Slim Chance: Diet Pills...Separate the Help from the Hype

Who wouldn't rather pop a diet pill than sweat at the gym or skip dessert? But are weight-loss drugs and supplements the answer for you? Read on to separate the help from the hype.
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Beppe Giacobbe

Slim Chance

If you're always struggling to shed extra pounds but haven't had any luck dieting or slaving away on the treadmill, taking a pill to get skinny may sound like a dream come true. With nearly two-thirds of Americans overweight or obese, and the statistics on successful dieters discouragingly low, weight loss through chemistry seems like the next logical step. There are lots of options out there, from health-food-store herbs to prescription medications. Some offer a measure of hope in combating obesity; others just aren't worth the health risks. But experts agree: If you want weight-loss pills to work, you must also adopt healthy habits. Meds won't make up for a bad diet or sedentary lifestyle. Here's a closer look at the options — what's effective, what's safe, and what's coming down the pike.

No Prescription Necessary

For the first time ever you can get a weight-loss medicine approved by the Food and Drug Administration (FDA) for over-the-counter use. Alli (orlistat) is the same medication as the prescription weight-loss drug Xenical, a fat-blocker that's been used in the U.S. for eight years. The only difference: Alli is half the dose of Xenical. Taken at each meal, Alli works by preventing 25 percent of the fat you eat from being absorbed. For a woman eating a low-fat, 1,800-calorie diet, it's like cutting out 135 calories a day. You can pick up a 30-day starter pack at your local drugstore or discount center for about $60.

However, if you want results with Alli, you still have to do most of the work: It's designed for adults with a BMI of at least 25 (that's about 146 pounds if you're 5'4") who are ready to make permanent lifestyle changes but need an extra nudge. In recent studies those who took Alli while following a low-fat, low-calorie diet like the one featured in The Alli Diet Plan (Meredith Books) lost 50 percent more weight than those who only dieted. So if you're able to drop 10 pounds on your own, you could lose as much as 15 by taking Alli too. "It's a tool, not a solution," says Roberta Anding, RD, a spokesperson for the American Dietetic Association.

Also, Alli isn't foolproof — or without side effects. If you eat much more than the recommended 30 percent of calories from fat while taking the medication, the excess undigested fat will bite back, in the form of diarrhea, oily stools, and gas. And it blocks calories only from fat — not carbs or protein — so you still need to curb your intake in general. "If you tend to overeat carbs or meat, or drink a lot of soda or alcohol, Alli won't help you lose weight," says Robert Kushner, MD, a professor of medicine at Northwestern University Feinberg School of Medicine. It can also cause loss of vitamins (such as A and D), so users must take a daily multivitamin at bedtime for the best absorption.

The FDA approved Alli for those who are overweight and obese, though it's over-the-counter, so anyone can buy it, says Caroline Apovian, MD, director of the Nutrition and Weight Management Center at Boston University Medical Center and author of The Alli Diet Plan. But considering the possible side effects (gas and even accidents) — which are the same for everyone, regardless of weight — it may not be worth it just to lose a few extra pounds.

From Your Doc

For people with significant amounts of weight to lose, only two prescription drugs are approved for long-term use: Meridia (sibutramine) and Xenical. Both are recommended for those with a BMI of 30 or higher (roughly 30 or more pounds overweight) or with a BMI of 27 and higher combined with risk factors like diabetes and heart disease. While Xenical and Alli work in the intestine, Meridia targets the brain, where it alters levels of the hormones serotonin and norepinephrine to help you feel full. But because Meridia can significantly increase heart rate or blood pressure in some people, taking the drug requires regular check-ins with a doctor.

Both Meridia and Xenical have been proved to help people drop pounds, but the losses are modest: an average of 5 to 10 percent of body weight within a year. "A lot of patients are disappointed by this," says Cathy Nonas, RD, administrative director of the VanItallie Center for Nutrition and Weight Management in New York City. As with Alli, you'll get better results if you make healthy lifestyle changes while taking the drugs: In a study from the University of Pennsylvania, people who were told to keep food records and up their exercise while taking Meridia lost more than twice as much weight in one year as those who only took the drug (39 pounds versus 11).

But losing just a few extra pounds can be enough to lower your blood sugar, cholesterol, or blood pressure to safe levels. "A small amount of weight loss can make a huge dent in health problems," explains Nonas. For example, in the Diabetes Prevention Program, a large government-funded trial, people who tried to lose just 7 percent of their weight lowered their risk of developing diabetes by 58 percent. That amount of weight loss can also boost quality of life, making it easier for people to climb stairs or play with their children without becoming winded. For others, dropping those first 10 pounds may be just the motivation they need to keep eating less and moving more.

Though weight loss with these medicines tends to level off after 6 to 12 months, many patients are encouraged to stay on them for longer periods of time. They've been proved safe up to four years, and it's believed they're safe well beyond that too, says Dr. Kushner. Research shows that people who stop taking them will likely regain weight — evidence that obesity should be treated like a chronic condition. "You wouldn't suddenly go off your blood pressure pills," says Dr. Apovian.

Unfortunately, since prescription anti-obesity drugs are still considered more about aesthetics than well-being by many insurance providers, they're often not covered and run about $100 a month.

In the Supplement Aisle

There are hundreds of products on the market promising quick body transformations, and research by the Centers for Disease Control and Prevention reveals that more than 20 percent of women and about 10 percent of men have tried them in the past year.

That scares a lot of health experts, who worry that desperation to drop weight, combined with misconceptions about supplement safety, is a recipe for dangerous dieting. In a recent survey from the University of Connecticut, more than 60 percent of adults said they believed that weight-loss supplements were tested and found to be safe and effective. More than half thought the FDA gave these pills its stamp of approval.

