Weight Management

Even With Weight-Loss Drugs,
Losing Pounds Isn't Easy

Out of the 90 million Americans who are overweight, 50 million go on a diet each year, according to the National Women's Health Resource Center. Ninety percent of those dieters who lose weight regain all or a part of it within five years.

Consumers continue to look for a magic potion that will make them slim and trim with little or no effort.

"Many patients who are overweight come into the office looking for an easy way to lose weight," says Dennis A. Cardone, D.O., assistant professor at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. "They think they can take a drug and not have to worry about changing their eating habits and exercising."

They are wrong.

Using prescription weight-loss drugs
According to the National Institutes of Health Weight-Control Information Network (WIN), weight-loss medications should be used only by patients who are at increased medical risk because of obesity.

Weight-loss drugs are recommended in combination with a diet and exercise program for people who are obese (BMI of 30 or greater) or for those who are overweight (BMI of 27 to 30) and suffer from two other risk factors for or diagnoses of chronic diseases such as high blood pressure, heart disease and diabetes, says Dr. Cardone. He generally recommends them to patients who are obese and have been unable to lose weight after making multiple attempts while under the supervision of a physician. A safe and reasonable goal for weight loss is 10 percent in six months.

How they work
Prescription weight-loss drugs work in one of two ways. In the first, the drug (for instance, sibutramine) suppresses appetite and increases metabolism by altering neurotransmitter uptake in the brain. In the second, the drug (orlistat, for instance) reduces the body's ability to absorb fat. Your doctor will determine which kind is best for you. "It's important to take into consideration the patient's past medical history and the potential side effects and interactions of each drug," says Dr. Cardone.

Side effects of appetite suppressants include headache, constipation, back pain, insomnia, dry mouth, nervousness and upset stomach. Side effects of drugs that affect how the body absorbs fat include changes in bowel movement habits, gas, stomach pain, and in women, irregular menstrual periods.

Prescription weight-loss drugs are not magic potions. WIN recommends they be used in conjunction with behavioral treatment and nutritional counseling so you can make long-term changes in your diet and activity patterns. You'll also need to see your doctor regularly. Studies indicate if you don't lose four pounds in four weeks, it is unlikely the drug will contribute to significant weight loss.

What to consider
Before you and your doctor decide whether you should take weight-loss medications, consider that there is a potential for abuse or dependence -- many appetite suppressants are controlled substances. You could also develop a tolerance to the drug. And there are side effects. "The patient should be made aware of the possible side effects and be a part of the decision-making process," says Dr. Cardone.

Weight-loss drugs will not keep the weight off forever. "The safety of most weight loss drugs has only been studied over a short period of time," says Dr. Cardone. "And most studies have found that even with weight-loss drugs, most people will not be able to maintain weight loss over the long term. Drug therapy is only effective when used in conjunction with a structured diet and exercise program."

About This Article
Publication: Vitality Digest; Publication Date: October 2001; Author: Bea Quirk; Source: National Institutes of Health; Source URL: http://www.nih.gov/; Online Editor: Dianna Sinovic; Online Medical Reviewer: Cynthia Godsey, M.S.N., F.N.P./C., Gordon Lambert, M.D.; Date Last Modified: 4/21/04