I recently read a debate between a Ph.D. nutritionist and a physician about whether a person can be fit and fat. This is an old argument that has lots of heat and emotion involved and not much logic or reason. These experts argue about whether an overweight athlete is healthy but never really agree on how athletic or active this imaginary person is or even what they mean by healthy.
In the end both agreed that being normal weight was a good idea and exercise is good for you. Amazing! The MD said what I’ve always said: show me this person and we’ll talk. After 15 years of examining thousands of patients a year, I don’t think I’ve met anyone in this category.
Debates aside, the fun links were at the bottom of this story. A stomach-filling diet drink, a rejected diet pill, and a petition by Public Citizen to ban two more. A lot to chew on, eh? (insert my wife’s dramatic groan here.)
Stomach-filling Diet Drink
The drink has a chemical called alginate that is liquid in a drink but changes to a gel once it hits stomach acid. Interesting idea though it doesn’t sound that safe, really. Intestines blocked with gel-sludge could keep surgeons way too busy.
Seriously, this may have a future, since much of the trouble with eating less is the hunger people dread. The recommendation I give is to eat apples and drink water to relieve the hunger pangs. The pectin in apples actually does this same thing, thickening in the stomach and providing a full feeling. My guess is the drink will cost a bit more than an apple.
Rejected Diet Pill
The diet pill Qnexa was getting some positive attention after news of the 10% weight loss people had in experiments. Now it’s getting more attention but of the bad kind. There were people with psychological problems and heart problems while taking the experimental drug. Not many doctors would be surprised by the news since those are the problems the ingredients can cause too!
There is an enormous market and demand for weight-loss drugs, which means the drug companies will keep working at it. The company that owns Qnexa says they will keep trying to convince the government of the drug’s safety. My hope is that the FDA will do their job and protect patients. Combining the ingredient in Adipex with a seizure drug and hoping its safe sounds like wishful thinking to me.
I’ve written elsewhere that I don’t prescribe Adipex. I get at least one request a week from someone desperate for some kind of help. I try to refuse gently and reasonably, but I still see the frustration and disappointment.
“Adipex isn’t safe,” I say. “It isn’t safe, it doesn’t work and I have to carry extra malpractice insurance just to prescribe it.”
That’s the best answer I could hope for — it means someone just listened! There is very little proof of phentermine (Adipex) working in the short-term and none at all that it works over the long-haul. If it works, most people lose 10-15 pounds over 3-6 months.
Once it is stopped, my experience is that everyone goes right back to their old eating habits and gains all that weight right back. Nothing really changed. If a person won’t change their attitude and approach to food, if they keep eating like an American, they should expect every fad diet and diet pill to fail, Adipex too.
The safety part of phentermine is my biggest problem with it. That whole “Do no harm” vow sure can slow a doctor down. There may not be much proof that it works but I think there’s plenty of proof that phentermine can cause mental problems and permanent heart damage. That’s why my first insurance company after graduation required me to pay for a policy rider if I prescribed medicine for diet and weight loss. They were so sure I would be sued for prescribing these medicines they wanted me to pay more ahead of time!
That’s actually when I started looking in-depth at these drugs and came to my decision not to prescribe them. The drugs in this family work by the same effect on the brain and all have the same risks to the brain and the heart. Two of the drugs have already been taken off the market: Fen-phen and Meridia. I think that phentermine should have been withdrawn too, but it is so old the FDA rules that apply to it are a little hazy about safety so it has stayed around.
Public Citizen wants them Banned
This ABC News article is about the other weight-loss drug type available, the fat-blockers Xenical and Alli. There have been complaints about both drugs in the public since they came out. Like the other diet pills, these don’t really work and don’t change the person, plus they offer the nifty side effect of “flatus with discharge” according to my epocrates app. For those not in the know, this is also called “oily anal discharge” or “anal incontinence.” However politely you say it, this is pretty gross.
The Public Citizen complaint to the FDA says they cause worse problems too, like pre-cancer in the colon and vitamin deficiency. Again, plenty of bad effects, underwhelming weight loss (10-15 pounds for all of them) and no permanent change in weight or health. Not a very good deal, especially when you consider how much these pills cost and that insurance won’t pay for them.
There is one other diet pill on the near horizon. Contrave is still working its way through the FDA, with a solid “Yes, maybe” from them in December 2010. Whatever they decide about this medicine (other than high blood pressure and seizures it seems pretty ‘safe’) it’s still good for only about 10 pounds. The company can sell it to us with a straight face, saying “If you take it for a year, you’ll probably lose 10 pounds.” Seriously?
Expensive, bad side effects, crummy results — how about learning some new habits and finding joy in feeling well and eating healthy? Come on, try it, you’ll like it!
Change Your Food, Change Your Life!