Are Diet Pills or Surgery Cures for Obesity?


OTC Diet Pills

MedShadow interviewed Louis Aronne, MD, director of the Comprehensive Weight Control Center at New York-Presbyterian/Weill Cornell Medical Center Briefly, here is his take on the most popular weight loss approaches used today.

Over-the-counter diet pills and supplements have an even worse track record than prescription drugs. To begin with, Dr. Aronne says, most people take them without medical advice and may not realize the dangers of mixing them with other drugs and supplements. Secondly, many of the products, particularly herbal supplements, are largely unregulated so there’s no telling what’s actually in them. (See MedShadow’s ‘Natural” Weight Loss Herb Contains Unnatural Drug)

In fact, fifteen ingredients commonly found in dietary supplements should be avoided as they can potentially cause cancer, cardiac arrest, or even organ damage, according to an analysis from Consumer Reports.

A panel of independent doctors and dietary researchers also found that many of the ingredients identified have the potential to interact with prescription drugs, such as statins, which are used to lower cholesterol, and over-the-counter medicines such as aspirin.

One of the ingredients cited in the report, yohimbe (also called johimbe), claims to treat low libido, erectile dysfunction, depression, and obesity. However, the researchers found that yohimbe is also associated with raising blood pressure, rapid heart rate, headaches, seizures, liver and kidney problems, heart problems, and panic attacks.

Another ingredient on the list, green tea extract powder (also known as camellia sinensis), claims to promote weight loss. However, risks associated with the powder include dizziness, ringing in the ears, and reduced absorption of iron; it can also worsen anemia and glaucoma, increase blood pressure and heart rate, and cause liver damage.

The adverse events and side effects (of weight loss and diet pills) were so disruptive that they were not worth the benefits.  Finally, there’s very little proof that these supplements, powders, and potions do any good. (See MedShadow’s Weight-Loss Products May Do Harm While Promising Miracles) Dr. Aronne stresses that the diet pills, powders, and potions sold today, whether they are sold online, in health food stores or at the neighborhood pharmacy, are an expensive way to lighten up your wallet without shrinking your waistline.

The USPSTF doesn’t recommend diet pills or surgery

The USPSTF (US Preventative Service Task Force) recommends that doctors should refer adults with elevated body mass index (BMI) to behavioral weight-loss interventions as the most effective way to lose weight.  Diet pills are not included in the recommendation because an evidence review by the USPSTF found that even though they are helpful in keeping weight off and lowering the rate of diabetes, the adverse events and side effects were so disruptive that they were not worth the benefits.

The bothersome side effects of all the weight loss medicines included dizziness, cognitive impairment, nausea, constipation, headache, and dry mouth. Researchers also found that there is relatively little data on whether weight-loss interventions can keep weight off and lead to other health benefits in the long term.

The reason for the dearth of effective diet drugs? Dr. Aronne says that until recently obesity has been viewed as purely a behavioral problem. It now seems clear that damage to brain circuitry contributes to weight gain and makes it more difficult to lose weight.

And, while the current drugs aren’t perfect, Dr. Aronne prescribes them in his practice because he believes they can help move the needle on the scale towards a healthier weight range, easing the burden of health problems commonly associated with obesity such as diabetes, heart disease, and arthritis. He believes that diet drugs are quickly becoming a first-line obesity treatment because their success rate is improving. He’s also optimistic that better, safer and more effective diet drugs will be developed now that researchers are focused on the toll obesity is taking on American health.

With nearly three-quarters of American adults now considered either obese (a BMI of 30 or greater) or overweight (a BMI of 25 to 29.9) safe, effective obesity treatments are badly needed. As the number of overweight or obese adults continues to climb, there has been a parallel increase in the number of Americans trying to lose weight. In a 2019 study of more than 48,000 people, researchers analyzed trends in weight loss attempts based on surveys completed between 1999 and 2016. During this period the proportion of people who tried to lose weight increased from 34.3% to 42.2%, the researchers reported in JAMA Network Open. 

Dr. Aronne says that since the American Medical Association’s 2013 statement declaring obesity a disease, consumers have had better access to all sorts of obesity therapies

Metabolically Healthy Obesity – is this a thing? 

One interesting side note is that while the majority of obese people develop chronic health problems like high blood pressure, high cholesterol, and diabetes, a small minority are considered to have metabolically healthy obesity (MHO) — they have managed to escape these components of a condition known as metabolic syndrome. The precise reasons for this are not known. In a 2019 review in The Journal of Clinical Investigation, researchers note that people with MHO have less intra-abdominal fat tissue and lower triglyceride levels in their liver compared to their counterparts with metabolically unhealthy obesity. Also, there is likely a genetic component that contributes to the advantage for people with MHO. 

The researchers, who are from the Center for Human Nutrition at Washington University School of Medicine in St. Louis, note that due to the lack of a universal definition of MHO, many people thought to have the condition are not actually metabolically healthy. In fact, when healthy is defined as the absence of any of the typical metabolic syndrome complications, only about 5% are metabolically healthy. And studies show that up to 50% of people with MHO convert to metabolically unhealthy obesity after four to 20 years. 

In addition to the metabolic syndrome conditions that put you at risk of heart disease, diabetes, and stroke, excess weight is also associated with several different cancers, knee and joint problems, sleep apnea, gallbladder and kidney diseases, and emotional and social problems.  So losing weight should be a goal for people who are obese or overweight with one or more risk factors for heart disease.


two women working out without anti-obesity drugs
Photo by Luis Quintero from Pexels

Diet and Exercise

The often-quoted statistic that more than 95% of dieters fail is based on a study done in 1959 where only 12% of dieters lost 20 pounds, and after two years only 2% had maintained their 20-pound weight loss. Since then, little has been done to substantiate the findings. It’s impossible to know how many dieters actually do succeed in their quest to shed unwanted pounds and keep them off. Safe to say, not many. This is true whether the diet is prescribed by a doctor or involves restricting your meals to grapefruit and cabbage soup.

The evidence for exercise’s impact on weight loss is also unclear. Some studies show it to be effective, others show no benefit and still others show it only works in combination with diet. However, there’s a growing body of evidence to suggest exercise is one of the most important habits for maintaining weight loss. The National Weight Control Registry, which tracks people who have lost 30 pounds and kept it off for at least one year, reports that nearly 90% of registrants exercise an hour a day, with exercisers reporting burning on average about 2,600  calories a week to prevent weight regain.

Dr. Arrone also points out that the science of exercise for weight loss is evolving. Recent studies suggest that a mix of moderate and high-intensity exercise may be most beneficial and that weight training may be essential to help preserve muscle mass and metabolism which is often lost along with fat.

Even if a diet and exercise plan doesn’t help you drop all the weight, Dr. Aronne stresses that sensible lifestyle habits are good for your health. He also notes that these interventions can mitigate many of the health issues associated with obesity with virtually no negative side effects.