Obesity has become a dangerous epidemic, particularly in the United States. From the 1930’s to the mid 1990’s, diet pills were prescribed regularly to combat the disease. In the wake of several failures, however, diet pills have been replaced by an unrealistic expectation of consuming fewer calories and participating in exercise regularly. Drugs such as Fen-Phen were often prescribed without taking baseline tests in order to determine if the subject was suitable; this led to the blame being placed on the drug rather than the possibility that the patients were defective. In addition, some doctors are prescribing alternative medications to lose weight, and many adults are self-medicating due to the lack of available drugs on the market. The statistics show that diet and exercise alone are not effective in promoting weight loss and combating obesity. In order to keep the problem from growing, diet pills need to be prescribed and the patients monitored closely.
Diet Pills: The Right Pill for the Right Reason
Obesity in America has become a frightening epidemic. The Center for Disease Control defines obesity using a “body mass index” scale which correlates weight and height in order to loosely determine body fat. For example, an adult who has a BMI between 25 and 29.9 is considered overweight while an adult with a BMI of 30 or higher is considered to be obese. In 2006, sixty-six percent of all adults were overweight or obese; thirty-six percent of children aged eleven through nineteen were overweight or obese (NCHS). Individuals who are overweight or obese are at risk for multiple diseases, including hypertension, type II diabetes, heart disease and stroke. In most cases, one can control one’s weight by watching calorie consumption and getting exercise. When one consumes more calories than they use, weight gain occurs (Overweight and Obesity). In addition, there can be genetic factors and health problems (such as a thyroid condition) that can lead to obesity; this paper is only concerned with normal, relatively healthy adults. While many individuals can control their weight through a diet and exercise program, others choose to take diet pills in order to lessen cravings, simulate the feeling of satiation, and acquire a boost of energy needed for exercise. The truth about obesity is simple: if Americans don’t lose weight, obesity-related diseases will become an epidemic. It is time to view diet pills as a weight loss tool. Diet pills are often considered an unnecessary crutch; when used correctly and under supervision, diet pills are an effective and safe way to lose weight.
Diet pills, in one form or another, have been around since the 1930’s. At this time, scientists began experimenting with a chemical called DNP that could speed up metabolism. It was readily prescribed and soon the U.S. Office of Drug Control (which later became the FDA) was forced to take it off of the market due to widespread abuse and serious side effects. This did not deter scientists from continuing to experiment with weight loss drugs, however. By the 1950’s, amphetamines were a popular stimulant – until side effects such as addiction, racing heart rates and chronic insomnia led the FDA to limit its use. In 1992, scientists found that they could combine two different appetite suppressants, fenfluramine and phentermine, to make a popular weight loss drug called Fen-Phen. This introduced a new phase of diet pill use because doctors, in addition to prescribing the drug, also recommended diet and exercise and monitored their patients’ reactions to Fen-Phen. Soon, Redux entered the market and both drugs were being prescribed to overweight and obese patients all over the United States. This boom did not last long; both drugs were pulled from the market in 1997 due to hypertension and heart valve defects caused by the drugs. In nearly seventy years of manufacturing diet pills, scientists had little success in countering the positive effects with the circulatory system problems. This is when they turned to natural drugs, such as Ephedra, for weight loss. Soon, however, it was found to have the same problems as synthetic drugs and products containing Ephedra were no longer permitted to be sold in the United States (Donnelly).
Diet pills have not had a very successful history, but it is difficult to determine if all of the problems attributed to these drugs are truly the result of the diet pill and not from a pre-existing condition. Fen-Phen will be forever known as the cause of heart valve defects among its users. There has been some evidence, however, that Fen-Phen may have been removed from the market prematurely. According to an article in The Harvard Heart, Harvard Medical School conducted a study in the aftermath of the drug scandal. Researchers studied the echocardiograms of 226 patients who had taken Fen-Phen before it was pulled from the market. They found:
new heart murmurs developed in less than 0.07% of patients;
not one patient had developed a heart valve disease;
mild aortic-valve leaking was found in 12 patients;
moderate aortic-valve leaking occurred in 15 patients;
mitral-valve leaking was found in 3 patients.
Due to the fact that there were no echocardiograms performed before the patients were prescribed Fen-Phen, no one can say for sure that these problems occurred as a result of the drug.
