Weight Loss and Diet Pills: A Doctor’s Perspective for 2010

effective drug, especially for those with cravings and compulsive eating. The feelings of fullness rather than appetite reduction may be the most significant effect. This is a drug approved for long-term use-months and even years. It has substantial benefits for those individuals who have a great deal of weight to lose and are willing to take the drug for long periods of time.

Orlistat

Approved by the U.S. FDA in 1999, Xenical (orlistat) is a lipase inhibitor for obesity management that acts by inhibiting the absorption of dietary fats. Orilstat prevents enzymes in the gastrointestinal tract from breaking down dietary fats into smaller molecules that can be absorbed by the body. This undigested fat is excreted in the bowel movement. Side effects of flatulence, fecal urgency, oily stools and leakage have limited its widespread use. An over-the-counter version, brand name Alli has been on the market for the past two years,While it is expensive and has limited benefits, some studies show that teenagers have done well with it.

New Weight Loss Drugs for 2010:

After the cannabinoid receptor antagonist, drug Rimbonbant (Acomplia) was rejected by the FDA because of psychiatric problems and latter pulled off the European market, focus in the US has been on combining older drugs, each having different effects. This has been used very successfully in the treatment of hypertension, diabetes, and high cholesterol. Doses can be kept low and there are synergistic effect of taking two drugs, each one at lower doses. Three combinations of older drugs are being tested:

Qnexia-phentermine and topamax
Empatic-buprion and zonisamide
Contrave-Buproion and Naltrexone

Of these three, the best result seem to have been from Contrave, which reminds one of phen/fen, only the fenfluramine has been substituted by the migraine/headache pill, Topamax. I have prescribed this combination of pills, off label, and have very good results, especially in patients who are eating out of cravings or emotion issues and not even hungry. The greatest side effect was fatigue and sleepiness.

Another approach has been to use the GLP-1 antagonists used for treating diabetes including Pramlintide,Exenatide and Symylin. The down side is that they have to be given by injection once or twice a day. A long acting once a week injection is being tested which may offer a lot of advantages to obese diabetics and people with morbid obesity. The drugs normalize blood sugars(but do not cause them to fall below normal), decrease gastric emptying time so a person is full longer, and may actually decrease appetite through central nervous system pathways.

Every pharmaceutical company is looking at this market, and no doubt in the next few years, new and exciting medication will be available to assist the overweight person. However, medications are only helpers, not much different than bariatric sugery in that people still need to pay attention to the food and move around more.If you are considering medications, you need to see a physician who is experienced with these medications.They are prescription medications (except for Alli) and all have significant side effects if not taken corrrectly.

Buying these kinds of drugs on the Internet is dangerous, you don’t know what is the best drug for you nor do you have any idea even what you are buying. Visit an M.D. or D.O., weight loss is a serious business. Treat your body as carefully as you take care of your computer or car. You will also save a lot of money, Internet prices are often four to five times what you would pay in a drugstore!

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