Everybody is asking about the new appetite suppressant, Redux. Does it really work? Is it safe? Have we truly found the cure for obesity?
For people with significant obesity, approximately 30 percent above ideal weight, or people who are 20 percent above ideal weight with another health problem like heart disease, diabetes or high blood pressure, Redux can play an important role in triggering weight loss, which reduces health risks. But for people with just 10 to 20 pounds to lose, it poses more health risks than it prevents.
Prescription of Redux, as well as the fenfluramine/phentermine (fen/phen) combination that has been in use for several years, signals a breakthrough in the way we think about and treat
obesity. We've finally gotten past the assumption that being overweight is just a sign of willful overindulgence. Science now acknowledges that natural body chemicals can misbehave and produce unwanted results.
Redux works by increasing the brain chemical serotonin, which leads to feelings of satisfaction, physical and emotional well-being and even of having had enough to eat. Redux doesn't miraculously eliminate fat cells. Instead, it helps patients feel satisfied with less food, so it's easier to stick to a weight-loss diet, according to physician Phillip DeVane of Redux producer Wyeth-Ayerst Laboratories.
In fact, Wyeth-Ayerst insists that Redux be used along with a healthful weight-loss diet, behavior modification techniques and a regular exercise program. The company even offers a patient starter kit suggesting sessions with a registered dietitian. The reason? Long-term studies show Redux is safe and effective up to one year. But the studies stop at that point, because it's hard to keep the placebo group interested after that. So we don't know what happens down the road.
What we do know is that Redux works only while you take it. When you stop, you need strong lifestyle habits to manage the loss of those "had enough to eat" feelings. Why would anyone stop taking it? Because it is not approved for lifelong use, so your doctor is supposed to stop prescribing it after a while.
Some of the side effects, like diarrhea, sleepiness, dry mouth or vivid dreams, are considered trivial and may subside. But one, primary pulmonary hypertension, although quite rare, can be fatal. According to Wyeth-Ayerst, European studies show people who used fen/phen or Redux for more than three months showed an increase in the rates of primary pulmonary bTC hypertension from one or two in 1 million per year to about 18 per 1 million per year.
While that may sound frightening, it's safer than remaining obese. Obesity increases risks for heart disease, high blood pressure, diabetes and some cancers and plays a part in 300,000 deaths each year.
Furthermore, we know that small weight losses of 10 to 20 percent of body weight (30 to 60 pounds in a 300-pound person) can lower blood pressure, improve cholesterol and even improve diabetes management. It may also make exercise easier.
The hope for Redux is that it will help people with significant obesity make a successful start on lifestyle changes that can be maintained when the drug is no longer prescribed. That will take a determined effort, but it's worth a try.
Colleen Pierre, a registered dietitian, is the nutrition consultant to the Union Memorial Sports Medicine Center and Vanderhorst & Associates in Baltimore.
Appropriate weights for prescription of Redux
NDHeight.. .. .. Healthy weight... .. Obese .. .. significant obesity
... ... ... ... ... ... ... ... ... (20%)... ... ... (30%)
5 feet 2 inches.. .104-137.. ... .. 125-164... ... 135-178
5 feet 5 inches.. .114-150.. ... .. 137-180... ... 148-195
5 feet 10 inches.. 132-174... ... . 158-209... ... 172-226
6 feet 2 inches... 162-177... ... . 194-212... ... 211-230
(Higher weights apply to people with more muscle and bone, usually men. Adapted from: "Dietary Guidelines for Americans," Fourth Edition, 1995. U.S. Department of Agriculture and U.S. Department of Health and Human Services.)
Pub Date: 10/01/96