Should You Take the New Diet Pill?

This week, one JAMA study showed that 21 people on 3 different diets for 4 weeks each burn calories at rest differently.

No real surprise here: the lowest carb diet had the highest energy burn, the second lowest was second, and the highest carb, well, was bad for metabolic syndrome. But the real news — that the first prescription medication for obesity in 13 years has been approved — slipped under the radar.

In other words, there is a small high profile study in a reputable medical journal that shows that the kind of calories you eat matters, calories are not all alike, and eliminating ultraprocessed carbs gives you a better chance of idealizing your weight. And also, now, there's a new FDA-approved drug, Belviq, for obesity. And maybe a second one, called Qnexa, shortly. Belviq (generic is locarserin) is metabolized by the liver, and works in the brain. It will be available in 2013. This drug was turned down in just 2010 because of safety problems (principally mental ones — it interacts with antidepressants, anxiety meds and more). The drug activates a receptor in the brain, called serotonin 2C, and accelerates satiety. But people have trouble staying on it: 40% dropped off in a year.

Qnexa is a phentermine (the go-go-go of phen-fen fame) and long-acting topiramate (the anti-seizure drug) combo. Research subjects lost, on average, about 6% of body weight, vs about 2% on control medication, per year. If you don't lose 5% in 12 weeks as a patient, you're supposed to go off the drug. Phentermine has been on the market for over 40 years; it is a stimulant, and boosts blood pressure and pulse slightly. Topiramate sometimes causes fatigue, slowed thinking, and impaired memory and concentration. And birth defects.

Nevertheless, the FDA wants doctors to have another tool in the toolbelt. With the US Preventive Services Task Force suggesting that all docs should measure BMI, and treat people who measure over 30 (and with Medicare already paying for 22 visits per year for obesity), I think the tide is turning. Doctors are going to become interested in treating obesity again, if they are paid and trained to do so. And have new drugs.

The real questions: are you really better off taking a pill than getting on the right lifestyle program for you? Do you think that the diet and lifestyle programs that are supposed to come with these new drugs will take into account the JAMA findings and nutritional science above? Will you be able to say to your doctor...I want your help in losing weight but I don't want to take drugs...and get what we know works? One on one self-monitoring, accountability, individual diet, and tailored fitness programs?

I don't know, but I can't wait to find out.

JL
Dr. JohnLaPuma.com

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