of fat-soluble vitamins.

Another group of diet drugs are appetite suppressants, which result in losses of about one pound a week. Phentride and Ionamin (phentermine), Tenuate (diethylpropion), Didrex (benzphetamine), and Obezine, Bontril and Adipost (phendimetrazine) are relatives of amphetamines and approved only for short-term use. Side effects are common, including insomnia and anxiety.

Another appetite-suppressing drugs, Mazanor and Sanorex (mazindol) are sold only online and must not be taken with MAO inhibitors or SSRIs.

Drugs approved for other uses are sometimes prescribed for weight control. They include Glucophage (metformin), Precose (acarbose) and Glyset (miglitol), approved to control blood sugar in people with Type 2 diabetes; the anti-seizure drugs Topamax (topiramate) and Zonegran (zonisamide) and the antidepressants Prozac (fluoxetine) and Wellbutrin (bupropion).

Among drugs in the pipeline, Acomplia (rimonabant) blocks brain receptors that stimulate the “munchies” in marijuana smokers. Daily treatment for a year has resulted in average losses of 19 pounds and 3.5 inches around the waist.

So what??™s the bottom line? For the foreseeable future, drugs are not likely to be the solution to obesity, at least not by themselves.

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