Slashdot Mirror
Diet Drugs Work: Why Won't Doctors Prescribe Them?
Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and 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. 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. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"
Your diet is a perpetual thing, not something you do for a little while to lose weight. Eat healthy, be healthy. Drugs and short term adjustments in what you eat aren't going to do shit.
Ask yourself the following:
(1) Are you cooking most of what you eat yourself?
(2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?
(3) Have you been tracking your calories and weight daily for the past month?
If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.
The previous post is a fine example of the problem: treating obesity as a moral failing. If you were a "good person" you'd have the willpower, eat right, etc.
Sure, modern lifestyles and diets are a contributor to the problem, but not the entire cause. There is ample peer-reviewed validated research out there that shows that some people are more efficient at metabolizing food, and that you can exercise as much as you like and eat as little, and still not lose weight as much (and suffer a variety of undesirable side effects in the process).
Bear in mind also that the underlying biochemistry of the "average adult" has changed as the result of food and activities during childhood. A travesty to be sure (juvenile onset diabetes, for instance), but now that you have that 20 year old with the screwed up biochemistry (in terms of comparison to 1900s man), you're not going to fix it by changing diet and activity.
And then, there's the practicality problem. If your job, which pays for the food you eat, requires you to sit in a cube with a headset on and a keyboard, no amount of Outside magazine inspired "get out and get fit" exhortation is going to provide an opportunity to "live a healthy lifestyle". Companies talk the talk, but when it comes to adversely affecting productivity, they do not walk the walk: that's why company wellness programs emphasize things like smoking cessation.. it's something you can do on your own time that saves the company money (yes, it's a good thing, but the real point is that the employee is doing the heavy lifting).
And so, after sitting in the cube all day, or inspecting people at a checkpoint, or whatever task there is, you ride the bus to your second job, so you can make the rent on your apartment in the food desert. Not a whole lot of time to prepare that nutritious meal from non-existent ingredients.
So, before exhorting "good healthy ways to eat", let's talk about paying people enough so they can afford to do so (in terms of time available, etc.)
Hello,
I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.
I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.
And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.
If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!
--PeterM
I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.
People are fat because they have poor diets and lifestyles and because most modern food is crap designed to make you crave more. Giving them a pill to remove the symptoms of their poor health will only reenforce their bad behavior and makes things worse. It'd be a loss for everyone. The population will get worse. WEIGHT IS THE EFFECT NOT THE CAUSE. Treating the effects doesn't fix their underlying causes.
What's so funny about this (and reinforced by the other replies to your post) is that people really object to the morality of other people "getting away with something" -- eating too much of the wrong food and not exercising enough.
I'm surprised they don't object to people with infections being treated with antibiotics, since if they had better hygiene they wouldn't get sick.
Why should you care if someone else is healthier by taking a pill?
Your personal physiology is identical to everyone elses', and so what worked for you will also work for every single other person on earth? Great! Spread the news! With this astounding insight, the obesity epidemic will be cured in no time!
Wait? What's that? You mean the metabolic pathways for storing and releasing energy are complex and very different from person to person? You mean that the body actively fights to retain fat stores when less energy is available resulting in crippling pain, headaches, listlessness, inability to cocentrate and insomnia? You mean to say that obesity is caused by numerous interrelated factors that each require corrective action in concert to be effective? It even says so in TFA? Well shucks!
Who'd have thought an illness that 100 million people are unable to cope with might actually be difficult to cure?? No, no! That can't be it. Let's just say they're lazy gluttonous porkchops so we don't have to find solutions to a difficult problem. So much easier for us to sleep well at night.
Scientists point out problems, engineers fix them
altslashdot.org: The future of slashdot.
Comment removed based on user account deletion
Im always amazed at the level of anger when the topic of obesity comes up. If there is a pill that helps fat people get skinny, so what? The logic must go like this "I put so much work into being fit, I am upset when someone else gets similar benefits without that same effort."
Manic
His basic assertion that if people eat less calories than they expend they will lose weight is 100% correct. Saying "it's a complex disease and the body wants to store fat and there's different metabolic pathways" is irrelevant - if you eat less, you will lose weight.
Slashdot: providing anti-social weirdos a soapbox, since 1997.
It is the cause. It IS a social one.
It is because of corporate food production, factory farming and industrial "recipes" that make cheap and plentiful Soylent Soy or Corpulent Corn - with added glutimate to overstimulate appetite generation.
These are the product of an agribusiness that has made this production a part of public policy, through the US Farm Bill and other legislative manipulation.
If you are deliberately misinformed, marketed to death, and underpaid, the last thing you need to solve for the attendant health effects is more pills. It's like plugging your nostrils, because you have a cold.
But I bet the pharmaceutical and health-insurance rackets love the idea...
"Flyin' in just a sweet place,
Never been known to fail..."
I've always found it both disgusting and a bit amusing, the way people get so angry and upset when you dare to suggest that maybe they are not victims, maybe they actually could assert some control over the problem they're having. The earlier posts in this thread did not deserve a "-1, Troll" moderation. Stating what you actually believe in a sincere manner is not trolling. It's not a "-1, MakesMyDenialUncomfortable" mod for fuck's sake.
Everyone I know who successfully lost weight and kept it off for years did it by making permanent, sustainable, healthy changes in their lives. A few of them learned to like veggies and other healthy foods. Others did that and also formed the habit of regular exercise. The point is to consume fewer calories than you burn until you reach a new equilibrium. Like so many other things that upset people, this works every time it's properly tried.
It is a miracle that curiosity survives formal education. - Einstein
Yes - and it can also make you very sick at the same time. People have starved themselves to death whilst remaining obese. To simply say "eat less, you'll lose weight!" makes as much sense as saying "just remove all the microorganisms from your blood stream, and you'll be cured!" Simple, right? Whilst technically correct, unfortunately it is not at all a useful suggestion. The sooner people stop deluding themselves with trivial knee-jerk responses that tacitly blame the patient, the sooner we can make progress to finding an actual solution for a real problem. Remember: if it was that easy, nobody would be fat.
"Eat less" isn't the same thing as saying "eat nothing or nearly nothing while failing to obtain the nutrients you need".
"Blame" is also a small-minded concern. When I personally needed to lose some weight, there was no concern with fault or blame. I (get this) *took responsibility* for my own condition and made some adjustments to it. Some sustainable, permanent adjustments that did not involve neglecting the nutrition I needed. It was never a problem after that. In fact it was one of the easiest things I've ever done. That's because I took responsibility and accepted that the power to change it was within myself, the exact opposite of victimhood. This is exactly what I never see from fat people. They're victims and they are hostile to the idea that they don't need to be. That's because they don't understand the difference between fault/blame and responsibility/power. That's the part that is "not that easy" for so many because we have such a shallow, small-minded culture that doesn't like to think too deeply about much of anything no matter how much better life can be.
All you are saying is that doing something the stupid and careless way won't yield a good result. This was already known.
It is a miracle that curiosity survives formal education. - Einstein
People will reflexively scoff at this, but it's Puritanism. If you're a good God-fearing person, you'll have willpower and be able to lose weight. If you're fat, it's because you're a bad person. Doctors have prescription power because they're a different kind of better person. Why should a good person give a bad person something that will encourage them to still be a bad person?
Americans (at least) refuse to accept how pervasive the basic concepts of Puritanism are in our society. The "head & up, good, below the head, bad" attitude is everywhere and irrational. Read some Thaddeus Russell before you disagree.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)