Better living through chemistry

Mother's little helper...

The dream, if we were all to be perfectly honest, is the ability to take a pill, eat whatever we want and be thin regardless.  This elusive dream drives a multi-million dollar market of everything from weird little crystals that you sprinkle on your food to prescription medications that are controlled substances. 

The options available over the counter alone are astounding:  Sensa, ketones, ephedra, caffeine, saffron extract, amino acids.  One thing is certain about all of these things - there is absolutely no clinical data to show that any of them work.  There is no data to show that in combination with diet and exercise your results are improved while taking them.  They are mainly a vehicle for creating very expensive urine.  Seriously, if any one of these was actually effective, there wouldn't be so many choices.  Everyone would just buy the one that works.

So what does work?  Right now there are a small selection of FDA approved prescription weight loss medications that are available in the US.  These and a few other prescription drugs that are for other diseases are the only proven adjuncts to weight loss in the US.   In order of their appearance on the market:

1. Phentermine:  half of the infamous phen/fen combo, this is the part that didn't cause mitral valve problems.  The original combo included the phentermine which is an appetite suppressant and fenfluramine which works by increasing serotonin.  The combo was very popular and relatively affective (doubled weight loss over 24 weeks!) while it was being taken.  Phentermine alone is still available and is effective, although not as effective as the combo.  It is a controlled substance due to it's similarity to amphetamine but has pretty low addictive potential. There are a handful of other "anorectics" available, although none seem as popular as phentermine.
2. Orlistat:  Otherwise known as Alli, this drug works by preventing absorption of fat in the intestines.  You take it with all your meals and it mixes with your food and blocks the enzyme that processes fats so they can't be taken up.  Ideally, used in combination with a low calorie diet, it can double your weight loss.  The caveat being that if your diet is too high in fat (>30%) you will have pretty bad side effects (diarrhea, incontinence)  and if it's too low in fat, it won't do anything for you.  BTW, the increased weight loss found in studies was at the prescription dose, not the OTC dose.
3. Qsymia:  The first new weight loss drug to be approved in more than a decade, this is actually a combination of 2 already-available drugs:  phenetermine and topiramate.  Yep, the same phentermine from above.  Topiramate has been long used as an anti-seizure medication and was noted during the use to have co-incidental weight loss.  We actually have little idea as to how it works, but it does.  It too is a controlled substance, based on the phentermine component.
4. Belviq:   Approved shortly after Qsymia, it has yet to be sent to market because it needs to "scheduled" by the DEA.  It is a new drug, locaserin, which works by stimulating serotonin receptors specific to appetite and satiety.  Since it is a new drug, the jury is still out on long term side effects.  As far as weight loss, it too seemed to double the amount of weight lost as compared to diet and exercise alone.

In addition to the above-mentioned pharmaceuticals, it's fairly common for other drugs to be used off-label for weight loss.  In particular, ADD/ADHD meds are well-known for their appetite suppression effects.  The most commonly used, the amphetamine class, includes adderall and dexedrine which were originally created for treatment of obesity.  Neither one is approved for that use now, but they are still widely used (and abused if you call taking someone else's prescription abuse) for that purpose.  In addition, some anti-depressants have been known to augment weight loss, although they may have the opposite effect if the person tends to eat little while they are depressed.  As long as treatment is carefully monitored by a physician, off-label use of prescriptions is common in the medical world and can be effective and safe in most cases.

So within the past 6 months we in the US have doubled our choices of drugs to help with weight loss.  As a weight loss professional, I see nothing wrong with giving these meds a try.  I think if you're otherwise healthy, they can help increase weight lost while participating in organized dieting (Weight Watchers, Jenny Craig).  What I hate to see is people using them while "trying to cut back" and then being upset when they can't maintain the weight loss after they go back to eating poorly.  This should really come as a surprise to no one.  Most people who have success with them need to keep using them long-term in order to maintain that success.  After all, you don't stop taking your blood pressure meds because they work.  You keep taking them.