However, the researchers could compare the rate of these abnormalities in the study group to the rate of heart-valve problems one would expect to find in the general population by looking at data from the Framingham Heart Study (the long-term epidemiological study being conducted in a Boston suburb). Study investigators found nearly the same rates of aortic and mitral valve leaking in the Framingham volunteers (who had not been taking fen-phen or related drugs) as in the diet-drug-study participants (The Harvard Heart).
While there has been no suggestion of returning the drug to the market just yet, the journal for the American College of Cardiology suggested that the risk of heart-valve problems is quite small. In addition, researchers at Harvard Medical School have found that many heart valve defects heal naturally after drug use is discontinued.
In spite of doctor recommendations that overweight and obese individuals should eat less and exercise more, it simply hasn’t happened. According to the Weight Control Information Network, “From 1960 to 2002, the prevalence of overweight increased from 44.8 to 65.2 percent in U.S. adults age 20 to 74” (NIDDK). Many adults have ignored the reported benefits of exercise: only 26 percent of adults report that they regularly engage in some form of physical activity (NIDDK). The following chart indicates the percentage of men and women who, from 2003-2004 were at a healthy weight, overweight or obese.
Far too many adults are overweight or obese, and this indicates that the mainstream suggestions of diet and exercise aren’t effective. A poll conducted by MSNBC asked respondents if they would consider taking a diet pill in order to lose weight. The poll was conducted in 2005; this was eight years after drugs like Fen-Phen and Redux were taken off of the market. In spite of the diet drug scare that brought countless patients to their doctor to demand an echocardiogram, the poll was strongly in favor of continued use of diet pills.
The result of the poll was as follows:
One problem is that many adults join weight-loss programs such as Weight Watchers or Jenny Craig, or follow particular diets such as Atkins, the South Beach Diet, or the Zone. When the program ends or the diet is no longer needed, many adults have difficulty maintaining their new weight. According to Samuel Klein, a professor of medicine of the Washington University School of Medicine
Patients eventually are left without group meetings and other medical and psychological support services. Maintaining lifestyle changes gets more difficult then. “During the first several months of the program, we provide behavior therapy, diet education, and exercise training, and that is usually very effective in getting patients to lose weight. But maintaining the weight toss is much more difficult.” (Fox and Stanten)
This is the reason why the Washington University School of Medicine offers diet pills – but only after a healthy weight has been achieved. Once a patient has proven that he or she can stick to a healthy diet, participate in an exercise program and achieve a weight loss goal, it is clear to the researchers that they are dedicated to losing weight. Klein admits that the study is relatively new and that long-term effectiveness hasn’t yet been proven. He likens obesity drugs of the past to drugs for diabetes and hypertension: while the first-generation drugs were not effective, future weight loss medication may prove to be successful without the harmful side effects.
There is a new trend in diet pills – doctors are prescribing medication for weight loss that was intended for other purposes. This practice is referred to as “off-label prescribing” and is legal in the United States.
In fact, a study that appeared recently in the Archives of Internal Medicine suggests that 21 percent of prescriptions for 160 common drugs (some 150 million prescriptions) are being written to treat conditions for which they aren’t specifically approved (Raymond).
For example, the drugs Adderall and Ritalin are used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) in children. It calms children down and allows them to focus; this creates students who can concentrate in the classroom and sons and daughters who behave at home. These drugs have an entirely opposite effect on adults – they act as a stimulant to the nervous system, inducing an increase in energy and suppressing the appetite. Adults in high-stress jobs have been taking these drugs for years; it has been only recently that doctors have prescribed Adderall and Ritalin for weight loss, but only for dieters with a BMI of 30 or higher. Another class of drugs that are being used for weight loss is, surprisingly, anti-depressants. Drugs such as Wellbutrin have been proven to improve a patient’s state of mind, therefore helping them to stick to a diet and exercise program. While the side effects of anti-depressants are such that a patient must be weaned from it, some doctors are prescribing these drugs (or recommending over-the-counter medication such as St. John’s Wort) to assist with weight loss. Anti-depressants do not act as stimulants, so the weight loss isn’t a result of a faster metabolism; rather, they eliminate the anxiety and stress that often accompanies a weight-loss program. Obtaining off-label drugs without a prescription, however, can be very dangerous. This is why it is only recommended if the drug is prescribed by a doctor, combined with a diet and exercise program, and followed up by close monitoring.
