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Diet Drugs Work: Why Won't Doctors Prescribe Them? 670

Posted by timothy
from the perhaps-they-feel-it-isn't-cricket dept.
Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"
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Diet Drugs Work: Why Won't Doctors Prescribe Them?

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  • by Anonymous Coward on Saturday December 07, 2013 @09:30AM (#45625987)
    Your diet is a perpetual thing, not something you do for a little while to lose weight. Eat healthy, be healthy. Drugs and short term adjustments in what you eat aren't going to do shit.
  • by stenvar (2789879) on Saturday December 07, 2013 @09:38AM (#45626029)

    Ask yourself the following:

    (1) Are you cooking most of what you eat yourself?

    (2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?

    (3) Have you been tracking your calories and weight daily for the past month?

    If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.

  • by Anonymous Coward on Saturday December 07, 2013 @09:46AM (#45626067)

    This. There is absolutely no point taking medication (FFS) to control your bad habits. As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more. The only caveat being there is some some recent evidence that some people do genuinely have more trouble with this than others but it doesn't make the advice any different. Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.

    For many people, this is the solution. However, with a bit of hyperbole, your same advice would be true with drug addicts, but not work. You going to tell a heroine addict that they should just quit? Now, for eating too much, it's not nearly so bad, but there are some edge cases where I'm not sure that it's so clear cut. Sometimes the holes that we dig for ourselves are too deep to get out of.

  • by Anonymous Coward on Saturday December 07, 2013 @09:48AM (#45626075)

    The previous post is a fine example of the problem: treating obesity as a moral failing. If you were a "good person" you'd have the willpower, eat right, etc.

    Sure, modern lifestyles and diets are a contributor to the problem, but not the entire cause. There is ample peer-reviewed validated research out there that shows that some people are more efficient at metabolizing food, and that you can exercise as much as you like and eat as little, and still not lose weight as much (and suffer a variety of undesirable side effects in the process).

    Bear in mind also that the underlying biochemistry of the "average adult" has changed as the result of food and activities during childhood. A travesty to be sure (juvenile onset diabetes, for instance), but now that you have that 20 year old with the screwed up biochemistry (in terms of comparison to 1900s man), you're not going to fix it by changing diet and activity.

    And then, there's the practicality problem. If your job, which pays for the food you eat, requires you to sit in a cube with a headset on and a keyboard, no amount of Outside magazine inspired "get out and get fit" exhortation is going to provide an opportunity to "live a healthy lifestyle". Companies talk the talk, but when it comes to adversely affecting productivity, they do not walk the walk: that's why company wellness programs emphasize things like smoking cessation.. it's something you can do on your own time that saves the company money (yes, it's a good thing, but the real point is that the employee is doing the heavy lifting).

    And so, after sitting in the cube all day, or inspecting people at a checkpoint, or whatever task there is, you ride the bus to your second job, so you can make the rent on your apartment in the food desert. Not a whole lot of time to prepare that nutritious meal from non-existent ingredients.

    So, before exhorting "good healthy ways to eat", let's talk about paying people enough so they can afford to do so (in terms of time available, etc.)

  • by PeterM from Berkeley (15510) <petermardahl&yahoo,com> on Saturday December 07, 2013 @09:56AM (#45626113) Journal


        I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.

        I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.

        And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.

        If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!


  • by DarkOx (621550) on Saturday December 07, 2013 @09:56AM (#45626115) Journal

    Diet and exercise is fine advice for someone like me, who the doctor has suggested could stand to lose 15 pounds. I can accomplish that without drugs, and by doing it now, I'll likely improve my eating habits and not find myself needing to take off even larger amounts of weight later. But my eating habits are already pretty good compared to many, and I get lots of exercise ( I love walking and do walk anywhere I can get on foot safely ). I just need to arrest my sweet tooth a little.

    Once people become obese though getting enough exercise to burn any serious calories can be very difficult. They can't walk to the store to do their shopping or spend 20min on the elliptical at home because they'd be exhausted after five. Yet they have all these fat cells their body now thinks it needs to maintain screaming eat constantly. Not impossible to conquer with will power alone perhaps but probably really freaking hard; at to the fact that because they can't get exercise easily their metabolism is probably lower than it should be and they can't burn the extra calories by working out so its going to take a seriously long time before they see any improvement. There is nothing more psychologically challenging then lots of hard work, and discomfort without any short term payoffs.

