Diet Drugs Work: Why Won't Doctors Prescribe Them?

[FarCenter]

Afterward, I realized that what my patient wanted was a pill that would make her lose weight. I could have prescribed her one of four drugs currently approved by the F.D.A.: two, phentermine and orlistat, that have been around for more than a decade, and two others, Belviq (lorcaserin) and Qsymia (a combination of phentermine and topiramate), that have recently come onto the market and are the first ever approved for long-term use. (Ian Parker wrote about the F.D.A.’s approval process for new medications in this week’s issue.) The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. These new drugs, along with beloranib—which produces more dramatic weight loss than anything currently available but is still undergoing clinical trials—were discussed with great excitement last month by experts and researchers at the international Obesity Week conference in Atlanta.

But I’ve never prescribed diet drugs, and few doctors in my primary-care practice have, either. Donna Ryan, an obesity specialist at the Pennington Biomedical Research Center at Louisiana State University, has found that only a small percentage of the doctors she has surveyed regularly prescribe any of the drugs currently approved by the F.D.A. Sales figures indicate that physicians haven’t embraced the new medications, Qsymia and Belviq, either.

The inauspicious history of diet drugs no doubt contributes to doctors’ reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. Then, in the nineties, fen-phen, a popular combination of fenfluramine and phentermine, was pulled from the market when patients developed serious heart defects. Current medications are much safer, but they produce only modest weight loss, in the range of about five to ten per cent, and they do have side effects.

Still, as Ryan pointed out, doctors aren’t always shy about prescribing medications that cause side effects and yield undramatic results. A five to ten per cent weight loss might not thrill patients, or even nudge them out of being overweight or obese, but it can improve diabetes control, blood pressure, cholesterol, sleep apnea, and other complications of obesity. And, although the drugs aren’t covered by Medicare or most states’ Medicaid programs, private insurance coverage of weight-loss drugs has improved and is likely to expand further under the Affordable Care Act, which requires insurers to pay for obesity treatment. So what prevents physicians from prescribing these drugs?

Several leading experts and researchers attending Obesity Week told me that the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. Even though physicians since Hippocrates have known that excess body fat can cause diseases, the American Medical Association announced that it would recognize obesity itself as a disease only a few months ago. These divergent views on obesity represent one of the widest gulfs of understanding between generalists and specialists in all of medicine.

http://www.newyorker.com/online/blogs/elements/2013/12/diet-drugs-work-why-wont-doctors-prescribe-them.html

[Cooley Hurd]

1. These drugs are a double-edged sword...

They may help the patient decrease their BMI, but for patients already obese and suffering the effects of it (diabetes, heart disease), these drugs can be dangerous.

Proper nutrition (and the ban on trans-fats), on the other hand, will do more to achieve the same goal without the risks.

[etherealtruth]

2. Without doubt

additionally without significant lifestyle changes 9made over time) ... the weight loss will be temporary. weight (in all likelihood) wood be gained back after cessation of the drug.

drugs can be one tool ... but only they should only be viewed as one tool of many

[cherokeeprogressive]

3. My Doctor prescribed phentermine and toparimate in September.

I've lost 40 lbs. 30 more and I'll be at my goal of 205. I haven't seen 205 since '97 when I was convicted of DUI and had to ride my bike to work for a year.

[a la izquierda]

4. I take topiramate...

As a migraine preventive. I am a small person, but I lost 15 pounds on it.
The side effects are kinda weird though.