Some patients that I see for body contouring ask about diet pill medication and request that I either recommend one or write them a prescription for a pharmaceutical weight loss drug. While I am not a diet doctor per se, I think there are some basic concepts for patients to understand.
If you see any of the infomercials for numerous weight management medications available by a phone call, it is easy to be swayed that these weight-loss aids surely must do something. How could they get on TV and make these claims (in fine print on the screen it always says that these claims have not been evaluated by the FDA…and that the results are not typical) if they really didn’t reduce fat areas? Well, the reality is that they can and do since they are not subject to pharmaceutical oversight by the FDA. (hope is still the greatest sales tool!) What most of them contain are appetite suppressants such as caffeine or ephedra or diuretics that cause temporary weight loss. There is very little true medical evidence that any of these work. And just because they contain ‘natural’ or ‘herbal’ compounds in no way means that they are safe or even effective either. This is evidenced by the recent recall by the FDA of Hydroxycut which had been found to cause some cases of liver damage.
In my Indianapolis plastic surgery practice, I tell my patients this….you didn’t get overweight by taking pills and it is therefore unlikely that you will lose weight by taking pills. There is no magic to losing weight and the effort is certainly not in a pill. The best strategy is eat more nutritious foods and get more exercise…and remember it is a long run plan.
But will prescription weight loss medications work any better? We have an assortment of options available today and there is medical evidence that they do provide some short-term benefit. But the history of prescription weight loss drugs is not good. Many have been ultimately shown to have significant side effects and were ultimately withdrawn. These most notably include amphetamines, PhenFen, and Redux.
Today we have Adipex, Meridia and Xenical as prescription weight loss aids. Only Meridia and Xenical have been approved for longer-term use in significantly obese people, although the safety and effectiveness have not been established for use beyond 2 years. Xenical is also sold in a lower dosage as an over-the-counter drug. (Alli) In general, Xenical and Meridia are moderately effective, leading to an average weight loss of 5 to 22 pounds over a 1-year period, more than what would be expected with non-drug treatments. However, the response to these medications is based on each individual, and some people experience more weight loss than others.The NIH guidelines for treating obesity in adults suggest that if a person does not lose 4 pounds in the first month of taking the drug, it’s likely that it won’t have an effect. And for those for whom the drug does produce weight loss, it’s often not the dramatic fat loss that they often expect.
This does not mean that I think prescription drugs don’t have a role to play in some patients with weight loss. But their use should be short-term and should be used in conjunction with other lifestyle management strategies.After liposuction, for example, I will supplement some patients with up to 3 months of weight loss medication to maximize their gains from the procedure. But there is no reason to continue it beyond that period. I will not start it until they are at least 3 weeks out from surgery when their body is starting to recover from the trauma of the liposuction procedure. But other than that use, patients are best managed by those physicians who can provide them with a more comprehensive medical treatment plan and oversight.
Dr. Barry Eppley
Indianapolis, Indiana