Pharmaceuticals In, Pounds Off

Some of this talk about weight-loss drugs might not seem relevant to childhood obesity, but the connection is, obese children tend to become obese adults. To learn about the possibilities is to fervently wish that our children will never have to experience them firsthand.

Orlistat (generic) comes in two brand names that denote different dosages. It is said to block absorption of 25 percent of the fat in a meal, and is recommended for very obese patients who are coping with the risk factors of hypertension, diabetes, or hyperlipidemia. The daunting list of side effects would seem to preclude any kind of social life.

Lorcaserin is an extended-release tablet that helps people feel fuller with smaller meals, by affecting the brain’s appetite-controlling signals. As expected, it comes with warnings about pre-existing conditions and possible conflicts with other medications. As always, the patient is enjoined to practice good dietary and exercise habits.

Lorcaserin has worrisome physical side effects and even more alarming mental effects, including impaired thinking, decreased alertness, urges to self-harm, and out-of-body sensations. It is not to be prescribed to people under 18.

Metformin is described by a patient Marcia Kadanoff (as told to writer Timothy Hay) as safe, effective, and affordable; not very stressful to the internal organs; and not linked to weight gain. Its primary use is the treatment of diabetes, and it is in fact (although not officially approved as such) also a weight-loss drug. The authors say of this member of the class biguanides:

The medicine does not increase insulin levels in the body, but instead lessens the amount of sugar the body produces and absorbs. As it lowers glucose production in the liver, metformin also lowers blood sugar by increasing the body’s sensitivity to insulin. It also decreases the amount of glucose that our bodies absorb from the foods we eat.

I expected it to work like insulin in pill form and drop my blood sugar (around 180 mg/dl at the time) right away. But… It can take four or five days to experience the full benefit, depending on your dosage.

Some patients experience side effects, which usually subside over time. They might include nausea, stomach pain, gas, bloating, and diarrhea. To prevent these discomforts, doctors like to start conservative and titrate up, which may delay the perceived start of the benefits even more.

Reportedly, gastric distress can be alleviated by avoiding carbohydrates in the diet, or by using the extended-release version of the medication. Also, metformin can block the absorption of Vitamin B12, so that needs to be monitored.

The more serious, alarming, and fortunately rare side effects include hypoglycemia, lactic acidosis, liver damage, and heart failure. On the plus side, metformin is being looked at for a variety of other uses including, paradoxically, heart disease.

Your responses and feedback are welcome!

Source: “Orlistat,”, undated
Source: “Lorcaserin,”, 11/13/17
Source: “Everything You Always Wanted to Know About Metformin, But Were Afraid to Ask,”, 01/08/19
Photo credit: Phuketian.S on Visualhunt/CC BY

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Profiles: Kids Struggling with Weight

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

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.
You can contact Dr. Pretlow at:


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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