Recently an FDA advisory panel voted against a proposed obesity drug treatment combination of phentermine-topiramate. Though the treatment was effective in terms of its impact on weight loss, safety concerns regarding elevated heart rate negated its general use as a treatment option. Currently, many obesity experts feel that there is a general lack of viable drug options for the treatment of serious obesity and its associated health conditions. One commentary in the Internal Medicine News (November 2010) offered the following observations:
Medical science in general seems to have a bias against obese patients.
Professionals chosen to participate in these panels often have little or limited clinical experience with anti-obesity drug development. So they may not have the knowledge necessary to really evaluate these drug options.
Many still view obesity as simply a lifestyle disorder, meaning it's a "willpower and education issue." So unless a drug has almost zero negative outcome, their position will be consistently against the drug as a viable and necessary option.
Many experts who sit on the panels allow concern over misuse of these new drugs to negate approval. With a past history of off label use, the panel has an overwhelming position of "protectionism" which further complicates passing new drugs through the approval process.
Many experts dispute the theory that obesity is an actual disease. There is almost a "bias of ignorance" in recognizing that excess fat - regardless of its origin - can directly contribute to a host of other diseases. And when the excess adipose fat is located in the abdomen, it is especially dangerous, with a pathogenic nature that can contribute to diabetes and other serious health conditions.
The commentary concluded that with the current low approval of anti-obesity drugs, at this time in history medical science is "on the cusp of proclaiming a current major metabolic epidemic as being untreatable with pharmaceuticals." The column author considered this a "tragic failing of those entrusted with patient care."
My position: There is no doubt that the treatment of obesity requires an arsenal of possible therapeutic tools including drugs and surgery. However, it is quite obvious to me that in some, if not many cases, individuals do not realize the need for accessing mental health professionals to help with behavioral or emotional issues with food. Just going on a diet may work for some individuals, but I think that many patients who struggle with weight issues need dietary, fitness and psychological guidance and ongoing support in order to lose and maintain weight loss. Too many people who struggle with weight just turn to the newest diet, many of which have little science to back the effort. Too many dieters also believe once they lose the weight (and regardless of how many times they do it) they are "cured," rather than considering themselves in remission. If we call it a disease, then sustained weight loss should be looked at as if it is a "remission phase" that requires ongoing support and therapeutics. That means maintaining a relationship with health experts, keeping a home environment that supports keeping the weight off, and utilizing behavioral methods that also help when you are outside the home. It also means remaining engaged with an exercise and eating program that only shifts slightly when you move from the weight loss phase to the weight maintenance phase. For many people, that is when trouble begins and weight gain ensues.
Published On: December 29, 2010