Can You Lose Weight with Pills?

Current options for weight-loss medications include the ridiculously named Qsymia, a combination of phentermine (the phen in fen-phen) and topiramate, a drug that can cause seizures if you stop it abruptly. Qsymia was “explicitly rejected” multiple times for safety reasons in Europe “because of concerns about the medicine’s long-term effects on the heart and blood vessels” but, at the time of making my video Are Weight Loss Pills Effective?, remains available for sale in the United States. Belviq is in a similar boat—allowed in the United States but not in Europe due to “concerns about possible cancers, psychiatric disorders, and heart valve problems…”  

Belviq is sold in the United States for about $200 a month. If you think that’s a lot, there’s Saxenda, which requires daily injections and is listed at the low, low price of only $1,281.96 for a 30-day supply. It carries a black box warning, the FDA’s strictest caution about potentially life-threatening hazards, for thyroid cancer risk. Paid consultants and employees of the company that makes it argue the greater number of breast tumors found among drug recipients may be due to “enhanced ascertainment,” meaning easier breast cancer detection just due to the drug’s effectiveness. 

Contrave is another option if you ignore its black box warning about a potential increase in suicidal thoughts. Then there’s Alli, the drug that causes fat malabsorption, thereby resulting in side effects “including fecal urgency, oily stool, flatus with discharge, and fecal incontinence”—Alli can be your ally in anal leakage. The drug evidently “forces the patient to use diapers and to know the location of all the bathrooms in the neighborhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.” A Freedom of Information Act exposé found that although company-sponsored studies claimed that “all adverse events were recorded,” one trial apparently conveniently failed to mention 1,318 of them. 

What’s a little bowel leakage, though, compared to the ravages of obesity? As with anything in life, it’s all about risks versus benefits. However, in an analysis of more than a hundred clinical trials of anti-obesity medications that lasted up to 47 weeks, drug-induced weight loss never exceeded more than nine pounds. That’s a lot of money and a lot of risk for just a few pounds. Since you aren’t treating the underlying cause—a fattening diet—when people stop taking these drugs, the weight tends to come right back, so you’d have to take them every day for the rest of your life. But people do stop taking them. Using pharmacy data from a million people, most Alli users stopped after the very first purchase and most Meridia users didn’t even make it three months. Taking weight-loss meds is so disagreeable that 98 percent of users stopped taking them within the first year. 

Studies show that many doctors tend to overestimate the amount of weight that can be lost with these drugs or are simply clueless. One reason may be that some clinical practice guidelines go out of their way to advocate prescribing medications for obesity. Are they seriously recommending drugging a third of Americans—more than 100 million people? You may not be surprised to learn that the principal author of the guidelines has a “significant financial interest or leadership position” in six separate pharmaceutical companies that all (coincidently) work on obesity drugs. In contrast, independent expert panels, like the Canadian Task Force on Preventive Health Care, explicitly recommend against weight-loss drugs, given their poor track record of safety and efficacy. 

In case you missed my related video, check out Are Weight Loss Pills Safe?.

As with all lifestyle diseases, it’s better to treat the underlying cause, which, in the case of obesity, is a fattening diet. For an example of what’s possible with a healthy diet intervention, see Flashback Friday: The Weight Loss Program That Got Better with Time. 

Check out the related videos below for more about weight loss.