Weight Loss Medications

I have some patients coming to me asking about weight loss medications; prescriptions as well as the fad ones sold on television. What information should I provide that lets them know that they are not safe? I know that they speed up the metabolism, cause heart palpitations and such, but don't have much solid information, nor do I know what drugs the physicians actually prescribe for their clients.

Please let me know. Thanks, all!

I have yet to see a physician prescribe a weight-loss medication, although I understand there are a handful out there (primarily the intestinal fat-absorption blockers I believe). One of them, orlistat, just got approved for OTC sale. I keep seeing it in Walmart.

The funny thing, and I think what most people are missing, is that these don't really work. Check this out:

http://findarticles.com/p/articles/mi_m3225/is_3_62/ai_65077511

52 weeks, and the treatment group lost 9lbs vs 3lbs for the placebo group. Wow. So not worth the money.

The other weight loss supplements that used to be popular (ephedra-containing products like Stacker, Hydroxycut, and their knockoffs) are no longer sold in the US. The palpitations, strokes, etc were primarily a product of the stimulant ephedrine. They changed the formulary on a lot of these labels, but I have no idea what they contain now.

Hi "P", (hope it's o.k to shorten!)

Have you looked into Ali/Xenical?

It has side effects for sure, but is not the typical. It blocks fat metabolism so it passes out as an orange, oily substance. It does not speed up metabolism or increase heart rate etc.

It works for me. Nothing else has. I started on it before it was over the counter, as an RX.

Hope this helps a little...

Suzi:mad:

Meridia. I stayed away from Alii (or however it's spelled) because it works on the GI tract. I do home health. I did not need to be out in the middle of nowhere in this ag county and suddenly needing a bathroom. Meridia was great, it's a suppressant that doesn't speed up the metabolism.

Thanks, everyone for the quick responses! And, yes, Suzi-Q, it's okay to shorten the name.

So, basically, it is not wise to take these over the counter medications because they may cause palpitations, stroke and that they should be monitored by a physician, correct? I heard that some of them affect the firing of the SA node of the heart, causing ectopic beats. Is that true?

phentermine 37.5mg 1qd or 1bid, You lose weight and your stomach shrinks so much that when you finish up your 2 months, you have to eat many small meals a day. Also, b12 injections once a week helps with speeding up metabolism. Most people I know that go to this diet clinic have lost 10-20lbs in the 2 months and have kept it off. I'm not sure as far as what comordities that you have to have to not be able to take this. I have none and I've had no side effects except I split my tablet and take half in morning and half around lunch time, otherwise you have such a burst of enery you have a hard time burning it unless it a good workout day. Tell me if you've heard any horror stories. Alot of GP's will prescribe it for up to 2 months. I know alot of people on it and have not heard of anything negative happening, cardiac, psych or anything else. This would be a great drug for nighttime workers to stay awake and be very, very, very productive without the heart palpatations or abnormal thinking.

The problem with that junk is that is is not a long term fix. Unless people change their eating and exercise habits, they are not going to keep the weight off. I've seen too many people taking the pills and even having the surgery and they think that once some weight is off - that's it, nothing else to do. I have seen bariatric surgery patients with teeny, tiny stomachs end up gaining weight because they are eating small meals of things like cake and cookies! Simple math: more calories eaten than your body can use = excess weight. A pill without a lifestyle change is not going to work. When you read the fine print of any of those supplements you see that they recommend a proper diet and exercise regimen in addition to their pill.

Just tell your patients that weight loss requires work, not a pill, and refer them to a dietician & PT/cardiac rehab specialist/gym (ask your social services dept for referrals if your hospital does not have and outpt wellness center) and encourage your pts to make the lifestyle changes to lose weight (and keep it off) safely and not waste their money on short term quick fixes or quack cures.

phentermine 37.5mg 1qd or 1bid, You lose weight and your stomach shrinks so much that when you finish up your 2 months, you have to eat many small meals a day. Also, b12 injections once a week helps with speeding up metabolism. Most people I know that go to this diet clinic have lost 10-20lbs in the 2 months and have kept it off. I'm not sure as far as what comordities that you have to have to not be able to take this. I have none and I've had no side effects except I split my tablet and take half in morning and half around lunch time, otherwise you have such a burst of enery you have a hard time burning it unless it a good workout day. Tell me if you've heard any horror stories. Alot of GP's will prescribe it for up to 2 months. I know alot of people on it and have not heard of anything negative happening, cardiac, psych or anything else. This would be a great drug for nighttime workers to stay awake and be very, very, very productive without the heart palpatations or abnormal thinking.

Can we say controlled substance? Of course it keeps people awake, it is similar to amphetamines and can be addictive. Let's not forget Fen-Phen and the resulting heartache from taking that. I would not recommend that for any of my patients.

RN1989 is dead on. It cannot be solved long term by a pill. Many OTC diet pills contain either caffeine or a form of it so yeah it can cause palpitations.

The root cause has to be fixed and that is almost always inactivity along with poor diet.

I would stress simple lifestyle changes that they can live with. It may be changing out soda for crystal light or tea. Perhaps trading out snack chips for popcorn (low fat) or yogurt. Add wheat bread instead of white. White/wheat is better than just white. Little changes can make a world of difference.

But people expect too much from pills and do not realize how harmful they can be. There is no completely safe medication. Even recently we have found out about taking high normal doses of Tylenol can start to raise your liver enzymes. Drugs are constantly being recalled.

I don't advocate any pills, get-thin-quick gimmicks. The best, most solid advice is increasing exercise, encourage activities that people enjoy so it's a part of their daily routine. Usually there is one thing that they can incorporate into their day, even if it is a brisk 15 minute walk daily. Something is better than nothing.

I have a problem with "fake" food additives, so I unless they have serious health issues such as diabetes, I don't advocate Saccharine, Aspartame, Splenda, etc. My rule is, if it's manmade, it's probably not that great for you. I advocate complex, whole-grain carbs over white refined flour products. I agree with keeping food as close to the natural state as possible and drinking an adequate amount of water a day. I like the common-sense approach.

They are right about the eating right and excercise. Ali helped me lose a little more, but if you aren't willing to make the other lifestyle changes you will be right back where you started.

I was commited and have changed alot. The med just helped keep my motivation up in the begining. I am still on track, but no longer take Ali.

i briefly tried the fat-blockers a few years ago.."oily anal leakage" is the nicest possible way to explain the effect...

finally tried a southbeach approach at md's suggestion to dh and me--tons of veggies, fish, berries, and walking. down 6 lbs and 1 pant size in 2 weeks, actually looking forward to my physical this friday (labs drawn yesterday). i have learned a bunch of new recipes, am saving $$ my cooking at home and bringing leftovers for lunch, and feel better. not a plug for the "official" program, just what is working for us--without ever being truly hungry--really!!:pumpiron: