If your health risk is high, very high, or extremely
high (see Chart III on page 17), weight-loss drugs may be
appropriate for you. The term "drugs" generally
refers to prescription and over-the-counter medications.
There are several kinds of weight-loss drugs available, and
if you are considering this option, be sure to ask your
doctor to identify the different drugs and describe their
benefits and risks.
Drugs can be a useful weight-loss aid, but they cannot
replace the important changes in eating and physical
activity that we have discussed. Drugs tend to work best
only if you also change your diet,
physical activity level, and lifestyle. In other words, they
enhance the effectiveness of healthful eating and exercise.
Drugs have risks of their own which can sometimes be
life-threatening. Ask your doctor to explain these risks to
you.
• How do weight-loss drugs work?
Most weight-loss drugs reduce, or suppress, appetite. As
a result, they can help you reduce the amount of food you
eat. Most drugs act directly on the brain to suppress
appetite. For most people, they can lessen the desire to eat
and may make it easier to stick with a diet. Others fill the
stomach to create a feeling of fullness, or act in the
intestines to decrease fat absorption.
• How much weight can I expect to lose if I use these
drugs?
This depends how much you modify your diet, physical
activity level, and lifestyle. It’s not just a matter of
taking the drug. People also respond differently to
medication, and some people may not respond at all.
In the case of prescription medication, people who do
respond and modify their diet, physical activity level, and
lifestyle can expect to lose at least four pounds in the
first four weeks (up to one pound per week during the first
month). The remainder of the weight loss will probably occur
during the first six months of treatment. Studies show that
people who respond to drug therapy lose from 10 to 20
percent of their initial body weight. These studies also
show that drug therapy must be continued under a
doctor’s supervision to help you keep the weight off.
• How do I know if weight-loss medication is right for
me?
You need to carefully discuss this question with your
doctor. Each drug has possible
benefits, risks and side effects, and you and your doctor
need to weigh the risks of each drug against its possible
benefits and your health risk. Your doctor will also need to
know about all other medications you are taking. If you are
taking certain medicines or have certain physical conditions
like moderate to severe high blood pressure, you may not be
able to take certain weight-loss drugs. Only your doctor can
determine if you are a candidate for weight-loss drug
therapy and, if so, which drugs may be best for you.
• Do weight-loss drugs interact with other
medications and, if so, how do I prevent problems?
Drug interactions are always possible, but you can help
prevent them by keeping a list of the name and dose of all
medications you take, and giving this list to your doctor
before s/he makes a decision about your drug therapy. Many
people think their doctor or pharmacist will know what they
are taking, but this is usually untrue. The only person who
knows all of the medications you take is you.
So, write down all non-prescription and prescription
medications you take, all herbal and homeopathic products,
and all medicines you have at home, even though you may not
be taking them right now. Keep the original list and
continue to add any new medications to it. Give a copy to
your doctor and pharmacist.
It is also important to know that illness and aging can
affect the way drugs are broken down by your body,
especially if you have kidney or liver problems. This is
another reason why it is very important to get your doctor’s
advice.
• If I am taking weight-loss drugs, how often should
I see my doctor?
You should meet with your doctor within four weeks after
you begin taking the drug(s). Your doctor will be able to
tell you if you are responding. If you do not lose four
pounds during the first four weeks of treatment, you and
your doctor need to talk about your options. You may elect
to stop drug therapy, or try a different drug or combination
of drugs. You should not continue to use a drug that does
not help you lose weight, because you would be taking an
unnecessary risk.
Your doctor also needs to monitor you if you are taking
other medications, such as those used for high blood
pressure, diabetes, or depression. Your doctor may need to
adjust the dosage of these drugs as you lose weight or your
weight-loss drug(s) so you can continue to lose weight. In
some cases, you may need to stop taking the weight-loss drug
due to interactions.
During the week-four visit, you and your doctor can
decide how often you should return.
• Should I be aware of any special risks?
Yes. If you are taking weight-loss drugs and you begin to
experience shortness of breath, you should see your doctor
immediately. One risk associated with prescription
weight-loss drugs is a rare but serious, sometimes
life-threatening condition called primary pulmonary
hypertension (PPH). In the general population, approximately
one to two people out of every 1,000,000 get this condition
each year. Among people who take prescription weight-loss
drugs, there are 23-46 cases of PPH per 1,000,000 patients
per year. PPH is not the same as high blood pressure. It is
an increase in the pressure in the pulmonary artery, which
is the main vessel that supplies blood to the lungs. This
condition causes a reduced supply of oxygen to your blood,
which causes shortness of breath. This can be
life-threatening.
Anyone who is taking prescription weight-loss drugs who
experiences shortness of breath should see their doctor
immediately.
• Can drugs be used to help keep weight off?
If you lose weight while taking weight-loss drugs, you
can regain weight once you stop taking medication. If you
have successfully lost weight with the aid of drugs, their
continued use may help you maintain your weight. It is
important to remember, though, that drugs alone are no
miracle cure. To keep weight off, you need to continue the
changes in your diet, lifestyle, and physical
activities.
If you continue to take weight-loss drugs, you must
continue to see your doctor regularly. You and your doctor
must continuously evaluate the drug therapy to decide if it
is helping you maintain weight, or if the benefits no longer
outweigh the risks.
Of all prescription weight-loss medications available,
dexfenfluramine, which is sold under the trade name
Redux™, is the first anti-obesity drug approved by the
Food and Drug Administration (FDA) for both weight loss and
weight maintenance in adults. It is not an amphetamine or a
stimulant. Please note that dexfenfluramine was removed from
the market in September 1997.
Two other drugs, fenfluramine and phentermine, have been
approved for short-term use (a few weeks) by the FDA.
Fenfluramine has been used successfully in clinical studies
lasting one year, and phentermine has been used successfully
in clinical studies lasting six months. Even though the FDA
has not approved these drugs for use together, many doctors
combine them in low doses. This combined therapy, known as
"phen-fen," has been used in studies lasting over
three and one-half years. In these studies, phen-fen helped
59 of 121 patients (49 percent) lose weight and keep the
weight off. Please note that "fen" or fenfluramine was
removed from the market in September 1997.
