Is There A Magic Pill for Weight Loss? - Part 2

Dr. Jeffrey Heit Health Guide
  • As you may already know, Part 1 of my blog regarding "magic pills" for weight loss, was downright discouraging- a hodgepodge of "uppers" and diuretics that were not worth their side effects, had addictive potential, and were for quick fixes.

    Not all the news is gloomy, however. There are a couple of FDA approved drugs for weight loss which, while they still have some side effects, are effective at helping people lose weight when part of a broader change in diet and lifestyle. Moreover, they seem to be a bit better tolerated (though, as you'll see, by no means perfect) and can be taken for longer periods.

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    Sibutramine (Meridia) - this drug has been around for some time and has been marketed as a weight loss pill. It blocks the breakdown of serotonin, norepinephrine and dopamine at the synapses between your brain cells. It is thought that these brain chemicals have something to do with appetite and satiety. You cannot get it without a doctor's prescription. Over a two year period, in addition to a low calorie diet, sibutramine has been shown to be safe and effective.

    It does have side effects- the drug can elevate blood pressure as well as heart rate, cause dry mouth, insomnia and constipation. However, if one does not have hypertension or coronary artery disease, close follow up by a physician may be all that is needed to insure that those side effects do not occur and that the drug is being well tolerated. Out of control hypertension is a contraindication to the drug as is concomitant intake of the very popular SSRI's or selective serotonin reuptake inhibitors used for anxiety and depression (i.e. Prozac, Zoloft, Paxil, Effexor, and others).

    Orlistat (Xenical, Alli) - another drug that has been approved by the FDA for weight loss is orlistat, which goes by the brand names mentioned above. The higher dose version, Xenical, can only be obtained with prescription by a physician, while the lower dose version, Alli, is available over the counter without prescription. This drug works in a completely different fashion than sibutramine. Orlistat works to interfere with the pancreatic enzyme lipase that helps breakdown and absorb fat from the gastrointestinal tract. Without lipase, fat cannot be absorbed as easily and, hence, the number of calories ingested from fat goes down- whether you want it to or not. In addition to dieting, orlistat has been shown to improve weight loss by 2.5-3kg more than those dieting and taking placebo.

    Look out for the side effects of this one though! - Flatulence (i.e. gas), oily spotting, abdominal pain and fecal urgency have been known to occur, especially when a fatty meal is ingested. Obviously, this is a big reason for discontinuation of the drug. Furthermore, since fat absorption is decreased, it is recommended that fat soluble vitamins (i.e. Vits A, D, E, K), be taken 2 hours before or 1 hour after taking orlistat.

    There are other drugs that interfere with appetite and satiety, and, hence, can interfere with or promote weight loss, but are too numerous to mention here. Also, many of them are not indicated primarily for weight gain or loss, but have those properties as side effects. I will be discussing some more of these drugs in future blogs, so look for them.

  • As for now, if you think that you might benefit from either of the two FDA approved drugs mentioned here as part of a larger lifestyle and exercise program to shed pounds and get fit, please talk with your primary care provider as soon as possible. You will, no doubt, need to be monitored to stay safe and healthy.

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Published On: July 16, 2008