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Why Don’t Doctors Prescribe More Weight-Loss Drugs?

June 17, 2014

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Trigger warning: Discussion of weight loss drugs, weight loss statistics and weight loss surgery.

Can I just shake my head over this questionWeight Loss Drugs

<sarcasm>Could it be that those weight-loss drugs don’t really work for anyone who needs to lose more than ten pounds in order to hit that magical “ideal BMI” that’s going to guarantee them “health” for the rest of their lives? </sarcasm>

Then we get hit with the “statistics” of “obesity” and the fact that physicians’ groups have decided that being fat is a “disease” that needs treatment.

About 35 percent of American adults are obese, according to the Centers for Disease Control. Another third are merely overweight. Physician groups last year designated obesity as a disease.

Nevermind that most of those people considered “obese” don’t look like the typical “headless fatty” that’s shown in every news article about the OMGOBESITYEPIPANIC!1!11!!! Nevermind that most of us couldn’t tell you if a person classified by BMI as overweight is actually “overweight.” If you can’t hit that magical B(ullshit)MI number, you’re fat and in need of immediate medical intervention or your health is going to suffer (if not now, sometime in the vague future, sorta, kinda, maybe — they don’t know when, just that it will).

Then we get this:

Despite the urgency of the problem, doctors and patients have had a lukewarm response to the latest meds. That’s partly because the drugs are only modestly effective. Patients and doctors also haunted by an earlier generation of diet drugs that were pulled from the market because of sometimes lethal side effects.

Oh yes, it’s definitely an urgent problem that needs an immediate solution. Problem with that line of thought is that fat people have been around since the dawn of time, diets have been around for more years than I care to count, and fat people still exist. You’d think they’d have gotten the idea by now that maybe, just maybe, there’s a reason fat people exist in greater numbers and they’d quit trying to get rid of us.

Not to mention that I don’t give a damn how many studies Big Pharma does in order to prove their latest anti-fat pill is “the one” that conquers fat, they will never do enough long-term studies to prove that it’s effective for most people, that it’s safe in the long term for most people, and there aren’t potentially fatal interactions with other drugs..

Dr Daniel Neides, medical director of the Cleveland Clinic’s Wellness Institute, was fresh out of his residency when the FDA approved an appetite suppressant called Redux in 1996. While the drug helped people lose weight, “the problem was that it was killing them,” Neides says. It was pulled from the market the next year, along with fen-phen, another diet drug found to damage some patients’ heart valves. A third drug, Meridia, was taken off the market in 2010 because of concerns about heart problems.

This history has made physicians and regulators wary of weight-loss medications. The two obesity drugs to reach the market—Belviq, sold by Arena Pharmaceuticals (ARNA), and Qsymia, sold by Vivus (VVUS)—were initially rejected by the FDA but approved after the companies submitted further data. (This is also Contrave’s second time up for approval.) Consumer Reports has advised patients to stay away, and neither has been approved in Europe. Perhaps unsurprisingly, sales have been thin.

Kind of makes you wonder what further data those companies submitted to the FDA in order to get approval for those two drugs, doesn’t it. And often we won’t really know how safe they are in the general population until the damage has already been done to the people who took them, thinking “The FDA said this drug was safe, my doctor thinks it’s safe, and it will help me lose weight.” What most people who are prescribed those drugs don’t know is that those drugs might help them lose 4-8% more weight than placebos did, but as soon as they quit taking the drug, the weight will come back. Well, unless they want to live the rest of their lives taking that drug and obsessing over every calorie they eat and how many hours of exercise they get per week — at least a part-time job in and of itself.

I’m DEATHFATZ, and 4% of my weight is only 16 pounds, so a drug that’s going to help me lose 16 pounds more than the 5-10% that diet and exercise are supposed to help me lose (20-40 pounds) isn’t going to get me out of the DEATHFATZ category — it’s not even going to get me anywhere close to “obese.” The most I could lose with that drug, if you add their 8% to the 10% I can expect from diet and exercise; altogether, about 72 pounds, which still leaves me at 328 pounds that still makes 5′ 8″ woman DEATHFATZ.

Orexigen Therapeutics (OREX), the company behind Contrave, is partnering with Japanese drugmaker Takeda Pharmaceutical (4502:JP) to market the medication in the U.S. if it’s approved. Company officials told analysts in an earnings call in May that they’ll target a broad audience of family doctors. Takeda would put 900 sales reps behind Contrave, “which we believe will deliver the scale, scope, and expertise to successfully reach a large and high potential audience of primary care physicians,” Orexigen Chief Executive Michael Narachi said, according to a transcript.

In other words, they know doctors are leery of new weight-loss drugs, and don’t prescribe them much anymore, so they’re going to have 900 sales reps target family doctors — doctors who aren’t all experts in nutrition, let alone how to get their patients to successfully lose weight and keep it off forever — about the safety and efficacy of this new drug. Many of these doctors just don’t have the time to read all the research done on the drug. Yeah, pardon me if I’m very skeptical of this drug doing any better than the last two “new and improved” weight-loss drugs have done.

