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The Skinny on Obesity Drugs

 

Friday, September 19, 2014

 

A Long History of Short-Term Solutions

 

Men and women have been looking for a quick fix to lose weight for a long time—more than a thousand years! According to a 2008 article published in the journal Obesity Surgery, 2nd century Greek physician Soranus of Ephesus wrote about obesity as a disease as early as the year 117 A.D. As treatment, he prescribed “Infliction of perspiration, very low caloric intake diet, exercise, and diuresis [increased or excessive production of urine].” As the journal article notes, “one cannot overlook the strong similarities of some of the treatments with those used nowadays as secondary aids for weight loss.”


Fast forward a few millennia. A rundown of some of the crazy things we’ve tried in an effort to shed a few pounds, according to EveryDay Health article “Fad Diets: A Look Back at Weight Loss Trends,” includes:

- 1850s – calisthenics, or “girly” gymnastics
- 1900 – calorie counts on menu items (introduced by Kellogg’s) and the first commercial meat substitute sold in America
- 1920s – fasting diets, popularized by author Upton Sinclair
- 1940s – the phrase “you are what you eat,” made popular by the book of the same name by American nutrition expert Victor Lindlahr

 

A 2009 Glamour article adds to this list cigarette smoking and Master Cleanse in the 1940s, prayer in the 1950s (yes, there really is a book called “Pray Your Weight Away”), the launch of Overeaters Anonymous and Weight Watchers in the 1960s, and diet pills in the 1970s. Since then, mankind has also seen it fit to invent the Thigh Master and the Shake Weight.

 

All told, that’s an awful lot of weight loss tactics to keep track of (and by the way, some of them, such as Weight Watchers and being aware of the calorie content of your food, can help you slim down when used responsibly). And the trend is still going strong today, with hundreds of consumer magazines bombarding us with pictures of airbrushed-perfect bodies on the cover and quick-fix tips on the inside. But to our credit, as medicine and nutrition has advanced, we have, as a society, gotten used to the idea that the most effective method of losing weight in a way that is sustainable is to exercise regularly (the American Heart Association says that 30 minutes a day, five days a week is a good start), and to eat a diet rich in fruits, vegetables, and lean proteins and low in Doritos. Many of us have finally accepted the fact that there is, in fact, no “magic pill.”

 

But all of a sudden, just when we’ve all decided to rekindle our relationships with our treadmills, there actually is a weight loss pill. As a matter of fact, there are three.

 

Magic Pills

 

In June of 2012, the U.S. Food and Drug Administration (FDA) approved the first weight-loss pill in 13 years, called Belviq. “Belviq is designed to block appetite signals in the brain to help people feel full after eating smaller amounts of food,” according to Reuters. “In large clinical trials, patients on average lost about 5 percent of body weight. The drug's FDA-approved label says Belviq use should be stopped if a patient has not reached 5 percent weight loss after 12 weeks of daily use.”

 

One month later, weight-loss drug Qsymia was approved by FDA in July 2012. “The 4,430 overweight and obese patients in the Qsymia studies experienced various levels of weight loss,” says an article from CNN. “About half of patients on the recommended dose lost 10% of their weight, while four-fifths lost 5%. That amounts to about 12 pounds for a 227-pound person.”

 

Most recently, on September 10 of this year, FDA approved another new weight-loss drug, called Contrave. “In a clinical trial involving patients without diabetes, those who took Contrave had an average weight loss of 4.1 percent beyond those receiving a placebo,” according to an article in The New York Times. “About 42 percent of those getting Contrave lost at least 5 percent of their weight compared with 17 percent of patients in the placebo group.”

 

It’s also worth noting that last week an FDA Advisory Committee panel took a vote on whether or not to approve a fourth obesity drug, liraglutide. The panel voted 14 to 1 in favor of approval for use in chronically obese patients with at least one weight-related health issue. The drug is already on the market as an approved treatment for diabetes under brand name Victoza. FDA is scheduled to make a final decision on whether or not the drug will be approved for obesity on October 20.

 

Smoke and Mirrors

 

Before we discuss whether these four pills are, indeed, the solution we’ve been waiting for since 117 A.D., you should know that we’ve tried to go the obesity-medication route before. A 1983 article from The New York Times discusses the recall of “starch blockers,” after it was determined that they should be classified as a drug, not a food. In 1997, two more diet drugs, marketed by Wyeth Laboratories as Redux and Pondimin, were also pulled off the market. “The Food and Drug Administration, acting on new evidence about significant side-effects associated with fenfluramine and dexfenfluramine, has asked the manufacturers to voluntarily withdraw both treatments for obesity from the market,” read the statement from FDA . “The action is based on new findings from doctors who have evaluated patients taking these two drugs with echocardiograms, a special procedure that can test the functioning of heart valves. These findings indicate that approximately 30 percent of patients who were evaluated had abnormal echocardiograms, even though they had no symptoms. This is a much higher than expected percentage of abnormal test results.”

 

But what about the drugs of 2012 and beyond? Are Belviq, Qsymia, Contrave, and liraglutide any safer for us than their predecessors? If the FDA approved them, they must be safe to take, right? It’s not quite that simple.

 

The 2012 approval of Belviq came after initial FDA rejection of the drug. Currently, it is approved only for use in adults with a body mass index (BMI) of 30 or greater, or adults with a BMI of 27 or greater who have at least one weight-related health condition (high blood pressure, type 2 diabetes, or high cholesterol). The FDA says patients should stop taking the drug if they have not reached 5 percent weight loss after 12 weeks of daily use. And there will be six follow-up studies, including a long-term study of whether Belviq increases the risk of heart attack or stroke. You can read the complete Important Safety Information for Belviq here


As for the second 2012 drug, Qsymia, “The FDA approved Qsymia only for obese people or for overweight people with a body mass index greater than 27 who also suffer from weight-related conditions like hypertension and diabetes,” says CNN. “An FDA advisory committee voted against Qsymia's approval in 2010.” Additionally, “The three clinical trials meant to measure Qsymia's safety and effectiveness were not designed to properly assess cardiovascular risk…Despite the label's warning that women of childbearing age should use birth control while on Qsymia, there are concerns that women will still get pregnant while on the drug…Previous clinical trials of topiramate, one of the ingredients in Qsymia, have shown a risk of about five birth defects for every 1,000 pregnancies.” Full Important Safety Information can be found here.


As for the newest of the bunch, Contrave, FDA declined to approve it in 2011 because of signs that it slightly raised patients’ pulse rates and blood pressure. Contrave’s label also has a boxed warning about the risk of suicidal thoughts. You can read the full Important Safety Information for Contrave here.

 

So what’s a sensible person to do? Must we constantly keep track of every new diet fad, fancy workout contraption, and obesity pill, and just keep trying them all until something works or until we give up and reach for the Oeros out of frustration and a sense of failure? Maybe not.

 

For starters, you should talk to your doctor if you’re struggling with losing weight. She or he may be able to help point you in the right direction and offer suggestions about healthy food choices. Your doctor can also order tests to see if you have related or underlying health issues. Some of the medications listed here may be right for your particular circumstances, and some may not. Other professionals that might be able to help include nutritionists, registered dieticians, and even psychologists. In the meantime, you can head over to ChooseMyPlate.gov for healthy eating recommendations from the United States Department of Agriculture. You can also find some great tunes, lace up your sneakers, and take a walk.


The journey toward a healthier lifestyle is best accomplished one step at a time.