Potential Risks and Concerns When Considering Medication
When considering long-term weight-loss medication treatment for obesity,
you should consider the following areas of concern and potential risks.
Potential for Abuse or Dependence
Currently, all prescription medications to treat obesity except orlistat
are controlled substances, meaning doctors need to follow certain restrictions
when prescribing many weight-loss medications. Although abuse and dependence
are not common with non-amphetamine appetite-suppressant medications,
doctors should be cautious when they prescribe these medications for
patients with a history of alcohol or other drug abuse.
- Development of Tolerance
Most studies of weight-loss medications show that a patient's weight
tends to level off after 4 to 6 months while still on medication. While
some patients and physicians may be concerned that this shows tolerance
to the medications, the leveling off may mean that the medication has
reached its limit of effectiveness. Based on the currently available
studies, it is not clear if weight gain with continuing treatment is
due to drug tolerance.
- Reluctance to View Obesity as a Chronic Disease
Obesity often is viewed as the result of a lack of willpower, weakness,
or a lifestyle "choice"--the choice to overeat and underexercise.
The belief that persons choose to be obese adds to the hesitation of
health professionals and patients to accept the use of long-term appetite-suppressant
medication treatment to manage obesity. Obesity, however, is more appropriately
considered a chronic disease than a lifestyle choice. Other chronic
diseases, such as diabetes and high blood pressure, are managed by long-term
drug treatment, even though these diseases also improve with changes
in lifestyle, such as diet and exercise. Although this issue may concern
physicians and patients, social views on obesity should not prevent
patients from seeking medical treatment to prevent health risks that
can cause serious illness and death. Appetite-suppressant medications
are not "magic bullets" or a one-shot fix. They cannot take
the place of improving one's diet and becoming more physically active.
The major role of medications appears to be to help a person stay on
a diet and exercise plan to lose weight and keep it off.
- Side Effects
Because weight-loss medications are used to treat a condition that affects
millions of people, many of whom are basically healthy, their potential
for side effects is of great concern. Most side effects of these medications
are mild and usually improve with continued treatment. Rarely, serious
and even fatal outcomes have been reported. Two approved appetite-suppressant
medications that affect serotonin release and reuptake have been withdrawn
from the market (fenfluramine, dexfenfluramine). Medications that affect
catecholamine levels (such as phentermine, diethylpropion, and mazindol)
may cause symptoms of sleeplessness, nervousness, and euphoria (feeling
Sibutramine acts on both the serotonin and catecholamine systems, but
unlike fenfluramine and dexfenfluramine, sibutramine does not cause
release of serotonin from cells. The primary known side effects of concern
with sibutramine are elevations in blood pressure and pulse, which are
usually small but may be significant in some patients. People with poorly
controlled high blood pressure, heart disease, irregular heart beat,
or history of stroke should not take sibutramine, and all patients taking
the medication should have their blood pressure monitored on a regular
Some side effects with orlistat include oily spotting, gas with discharge,
urgent need to go to the bathroom, oily or fatty stools, an oily discharge,
increased number of bowel movements, and inability to control bowel
movements. These side effects are generally mild and temporary, but
may be worsened by eating foods that are high in fat. Also, because
orlistat reduces the absorption of some vitamins, patients should take
a multivitamin at least 2 hours before or after taking orlistat.
Primary pulmonary hypertension (PPH) is a rare but potentially fatal
disorder that affects the blood vessels in the lungs and results in
death within 4 years in 45 percent of its victims. It should be noted
that the vast majority of cases of PPH have occurred in patients who
were taking fenfluramine or dexfenfluramine, either alone or in combination.
There have been only a few case reports of PPH in patients taking phentermine
alone, although the possibility that phentermine alone may be associated
with PPH cannot be ruled out. No cases of PPH have been reported with
sibutramine, but because of the low incidence of this disease in the
underlying population, it is not known whether or not sibutramine may
cause this disease.
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