They may have a difficult time persuading physicians such as Neides. He’s skeptical that the benefits of new medications outweigh the risks, especially for obese patients, who may be taking medications for other health problems that interact with the new remedies in unknown ways. ”I want to know that I’m not going to harm my patients first and foremost,” Neides says.

Good point, Dr Neides.

If my doctor said I should try this drug, I would say to him, “How is it going to interact with my Synthroid (no thyroid here), propranolol (for migraines), Celebrex (arthritis), lisinopril (minimal dosage so the doctor will get off my ass about my white coat hypertension), and the vitamins and supplements I take because I had a weight loss surgery 17 years ago that failed to make me thin and, in fact, made me fatter?”

At my weight, if I manage to lose 5% of my weight, it’s not going to be enough for my doctor — he’s going to want me to lose another 5%, and then another 5%, and another 5%, and on and on and on, until I’m down to the weight he thinks is optimal for me. Sorry, I have better things to do with my time than obsess over food and exercise in a futile attempt to become an “acceptable” size.

Say I did manage to lose that 5%, 10%, 15%, or 20% of my body weight — it’s not going to stay off forever, it’s not going to improve my health more than just exercising and eating a balanced diet. Losing 20, 40, 60, 80 pounds will not get me out of the DEATHFATZ category — I’ll still be super-morbidly obese, and could end up with complications from the drug that are just as bad, if not worse, than the complications I’m already dealing with from my failed WLS. I think I’ll be like a lot of other fat people who seem to have become disillusioned with the ability of weight-loss drugs to drastically change our lives and take a pass on this one too.


5 Comments leave one →
  1. 95035 permalink
    June 17, 2014 8:31 pm

    Good for Dr. Neides! At least he is wanting to stick to the credo “First, do no harm”. Most doctors seem to have thrown that out the window when the drug companies start waving that moolah in front of their eyes. Funny how these same doctors can’t be bothered to do the actual research on these very same drugs that they have no problem passing out to their fat patients like candy on Halloween. And I agree with you – no matter how much weight we do lose, we’ll never be good enough for this thin-crazed society. I am beginning to think they don’t simply want us to conform and look acceptable, when they say they want to have us keep shrinking down like that, I think they want us to DIE! But I think people are finally wising up, praise the Lord!

  2. June 18, 2014 11:03 am

    Ugh. fen-phen. I’ll always remember it for causing the death of the great Shirley Scott, one of my favorite musicians of all time. Not that anyone who died from it deserved to.

    Also, even well-intentioned doctors have a lot of patients and a lot on their minds. Most just plain don’t think of everything they need to, all the time. I recently found out that Sudafed is bad for my blood pressure. Well, the alternative med I brought home on a doctor’s advice is not recommended if you have kidney diseases, which I do have. [rolleyes] So now I’m out fifteen bucks for nothing, and it’s back to the drawing board. At least I read the label first. :/

  3. Dizzyd permalink
    June 18, 2014 3:55 pm

    Huh…why does my username say my zip code? Whoops!

  4. Natalie permalink
    June 21, 2014 4:17 pm

    wow, so those drugs don’t work and are potentially lethal – well, let’s send some sales guys to persuade doctors to prescribe them. sounds like a plan… anyway, if your doctor wants you to take those, it may be a good sign you need a different doctor that actually cares about your health. i

  5. June 26, 2014 4:19 am

    Great post. A couple of comments about the comments – these are not criticisms, just clarifying one fact and putting another into perspective.

    Contrave isn’t the drug that is killing people and does not work in the same way. I don’t know if it works for weight loss – last I remember, a few years back, it seemed to have a lot of potential but hadn’t fared great in early trials. I don’t remember what’s happened since then. It is a combination of a product used successfully to help people stop smoking and one used for opiod overdose. Both have individually been shown to cause some weight loss. The initial rejection was after the FDA decided they’d been burned too often (yeah, and those dead fat people) and wanted larger, longer-term trials to check for any cardiovascular effects. I don’t know what the results of the trials were, and I am not in any way suggesting that people should be taking this drug or doctors prescribing it.

    The second was about a point DizzyD (and his/her zip code) made about how doctors can’t be bothered to do the research on the drugs they’re prescribing. I have a heck of a lot to say about how doctors treat fat people, and say it, at length, but I think this ‘can’t be bothered’ point is a bit unfair. As someone who does do research, it is practically a full-time job to follow the full evidence trail for even one topic/publication etc. When you think about how many products doctors have on their books, how many conditions a patient might walk through the door with, each of which has its own literature base that is likely growing at such an extent that you couldn’t possibly keep up with it even if you did nothing else, we can not expect doctors to do this. We can’t. I’m sorry. That’s why you have the FDA and we have the EMA. It is their job to read this stuff, all this stuff, and evaluate it. If it gets approved, the doctors are entitled to assume that it is because it is ok. Sometimes the regulatory authorities get it wrong: phen-fen, thalidomide… Doctors learn their lesson and change their behaviour to protect their patients. That’s as much as we can reasonably ask from them.

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