The Risks and Benefits of Weight Loss Pills
Weight loss pills have been a popular topic, particularly due to the approval of two prescription medications by the U.S. Food and Drug Administration (FDA) in 2012. Since obesity was classified as a disease by the American Medical Association, these pills are becoming one of the main treatments for obesity. Dr. Louis Aronne, Medical Director of the Center for Weight Management and Metabolic Clinical Research at Weill Cornell Medical College and New York Presbyterian Hospital, discusses these new developments and the facts behind weight loss pills.
Who qualifies for taking weight loss pills?
People with a body mass index (BMI) of 30 or higher, or those who have a BMI of 27 with an obesity-related illness.
Are weight loss pills for short-term or long-term usage?
They used to be for short-term use, but the new ones are approved for long-term use. There are some that are still short term. They haven’t been approved for long-term use because they haven’t been studied. Generally, studies are two years long. So if you do a study for two years, the FDA gives approval for long-term use.
What’s your take on consuming weight loss pills that are not FDA approved?
These medicines are called “off-label.” There are over-the-counter (OTC) medicines and they really haven’t been studied carefully enough to determine if they work or not. There’s only one medicine that’s been proven to work and that’s called Alli. Other OTC products could work, but nothing has shown that they do, and there are no adequate studies that tell us that they are safe.
Why do people still take these medicines that have not been approved or regulated?
Because they see them advertised. Now [people] say, “Well, how can these be advertised?” Because of a rule called the DSHEA law, they don’t have to prove that they work. So people assume that they’re safe and that it’s okay to take them. This is something that Congress would have to change. It was a congressional bill that allowed supplement companies to sell stuff but not have to prove that they actually work. But the Federal Trade Commission is cracking down on companies that make these claims. It’s like a game that supplement companies play. There is a long history of this kind of stuff. So that’s the over-the-counter product market. Buyer beware—that’s what I have to say.
Editor’s Note: The Dietary Supplement Health and Education Act (DSHEA) law, passed in 1994, reclassified supplements as a food product instead of a drug, removing them from the new drug approval process by the FDA. It also states the burden of proof for determining safety of supplements falls upon the FDA, not the manufacturer. According to the Alliance for Natural Health, “The Federal Trade Commission maintains authority over supplement advertising: Manufacturers must report truthfully what their products contain and must have proof backing up any claims they make.”
What are the benefits of taking prescription weight loss pills?
If you have health problems associated with your weight, it’s not an unreasonable thing to do. More and more doctors are agreeing, more and more organizations are agreeing that this is a very reasonable strategy. And the reason is because obesity is now classified as a disease. Recent research is showing that obesity is the root cause for 60 other illnesses. That’s fulfilled one of the most important [disease category] criteria, which is that it causes people to live a shorter life span.
But more importantly, it’s been shown that it affects stabling pathways in the brain. That’s the way your brain hears from the fat cells in your stomach how much food has been eaten and how much fat is stored. But that is disrupted by eating fattening food. This process starts out as reversible initially, but eventually inflammation occurs and there’s an irreversible component at some point that develops. What is that? It looks like there may be chronic inflammation and it may be that some of the nerves that actually send the signals are damaged and can’t send the signals anymore. So the reason this is critical is if you look at what the new medications can do is that they amplify signals through this part of the brain.
Why don’t people just stop eating? It’s because something physical happened along the way to make it impossible to just stop eating and go back. If it was that easy, then people would just do it. What [the medications] do is amplify signals for a part of the brain that we believe is not functioning well. And it makes a lot of sense to do that until we can actually repair it or do something else.
Are there side effects people should be aware of?
Like any medicine, there are side effects and people need to be aware of them. For some people, one medicine may be terrific and for someone else the same medicine gives them side effects. Two different medications have been approved: Qsymia and Belviq. In a patient clinical trial, the benefits were a reduction in blood pressure, blood sugar, triglycerides, decrease in inflammatory markers, decrease in sleep apnea as well. Side effects were dry mouth, altered taste (called dysgeusia), lightheadedness, dizziness, headache—those were the common ones. More uncommon ones were that people could feel anxious, activated, or unfocused. If you have the side effect, stop the medication.
What is the biggest misconception people have about weight loss medicines?
There are several. Number one is that you don’t have to diet. Second is the idea that this medicine is going to take you down to your ideal weight. When you don’t eat well and eat fattening foods, then it interrupts the signaling pathways so the medicine doesn’t work very well. So it undoes what the medicine does. On the other side, a common misconception is that they’re bad. I think it depends on the way they’re prescribed. Any medicine can be prescribed the wrong way for the wrong reason.
How common does addiction develop in patients taking weight loss pills?
The medicines that are currently available and approved by the FDA have no addictive potential. But if you don’t take them, they won’t work. Same thing with diabetes. If you are taking insulin, your blood sugar goes down. If you stop taking the insulin, your sugar goes back up. Are you addicted to insulin? The answer is no. What it is, is that the medicine is having its effect. Now, with weight regulation it’s different because, interestingly, some people when they take these medicines don’t need them in the long run. They can take them intermittently. Why is that? What we think is that some of the signaling pathways may improve, some of the inflammation in that part of the brain may go down. There are a number of hypotheses as to why this happens.
But it’s unrealistic to expect that you can take the medication for a short period of time and then go off it in every case. That’s just not going to happen. This is a major reason why we set limits on body mass index and other things. We want to treat people who have health problems associated with obesity. This is a treatment for health problems, not “I want to look good in a bathing suit.” So we actively discourage that type of use of medication.
So it really goes back to changing the way people view obesity in general.
That’s right. People have been looking at this as someone’s fault. There are clearly cultural and behavioral things that go on, but once obesity is established, all the evidence is pointing to the idea that something physical happens—and that’s what makes it so hard to lose weight. What we’re working on are ways to overcome that to try to help people have a healthier life. But it takes time. As we have more treatments available, it’s going to become easier to do and we’ll have better medication. We only have two medicines right now. Once we [have more medicines], we won’t have to talk about obesity as an epidemic, we’d just treat it. We’d more aggressively try to prevent obesity in children—the key to managing this is early prevention.
Can you talk about the future development of weight loss medications?
One of the things we learned about the weight-regulating mechanism is that it’s very complicated and it has many overlapping systems. For example, when you put a mouse on a diet, the intestinal bacteria changes in a way that will make it gain back weight. Your intestinal bacteria try to get as much as it can out of the food that you have. A friend of ours over at Mass General at Harvard did a study where they did gastric bypass in mice. They took the microbes from mice and put it into other mice and showed that they lost weight, just as a direct result of the transplantation of the gut bacteria. That’s incredible when you think about it—an amazing finding. What it all means, it’s going to take time to sort out. But are we going to be able to put all the right bacteria into someone? Maybe. Maybe we will be able to do that.