Are the Weight-loss Drugs Worth It?

Weight-loss drugs work by different methods, and people often react to them differently. The phrase “Doctor’s orders” is well-known for a reason. A patient is often told to start off slowly and follow the expert’s guidance about when, and by how much, to increase the dosage. As with many other types of medication, several brands might need to be road-tested.

Childhood Obesity News has spoken of several weight-loss drugs, some with rather disturbing side effects. A report from Harvard Health Publishing mentions a few that had to be withdrawn from availability:

Dexfenfluramine and fenfluramine were taken off the market after they were linked to heart valve damage. Sibutramine (Meridia) was removed after it was linked to heart attack and stroke in people at highest risk for them.

But not all are dangerous, especially when prescribed by a conscientious doctor to a patient who gives a complete history, and follows instructions. Also, even serious side effects have to be accepted in some cases, when a comorbidity, or the obesity itself, is more threatening than the risk posed by the pharmaceutical. Under optimal conditions and with mindful compliance, what can be expected from weight-loss drugs? The Harvard report says,

When they are successful, they result in an average weight loss of about 5% over a period of six to 12 months.

So if the starting point is 200 pounds, 5 percent of that is 10 pounds. Down to 190, and it might take a year. Or, a person could just give up eating potato chips, or putting sugar in their tea. The potential for frustration can be reduced by careful assessment ahead of time.

The physician needs to know everything about the patient’s family history, current medications, allergies, and all those other boring but potentially crucial details. Not surprisingly, a vast number of patients also want to be fully informed before they commit to anything.

Aside from patients themselves, many wonderful folks act as advocates for relatives or friends who are not equipped to look out for their own interests. Sadly, a doctor simply does not have time to educate people in either breadth or depth, and may not have a staff member competent to do it either. In short, anyone who thinks about asking for a prescription must not expect a personal course in Weight-Loss Meds 101.

Frequently, the patient will be handed a sheaf of paper, which is a thoughtful gesture, but often futile, for a variety of reasons we will not attempt to explore here. In the main, those are printed-out web pages, carefully chosen by the doctor, to be sure — but still, information that a computer-literate person can obtain. Rather than wait, a person could do some research, highlight the most important factor, formulate one succinct, intelligent question for the doctor, and quite possibly receive an answer.

The bad news

For the non-professional who looks things up on the web, the most important part is, “Don’t use this if you have one of the named conditions, or if you take one of these other medications.” Say you’ve heard tell of Contrave, and you want to know what’s up. Some respectable institutions collate this kind of information. A web search for the product name plus “Mayo Clinic” brings up a page titled “Naltrexone and Bupropion (Oral Route).” Those are the two generic ingredients in the pills.

From there, the visitor is guided to a page enumerating more than 50 drugs that Contrave must not be taken with, and about a million more combinations that are recommended only in extreme need. Another list names a couple of dozen pre-existing conditions that should rule out the use of this compound.

By the way, what about non-prescription or over-the-counter weight loss pills? They are likely to contain caffeine and similar diuretic substances. In the context of genuine change, water loss is meaningless and potentially dangerous.

Your responses and feedback are welcome!

Source: “Are Weight-Loss Drugs Worth Trying?,” Harvard.edu, 05/22/18
Source: “Naltrexone and Bupropion (Oral Route),” MayoClinic.org, undated
Photo credit: Marcin Wichary on Visualhunt/CC BY

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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:

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.

Food & Health Resources