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The Latest Crop of Diet Drugs

By: Nancy Snyderman, M.D.

Diet pills

p. dazeley/getty images

If you have not responded well to a diet and exercise program, your doctor’s next line of defense may involve drug therapy to help get your weight under control. As of now, the only two drugs officially approved for use to treat weight loss are the appetite suppressant sibutramine (Meridia) and the “fat blocker” orlistat (Xenical), along with its over- the- counter version, Alli. They can give you a modest weight loss of about 5 to 20 pounds, usually within the first six months of use. (An amount, by the way, that following a healthy exercise and diet plan could provide without negative side effects.) But none will automatically shrink you back into your college jeans or your wedding tux. These diet drugs work only if you also adopt healthier habits, and that still means facing up to the fact that exercise and healthy food must become a part of your life. Let’s look briefly at these options and how they work.

Diet pills
                                                                                                              s. sasaki/neovision

Meridia (Sibutramine)

THE SKINNY: Meridia was approved for use in the United States in 1997 as one of the latest in a new generation of appetite suppressants. It works by increasing the level of serotonin— the chemical in the brain that triggers the pleasure center—and, to a lesser extent, a brain chemical called norepinephrine that is linked to changes in mood. Meridia controls your appetite so that you’re less likely to paw around for McDonald’s two- for- one coupons in your glove compartment. And the drug does this quite well. 

According to research: If you follow a reduced- calorie diet while taking this drug, you can typically lose 5 to 8 percent of your weight over six months, on average. That is compared with 1 to 4 percent of weight in dieters following only a diet and taking a placebo (look-alike) pill. If you knock off pounds during the first six months, keep using Meridia and you’re likely to keep them off, according to studies, many of them conducted by drug makers. This research hints that Meridia may be a good tool for keeping weight off.

DOWNSIDE: Meridia can raise blood pressure, increasing the risk of heart attack or stroke. It should not be taken by people with liver or kidney problems. Anyone who takes Meridia should treat it with respect and not as a wonder drug or miracle cure.

SHOULD YOU TAKE IT? Clearly, Meridia isn’t a drug that just anyone can take. It’s indicated only if you’ve been diagnosed as obese (a body mass index [BMI] over 30) or overweight (a BMI over 27), with other risk factors such as diabetes or high cholesterol. By promoting weight loss, Meridia indirectly helps regulate blood sugar and helps keep cholesterol in check. If you’re considered overweight, your doctor may prescribe it for you, especially if you have cholesterol and blood sugar problems. You shouldn’t take Meridia if you have uncontrolled high blood pressure, heart disease, congestive heart failure, or heart rhythm disturbances or if you are taking other drugs such as antidepressants that increase serotonin levels.

Diet Pills
                                                                                                                    jeffrey hamilton

Xenical (Orlistat)

THE SKINNY: The particular excitement involving Xenical, approved in 1999, hinges on the drug’s ability to disable pancreatic enzymes that help the intestines absorb the fat in foods. About 30 percent of the fat in your diet (and the calories in that fat) passes through your digestive tract without being digested or absorbed. In clinical trials, people taking Xenical lost 9 percent of their body weight in one year, on average, compared with 5.8 percent among those who took a placebo. The drug has also been found to improve blood sugar, cholesterol, and blood sugar control—so it may help prevent heart disease and diabetes if you’re at risk. 

Taking Xenical may also help you maintain your weight loss. That’s no small feat, either, when you consider how tough it is to keep pounds off. Case in point: In long- term studies, people on Xenical regained about 35 percent of their weight during their second year on the medication, while those taking a placebo regained a lot more—about 62 percent.

DOWNSIDE: As a way to get thin, Xenical has some drawbacks. Fat that isn’t absorbed has to go somewhere, and Xenical takers find out in a hurry just where. The oily fat that is not absorbed in your gut can slide right out of you. (Doctors advise keeping an extra pair of pants handy in the event of calamitously embarrassing accidents.) Among the drug’s other less elegant side effects are gas with discharge, urgency to have a bowel movement, and fatty or oily stools.

Moreover, about 20 percent of those who take Xenical absorb not only less fat but also fewer nutrients— particularly vitamins D and E and beta- carotene, which is why your doctor will advise you to take a multivitamin daily, at bedtime. To minimize the risk of side effects, it is best to follow a low-fat diet (less than 20 percent or lower of your total daily calories come from fat). You’ll be advised to take Xenical with your three main meals because the drug has to be in your digestive tract when the meals are consumed. It doesn’t do much good against between-meal snacks, which are what make many people fat in the first place. And the drug won’t work against bad carbs.

SHOULD YOU TAKE IT? Xenical may be an option for you if you have a BMI of 30 or greater or have a BMI of 27 or greater and have other risk factors, such as high blood pressure, high cholesterol, heart disease, or diabetes. But you should not take it if you just need to drop a few pounds or suffer from disorders of intestinal absorption, inflammatory bowel disease, or blockage of bile flow. The drug can aggravate these conditions.

Diet pills
                                                                                                              bambu productions

Alli (Over- the- Counter Orlistat)

THE SKINNY: I reported on Alli when it became available at drugstores in 2007, no prescription required. With the prescription version (Xenical), up to 30 percent of fat from food is blocked; with the lower- dose OTC formulation, 25 percent of fat is blocked. Alli contains 60 milligrams of orlistat per capsule, taken three times daily with meals; Xenical is prescribed at 120 milligrams three times daily with meals. The amount of fat calories blocked will depend on how much fat you eat, but most patients block 100 to 200 calories per day.

So, how does that play out in pounds? Subjects who took Alli for six months lost 50 percent more weight— say, 15 pounds versus 10—than those who only dieted. If you decide to take Alli alone, without undertaking a weight- loss program, you’re going to be disappointed. The drug doesn’t work unless you follow a healthy, lowfat diet and do some regular exercise. A starter pack of Alli includes a month’s supply of pills, dietary guidelines, a calorie and fat counter, and a food journal.

DOWNSIDE: If you like your steak, bacon, butter, and other high-fat fare, you’re going to have problems with this drug. Eating more than 30 percent of your calories, or roughly 15 grams of fat per meal, can trigger loose, oily stools, since the excess fat that is blocked from absorption is quickly excreted.

SHOULD YOU TAKE IT? Alli is intended for people who have a BMI of 27 or higher. Some doctors feel that Alli and Xenical are useful for people who eat out often and don’t have much control over the amount of fat they are served. However, if you want to lose 5 pounds to fit into your bikini, I suggest that you don’t take this drug. Normal- weight people who take Alli place themselves at an unnecessary risk of suffering side effects such as loss of bowel control and vitamin loss. So for the casual dieter, go back to the basics, push yourself away from the table, exercise, and change your lifestyle.

Excerpted from:
Diet Myths That Keep Us Fat by Nancy Snyderman, M.D. © 2009, Crown.

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