Should You Take the New Diet Pill in the New Health Care?

Topics: Drug Food Safety, Obesity and Weight Loss, Wellness and Health

Amid the hub-bub of the week, with the Supreme Court affirmed Affordable Care Act health care law upheld, and with one JAMA study showing that 21 people on 3 different diets for 4 weeks each burn calories differently (no real surprise here: the lowest carb diet had the highest energy burn, the second lowest was second, and the highest carb, well, was bad for metabolic syndrome), other news–that the first prescription medication for obesity in 13 years has been approved–slipped under the radar.

In other words, there is a small high profile study in a reputable medical journal that shows that the kind of calories you eat matters, that calories are not all alike, and that eliminating ultraprocessed carbs gives you a better chance of idealizing your weight.

And also, now, there’s a new FDA-approved drug, Belviq, for obesity. And maybe a second one, called Qnexa, shortly.

Belviq (generic = locarserin) is metabolized by the liver: it acts in the brain to promote satiety by activating the serotonin 2C receptor to increase satiety and taste aversion (so food doesn’t taste good).

About half of obese people who took the drug for a year lost at least 5% of their body weight, compared to 20% of dieters who took a placebo pill.

But people have trouble staying on it: 40% dropped off in a year.

And the drug was turned down in just 2010 because of safety problems (principally psychological and cognitive ones). It can interact with medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclics, lithium, selective serotonin uptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), or antipsychotics.

It will be available, reportedly, in early 2013.

Qmexa, on the other hand, is a phentermine (the go-go-go of phen-fen fame) and long-acting topiramate (the anti-seizure drug) combo. Research subjects lost, on average, about 6% of body weight, vs about 2% on control medication, per year.

Phentermine has been on the market for over 40 years; it is a stimulant, and boosts blood pressure and pulse slightly. Topiramate sometimes causes fatigue, slowed thinking, and impaired memory and concentration. 

Nevertheless, the FDA wants doctors to have another tool in the tool belt, and with the US Preventive Services Task Force suggesting that all docs should measure BMI, and treat people who measure over 30 kg/m2 (and with Medicare already paying for 22 visits per year for obesity), I think the tide is turning. Doctors are going to become interested in treating obesity again, if they are paid and trained to do so.  And have new drugs. And they will.

The real questions: are you really better off taking a pill than getting on the right lifestyle program for you? Do you think that the diet and lifestyle programs that are supposed to come with these new drugs will integrate the nutritional science above? Will our new DIY economy spill over into health care, so you do more of this too, or will you become integrated into the health care system, now that nearly everyone will be covered (say, 5 years from now, and excepting Medicaid patients, whose coverage will likely be quite limited)

Will you be able to say to your doctor…I want your help in losing weight but I don’t want to take drugs? One on one self-monitoring, accountability, individual diet, and tailored fitness programs? Or will you just want the drugs, because they’re new, and your knees hurt, and you’ve tried to stick to diet and exercise, but they’re just not enough? What if you just want the best online programs, rated for weight loss?

I don’t know, but I can’t wait to find out. Meanwhile, you’d be shocked what simply cutting out ultraprocessed carbs and calories will do to your weight. Here’s a first step.