January 29, 2003

Dear Florida Medical Board,

I am a physician who has committed his practice to the medical treatment of the overweight and obese patient for the past ten years. As you know obesity is a genetic, metabolic, chronic and progressive disease much like its “co-morbid cousins” diabetes and hypertension. Chronic diseases require long term treatment for control not cure. The traditional paradigm for obesity treatment; ie, diet, exercise and behavioral modification has proven ineffective for the vast majority of patients (95% failure rate at 3-4 years) and thus the need for a more aggressive medical approach. The use of combination drug therapy to suppress appetite, control cravings, improve insulin sensitivity and lower the metabolic set-point has proven highly successful for “long-term” weight control in most of my patients. Since September 1997 I have used a combination of phentermine and an SSRI such as prozac, zoloft, celexa or luvox as initial treatment in probably 4000 plus patients. Paxil the other SSRI is avoided due to its weight gain potential. Since many overweight/obese patients are symptomatic for mild depression, carbohydrate cravings, migraine, irritable bowel , fibromyalgia, premenstrual symptoms; the use of an appropriate SSRI is highly effective for treatment of these “low serotonin” symptoms. The additional use of wellbutrin, effexor, serzone, glucophage or xenical is helpful in selected and resistant patients. I have found phentermine alone or meridia to be useless for most patients for long term success. Although some patients may do better with one SSRI vs another, or possibly using serzone or effexor in place of an SSRI; I rarely have to discontinue the medications due to side effects. The use of safe and effective medications in addition to diet and exercise protocols I believe is key for long term weight loss maintainence.

Sincerely,

Robert Skversky, M.D.