Are Diet Pills or Surgery Cures for Obesity?

anti obesity drugs

Diet drugs, implants, and bariatric surgery have all hit the market but do they work and are they safe? Are diet and exercise really better than drugs? 

Weight is a universal topic, we all obsess about our weight, at least a little. Is there a shortcut to losing weight? A magic way to stay lean once you’ve gotten there? Can you be healthy and overweight? Here’s your overview of everything you want to know about:

Prescription diet pills: Four are available

OTC diet pills: Drugs, herbs and more

Diet and exercise: Slow but the side effects are great

Bariatric surgery: 3 major types

Non-surgical options: balloons?

Prescription diet pills

Currently, just four drugs are officially approved by the FDA for overweight or obesity treatment. All were tested only on people who were significantly overweight (obese) and were part of a diet and exercise program. If you are serious about losing weight, there is no avoiding changing your lifestyle. 

Poor history of safety

Weight-loss medicines have a history of being dangerous. Belviq and Belviq XR (lorcaserin) seemed to have a lot of promise. It was approved in 2013 and was the first weight-loss medicine that didn’t (seem to) cause heart conditions. However, FDA-required post marketing studies showed that the risk of cancer was much higher than previously anticipated.

“[O]ur review of the full clinical trial results shows that the potential risk of cancer associated with [Belviq] outweighs the benefit of treatment,” Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research, said in a statement. “The company has submitted a request to voluntarily withdraw the drug.” (from Stat News)

Fen-Phen (fenfluramine-phentermine) lasted barely six months in 1997 before it was pulled from the market because of it increased risk of symptomatic valvular heart disease. From 1999 to 2012, the FDA didn’t approve any weight-loss drugs.

Meridia (sibutramine) was approved in 1997 (the same year as Fen-Phen) and was yanked off the shelves in 2010 due to higher risks of strokes and MI.

Redux was approved by the FDA in 1996 for markedly obese people. It contained the appetite suppressant dexfenfluramine and was the first diet drug approved since its predecessor, Pondimin (fenfluramine) which had been awarded approval 23 years earlier. Only one year later, in 1997, Redux and Pondimin were linked to serious heart problems and yanked from the market. In the previous two years alone (1996-7), approximately 14 million prescriptions had been written, and nearly 5 million people had been exposed to the drugs.

(See MedShadow’s Bitter Pills: Once-Popular Drugs Pulled From the Market)

If all of this seems like too many red flags on safety, you might want to jump to page 2 of this article for Are diet and exercise better? 

Diet Pills

None of the weight-loss drugs now on the market appear to be a breakthrough treatment nor are any recommended without a rigorous diet and exercise program. And they all carry a distressing number of side effects from life-threatening to distracting.

In general, bothersome side effects of all the weight loss medicines included the risk of heart problems, dizziness, cognitive impairment, nausea, constipation, headache, and dry mouth. Look below for additional side effects and risk specific to each drug.

Contrave – approved in 2012, this drug is a combination of naltrexone, an opioid antagonist, and bupropion, an antidepressant, and is offered in extended-release tablets. Naltrexone is used to treat alcohol and opioid dependence while bupropion is approved to address depression and seasonal affective disorder and serves as an aid to smoking cessation treatment.

In addition to the side effects typical of most weight loss pills (see above), side effects for Contrave are: diarrhea, increased blood pressure, increased heart rate, insomnia, liver damage.

A significant side effect of Contrave is the risk of causing suicidal thoughts and behaviors and neuropsychiatric reactions. In addition, the FDA has received reports that some patients are losing consciousness. Contrave can also cause seizures and should not be used in patients who have seizure disorders. Contrave can also raise blood pressure and heart rate and should not be used in patients with uncontrolled high blood pressure.

Qsymia – Topiramate and phentermine, the “safe” ingredient in phen-fen, approved in 2012. It appears to suppress appetite by triggering the release of the chemical norepinephrine in the brain, which increases blood concentrations of the hunger-regulating hormone, leptin. The topiramate side of the drug acts to increase feelings of fullness, makes food less appealing, and increases calorie-burning capabilities.

The side effects of Qsymia include the typical ones listed above, but when using Qsymia you may find that your taste changes, especially with carbonated beverages, you may experience numbness or tingling of your hands and feet and have trouble sleeping. (NIH) In addition, you may experience Abnormal movements or sensations in your legs, arms, fingers, and/or toes. 

Stopping Qsymia too quickly can cause a seizure. To discontinue Qsymia safely, you’ll need to work with your doctor to gradually taper off by taking a dose every other day for at least 1 week prior to stopping treatment altogether.

