Diabetes Self-Management Blog

Wouldn’t it be nice to hear on the nightly news that researchers had finally found the magic pill that helps you lose weight…and keep it off? This pill would be taken once a day and wouldn’t have any side effects. It would start working immediately and the pounds would just melt off. Can you imagine all the happiness and excitement this would generate?

Unfortunately, there’s no magic pill at this time, and there may never be one. The safest and most effective way to lose weight is to take in fewer calories and burn off more calories through physical activity. However, some people need a jump-start to get them going.

Weight loss medicines are prescription drugs, with the exception of a brand new, over-the-counter pill called alli. As you well know, any prescription drug carries the potential for side effects, some more serious than others. And many of these drugs can interact with other drugs that you might be taking.

Most people who take a drug for weight loss will need to take it long-term to be effective. It’s also important to keep in mind that, in general, weight-loss drugs are only prescribed for people with a body-mass index (BMI) of 30 or higher, or a BMI of 27 along with a condition such as Type 2 diabetes, high blood pressure, or high blood lipids (cholesterol and triglycerides). The point, then, is that before taking any kind of weight loss pill, it’s important to have a lengthy discussion with your physician about the pros and cons.

That being said, this week we’ll take a closer look at two classes of drugs. The first class is the appetite suppressants. Pills in this group work on the part of the brain that regulates your appetite. Specifically, they work to decrease your appetite and make you feel more full by altering one or more of certain brain chemicals.

Two of the most commonly prescribed appetite suppressants used in the United States are phentermine (brand names Ionamin, Adipex-P, and others) and sibutramine (Meridia). Amphetamines are also considered to be appetite suppressants, but aren’t as commonly prescribed.

Phentermine can lead to dependence, especially if it’s used for long periods of time. Side effects include: diarrhea, dry mouth, constipation, insomnia, palpitations, and high blood pressure, to name a few. It’s not typically recommended for anyone with heart problems, especially arrhythmias.

Sibutramine can also be habit-forming. It can potentially interact with a multitude of other drugs, and its numerous side effects include chest pain, heart palpitations, dizziness, shortness of breath, anxiety, depression, and seizures. Sibutramine may not be appropriate for some people with high blood pressure, either. Unfortunately, the amount of weight loss with sibutramine isn’t all that impressive, and people who take it may stop losing weight after 6 months. The tricky thing is that if you stop taking sibutramine, the weight you lost can come right back.

A brand new drug that has generated a lot of hype and excitement is called rimonabant. Unlike phentermine or sibutramine, rimonabant helps reduce appetite and hunger by blocking pleasure centers in the brain (the same centers that are affected by marijuana, by the way). While studies have shown promising results in terms of amount of weight loss, a cause for concern popped up just as this drug was about to be approved by the U.S. Food and Drug Administration (FDA). Further analysis of studies with rimonabant has shown that there’s a 30% higher risk of “suicidality,” which ranges from suicidal thoughts to actual suicide, in people who take the drug. So, things are on hold for now. The FDA is scheduled to decide if it should be approved on July 27. If it’s approved, it will be marketed under the name Zimulti.

So, no magic pill yet.

Next week: An ally in “alli”? And the benefits of Byetta.

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