Are New Weight Loss Drugs the Answer?
If you poll doctors who treat patients with obesity, results will show that many if not most of the doctors feel the need for more tools in the obesity treatment arsenal. The treatment option that seems to be most challenging is the medication sector. Many of the obesity medications that come down the pipeline and are effective in helping patients to shed weight, have moderate to serious negative side effects. In recent years Orlistat (Xenical) a fat-blocking drug was approved, but patients who use it complain about the unpleasant side effects which can include excessive gas, increased frequency of bowel movements, oily bowel movements, and oily discharge or spotting on your undergarments if you eat too much fat in a single meal. Not a drug panacea by any means. As with many drugs, you have to weight the positives and the negatives, in order to decide if a medication is a good fit for your condition.
Many of the drugs that are developed to treat obesity, but that never make it through the FDA approval process, have untenable side effects, including mental health risks and cardiac complications. Some approved diet drugs were paired up (off label) without FDA approval a couple of decades ago, and were found to cause heart valve damage in patients who used the combo drug therapy. The heart damage they experienced was irreversible and in some cases, resulted in a patient's death. Now the FDA has approved a new drug, Contrave (naltrexone hydrochloride and bupriopion hydrochloride extended-release tablets) for the treatment of chronic obesity. Its use is recommended, along with a reduced-calorie diet and exercise in adults with a BMI over 27 who also have weight-related complications like diabetes type 2, hypertension, or elevated cholesterol levels.
Contrave’s active ingredient naltrexone, is approved to treat alcohol and opioid dependence, while its second active ingredient, bupropion, is approved to treat depression, seasonal affective disorder (SAD) and also as an aid for smoking cessation. The drug’s effectiveness was examined in several clinical trials, including one study involving 4500 obese and overweight patients. Some had weight-related secondary conditions, while others were diagnosed with obesity as a singular diagnosis. All patients in the study received lifestyle counseling, including a reduced calorie diet and exercise recommendations. The results of that study and some of the other studies showed an overall weight loss of 5% at one year among, on average, 35% to 42% of study participants.
Patients who choose to remain on the drug long term need to have regular evaluations, and the drug should be terminated if clinicians feel that beyond a certain time period, statistically meaningful weight loss will not occur. Contrave does have a boxed warning regarding increased risk of suicidal thoughts and behaviors, as well as possible seizure risk (the risk is dose-related). There are other possible health risks associated with use of the drug, and the FDA is requiring further post-release studies to evaluate other concerns that may only show up with longer use of the drug. The drug cannot be used by certain obese individuals who have specific health conditions including seizure disorder.
Experts from The Obesity Society, a leading professional society dedicated to better understanding of obesity, prevention and treatment, suggest this new drug, and others coming down the pharma pipeline are a good step in enhancing the viable arsenal of therapies for the treatment of chronic obesity. Patients need to realize that the purpose of these drugs is to enhance the impact of diet and exercise, often times by suppressing hunger. You still have to do the hard work of changing your lifestyle, and maintaining those habits.
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