Lose 30 lbs in 30 days! The sign on the telephone screamed at me. Years ago pink and yellow signs like this scattered my neighbourhood. I knew this was too good to be true and may even be unhealthy.
With the weight loss industry worth billions of dollars each year, it’s no surprise there’s a market for quick and easy promises. And when your doctor can’t offer much in the way to lose weight, people go looking elsewhere.
Many of us are waiting for the miracle pill that can make people lose weight. And why not? A lot of us are unhappy with our weight and how we look. At times I would include myself in that camp wishing to have the abs of Christian Ronaldo.
But wait, according to various news articles, the ‘Holy Grail’ of weight loss has arrived. Could it be true, or has the health industry now come to using inflammatory headlines just to attract attention?
The excitement comes from the results of a study in 12 000 overweight and obese people taking lorcaserin (an appetite suppressant). After three and a half years, lorcaserin resulted in an average weight loss of just under 2 kg compared to people taking a placebo. Most of us wouldn’t think this is much to write home about. But the actual excitement was regarding the fact that this drug was safe for the heart. Huh?
To put this into perspective, the road to finding a safe and successful weight loss drug is filled with failures. Much of which were due to concerns about drug safety. One of the earliest drugs, fenfluramine, elevated blood pressure in the lungs and also led to heart valve problems. Soon after these findings were published, the drug was pulled from the market.
Other weight loss drugs have also been pulled from the market. These include sibutramine, which was associated with a higher risk for stroke and heart attack, and rimonobant, which was associated with a higher risk for suicide.
So where does that leave us? Besides lorcaserin, there is phentermine, one of the oldest and most prescribed weight loss drugs. However, it’s considered potentially additive and is only approved for up to 12 weeks of use. Although, when prescribed in combination with topiramate, it can be used for longer and has resulted in an average 10kg weight loss after one year.
Orlistat is another weight loss drug that is available over the counter in many countries. As opposed to reducing appetite as most the other drugs do, it prevents the absorption of fat in the gut so the fat passes right through. Over four years, people using orlistat lost 2.8 kg compared to people taking a placebo. Despite this small amount of weight loss, there was a 33% reduction in risk for diabetes during the study.
Orlistat is not without its side effects, the worst being diarrhea and gas. Not a major health concern, but very uncomfortable and a huge social concern, which leads to a lot of people quitting it. One of my colleague’s patients had this happen to him while on the golf course. Needless to say, he stopped taking the drug. These effects can be controlled if the user is eating a low fat diet, so orlistat’s benefit may come in part due to ensuring people are eating less fat (and likely less calories).
Going back to lorcaserin, and the ‘Holy Grail’ of weight loss drugs, the safety issues with previous weight loss drugs led to regulatory agencies like the US Food and Drug Administration requiring all new drugs to test for adverse effects on the heart. Therefore, the finding that lorcaserin was one of the first new drugs in 20 years to be safe for the heart generated much excitement.
Now using a drug to lose 4-5 pounds may not appeal to many people, and for good reason. But there are three reasons I can think of not to be so cynical: 1. These studies report the average weight loss. In some cases, people lost a lot more than that, while others lost less. 2. The placebo groups in these studies were on a lifestyle weight loss program, so the drug is providing weight loss above and beyond a lifestyle program, and 3. Even a small amount of weight loss can result in substantial improvements in health such as lower blood pressure, blood sugar and reducing risk for diabetes.
In the end, even though the health industry is in the game of searching for a weight loss drug, the motivations are different from the mainstream weight loss industry. In health care, the reason to lose weight is to improve a person’s health. Maybe reduce the risk for diabetes or help cure sleep apnoea or reduce arthritic pain in the knee. This is in stark contrast to the majority of people wanting to lose weight to fit into that bathing suit for summer or look good for the high school reunion.
While effective and safe, suggesting that lorcaserin is the Holy Grail of weight loss drugs is a bit over the top, and it’s unfortunate it was suggested as such. The bottom line, weight loss is hard, and sustaining weight loss is even harder. It requires adherence to a different way of living than before. And, as I’ve discussed before, doing so in an environment that may not be totally supportive of healthy living.
We also need to keep in mind it likely took years to put on that excess weight and losing it, for good that is, won’t happen overnight. It takes positive changes to one’s lifestyle and in some cases, assistance from your doctor. And while it may not be the silver bullet you’re looking for, at least there are safe options for weight loss, which aren’t advertised on your local telephone poll.
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