Most physicians prescribe weight loss medication and weight loss herbal supplements to their patients. But what do docs do themselves?
In an Archives of Internal Medicine study of 394 practicing physicians, only 11% of physicians had taken something for weight loss.
Just 19 had taken a drugstore remedy, and 16 took prescription drug. Almost half of the physicians–44%–were overweight or obese.
In contrast to their personal choices, however, nearly all (273 or 90%) of the 303 physician recommendations to patients were for prescription drugs.
Only 30 or 10% of recommendations were for “herbal products” or phenylpropanolamine.
Many physicians are wary of prescription drug side effects–no one wants to prescribe another phen/fen.
Few physicians have the time and resources to help people lose weight and keep it off–and may be embarrassed about seeing a fellow physician for weight loss themselves.
The research was presented as a paper at the University of Chicago Annual Conference on Alternative Medicine. Read the whole paper here…
Physicians’ Personal Intake and Prescription of Weight Loss Products: Are We Practicing What We Preach?
In the May 12, 2003, issue of the ARCHIVES, Stafford and Radley1 reported a significant increase in general population use of prescription medications for weight loss. National guidelines recommend that physicians prescribe prescription weight loss products to treat obesity but do not recommend nonprescription weight loss products (NPWLPs).2 In fact, phenylpropanolamine hydrochloride, an over-the-counter sympathomimetic used in some NPWLPs, was voluntarily withdrawn from the US market after reports of excessive risks of hemorrhagic stroke in women.3 More recently, ephedra, while effective for short-term weight loss, has come under greater public and federal scrutiny because of reports of adverse effects ranging from anxiety to tachycardia and death4-5; the Food and Drug Administration has banned ephedra sales. As part of a physician survey of personal weight management strategies, we set out to investigate physicians’ own personal use of weight loss products and their prescriptions for their patients.
Methods
We conducted a descriptive, cross-sectional study using an anonymous mailed questionnaire of a large, suburban, community, nonteaching midwestern hospital in fall 2001. We surveyed the entire active, current medical staff (MD or DO degree), which totaled 538 individuals; 2 questionnaires could not be delivered. Nonresponders did not differ with respect to age, sex, and physician specialty. Among other questions, we asked “Have you taken any of the following weight loss products yourself?” and “Have your prescribed or recommended any of the following weight loss products for your patients?”
Results
Of the 536 responses, 402 (75%) were returned; 394 (74%) included weight and height data and 8 were blank. Most responders were male (75%); mean � SD age was 45 � 9 years. Over 83% spent more than 75% of their total work time in direct patient care. Mean � SD body mass index (calculated as weight in kilograms divided by the square of height in meters) was 25.1; 44% of respondents were overweight, including 8% who were obese (body mass index >30).
Most physicians surveyed (358 [89%]) had not taken weight loss products themselves (Table 1). Of the 35 reports of physician personal use, 19 (54%) were for NPWLPs and 16 (46%) were for prescription medication. There was no significant difference between healthy weight respondents and overweight and obese respondents with respect to their personal use of weight loss products. Most respondents (265 [66%]) had not recommended or prescribed weight loss products for their patients, with no significant difference between healthy weight and overweight and obese respondents.
View this table:
Physician Reports of Weight Loss Products Personally Taken and Prescribed for Their Patients in the Past 5 Years (1996-2001)
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In contrast to physician personal use of NPWLPs, nearly all (273 [90%]) of the 303 physician recommendations reported were for prescription medication. Only 30 [10%] of the recommendations were for NPWLPs (specifically, “herbal products” or phenylpropanolamine). Orlistat and sibutramine hydrochloride were prescribed more than any other prescription drug.
