Medications - Issues and Options

The most important thing a person can do to combat obesity is to prevent obesity before it develops. For those who need to treat or manage obesity, there are numerous options to consider. Weight loss and weight management efforts to combat obesity require a balanced combination of behavioral change and medical intervention. Although consuming fewer calories and implementing a regular exercise regimen are essential to the weight-loss process, some individuals dealing with obesity may need to incorporate prescription drug therapy into their weight loss program. Drug therapy is commonly recommended as a weight loss treatment option for persons with either a BMI or Body Mass Index > 30 who have no obesity-related conditions, or a BMI - Body Mass Index > 27 with two or more obesity-related conditions⁴⁰.

U.S. Food and Drug Administration (FDA)-Approved Medications
Medication for treating obesity, as prescribed and monitored by a physician, may be beneficial for some obese patients and their weight-loss regimen when combined with lifestyle, behavioral and dietary modifications. There are currently two drug types that are approved by the FDA for the long-term treatment of obesity.

Long-term Obesity Treatments⁴¹
Sympathomimetic Drugs – These weight loss drugs help treat obesity by suppressing one’s appetite through restricting nerve endings’ ability to pick up norepinephrine and serotonin⁴². Sibutramine, the generic marketed as Meridia^® in the U.S. and Reductil^® abroad, is manufactured by Abbott Laboratories.

Lipase Inhibitors – This class of weight loss drugs prevents the action of lipases – the enzymes that break down fat – produced in the pancreas⁴³. Orlistat, the generic marketed as Xenical^®, which is manufactured by Roche Pharmaceuticals, is the only weight loss drug approved to alter the way the body responds to fat intake. In February 2004, the FDA approved Xenical’s use for the treatment of obesity among adolescents, thereby making Xenical the first approved weight-loss treatment for children and adolescents in the U.S.

Short-term Obesity Treatments
Other FDA-approved weight loss prescription formulations include Bontril^® (phendimetrazine tatrate), manufactured by Carnrick Pharmaceuticals; Tenuate^® (diethylpropion), manufactured by Aventis Pharmaceuticals; Didrex^® (benzphetamine), manufactured by Pharmacia Corporation/Pfizer; and Lonamin^®, Oby-Cap^®, Fastin^® and Adipex-P^® (phentermine), manufactured by several pharmaceutical companies. People treating obesity that have chronic conditions including heart disease, high blood pressure (including hypertension) or thyroid problems (thyroid disease, hypothyroid) should not use these weight loss drugs⁴⁴.

Future Treatments
Clinical trials for several weight loss drugs that are not yet approved for the treatment of obesity are currently being conducted. For instance, Metformin^® was recently found to produce a one to three kg. weight loss over an average of 2.8 years in the randomized, double blind Diabetes Prevention Program (DPP)⁴⁵. Bupropion, which is marketed as Amfebutamone^®, Wellbutrin^® and Zyban^®, is an anti-depressant and anti-smoking drug that produced significantly more weight loss in a randomized clinical trial than placebo during a one year examination⁴⁶. Although it was found effective for significant weight loss, Topiramate^®, a drug approved for treatment of epilepsy, also produced significant side effects during several trials of six to 12 months duration⁴⁷. Zonisamide^®, an anti-epileptic drug, also produced significant weight loss in a four-month randomized clinical trial⁴⁸. Most recently, rimonabant administered to patients with dyslipidemia produced significant weight loss in patients, while decreasing triglyceride and increasing HDL-cholesterol levels and reducing blood pressure. The trial, which spanned one year, also demonstrated rimonabant’s potential as an effective treatment to aid in smoking cessation⁴⁹. This drug has not yet been FDA-approved for any indications.

Over-the Counter (OTC) Weight Loss Treatments
Many OTC weight loss pills contain ephedrine, a compound that encourages weight loss by reducing the patient’s appetite while stimulating the body to produce more heat. One form of this weight loss drug is found in the Chinese plant ma huang and is sold in the U.S. without a doctor’s prescription. There are many other herbal weight loss treatments containing ephedrine marketed to promote weight loss. Ephedrine is not proven safe for the treatment of obesity. Although some preliminary studies had shown that taking supplements containing ephedrine was, at times, associated with weight loss, it is important to note that there are serious side effects associated with this weight loss treatment⁵⁰. On February 6, 2004, the FDA published a regulation prohibiting the sale of weight loss supplements containing ephedrine. This prohibition took affect April 12, 2004⁵¹. The Endocrine Society supports this regulation. Individuals are strongly advised to consult with a physician before taking any OTC product for weight loss.

Other OTC weight loss pills, including Dexatrim^® and Acutrim^®, are now ephedrine free. Although these products could be used in the treatment of obesity and claim to help weight loss by boosting energy levels and stimulating metabolism, there are no published peer-reviewed data to support these weight loss claims.

NOTE: As of press time, the nationwide FDA ban on supplements containing ephedrine was enacted. Components of this regulation may be amended at a later date.