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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.'"
I lost 40 pounds by drastically increasing my saturated fat intake while reducing my refined carb intake.
I love Jesus, except for his foreign policy.
My wife is morbidly obese. She for years has tried to lose weight with various diets and drugs. These had temporary weight loss effects, but all ultimately failed.
Why? Was my wife of inferior moral fiber and simply unable to follow through? Is she simply someone who needs to eat from a smaller plate, sit further away from the table, exercise more, eat less sugar, eat less carbs, eat more carbs, follow some arcane points system?
Nope. None of that works.
I'm a software engineer. Failure is a daily occurrence, and when we fail and study the failure, we learn the underlying problems and then we have success; and I've constantly encouraged my wife to keep trying. And she has; for over 10 years.
Two years ago, she contacted a weight counsellor / psychologist in Florida. In that time, they have peeled back the layers of her life, looking for the real, underlying problems. And, they found them. Who knew, for example, that being sexually abused as a 4yo child for years would cause problems? Who would have thought that when the attacker (a family "friend" next door) said things like "you would look prettier if you lost a bit of weight", it causes problems like gaining weight to try and make the pain go away? Why on earth would a narcissistic mother cause problems - especially when a 4yo comes to her bleeding from the vagina and covered in semen, and the mother simply wipes it away and says it never happened?
My wife's weight is far from something to be ashamed of. Instead, it's the mark of a person who came through some of the most horrendous things you can imagine - and lived.
The reason all the diets and drugs failed? Denial of the past and the problems in it. Simply becoming an adult doesn't mean the past will not affect you.
The future? Looking good. Since breaking through and working through all of her past, the underlying need to eat compulsively has gone. Guess what? She's loosing weight without a restrictive diet, drugs, surgery - whatever.
Obesity isn't a "disease" or anything like that. It's the symptom of something else. Medical dollars are best spent for people who are ready to lose the weight AND deal with their pasts by supplying them with competent psychologists, not the latest diet pills.
As a primary care physician, I gave in years ago. I now prescribe assorted appetite suppressants whenever some one asks me, it saves me lots of arguments, and a lot of time.
However, I get them back monthly for weigh ins. The drugs work great for a couple months, losing 4~8kg a month, then tapering off to nothing. Folk then realise that this is not a wonder cure.
The only stuff that works long term is eating less +/- exercising more, or surgery to shrink your stomach (actually the latter works pretty well, better than pills long term, in my experience. little change out of $10K, but probably worth it)
Pills are short term appetite suppressants. The following year, you are back to your previous weight, but your wallet is much lighter. Look to advice that you already know about for long term losses.
Nah, as a doctor (in Australia, but i suspect most places are the same), we prescribe them only when a patient goes on & on, "but honestly, I dont eat much...", especially when the waiting room queue is getting longer.
We know they work, for a few months, before becoming less and less effective.
I'm guilty, I prescribe them to turn off a patients demands and get them out of my room, knowing they will see that the response is poor after the first few months.
Eat less, do more. That is reality, everything else is bullshit, or very temporary.
After 3 or 4 months, when the drugs stop working, some are ready to face reality. Those I can work with.
Stop starving your body by living on quick rushes of carb, and get off your ass.
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It's even worse for those who are overweight than it is for drug addicts. Drug addicts aren't constantly being bombarded with happy, uplifting advertising claiming how good it is to use drugs. Once weaned from their drugs, drug addicts don't have to continue taking measured amounts of drugs simply to survive.
There are so many aspects to why we're overweight as a society that it's stupid to cite any one thing as why. Sure, we don't move around enough, either at work or for our leisure time. We're taught that active, physical jobs are low-brow, and that the definition of success is to have others do things for us. We watch TV and sit at the computer instead of taking care of our homes and playing sports and working on things. We eat more than we should calorically. The kinds of things that we eat are bad for us. There aren't many rules about what companies are allowed to prepackage for food for us, and when rules do get passed, the public get pissed off and tries to reverse them.
This, "I don't wanna!" neoteny that our culture has fallen into, regarding getting out, being active, actually doing things is going to be our undoing. I actually support the idea of using medication to stimulate metabolism, at least enough to help us overcome the hump of inactivity, maybe if our metabolic rates were raised for a time before we get active, it'll be easier to get active in the first place.
I'm stuck in the same trap that we're all stuck in, it's Saturday morning and I'm sitting on my ass on the couch on my laptop, not really interested in fixing the compressed air distribution system in my shop or in insulating around the whirlpool bathtub or in putting new hatches on some of the openings to mechanical spaces, I'm warm and comfortable in my laziness. Yes, give me medication that makes it harder for me to sit still, and maybe I'll get my ass up and go do something. At least I finally accepted a few years ago that 99% of what's on TV is crap, so I have one less thing holding me here.
Do not look into laser with remaining eye.
Here are two more 100% correct assertions: you can live forever as long as you avoid death, and you can be wealthy by earning more money than you spend.
During World War 2, the "Minnesota Starvation Experiment" was conducted. 30 healthy men had their maintenance level of calorie intake measured for a month or two, and then had that calorie intake cut in half with no changes to their daily minimum half an hour of exercise. At the end of the study, the participants had an average drop in resting metabolism of 30%, and that's not 30% lower than when they were heavier, it was 30% lower than predicted for someone at their new skinnier sizes. Most of the men had developed an eating disorder, a mood disorder (bipolar, depression, etc...), an obsession with food, or all three.
The devil is in the details.