Comment
In 1997, 2.5 million Americans took prescription weight loss products, a number which has fallen somewhat since the withdrawal of dexfenfluramine hydrochloride and fenfluramine hydrochloride.1 For NPWLPs, estimates suggest that 7% of the general American adult population has reported using NPWLPs compared with 4.7% of community physicians in our sample.6 This congruence with nationally representative data suggests that physicians use NPWLPs with a prevalence similar to the American public, despite safety concerns about them. We hypothesize that the high out-of-pocket expense of prescription weight loss drugs; the ubiquity, convenience, and low cost of over-the-counter diet aids; and the potential discomfort of seeing a fellow physician for weight loss all may contribute to physician personal preference for NPWLPs over prescription drugs. When seeing patients, however, physicians were much more likely to prescribe prescription medication instead of recommending NPWLPs. While the sample size of physicians is small and may be representative only of the community described, NPWLPs are personally used by physicians but are seldom recommended to patients.
This study was presented at the Fourth Annual University of Chicago Conference on Alternative Medicine; December 13, 2002; Chicago, Ill.
Dr La Puma has received compensation from 1999 through 2004 for consulting with medical conference sponsors to create and supervise healthful conference meals and has received expert fees in the Phen-Fen litigations. Dr Maki has received honoraria, research stipends, and/or consulting fees related to products or research on weight management from Roche Pharmaceuticals, Ross Products Division of Abbott Laboratories, Kao Corporation, Glanbia Foods, AMBI Corporation, and General Mills.
John La Puma, MD
Santa Barbara, Calif
Philippe Szapary, MD
Philadelphia, Pa
Kevin C. Maki, PhD
Chicago, Ill
REFERENCES
1. Stafford RS, Radley DC. National trends in antiobesity medication use. Arch Intern Med. 2003;163:1046-1050. ABSTRACT/FULL TEXT
2. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults�The Evidence Report. Obes Res. 1998;6(suppl 2):51S-209S. ISI | MEDLINE
3. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med. 2000;343:1826-1832. ABSTRACT/FULL TEXT
4. Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA. 2003;289:1537-1545. ABSTRACT/FULL TEXT
5. Meadows M. Public health officials caution against ephedra use: health officials caution consumers against using dietary supplements containing ephedra: the stimulant can have dangerous effects on the nervous system and heart. FDA Consum. 2003;37(3):8-9. MEDLINE
6. Blanck HM, Khan LK, Serdula MK. Use of nonprescription weight loss products: results from a multistate survey. JAMA. 2001;286:930-935. ABSTRACT/FULL TEXT
Arch Intern Med. 2004;164:806-807.
About Dr. La Puma
John La Puma, M.D., F.A.C.P. is board-certified in internal medicine and co-author of The RealAge Diet: Make Yourself Younger with What You Eat (HarperCollins, 2001). Dr. La Puma directs the Santa Barbara Institute for Medical Nutrition and Healthy Weight, specializes in nutrition, and sees patients from all over the U.S., who want to lose weight, lower cholesterol, blood pressure, or blood sugar no matter what it takes, using nutrition, fitness and lifestyle change. Dr. La Puma�s work has been published in The New England Journal of Medicine, The Journal of the AMA, The New York Times, The Wall Street Journal, and the Encyclopedia Britannica, and he has appeared on major network outlets (NBC, CBS, ABC, FOX, CNN and PBS) nationwide. In 2003, he taught the first cooking class in the country to medical students, at SUNY and was named “One of the Country�s Top Physicians” by the Consumer�s Research Council. Dr. La Puma is based in Santa Barbara, California.
For additional information, contact:
John La Puma, MD, FACP
Medical Director, The Santa Barbara Institute for Medical Nutrition and Healthy Weight
SB Institute Office: 805.569.7827
SB Institute Fax: 805.569.7828
Mailing Address: P.O. Box 24039
Santa Barbara CA 93121
e-mail: drjohn@chefclinic.com
About The Archives of Internal Medicine
The Archives of Internal Medicine reaches over 100,000 American physicians bimonthly. In 2001, the Impact Factor for the ARCHIVES was 6.66, fifth highest among 112 internal medicine journals, which includes JAMA, the New England Journal of Medicine, the Lancet, and the Annals of Internal Medicine. It is edited by Philip Greenland, MD. Dr Greenland is the Harry W. Dingman Professor and Chair of the Department of Preventive Medicine and Professor of Medicine at Northwestern’s Feinberg School of Medicine.
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