    Yea I agree they did it to themselves and when it comes to who should have to pay more for a plane ticket, medical insurance, and similar where obesity decidedly raises costs, yea I think they should be expected to pay. They should have recognized a problem early and done something about it when it was possible, if they became obese as children their parents should have intervened.

    But they are where they are now and if a drug can help them better themselves, why would you want to deny them? Once they get healthy they are going to need to learn good habits to stay healthy but that will be much easier for them if they could get healthy first.

  • by Anonymous Coward on Saturday December 07, 2013 @09:59AM (#45626137)

    If it's elective surgery, then they can wait and lose the weight normally.

  • by LordLucless (582312) on Saturday December 07, 2013 @09:59AM (#45626139)

    Uh-huh. And if you haven't tried living off bananas [], limited fasting [], acai berries [], or whatever the next fad diet to come along is, you haven't seriously tried losing weight either.

  • by Assmasher (456699) on Saturday December 07, 2013 @10:06AM (#45626173) Journal

    It's not difficult. Eat less, move more.

    Perhaps you meant to say "It's not complicated." It is quite obviously difficult for many people.

  • by DogDude (805747) on Saturday December 07, 2013 @10:08AM (#45626177) Homepage
    #2 is mostly bullshit. It doesn't matter what you eat, in terms of obesity. It's simple calories in, calories out. I eat tons of bread and starchy foods, and can maintain my weight just fine if my calories in are what they're supposed to be.
  • They are scared (Score:5, Insightful)

    by Matt_Bennett (79107) on Saturday December 07, 2013 @10:09AM (#45626185) Homepage Journal

    I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen [] debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.

  • by Anonymous Coward on Saturday December 07, 2013 @10:11AM (#45626199)

    People are fat because they have poor diets and lifestyles and because most modern food is crap designed to make you crave more. Giving them a pill to remove the symptoms of their poor health will only reenforce their bad behavior and makes things worse. It'd be a loss for everyone. The population will get worse. WEIGHT IS THE EFFECT NOT THE CAUSE. Treating the effects doesn't fix their underlying causes.

  • by DarkOx (621550) on Saturday December 07, 2013 @10:12AM (#45626215) Journal

    You can't exercise it off because exercise itself does not burn many calories at least not in proportion to what you can easily consume in a sitting. What it does do though is raise your metabolism. it causes your body to basically use more fuel all the time, so that its ready to support those more frequently occurring higher activity levels. So being physically active for a least a little while every day really is very important for most people to maintain a healthy weight.

  • by ShanghaiBill (739463) on Saturday December 07, 2013 @10:38AM (#45626347)

    There is absolutely no point taking medication (FFS) to control your bad habits.

    You are wrong. Nicotine patches have helped millions of people quit smoking. These diet pills have also been shown, in controlled studies, to help many people achieve long term weight loss. Yes, people need to change their habits. But what you are missing, is that the drugs can help them do that. By achieving some weight loss, it can start them on the cycle of positive reinforcement.

  • by O('_')O_Bush (1162487) on Saturday December 07, 2013 @11:21AM (#45626573)
    It is really easy to chalk up reasons why are you not overweight to for whatever superiority complex you have about it. You see similar things with the ultra rich that were born with their parents money ("all those plebians should just work harder and become wealthy like me").

    The reality is that unless you've been 50-100 pounds overweight all your life and worked your way down to a healthy weight for at least 5 years, your opinion about what makes people fat is worth less than dog shit.
  • by Anonymous Coward on Saturday December 07, 2013 @11:26AM (#45626589)

    This. There is absolutely no point taking medication (FFS) to control your bad habits.

