Doctors and dieters alike have been chasing the dream of a weight loss pill that melts away extra pounds without negative side effects for years now.
This quest is an acknowledgment of the fact that it takes more than just willpower – more than just resisting the urge to splurge if you will – to lose weight safely and effectively.
New research shows that weight gain can alter the brain and body. Even if someone manages to lose weight and get thin, they might not reverse the changes. This causes us to gain the weight back as our brain is convinced we need it.
Doctors thought they hit a goldmine in the 90s with the combination of fenfluramine and phentermine, known as fen-phen. The combination seemed to literally melt away the fat. A few years later though, and patients started to notice some scary side effects of using fen-phen. These effects included heart damage that could potentially lead to heart failure, and pulmonary hypertension; a kind of high blood pressure that was fatal for some patients.
The Food and Drug Administration (FDA) got involved and called for drugmakers to pull fenfluramine, which they did. It was determined that the fenfluramine was the culprit behind the side effects. The media quickly latched on to the story and patients were scared off of even trying diet pills – a fear that can still be felt today.
There’s an even bigger problem now though; America is getting fatter by the year. Two-thirds of Americans are classified as being overweight or obese. With this in mind, doctors believed the only course of action was to find a safe and – even moderately – effective medicine that could help patients to lose weight and keep it off.
The newest drugs appear to do this. They can’t transform a morbidly obese patient into a model, but they can help to get rid of enough excess fat to reduce the risk of heart disease by reducing hypertension, cholesterol, and blood sugar levels – according to the experts.
Lorcaserin is one example of such a drug. Researchers found the drug helped lead to a consistent, sustained weight loss of up to 5% of body weight for 40% of patients at risk of heart attack, stroke, and death from the cardiovascular disease without increasing the risk of such events, according to a recent report from the New England Journal of Medicine.
The study was carried out over a period of three years. This is important because most weight loss studies only follow patients for one year, according to Dr. Erin Bohula, the lead author of the study. Dr. Bohula serves as an assistant professor of medicine with Harvard Medical School and is a cardiologist and investigator with the TMI Study Group of Brigham and Women’s Hospital in Boston. “The challenge with lifestyle intervention,” says Bohula, “is that patients tend to lose weight up front, and then the weight is regained, sometimes beyond the original weight.” The challenge becomes keeping the weight off in the long-term.
A weight loss of 5% might not sound like much, but Dr. Louis Aronne – a professor at metabolic research at Well Cornell Medicine – says that just 5% is “the point where there is a very significant reduction in the risk of diabetes”. A weight loss of 5% cuts the risk of developing diabetes in half, while a 10% weight loss is associated with reducing the risk of diabetes by 80%.
The patients in the study run by Bohula did indeed see improvements in blood sugar levels and hypertension with their weight loss.
One problem is that there’s no such thing as a catch-all solution for obesity treatment, just like there isn’t for hypertension. There are currently over 100 different medications and 10 different therapeutic categories for hypertension. This is why hypertension treatments are so effective. Not every patient can – or will – be treated by the same drug. This kind of thinking needs to be brought to drugs for obesity too.
Aronne says that many people don’t understand that gaining weight can cause changes in the brain that might prove irreversible. Gaining weight makes it even harder to lose weight. In some cases, nerve cells in the brain are damaged and can die from it.
This new understanding is why some medical associations consider diet pills to be intrinsic in the fight against obesity.
Weight loss drugs are recommended as supplements to a healthy diet and exercise plans. For example, they were included in guidelines from the American Heart Association, the Obesity Society, and the American College of Cardiology in 2013. Even so, these drugs are still being used in relatively low amounts of cases. There may be several factors involved with this; including the cost of the pills if they aren’t covered by insurance, and the perception that weight loss pills aren’t safe given the history of them.
A report from 2017 that looked into the medical records of 2.2 million patients showed that less than 1 in 50 patients who were eligible to receive a prescription for diet pills actually did.
This hasn’t come as much of a surprise to Dr. Vijaya Surampudi, an endocrinologist and assistant professor of medicine at the Center for Human Nutrition at the University of California in Los Angeles. Surampudi says she prescribes them all the time, but they aren’t very popular. She feels that physicians are uncomfortable prescribing weight loss medications because of the history with fen-phen.
She also said that Americans need to rethink how they view weight loss and dieting. “People need to focus on the health benefits,” she says, “rather than thinking about how good you’ll look in that dress, you need to be thinking, ‘I won’t get diabetes now’.”
Of course, one of the most effective tools when it comes to weight loss is patience. Weight gain doesn’t happen overnight, so no one should expect weight loss to happen overnight either.