The truth is herbal supplements don't need FDA approval to make it onto store shelves. Basically supplements are considered safe until proved otherwise — and in some cases that's too little too late: Several years ago the popular supplement ephedra melted off pounds as promised but was linked to numerous deaths (from heart attack and stroke) and eventually banned from the market in 2004. History may be doomed to repeat itself with herbs such as bitter orange, which has the same stimulant as ephedra. "We have no idea what these herbs do and what harm they could cause," warns Dr. Apovian.

Up Next

Pharmaceutical companies are scrambling to deliver the next big thing, including formulas that halt hunger, blast fat, and rev up metabolism. One highly anticipated contender is Zimulti (rimonabant), a medication now available in more than 50 other countries that works with brain receptors to regulate fat storage. Though it was expected to gain approval, the maker chose to withdraw it from consideration after an FDA advisory panel had concerns about its side effects, including anxiety and depression. More data is being gathered, and Zimulti may be brought back to the FDA within the next few years.

Though they are a few (or more) years away from approval, there are other promising developments on the horizon. Lorcaserin hydrochloride targets one of the serotonin receptors in the brain and causes a decrease in appetite. It is similar to fenfluramine (the "fen" in fen-phen, a diet drug that got big results but was withdrawn in 1997 due to concerns about a link to heart-valve disease) yet hasn't been shown to cause the same heart problems. Another possibility is Cetilistat, which works like Xenical and Alli to disable fat-digesting enzymes but may have fewer GI side effects. Researchers are also studying a nasal spray containing Peptide YY, a hormone that causes the feeling of fullness. In preliminary studies people taking it consumed up to 30 percent fewer calories. Byetta (exenatide) and Symlin (pramlintide), already used to treat diabetes, are being considered as antiobesity agents as well.

But finding one single wonder drug seems doubtful. "For some reason 25 percent of people don't respond to one weight-loss medicine," says Donna Ryan, PhD, associate executive director of clinical research at Pennington Biomedical Research Center in Baton Rouge, Louisiana. And raising the dosage to get weight losses higher than 10 percent of body weight can lead to too many side effects. But perhaps the biggest challenge is that fighting obesity is like fighting biology. The body is designed to hold on to whatever fat it has (even if there's way too much of it) to keep itself alive — a mechanism that served us well as hunter-gatherers but backfires in today's world. "When you target a certain pathway in the body, another says 'whoops, we're losing weight' and kicks in to defend against starvation," says Nonas.

So the most promising option may be a cocktail of meds that hit multiple pathways — much like the way doctors treat diabetes and hypertension today, says Ryan. Having more medicines means more doctors can actively treat obesity, making it less likely patients will need additional drugs for the health problems obesity can cause. "It's not surprising to see overweight patients on drugs that treat diabetes, high blood pressure, and high cholesterol," says Nonas. "But if we could keep their weight off with two weight-loss meds, they might not need any of the others."

Off-Label Options

With a growing obesity epidemic and only two prescription weight-loss medications approved for long-term use, some doctors are getting creative. They're supplying their overweight patients with medicines that treat problems they don't even have — like seizures, migraines, and hyperactivity — because the drugs produce weight loss as a side effect.

"Off-label" drug use is common (a recent study found that as many as 21 percent of all prescriptions are written for off-label purposes), but there are obvious risks. Since these drugs often have negative side effects — ranging from insomnia to chest pain — they're definitely not for people with just a few pounds to lose. Also, be sure your doctor is well-versed in obesity treatment — or find one who is. Combating obesity with an off-label medicine from a qualified doctor is probably okay. "Borrowing" a few of your child's Ritalin tablets is not.

The Skinny on Supplements

Americans spent about $1.62 billion on weight-loss supplements in 2005. But since there's no guarantee from the FDA that these supplements work, you may be wasting your money and harming your health. "Herbs aren't a shortcut to weight loss," says Brent Bauer, MD, editor of the Mayo Clinic Book of Alternative Medicine (Time Inc.). "They contain potent chemicals, and they're not automatically safe just because they're natural." Check out his view on some popular options — and talk to your doctor before taking any supplement.

Bitter Orange

  • Claims: Decreases appetite.
  • What You Need to Know: Contains the same stimulant as ephedra, which has been linked to health problems such as heart attack and stroke.

Chitosan

  • Claims: Blocks absorption of dietary fat.
  • What You Need to Know: Unlikely to help with weight loss and can cause constipation, bloating, and other gastrointestinal complaints.

Chromium

  • Claims: Reduces body fat, decreases appetite, and builds muscle.
  • What You Need to Know: Can cause kidney failure if taken in large doses. Unlikely to build muscle or help with weight loss.

Conjugated Linoleic Acid (CLA)

  • Claims: Reduces body fat, decreases appetite, and builds muscle.
  • What You Need to Know: Might decrease body fat and increase muscle but isn't likely to reduce total weight. Can cause gastrointestinal problems.

Country Mallow (Heartleaf)

  • Claims: Decreases appetite and increases the number of calories burned.
  • What You Need to Know: Contains ephedrine, which can raise both heart rate and blood pressure to unsafe levels.

Green Tea Extract

  • Claims: Increases rate body burns calories and fat, decreases appetite.
  • What You Need to Know: Limited evidence to support claims. Can cause vomiting, bloating, indigestion, and diarrhea.

Guar Gum

  • Claims: Blocks absorption of fat and increases the feeling of fullness.
  • What You Need to Know: Thought to be relatively safe but unlikely to cause weight loss. Has been linked to gastrointestinal problems.

Hoodia

  • Claims: Decreases appetite.
  • What You Need to Know: No conclusive evidence to support claim.

Copyright © 2008. Used with permission from the April 17, 2008, issue of Family Circle magazine.