The dilemma of those chubby folks whose diet drugs are under a cloud

The Outlook

September 21, 1997|By Samantha Kappalman

The Food and Drug Administration announced last week that the nation's two most popular diet drugs, dexfenfluramine and Pondimin, or fenfluramine, would be pulled off the market because they may be linked to serious damage of patients' heart valves. Fenfluramine is half of the popular fen-phen combination, and dexfenfluramine is commonly known as Redux.

The announcement has left many patients wondering what safe alternatives they now have to help them lose weight. The FDA said patients can continue to use the other half of fen-phen, phentermine, but some doctors doubt its effectiveness and are concerned with side effects.

Will the lack of prescription weight-loss drugs cause an increase in business at weight-loss and nutrition centers? What other safe alternatives do these patients have?

Melyssa St. Michael

Owner, Ultra Fit Human Performance, Towson

We have definitely seen an increase in clients since the first scare articles. We have been receiving more patients who want to get off fen-phen. They realize that this isn't a quick fix and that there is no such thing as a miracle pill.

We teach patients that they have to change their eating habits. If those habits have not changed after they get off medications, then they will still have those habits to deal with and they will put the weight back on. So, we teach positive lifestyle modifications.

This is a gradual process. Most people want to see the numbers on the scale drop, but they don't understand what the body is losing. They lose inches on drugs, but not the shape. They lose water and tissue instead of fat.

Liposuction doesn't work either unless there is a change in lifestyle.

This is not gender specific. Men have called who are on Redux or phentermine, and say they need help because they don't want to take drugs any longer.

We have seen a 35 percent total increase in clients since the first articles came out. After the initial consultation and assessments, the average nutrition and fitness program takes about six months, but we don't stop there. People need our support. We have follow-up programs so that clients don't go back to their negative lifestyles.

Lauri Kane

Program director, cosmetic surgery specialist, Mercy Medical Center, Baltimore

I think it will take time to see an increase. People won't instantly gain weight. Once people see that they are gaining weight again, then they will have to weigh their options.

Surgery is more costly and more risky than a fitness and nutrition program, but it is not as hard work. People will decide by their financial situation, how well they stick to a fitness program or if they are looking for a quick way to lose weight.

In our office, we promote fitness and nutrition before liposuction. Surgery is not the end-all, and people can't be on diet medication if they are going to have surgery. We try and get people off the drugs.

In addition, people tend to gain confidence with a fitness program if someone is constantly saying, "you can do this." It's all in the way people think. We recommend that they continue with the fitness and nutrition program after surgery. These programs are the only way to keep the weight off.

Lyn Conlon, M.D.

Chief resident, Sheppard and Enoch Pratt Hospital, Towson

Ultimately, the best way to lose weight is to put in less than you burn off. Weight Watchers is good, Jenny Craig is good, those programs are all good. I'm one who doesn't think that all things can be treated with a magic pill, but with hard work and watching what you eat.

There is the class of folks who have benefited from it, the morbidly obese, but it doesn't seem that those are the ones who are having trouble with heart valve difficulties. This is probably because these diet drugs are prescribed without the proper work-up, and that is not the right way to practice medicine.

Lawrence Cheskin, M.D.

Director, Johns Hopkins Weight Management Center, Baltimore

We have used medications, but we're not big users. Although the diet drugs were popular, I'm not sure they had a big effect on obesity in America.

The combination of fen-phen is discouraged, but phentermine alone is still OK. Any medication has side effects. I doubt that the loss of the combination will cause an increase in patients at my center, but people will now have less miracle options.

Our average patient is 75 to 100 pounds overweight, and we treat them with a fairly aggressive diet, physical exercise, there is a possibility of surgical options and behavioral modifications. It is a program that uses what we know about why people gain weight. We attract people who want to make permanent changes in their lives -- they don't usually look for a miracle cure.

Pub Date: 9/21/97

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