60-year-old Weight-Loss Drug Makes a Comeback

There was a time when “diet pills” were more liberally prescribed. They would lead the user to alphabetize the closet, scrub the floor with a toothbrush, or simply bounce off the walls. They were basically pure speed, and sometimes the results were far from salubrious.

Then, in the 1990s, fen-phen, a combination of fenfluramine-phentermine, was The Thing for a few years. But all along, reports were coming in about such non-trivial problems as heart valve damage and primary pulmonary hypertension (PPH). Also, hair was falling out of women’s heads. In 1996, its year of peak use, doctors wrote 18 million prescriptions for fen-phen. The next year, fenfluramine was banned by the FDA.

A ton of people sued the Wyeth Pharmaceuticals, which was ordered to make $21 million available for compensatory payments to consumers. Things cooled off for a while, but the amphetamine-like phentermine, even without its former partner, is still an appetite suppressant. Journalist Leslie Goldman writes,

Doctors believe it works by targeting the hypothalamus (the part of the brain responsible for satiety) and boosting neurotransmitters that help minimize hunger and cravings.

In a piece called “The Secret, Scary Way Your Friends Are Losing Weight,” Goldman asserts that although today’s weight-conscious women eat more mindfully and exercise more religiously, many still take pills, and probably do not admit it to their friends. She paints the picture of a culture where the use of pills is stigmatized and thus hidden — although believers do go online to chat anonymously about their secret.

But in real life, some women prefer to promote the illusion that their slim figures are righteously earned. Consequently, their friends don’t cop to having pharmacological help either, because they believe that others are succeeding on diet and exercise alone. This creates a self-reinforcing web of deception.

The way it’s supposed to be

The recommended way to use phentermine is in a limited course, for two or three months at most, and with close monitoring by a medical professional. There are success stories, where the temporary advantage is treated as a jump-start, for psychological encouragement. But as always, the most important thing is to develop a whole new kind of lifestyle, because otherwise, the weight will inevitably return when the prescription runs out.

If a person can pay a lot, and doesn’t mind dealing with shady online sources or the risk of not even getting what was ordered, little things like recommended limits are irrelevant. Nevertheless, the side effects of heart interference and PPH are still in play, and sadly, taking a higher dosage does not lead to more weight loss, but does increase the undesirable side effects.

Ed J. Hendricks of Center for Weight Management in Roseville, CA, reveals that despite the warnings, some doctors have been okay with extended prescriptions all along, like since 1959, when phentermine was first approved. They reason that the risks are acceptable compared to the risk of morbid obesity.

For many years, until the 1980s, the drug was even deemed safe for children. Hendricks writes,

There are no reports of harm from phentermine treatment in either very young or elderly patients. The surveys of obesity medicine physicians cited above indicate that a majority use phentermine in treating adolescents… [O]bservational reports have included patients safely treated with phentermine as young as 3 years…

Clinically significant psychiatric distress similar to that described in the DSM-5 in discussing stimulant use disorders has never been observed in overweight or obese patients treated with phentermine. A phentermine withdrawal syndrome has never been observed or described.

Due to recent studies showing that long-term use does not in fact increase blood pressure or the risk of heart attack and stroke, phentermine is now back in the good graces of the medical world. As a generic drug, it is relatively affordable. Also, official definitions have changed. As one source puts it,

Now that we view obesity as a chronic disease, it’s important to have medications that can be used indefinitely.

Your responses and feedback are welcome!

Source: “The Secret, Scary Way Your Friends Are Losing Weight,” Cosmopolitan.com, 02/12/19
Source: “Off-label drugs for weight management,” NIH.gov, 06/10/17
Source: “Generic weight-loss drug may be safe and effective for long-term treatment,” ScienceDaily.com, 03/22/19
Photo credit: ezhikoff on Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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