I’ve written before that we live in an obesogenic environment – one that seems designed to make us fat. So where is our magic pill? I’m down on magic pills, simply because there is no magic. They are expensive, have negative side effects and usually don’t work. Of course, I’m talking about the over-the-counter “dietary supplement” magic-type [...]
I’ve written before that we
live in an obesogenic
environment – one that seems designed to make us
fat. So where is our magic pill?
I’m down on magic pills, simply because there is no magic. They
are expensive, have negative side effects and usually don’t
work. Of course, I’m talking about the over-the-counter “dietary
supplement” magic-type medications promoted by people with names like Kardashian and
Snooki. If there is going to be an effective anti-obesity drug,
it’s not going to be an over-the-counter supplement and have reality TV stars as
their pitch people. Supplements aren’t regulated by the FDA. The regulations are
so lax that I could probably fill gelatin capsules with my neighbor’s dog poo and
sell it as an all-natural appetite suppressant and make millions. The
fines
for false advertising are just part of the overall marketing
budget. Instead, it’s going
to come from the pharmaceutical industry. It knows there is plenty of money to be made in
developing a safe and effective weight-loss drug. It’s pouring billions into research and
has to meet strict requirements for efficacy and safety. Still, sometimes I wonder if
the requirements are strict enough. Here’s a
brief history of weight loss drugs:
Orlistat
(aka “alli”)
Modest weight loss mixed with, uh, shall we say, gastrointestinal distress. If
you dare eat fat you can experience “fatty/oily stool, oily spotting, intestinal
gas with discharge” and a bunch of other side effects that make reference to
“bowel.” At any rate, the effects are such that, when combined with caloric
restriction, you achieve 8.4% weight loss at six months with Orlistat vs. 5.7% in the
placebo group, which is totally not worth having to ensure you’ve always got clean
underwear on hand. Orlistat prevents the absorption of some fat, and that fat has to go
somewhere.
Sibutramine (aka “Meridia”)
This has been withdrawn from the market. It was a serotonin and norepinephrine
re-uptake inhibitor that was first created as an antidepressant but was also shown to
suppress appetite. When sibutramine was taken in combination with a low-calorie
diet, at six months, weight
loss was 7.5 kilograms vs. 3.6 kilograms in the placebo group. That’s
notable, but it was also shown to raise blood pressure and increase the risk of heart
attack.Remember Fen-Phen? It worked fairly well by
increasing serotonin, resulting in a shutdown of dopamine action, reducing sensitivity to
reward so that people were less inclined to eat highly palatable food. Unfortunately,
the side effects were terrible, such as heart valve damage, and the manufacturer American
Home Products Corporation ended up paying
billions in settlement costs.Experiments have been done with anti-cannabinoids (although they’re not approved
for sale in North America), which work great to suppress appetite but also suppress your
will to live. Think of smoking pot (a cannabinoid). If you’ve never done it, you
know the stereotype: It creates a feeling of euphoria and causes munchie attacks.
Anti-cannabinoids do the opposite. They give you the anti-munchies, but also the
anti-euphoria. It’s a bad trip, man. The side-effects include depression
that can lead to suicide. Now comes
the part where I tell you I’m not an MD. These are my non-MD opinions.
Qnexa
There’s a new drug in town (called Qnexa), and time will tell if the good
will outweigh the bad. See, that’s largely what pharmacotherapy is about. If you
don’t need to take pills, then you don’t take them
because pretty much every drug has negative side effects. The question becomes: Do the
benefits of the pill outweigh the risks? Know that
obesity is a multifactorial condition. Researchers have discovered dozens of different
genes that affect body weight. Some people store fat easily while others build
muscle. There are also epidemiological, hormonal and psychological issues that can
affect food intake and activity levels. Saying “eat less, move more” to the
obese is like saying to a person living in crushing poverty to “spend less, earn
more.” Is Qnexa going to be that drug?
It’s too early to tell. An expert
panel of advisors recommended 20-2 that the FDA approve it. Note that
this drug was rejected by the FDA in 2010 because of concerns over heart rate and birth
defects. People have a tendency to freak out when
they see words like “birth defects,” but it seems like they are proceeding
cautiously. Dr. Arya Sharma, who is chair of obesity research at the University of
Alberta and a paid consultant to the company that manufactures Qnexa,
said,
“Back in medical school, I was taught that when the risk of not treating the
condition exceeds the risk of treating it, we should treat.” (More
details here.)
Like all drugs, this is what it’s going to come down to: Do the
substantial weight-loss benefits of Qnexa more than compensate for the risks of taking
it? If the drug is approved for sale this April by
the FDA, which would make it the first new weight-loss pharmaceutical on the market in 13
years, we’ll find out.
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