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Obesity

MEDICATIONS

Drug Combinations

In 1999, the drug orlistat was approved by the Food and Drug Administration (FDA) as an obesity treatment. Orlistat works by reducing the body's ability to absorb dietary fat by about one third.

Most currently available weight-loss medications are approved by the U.S. Food and Drug Administration (FDA) for short-term use, meaning a few weeks or months. Sibutramine and orlistat are the only weight-loss medications approved for longer-term use in significantly obese patients, although the safety and effectiveness have not been established for use beyond 1 year. (See table 1 for the generic and trade names of prescription weight-loss medications.) While the FDA regulates how a medication can be advertised or promoted by the manufacturer, these regulations do not restrict a doctor's ability to prescribe the medication for different conditions, in different doses, or for different lengths of time. The practice of prescribing medication for periods of time or for conditions not approved is known as "off-label" use. While such use often occurs in the treatment of many conditions, you should feel comfortable about asking your doctor if he or she is using a medication or combination of medications in a manner that is not approved by the FDA. The use of more than one weight-loss medication at a time (combined drug treatment) is an example of an off-label use. Using weight-loss medications other than sibutramine or orlistat for more than a short period of time (i.e., more than "a few weeks") is also considered off-label use.

Table 1

Prescription Weight-Loss Medications
Generic Name - Trade Name(s)
Dexfenfluramine - Redux (withdrawn)
Diethylpropion - Tenuate, Tenuate dospan
Fenfluramine - Pondimin (withdrawn)
Mazindol - Sanorex, Mazanor
Orlistat - Xenical
Phendimetrazine - Bontril, Plegine, Prelu-2, X-Trozine
Phentermine - Adipex-P, Fastin, Ionamin, Oby-trim
Sibutramine - Meridia

Combined drug treatment using fenfluramine and phentermine ("fen/phen") is no longer available due to the withdrawal of fenfluramine from the market. Little information is available about the safety or effectiveness of other drug combinations for weight loss, including fluoxetine/phentermine, phendimetrazine/phentermine, Xenical/sibutramine, herbal combinations, or others. Until more information on their safety or effectiveness is available, using combinations of medications for weight loss is not recommended except as part of a research study.

Traditional weight loss methods include low-calorie diets between 800 to 1,500 calories a day and regular exercise. An alternative method sometimes considered for bringing about significant short-term weight loss in moderately to severely obese people is the very low-calorie diet (VLCD). VLCDs are commercially prepared formulas of 800 calories or less that replace all usual food intake. VLCDs are not the same as over-the-counter meal replacements, which are meant to be substituted for one or two meals a day. VLCDs, when used under proper medical supervision, effectively produce significant short-term weight loss in moderately to severely obese patients. Fad diets are not the best ways to lose weight and keep it off. These eating plans often promise to help you lose a lot of weight quickly, or tell you to cut certain foods out of your diet to lose weight. Although you may lose weight at first while on these kinds of diets, they can be unhealthy because they often keep you from getting all the nutrients that your body needs. Fad diets may seriously limit or forbid certain types of food, so most people quickly get tired of them and regain the lost weight.

Drug Therapy

Medical treatment for obesity is available, but only in extreme cases. Treatment currently available can be prescribed if you can demonstrate weight loss on a calorie-controlled diet first.

A lot of stimulant appetite-suppressant drugs have been used in the past, but many have been found to be dangerous. The stimulant drugs are based on amphetamine and carry a risk of sudden death from fatal heart rhythms.

Drugs are sometimes prescribed for patients who are unable to lose weight by changing their diet and increasing their activity levels. Orlistat is a pancreatic lipase inhibitor, which means that it reduces the body's ability to absorb fat. It may be used in conjunction with a low fat diet to achieve more rapid and greater weight loss. If a low fat diet is not used there may be unwanted side effects. Before your doctor will prescribe Orlistat, you must show that you are motivated to lose weight and have lost 2.5kg prior to treatment.

Another drug recently approved for the treatment of obesity in the UK is Sibutramine. This works in the brain by altering the chemical messages that control how the person taking it feels and thinks about food. It mainly affects two chemicals called noradrenaline and serotonin and promotes a feeling of being full or having eaten enough. It is only prescribed to obese people with a BMI of over 30 or those with a BMI of over 27 with life-threatening conditions such as high cholesterol or Type II diabetes and who have made serious attempts to lose weight by dieting, exercise and/or other changes in their behaviour.

If either of these drugs is prescribed for you, you will also be offered advice, support and counselling on diet, exercise and behaviour changes.
Diagnosis

The Body Mass Index (BMI) is currently the best and most convenient measure of its severity and therefore of the risk to health.
You can work out your own BMI using this calculation:

Step 1: Measure your height in metres and multiply the number by itself.
Step 2: Measure your weight in kilograms.
Step 3: Divide your weight by the answer you got in step 1. The number you are left with is your BMI.

An ideal BMI for most people is between 20 and 25.

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