Weight Loss With Medication
There's no magic bullet yet -- but for people with obesity, weight loss drugs can be a helpful part of treatment.
How Long Would Someone Need to Use Them? continued...
"The physiology that causes someone to become obese doesn't go away," says Wyatt. Stopping the drugs usually means that the weight will come back. And losing the weight doesn't matter as much as keeping it off. If you lost 20 pounds but regained it all within the year, it's not going to help all that much.
Long-term treatment doesn't mean that people will necessarily be taking the same weight loss drug every day for the rest of their lives. Instead, it's possible that someone might switch between Xenical, Meridia, or other drugs.
It may also be possible for people to take breaks in treatment. "Weight isn't like blood pressure," says Wyatt. "If you stop taking your blood pressure medication, it goes up within a few days. Regaining weight takes longer." So far, studies have not shown any advantages to using weight loss drugs periodically. But as researchers learn more about how to best use these medications, it may be a possible form of treatment in the future, Wyatt says.
Are They Safe?
One of the biggest concerns for anyone considering a weight loss drug is its safety. The fear is understandable. The much-touted combination of weight loss drugs called fen-phen -- phentermine and another drug, fenfluramine -- was found to cause dangerous damage to the heart valves in some people. As a result, both fenfluramine and Redux, another similar weight loss drug, were pulled from the shelves in 1997. On its own, phentermine is considered safe and still used.
Being cautious about any weight loss drug is good policy. None of these drugs have been around that long, and so we can't be sure of their long-term effects.
That said, the safety records for both Xenical and Meridia are good and the risk of side effects are low. Meridia can cause headaches, dry mouth, and a rise in the pulse and blood pressure.
Xenical can cause gastrointestinal side effects, such as spotting, an urgent need to go to the bathroom, and an increased number of bowel movements. These side effects tend to fade over time, and are aggravated by eating a high-fat meal. Xenical can also reduce the amount of vitamins that your body absorbs, so you may need to take a multivitamin to compensate.
But researchers have found no side effects like those of fen-phen.
"Any medication carries risk," says Wyatt. "But at this point, I think that [Xenical and Meridia] are as safe as any other medication that we routinely prescribe." In fact, because of the fen-phen debacle, she thinks that weight loss drugs may be held to an even higher level of safety than other types of medicine.
Wyatt also observes that the very small risks of these drugs have to be compared to the real risks of obesity, such as high blood pressure, diabetes, stroke and heart disease. For people who are very obese, another way to frame the choice could be to compare the low risks of weight loss drugs with the higher risks of bariatric surgery, often called stomach stapling.