Most American adults today are overweight; one in three is obese. And despite that potentially lucrative market, the pharmaceutical industry hasn't come up with any magic bullets to address what science is coming to understand as a complex medical issue.
There are a handful of FDA-approved weight-loss drugs, but they are meant only for the seriously obese since they all have unpleasant and possibly dangerous side effects. And in most cases they offer only a little extra help; you still have to do the hard work of diet and exercise, notes Tampa weight-loss physician Jay Garcia, who prescribes diet and lifestyle changes, as well as amphetamines as appetite suppressants, and B-12 shots.
Meanwhile, millions of people looking for an over-the-counter dietary boost are turning to the weight-loss supplements that look so alluring on TV, in magazines and all over the Internet.
With no long-term, peer-reviewed scientific studies and no FDA regulation over their production, the efficacy of products such as acai and hoodia is unproven. But the marketing works: Americans spent $1.67 billion on dietary supplements in 2007 alone, according to the Nutrition Business Journal.
Last month, the maker of the popular Hydroxycut line recalled 14 of its products after they were linked with liver damage and cardiac problems. In 2004, the FDA banned ephedra after linking it with more than 100 deaths. Prescription drugs, too, have been pulled for harming people — remember fen-phen?
But store shelves still are lined with options. So what is a dieter to do?
We checked out some of the most commonly advertised weight-loss aids. Here's what you need to know before you buy an over-the-counter diet aid or fill a prescription.
And here's another tip, from Tampa pharmacologist Dan Buffington, who helped us understand some of these weight-loss products: Keep exercising. He went to Dr. Garcia two years ago, lost 50 pounds, but has regained 25. "The minute I stopped bike-riding," he says, "it started to creep back on."
Acai
What it is: Acai (pronounced ah-SA-hee) berries come from a palm tree grown in Brazil; they are freeze-dried and sold in pill, powder and juice form.
Stated benefit: Said to suppress appetite, boost energy; often combined with green tea extract, which is said to burn calories by increasing core body temperature.
Does it work? There are no long-term, peer-reviewed scientific studies. Although some Internet ads claim Acai is endorsed by Dr. Mehmet Oz, Oprah Winfrey and Rachael Ray, all three have distanced themselves from the product.
Hoodia gordonii
What it is: A cactuslike plant grown in South Africa; so popular, it is now a protected plant and requires a license to harvest; sold in capsules, tablets, protein shakes.
Stated benefit: A natural appetite suppressant said to work without jitters, stomach distress, headaches.
Does it work? Bushmen in Africa are said to have eaten fresh Hoodia for centuries to suppress hunger while hunting; no peer-reviewed studies prove the supplement form works similarly.
Vitamin B-12
What it is: Vitamin B-12 is important for the function of every cell in the body, brain, nervous system, and for blood production; sources include foods such as shellfish, beef liver, fortified grains.
Stated benefit: Injections are said to help burn calories by boosting energy.
Does it work? Offered by many medical weight-loss programs, but no long-term, peer-reviewed scientific studies prove a weight-loss connection.
Alli
What it is: Alli is the only FDA-approved, over-the-counter weight-loss medication (sold by prescription in double strength as Xenical). It blocks fat absorption; but if you eat too much fat you risk cramping, poor bowel control and an oily discharge — the infamous "anal leakage.''
Stated benefit: Helps slightly with weight loss when used with a reduced-calorie diet and exercise. Tests on double-strength Xenical found that users lost 6 pounds more after a year than those who didn't take the drug, according to the Mayo Clinic.
Does it work? FDA approved Xenical in 1999; more than 100 controlled clinical trials.
Meridia
What it is: Prescription medication, recommended only for the seriously obese, that suppresses appetite. Side effects include increased blood pressure and insomnia.
Stated benefit: Tricks the brain into thinking you're full; clinical trials indicate a modest weight loss of 5 to 10 percent of starting weight.
Does it work? FDA approved Meridia in 1997; 6,000 patients participated in clinical trials.
Phentermine, phendimetrazine
What they are: Prescription drugs, members of the amphetamine family. Phentermine was given in combination with fenfluramine from 1992-97, a drug later associated with heart valve damage and pulled from the market. Phentermine, like phendimetrazine, remains available for short-term treatment of obesity; may be habit-forming.
Stated benefit: Appetite suppressant; may also increase energy; use with a doctor-supervised diet, behavior modification; generally thought to lose effectiveness after several weeks, although some physicians dispute that.
Does it work? FDA-approved; included in numerous controlled clinical trials.
Sources: Dr. Jay Garcia, pharmacologist Dan Buffington, RxList.com, MayoClinic.com, MedPageToday.com, Los Angeles Times
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