An article in the British Medical Journal discussed one doctor’s treatment options for an obese patient. Dr. Cynthia D. Mulrow was treating a 48 year-old woman with a BMI of 30.2. Dr. Mulrow had to consider two important options when presenting her patient with a weight-loss plan: her medical insurance did not offer a weight loss plan, and it did not cover the cost of any weight loss drugs. Dr. Mulrow knew that she had two options to treat her patient: she could recommend a diet and exercise plan or combine it with an appetite suppressant. According to the doctor, the risk of death increases for patients with a BMI above 27, so it was crucial to recommend a program that would work. On the lighter side, when a patient’s weight is reduced by 10 to 15 percent, there are immediate benefits, such as a decrease in blood pressure and a decreased risk of Type II Diabetes. Dr. Mulrow first considered suggesting a diet and exercise plan. By consuming 1200 calories a day and participating in a moderate exercise program, her patient would likely lose 10-15% of her body weight in 5 months. However, low-calorie diets are often difficult to maintain due to uncontrollable hunger, and many dieters fail to continue after a few months. When combined with an appetite suppressant, Dr. Mulrow’s research found that patients lost at least an additional 10 pounds in the same amount of time than diet and exercise alone. In the end, Dr. Mulrow recommended a diet and exercise plan and prescribed the weight loss drug Phentermine (Mulrow).
The benefit of reducing obesity in the American population has an economic benefit in addition to the obvious health benefits. According to the Center for Disease Control, the U.S. as a whole spent over 21 million dollars in 2000 in order to treat illnesses and diseases caused by obesity. The state of New York alone had just over three million dollars worth of obesity-related expenses – with a population of 5.5 million, this means that approximately $600,000 is being spent, per person, to combat the effects of obesity. In 1999, the CDC joined with 28 states in order to create state-based programs to combat obesity. Clearly, it is a growing epidemic.
In conclusion, there are many recommended suggestions for losing weight. The most simple is to consume less calories than one uses. In a nation where portion sizes are extremely large and clothing sizes have increased, diet and exercise aren’t enough in order to control the expansion of overweight and obese individuals. For many people, it all comes down to appetite: when a person is hungry, it is difficult to eat less and eat the right foods. Therefore, diet pills need to be re-introduced as a viable, acceptable option for weight loss. These pills should be available by prescription only and patients closely monitored by their doctors while following an organized diet and exercise program. The latest drugs to arrive on the market are fat blockers – they simply prevent the body from absorbing fat. It gives no incentive for a dieter to change eating habits, for the worst side effect involves diarrhea and other evacuation-related inconveniences. Obesity must be considered a medical problem and treated the same way as other medical problems – with medication and an understanding that behavior modification simply isn’t enough for everyone.
“Contributing Factors.” Overweight and Obesity. 26 Aug 2006. Center for Disease Control. 2 May 2007 <http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm>.
Donnelly, Kathleen. “Diet Pills: A Dubious History.” Health & Fitness. 2007. MSN . 2 May 2007 <http://health.msn.com/dietfitness/articlepage.aspx?cp-documentid=100148215>.
Fox, Marisa, and Michele Stanten. “Obesity Drugs Not A Quick Fix.” Prevention 49(1997): 7.
Mulrow, Cynthia. “Helping an Obese Patient Make Informed Choices.” British Journal of Medicine 317(1998): 7153.
“Overweight Prevalence.” National Center for Health Statistics (NCHS). 12 Feb 2007. Center for Disease Control. 2 May 2007 <http://www.cdc.gov/nchs/fastats/overwt.htm>.
Raymond, Joan. “The “New” Diet Pills.” Health 21(2007): 85-86.
“Statistics Related to Overweight and Obesity.” NIDDK. Aug 2006. Weight Control Information Network . 2 May 2007 <http://win.niddk.nih.gov/statistics/>.
“Weight Loss In A Pill.” Heath & Fitness. 08 Mar 2005. MSNBC. 2 May 2007 <http://www.msnbc.msn.com/id/7128223/>.