In the last issue of Personal Best, there was an article about diet pills that said they were of little value in weight loss, and might even hurt efforts to lose weight. • As a medical doctor specializing in weight loss, I believe the subject is more complicated. • First, it's important to define what "diet pills'' are. The term is used for all kinds of pills and potions, many available without prescriptions at drugstores, health food stores and over the Internet. Some promise to tame your appetite, others say they'll block carbohydrate absorption, others claim they'll speed up your metabolism.
If any of these products had significant and research-proven benefits, we wouldn't have so much obesity in our country. Think about it: If weight loss were as easy as popping a pill, why isn't everyone slim?
Still, there are a few prescription appetite suppressants that I have found can help people who are obese, face significant health issues and are willing to do the hard work of changing what and how much they eat, as well as increasing their activity.
But they are not miracles by any means. They won't make you lose weight if you don't change your lifestyle, and they work only for as long as you use them. And patients must be closely monitored by a qualified physician.
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Appetite suppressants do pretty much what their name suggests: They suppress the perception of appetite. So they can be particularly helpful to people who eat for reasons other than true hunger.
The two prescription appetite suppressant drugs that are most commonly used in weight loss practices in the Tampa Bay area are phentermine and phendimetrazine. There are others less often used here, including Meridia.
Phentermine has been in use since 1959. It's taken once daily, and is the most commonly used appetite suppressant nationally. You may recall hearing about it being used in combination with fenfluramine (phen-fen), a mixture that caused serious heart problems in some patients. That particular combination is no longer in use.
But on its own and used correctly, phentermine is a very safe drug, categorized as a Class 4 drug by the FDA (Class 1 is considered highest risk, Class 5 is lowest risk).
Phentermine is not an amphetamine (though the two are chemically related). There is no withdrawal from its use and there has never been a case of addiction to it. Side effects are minimal if used properly.
Another appetite suppressant, phendimetrazine, has been in use since 1982. It's a Class 3 drug, and must be taken three times daily. It has the potential for more side effects than phentermine, including withdrawal syndrome if it is abruptly discontinued after being on maximal dosages.
Side effects of both medications include restlessness, dry mouth, some potential for agitation, and sleep disturbances. The FDA says that they also can raise pulse and blood pressure. But in my practice, I have found that as patients lose weight, their blood pressure drops even if they are taking appetite suppressant drugs.
What about Xenical or the over-the-counter version, Alli? They're not appetite suppressants; rather, they are fat blockers that discourage users from eating excess fats by producing very unpleasant side effects, such as sometimes unpredictable diarrhea. I don't often recommend them to my patients.
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If you go to see a doctor for a weight-loss program, you should expect a thorough medical history (both general and weight-specific), a physical exam, lab testing and an EKG, weight and body fat analysis.
Then comes education and training in how to eat, what to eat and what to avoid. Interestingly, protein actually has an appetite suppressant effect, so patients on protein-rich diets can often get by without appetite suppressant drugs.
But even for those who choose more balanced diets, we generally don't consider using an appetite suppressant until the daily calorie intake drops below 800-1,000 calories.
No one should go on such a restrictive diet without close medical supervision. I wouldn't recommend such a plan for a person who only wanted to lose 20 pounds.
But for a patient who is obese (with a BMI greater than 30), and especially with conditions like diabetes and high blood pressure, their health is at risk. This is a person carrying around a metabolic time bomb, and you want to get right on it.
We start with a low dosage of medication and increase it very carefully, depending on how the patient responds. It's the physician's job to monitor the patient closely to make sure he or she is getting enough to suppress appetite, without causing negative side effects.
It's important to recognize that the drugs themselves don't cause weight loss — they just help some people stick with the diet that causes weight loss.
But you can't stay on the drugs indefinitely, so it's essential that your physician wean you off them gradually, and then address how you keep the weight off.
If you visit a doctor for a weight management program and all you get is a weigh-in, a shot, pills and not much more, you might want to question if you are getting real value from that program. Additionally, not evaluating and treating associated conditions such as thyroid deficiency or other hormone-related issues will limit your success in the long run.
Larry Vickman, M.D., is medical director of Inches and Pounds of Tampa Bay. He is board certified in family practice and emergency medicine and has completed two of three parts for board certification in medical bariatrics. You may contact him at (813) 868-1511 or at [email protected]