March, 1998

published, Marin Independent Journal and American Journal of Bariatric Medicine.
Metro Magazine and Daily Pilot.

It has been almost one year since Wyeth-Ayerst voluntarily withdrew Pondimin and Redux from the US Marketplace. Although we now know that the “studies” which precipitated the FDA’s action were unreliable, new and accurate studies, which were promised, have not been forthcoming.

Instead of substantial medical material written on this subject, most editorials and articles have focused on drug therapy abuse by patients and physicians, America’s obsession with thinness, and class action lawsuits. In this rush to judgment, the real losers ultimately are the obese patients. Many taking prescribed medication, as an integral part of a medical weight loss program, felt in control, often for the first time, of their appetites, cravings and lives. One may ask are there any positive lessons to be learned from the chaos of the recent drug treatment of obesity? I believe the answer is yes.

Lesson #1: Weight Loss Proven

For the first time ever in the history of obesity treatment, long term weight loss maintenance has been achieved through long term drug therapy. Nothing in the past, including diet, exercise, behavior modification or hypnosis has had long term results anywhere near comparable to drug therapy.

Lesson #2: Obesity Is Not Your Fault

To skeptics who believe that obesity is due to a lack of “discipline,” be advised: Obesity is a chronic metabolic disease with a significant genetic predisposition much like diabetes and hypertension. This means that obesity is not the individual’s fault. Because this disease is chronic and progressive, treatment must also be continuous for long term control.

Losing and controlling weight may also delay or prevent other diseases such as diabetes and hypertension from occurring. In many cases, weight reduction will decrease or eliminate medications used for these other debilitating diseases.

Lesson #3: Weight Regain

Weight regain is the inevitable consequence when medication is discontinued. This is not unlike what happens when one stops their blood pressure medication or anti-diabetic medication; blood pressure returns to pre-treatment levels, blood glucose elevates. 95% of the people who try non-medical weight loss programs regain their weight, plus more, within 3 -5 years. This is proof positive of the genetic and progressive nature of this disease.

Diet, nutrition, and exercise regimens are vitally important for a multitude of reasons including improved glucose and insulin control, lowering of cholesterol and improved cardiovascular fitness. However, maintaining weight loss is rarely one of the prolonged benefits of these programs when used alone.

My belief that obesity is primarily the result of genetics and that sustained drug therapy is the key for long term success is highly controversial. Thirty years ago birth control pills were considered to be used “short term”, as there was a fear that long term birth control might cause infertility. Today we know that this is not true.

Medicine is an evolving science. Fifteen years ago male impotence was thought to be 90% psychological. Today, we know that male impotence is 90% physical and current treatment is highly successful.

I encourage all to keep an open mind. I challenge those “normal” weight people who chide their overweight friends for a lack of discipline to try to gain 30 to 40 pounds and keep it on for three years. My guess is that 95% will fail! Why? Because I believe weight, whether it be too much, too little, or ideal, is based primarily on “them” genes.

The revolution in obesity treatment is well under way. Current drug therapy using appetite suppressants and serotonin modulators are highly effective and hope for winning the war against obesity for many has arrived.

Disclaimer:

Individual results may vary with treatment.