The Weight-Loss Drug That Could Actually Work

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I’ve written before that welive in an obesogenicenvironment -- one that seems designed to make usfat. So where is our magic pill?I’m down on magic pills, simply because there is no magic. Theyare expensive, have negative side effects and usually don’twork. Of course, I’m talking about the over-the-counter “dietarysupplement” magic-type medications promoted by people with names like Kardashian andSnooki. If there is going to be an effective anti-obesity drug,it’s not going to be an over-the-counter supplement and have reality TV stars astheir pitch people. Supplements aren’t regulated by the FDA. The regulations areso lax that I could probably fill gelatin capsules with my neighbor’s dog poo andsell it as an all-natural appetite suppressant and make millions. Thefinesfor false advertising are just part of the overall marketingbudget. Instead, it’s goingto come from the pharmaceutical industry. It knows there is plenty of money to be made indeveloping a safe and effective weight-loss drug. It's pouring billions into research andhas to meet strict requirements for efficacy and safety. Still, sometimes I wonder ifthe requirements are strict enough. Here’s abrief history of weight loss drugs:Orlistat(aka “alli”)

Modest weight loss mixed with, uh, shall we say, gastrointestinal distress. If you dare eat fat you can experience “fatty/oily stool, oily spotting, intestinalgas with discharge” and a bunch of other side effects that make reference to“bowel.” At any rate, the effects are such that, when combined with caloricrestriction, you achieve 8.4% weight loss at six months with Orlistat vs. 5.7% in theplacebo group, which is totally not worth having to ensure you’ve always got cleanunderwear on hand. Orlistat prevents the absorption of some fat, and that fat has to go somewhere.Sibutramine (aka “Meridia”)

This has been withdrawn from the market. It was a serotonin and norepinephrinere-uptake inhibitor that was first created as an antidepressant but was also shown tosuppress appetite. When sibutramine was taken in combination with a low-caloriediet, at six months, weightloss was 7.5 kilograms vs. 3.6 kilograms in the placebo group. That'snotable, but it was also shown to raise blood pressure and increase the risk of heart attack.Remember Fen-Phen? It worked fairly well byincreasing serotonin, resulting in a shutdown of dopamine action, reducing sensitivity toreward so that people were less inclined to eat highly palatable food. Unfortunately, the side effects were terrible, such as heart valve damage, and the manufacturer AmericanHome Products Corporation ended up payingbillions in settlement costs.Experiments have been done with anti-cannabinoids (although they're not approved for sale in North America), which work great to suppress appetite but also suppress yourwill to live. Think of smoking pot (a cannabinoid). If you’ve never done it, youknow the stereotype: It creates a feeling of euphoria and causes munchie attacks. Anti-cannabinoids do the opposite. They give you the anti-munchies, but also theanti-euphoria. It’s a bad trip, man. The side-effects include depressionthat can lead to suicide. Now comesthe part where I tell you I’m not an MD. These are my non-MD opinions.Qnexa

There’s a new drug in town (called Qnexa), and time will tell if the goodwill outweigh the bad. See, that’s largely what pharmacotherapy is about. If youdon’t need to take pills, then you don’t take thembecause pretty much every drug has negative side effects. The question becomes: Do thebenefits of the pill outweigh the risks? Know thatobesity is a multifactorial condition. Researchers have discovered dozens of differentgenes that affect body weight. Some people store fat easily while others buildmuscle. There are also epidemiological, hormonal and psychological issues that canaffect food intake and activity levels. Saying “eat less, move more” to theobese is like saying to a person living in crushing poverty to “spend less, earn more.” Is Qnexa going to be that drug?It’s too early to tell. An expertpanel of advisors recommended 20-2 that the FDA approve it. Note thatthis drug was rejected by the FDA in 2010 because of concerns over heart rate and birthdefects. People have a tendency to freak out whenthey see words like “birth defects,” but it seems like they are proceedingcautiously. Dr. Arya Sharma, who is chair of obesity research at the University ofAlberta and a paid consultant to the company that manufactures Qnexa,said, “Back in medical school, I was taught that when the risk of not treating thecondition exceeds the risk of treating it, we should treat.” (Moredetails here.)Like all drugs, this is what it’s going to come down to: Do thesubstantial weight-loss benefits of Qnexa more than compensate for the risks of takingit? If the drug is approved for sale this April bythe FDA, which would make it the first new weight-loss pharmaceutical on the market in 13years, we’ll find out. Continue Reading

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