Q: My doctor has not gone along with my requests for a drug to help in my losing battle with a weight problem. Newspapers and magazines are filled with advertisements for weight-reducing pills. Surely, there must be some drug that can help me lose weight.
A: Don't be misled by all those advertisements for weight-losing pills. They fatten the bank accounts of the sellers but do not un-fatten the users.
Several types of prescription drugs can promote weight loss by reducing appetite. Amphetamines, which stimulate the central nervous system, were the first drugs used successfully for this purpose when coupled with a diet; but the effects lasted for no more than a few months and were associated with serious side effects in some people. In addition, amphetamines have a high potential for abuse and prolonged use can lead to drug dependence.
Newer drugs that are chemically similar to the amphetamines are safer but share the same stimulatory effects on the nervous system and short-lived effectiveness.
Another group of appetite suppressant drugs increases the action of serotonin, a naturally occurring brain chemical that reduces the appetite. Although these drugs do not stimulate the nervous system, they may cause dry mouth, tiredness, drowsiness, headaches, nausea, diarrhea and excessive urination. They can promote weight loss for as long as six months, but the amount of weight loss is only modestly greater than that achieved by diet alone. And most often weight is rapidly regained once the drug is stopped.
Most doctors are reluctant to use drugs to assist in weight loss. Many recall bad experiences with amphetamines in the past. Doctors also believe that exercise and improved dietary habits are the keystones to initial weight loss and essential for maintenance of the lower weight. Without these lifestyle changes, any weight lost by use of a drug will quickly be regained.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.