Weight Loss Drugs: How Much Do Diet Pills Help? (cont.)
"We recommend regular blood pressure checks for anyone on Merida," says Blatner.
Phentermine is generic, the least expensive of the medications, and has been on the market the longest. Once a part of the famed fen-phen combination weight loss drug, Phentermine works to decrease appetite.
It is the most widely used weight loss drug. While it's officially approved only as a short-term drug, some doctors use it as long term therapy.
"I use phentermine for people with strong appetites. [It] seems to work best on reducing hunger and the number of eating episodes. I also like it because it is generic, and inexpensive for patients who do not have insurance coverage," says Kushner.
Side effects may include depression, insomnia, increased blood pressure, irritability, and nervousness.
While these are the only medications approved for weight loss, some people also lose weight on prescribed medications used to treat other conditions such as depression, seizures, and diabetes.
Insurance coverage of these weight loss medications varies. Some companies will cover them completely, some partially, and some not at all.
Over-the-Counter Weight Loss Supplements
Dietary supplements should not be confused with weight loss medications. Most experts give little credence to the weight loss remedies that line drugstore shelves.
"There is a bewildering array of weight loss dietary supplements, but the sad fact is, there is no credible medical evidence that the supplements are safe, effective, and perform the way they claim," says Aronne.
Even so, many people plunk down their money. Promises from manufacturers range from reduced appetite to increased metabolism. But these claims are loosely regulated, and if they sound too good to be true -- chances are, they are.
"It is not as simple as many of the ads claim, and invariably what happens is patients try the supplements, they don't deliver as promised, and patients gain another notch on their failure belt," says Kushner.
Blatner suggests talking to your doctor or a registered dietitian before buying supplements.
"Wouldn't you rather take an FDA-approved medication than take the risk of choosing an over-the-counter weight loss remedy that may not be safe or effective?" she asks.
The Today show nutritionist Joy Bauer, RD, tries to inspire her clients to lose weight the old- fashioned way.
"Very few of my clients rely on supplements or drugs, and my advice is to find the natural health benefits in food," she says. "It is much better to drink a hot cup of green tea that is soothing, relaxing, gives you something to do with your hands and mouth, and delivers the benefits [of green tea] in a much better form than taking a pill."
Who Can Use Weight Loss Medications?
Not everyone is a candidate for diet drugs.
"About one-third of my patients are on weight loss drugs, but they don't start off that way," says Kushner. "The initial approach is to change their lifestyle, and after about 4-6 months of being engaged in a healthy lifestyle, if they are not getting results of 1- to 2-pound loss per week, we consider drugs."
He says another third of his patients have surgery, and the last third are successful with what he calls "lifestyle medicine."
So who does do well on weight loss drugs? Before prescribing drugs, experts look at whether patients are eating a variety of healthy food, controlling portion sizes, using strategies to monitor and plan their meals, adhering to reasonable calories goals, and getting exercise. If the traditional approach to weight loss is not working, drugs are an option.
But don't think that if you are 5 pounds overweight, you are going to be prescribed weight loss medication.
"We follow the NHLBI [National Heart, Lung and Blood Institute] guidelines that patients must have a BMI of 27 along with other complaints, or a BMI of 30, before using drug therapy," says Aronne, editor of The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults.
Even when a patient meets the criteria and takes the drugs as an adjunct to a healthy lifestyle, there is no guarantee they will work.
"We can usually tell who will be a responder in 4-6 weeks," Blatner says.
Published October 5, 2007.
SOURCES: Joy Bauer, MS, RD,Today show nutritionist; author,Joy Bauer's Food Cures. Dawn Jackson Blatner, RD, spokesperson, American Dietetic Association. Robert Kushner, MD, professor of medicine, Northwestern University; author, Dr. Kushner's Personality Diet. Louis Aronne, MD, director, comprehensive weight control program, New York Presbyterian Weill Cornell Medical Center. WebMD Feature: "All About Alli." National Institutes of Health Weight Control Network web site. The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults, NHLBI, 2000.
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Last Editorial Review: 10/8/2007