Weight loss – a new/old option

We all know the facts: Over two thirds of Americans are overweight. Half of them (one third of Americans) are medically obese, which places them at high risk for the development of premature heart attacks and a variety of other serious medical conditions.

The main cause of obesity is overeating, even more so than lack of physical activity.

The most effective way to lose weight is portion control, and with it comes the control of caloric intake.

But portion and calorie intake control is a tough job. It’s a “full time job,” and it takes willpower and discipline.

So what do you do when the brute force approach doesn’t work for you?

The New York Times Business section of February 16^th had an interesting article on the possible approval by the FDA of a new appetite suppressant, Qnexa (U.S. to Review Diet Treatment Once Rejected).

The use of appetite suppressants for the treatment of obesity has a long history. Medications like phentermine, Tenuate and Xenical have been used for years (we all remember the fen-phen period, of which phentermine emerged as the surviving drug…).

More recently, metformin (used in diabetes) has been used in some cases, and a combination of phentermine and certain antidepressants has been shown to be more effective than phentermine alone.

What’s new about Qnexa is not really new. The proposed drug is a combination of two well known medications now widely used: phentermine, the familiar appetite suppressant, and topiramate (Topamax) which is most commonly used for migraine prophylaxis.

Topamax, like most other drugs has a long list of side effects, one of which is weight loss. So physicians who treat obesity, have now begun using Topamax “off label” for it’s weight loss side effect, in combination with phentermine. The combination appears to be very effective.

The use of a medication for its side effects is not new. A good example is the wide use by hospitals of the Benadryl as a sleep medicine. In reality Benadryl (or its equivalents) is an antihistamine used for the treatment of allergies, and sleepiness as its most common side effect.

Whether Qnexa is actually approved by the FDA for weight loss or not, physicians are already using its components,  the combination of phentermine and topiramate, to help patients lose weight when attempts at self control and lifestyle changes are not successful.