Qsymia can cause mood disorders, including depression, and anxiety, as well as insomnia. Qsymia can cause cognitive dysfunction (e.g., impairment of concentration/attention, difficulty with memory, and speech or language problems, particularly word-finding difficulties). Since Qsymia has the potential to impair cognitive function, patients should be cautioned about operating hazardous machinery, including automobiles. Topiramate, a component of Qsymia, increases the risk of suicidal thoughts or behavior in patients taking these drugs for any indication.

None of the weight-loss drugs appear to be a breakthrough treatment nor are any recommended without a rigorous diet and exercise program. And they all carry a distressing number of side effects from life-threatening to distracting. 

Topiramate an ingredient in Qsymia, may cause vision problems that can be permanent if not treated quickly. Call your doctor right away if you have a sudden decrease in vision. Do not use Qsymia if you are pregnant or if you become pregnant. Topiramatean may increase the risk of cleft lip and palate in a newborn.

Some lingering doubts about the safety and efficacy of this drug remain which is why the FDA has required Qsymia’s parent company, Vivus, to continue studying the drug for up to five additional years to rule out long-term cardiovascular risks. 

Saxenda – This drug (liraglutide), which is administered through daily injection, was approved in 2014. It mimics a hormone made in the intestines called GLP-1 (glucagon-like peptide) that tells the brain the stomach is full. It may also help stabilize blood sugar which is why it is also used in diabetes treatment.

Saxenda has many of the typical side effects of weight loss-drugs: nausea, diarrhea, constipation, abdominal pain, raised pulse and headaches. The most common reason for stopping the drug is being unable to tolerate the gastrointestinal discomforts. If you are starting Saxenda, you doctor should warn you about the risks of acute pancreatitis, acute gallbladder disease, serious hypoglycemia, hypersensitivity reactions and suicidal behavior.

In addition, Saxenda should not be used by patients with a personal or family history of Medullary thyroid cancer (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). In rodent studies, the drug caused thyroid gland tumors but it is not known if it will do the same in humans. Saxenda may increase the chance of developing pancreatitis.

Xenical – generic name Orlistat, was approved in 1999 and is available without prescription over the counter under the brand name Alli since 2009. As a fat blocker, the drug blocks between 25%-30% of dietary fat from a meal. Xenical has demonstrated only a modest effect on weight loss. In trials, average weight loss after one year has been about 5 to 7 pounds greater than diet and exercise alone.

Patients anecdotally report that side effects such as oily stools, abdominal bloating and gas may persist for several months after ceasing drug usage. Lowering the amount of fat in your diet can help. Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat.

Four drugs that curb appetite and are sometimes prescribed for weight loss but should only be used for three months or less: 

  • phentermine
  • benzphetamine
  • diethylpropion
  • phendimetrazine

All increase chemicals in your brain to fool it into not feeling hungry. They share a common side effect profile: dry mouth, constipation, difficulty sleeping, dizziness, feeling nervous, feeling restless, Headache, raised blood pressure, raised pulse. Don’t use these drugs if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma. Tell your doctor if you have severe anxiety or other mental health problems.

Where to get treatment for obesity

A NYT article highlighted the abuses in the field of treating obesity. In Health Law: A Boon for Diet Clinics describes doctors who advertise, diagnose and sell their solutions for obesity and these tools can include prescription medicines, supplements, vitamins and counseling.

From the article: “But selling medication at a for-profit clinic, whether as part of a package or on its own, still raises red flags for obesity specialists like Dr. [Michael D.] Jensen.” (Dr. Jensen is identified as the director of the obesity treatment research program at Mayo Clinic in Rochester, Minn.)

“Obesity specialists at major medical centers say the proprietors of diet clinics often employ unproven tactics — like vitamin injections, costly supplements and extreme diet plans — that lure customers but do not lead to lasting results. Diet-clinic owners contend that they are filling a needed role because the mainstream medical establishment pays little attention to patients’ struggles with weight.”

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Liz Neporent

Liz Neporent is a health and fitness expert, writer and social media consultant. She is a regular contributor to ABC News and author and coauthor of 15 health books including Fitness for Dummies, now in its 4th edition. In her work with Harvard Medical School Publications she co-wrote the acclaimed best seller The Winner’s Brain as well as the recently released Harvard Medical School’s Guide to Managing Migraines and Change Your Gambling Change Your Life. She also serves on the emeritus board and is a national spokesperson for the American Council on Exercise, a leading national authority on fitness and weight loss.


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