New Weapons in Battle to Lose Weight

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Category: Medical Weight Management Published on Monday, 23 December 2013 Written by Yong Tsai, MD
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The National Health Assessment and Nutrition Examination Survey for 2009 through 2010 found that about one third of American adults were obese.  Due to the numerous healthcare conditions that can develop as a result of obesity, this has escalated from a personal issue to a national crisis. Only some patients are able to lose weight with diet and exercise alone. Weight loss drugs should never be the first choice for patients; however there are new pharmaceutical treatment options available for those who struggle with weight loss. Those typically eligible for weight loss drugs have a BMI over 30 kg/m2 or those with a BMI greater than 27 kg/m2 and have a significant weight related condition, such as type 2 diabetics, hypertension, or high cholesterol.

Some prescription weight loss medications are stimulants, which are recommended only for short-term use, and therefore are of limited usefulness for extremely obese patients due to their need to reduce weight over months or years. Appetite is regulated by a close interplay between the digestive tract, adipose tissue, endocrine organs and the brain; it has a relationship with every individual behavior. Developing a non-stimulant medication that controls appetite and hunger has been a priority for the pharmaceutical industry.

After banning Amphetamine, Fen-pen, Dexfenfluramine, Ephedra, and Subutramine due to severe side effects, there were no options on the market since no new weight loss drugs were approved between 1999 and 2012. Finally, in 2012, the FDA approved two weight loss drugs: Qysmia and Belviq. The new weight-loss drugs were designed with the previous drugs’ safety concerns in mind.

Qsymia combines low doses of topiramate, a generic drug used to treat seizure and migraines, and phentermine, a stimulant that suppresses appetite and gently increases metabolism. The phentermine acts soon after the pill is taken while the topiramate activates later in the day and creates a sense of feeling full. While the mechanism action of topiramate is not entirely known, one of its effects is the alteration of taste; this lessens the reward of eating. Common side effects from Qsymia include parenthesis, change in taste, dry mouth, constipation, and insomnia. Despite this, two years of clinical trials has been found Qsymia to be effective and safe.

Belviq is meant to target specific receptors for appetite in the brain and trick the body into feeling full. During two years of clinical trials, patients on Belviq lost about 5-10% of their original weight. Total cholesterol, LDL cholesterol, and triglycerides were also significantly lowered. The common side effects are headache, dizziness and nausea. Currently, a pharmaceutical company is conducting post marketing research studies to ensure levels of cardiovascular events are not increasing when using Belviq.

Both Osymia and Belviq can both be used long term as long as there are benefits and no side-effects. Remember, weight-loss drugs are appropriate only as an addition to diet, exercise, and lifestyle changes – not a substitution!

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