My Experience Prescribing Diet Pills: An Internist’s Perspective

15 May

I’ve been reading in the news lately that the FDA is considering approving the use of several diet pills in the next few months.  Although the drugs will likely be approved, even the approval committee members are impressed by one aspect of the drugs…their apparent lack of data supporting effectiveness.  The rationale for approving them anyway is that they feel physicians need SOMETHING to battle the growing obesity epidemic.  It’s essentially an “all we got at this point” attitude.  Just think about that!

I would like to give you my experience on prescribing diet pills in detail.  I hope that through my eyes you can ultimately see how I feel about them.  So, here we go.  In 3 years of residency, and going on 8 years of private practice, I have prescribed diet pills a grand total of ZERO times.  Have I been asked for them…many, many, many times.  Why don’t I give them out?

First is the safety factor.  For years diet pills have emerged and one by one they have been taken off the market for unforeseen side effects.  Normally these are not run of the mill side effects; they are normally severe cardiovascular ones.  In my first few months in private practice I was called to the ER to see a 30’s year old female that apparently had congestive heart failure.  I found it odd of course because of her age, and I was curious to talk to her more in detail.  Come to find out she had take Fen-Phen for around ONE MONTH a few years earlier, and had developed severe valvular heart disease which had stricken her with chronic and severe heart failure.  Just telling me the story you could see that she felt like a fool for having done it, especially since she was not that overweight to start with.   What started out as a quest to lose a quick 6-8 pounds had landed her with a chronic incurable problem.  As we all know she was not alone, and this drug was fairly quickly taken off the market due to serious cardiovascular adverse events.

It has been 13 years since a weight loss pill has been approved by the FDA.  Both drugs up for approval were denied in 2010 due to safety concerns.  The first issue seems to be an increase in tumors when studied in rats.  In addition, the more serious concern is that the drugs could cause damage to heart valves (sound familiar). Is it worth the risk?

So, what do I tell my patients when they ask for pills?  Diets by nature are designed to either be on them, or be off them.  You lose weight when on a diet, and gain weight when off a diet.  If you can transform a “diet” into a permanent lifestyle change then you have a chance of success long term.  Successful long term weight loss on traditional low fat, high carbohydrate diets is uncommon because it is very hard to lose weight in an excess-insulin environment.  Read some books by Gary Taubes to learn more about how low fat diets can actually lead to weight gain long term.  I agree with him not only because I believe and understand the science, but also because I see it week in and week out in my patients.

Diet pills have always been something you prescribe for a short period of time as they are not safe at all over more than a month or two.  Losing weight with pills requires simple steps…insert pill and swallow water.  There is no associated change in eating patterns, exercise habits, meal preparation, etc.  Diet pills do not lead to CHANGE, they simply may lead to minimal short term gain in the form of weight loss.  They do not work long term, end of story.  If there was a magic pill, does anyone think there would be a fat doctor on the planet?!

The Paleo diet stops the insulin train and allows you to control your cravings and hunger with an easy to follow long term LIFESTYLE change.  You cannot “do” Paleo for a few months and then go back…it just won’t work.  That’s the difference between a lifestyle change and a diet plan.  One works…one does not.

Do we know for certain that one or both of the diet pills likely soon to gain FDA approval will cause serious side effects?  Of course not.  Do we know that people taking the pill will gain minimal short term success, and very little if any long term success?  Absolutely!  How about working on changing school diets, improving access to fresh and local produce/protein, eliminate misleading advertising on products making them look healthier than they are (my personal favorite would be the “Heart Healthy Whole Grain” sign on a box of Lucky Charms), changing the food pyramid to better agree with the science of nutrition as we know it, or something as simple as requiring calorie information on every menu in the country?  As long as these ideas are harder than “Open mouth, insert pill, swallow water”…we will continue to lose this battle.

Diet Pills?…just go Paleo instead J


1 Comment

Posted by on May 15, 2012 in General Paleo Discussion


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One response to “My Experience Prescribing Diet Pills: An Internist’s Perspective

  1. John Smith

    June 22, 2012 at 7:12 am

    I was in search of it so long before. I really appreciate your tips regarding internist’s diet pills.


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