    Except for many, weight gain is not about bad habits. As much as the internet likes to have this "energy in needs to be less than energy out" story repeated at all corners, there's tons of reasons why it's not actually that simple. It's been found that overweight people commonly have a large variety of reasons why it doesn't work like that:

    • Metabolic rate –which affects how much of that energy in is transferred into the body.
    • Bacterial fauna –which affects how much of that energy is consumed by other organisms (and alone has been demonstrated to make the difference between morbid obesity and underweight)
    • Genetic factors that affect whether your body decides to store the fat, or reject it
    • Genetic factors that affect whether your body decides to burn predominantly fat or sugars (and hence affects how much is stored/rejected)

    There's probably more, and this ignores a whole swathe of psychological reasons why overeating might occur without direct will, or in a similar way to addiction. This is simply some of the list of reasons why you might be fat, by eating the same amount as a skinny person, and exercising the same amount as them.

    As soon as you stop taking them, you'll revert back. It's not difficult. Eat less, move more.

    Actually, that's not necessarily true. Commonly one of the reasons for high energy intake in fat people is that they are not processing sugar efficiently any more. This actively contributes to their body telling them they are hungry earlier, and that they want more sugary foods. By getting them down to a healthy weight, and keeping them there for a reasonable time, these diet pills may actually have a sufficient impact on the addiction that it breaks the cycle. That, and of course by reducing appetite they may well help control the brain's assumption of what a healthy meal size is.

    Grow a pair, stop blaming other people for your own bad eating habits, take control of your life and stop being conned by all the faddy diets aimed at quick fixes. There are no quick fixes, just good, healthy ways to eat.

    Well done, you are demonstrating exactly the belief that it's a social condition, not a medical one talked about in TFA.

  • by swb (14022) on Saturday December 07, 2013 @11:29AM (#45626603)

    What's so funny about this (and reinforced by the other replies to your post) is that people really object to the morality of other people "getting away with something" -- eating too much of the wrong food and not exercising enough.

    I'm surprised they don't object to people with infections being treated with antibiotics, since if they had better hygiene they wouldn't get sick.

    Why should you care if someone else is healthier by taking a pill?

  • by Jody Bruchon (3404363) on Saturday December 07, 2013 @11:57AM (#45626731)
    Demonizing saturated fats and pushing grain as the primary food source is why we're so fat. Excessive carbohydrate intake makes you fat. Humans must eat at least some animal products to be healthy.
  • by trout007 (975317) on Saturday December 07, 2013 @12:03PM (#45626749)

    Exactly. What do they feed cows to fatten them up for slaughter? Hint it's not fat.

  • by Kell Bengal (711123) on Saturday December 07, 2013 @12:25PM (#45626887)
    Your personal physiology is identical to everyone elses', and so what worked for you will also work for every single other person on earth? Great! Spread the news! With this astounding insight, the obesity epidemic will be cured in no time!

    Wait? What's that? You mean the metabolic pathways for storing and releasing energy are complex and very different from person to person? You mean that the body actively fights to retain fat stores when less energy is available resulting in crippling pain, headaches, listlessness, inability to cocentrate and insomnia? You mean to say that obesity is caused by numerous interrelated factors that each require corrective action in concert to be effective? It even says so in TFA? Well shucks!

    Who'd have thought an illness that 100 million people are unable to cope with might actually be difficult to cure?? No, no! That can't be it. Let's just say they're lazy gluttonous porkchops so we don't have to find solutions to a difficult problem. So much easier for us to sleep well at night.
  • by Kr1ll1n (579971) on Saturday December 07, 2013 @12:27PM (#45626899)

    Growing up, I had Juvenile Rheumatoid Arthritis. Part of that was being prescribed a steroid called Predisone. Want to guess how that impacts appetite and long term weight gain?

    Finally, my Arthritis went into remission, and I was doing good, except for one little thing. I was working 60+ hours a week, and still had a major appetite problem, and no time for exercise. Eventually, due to stress and other factors, I developed adult onset type-1 diabetes. Now 12-13 years later, with the type-1 diabetes, I struggle to adjust my eating habits, as the insulin dependency means I can't just eat less, exercise more. I have to figure out the following;

    How much food do I anticipate eating the following day?
    How much exercise do I think I am going to get?
    How much stress am I going to be under?
    How many carbs are in this meal I am about to eat?

    The level of hate and vitriol I hear coming out of the mouths of people in the fit and healthy crowd is borderline psychotic.
    People that attack the overweight, and regurgitate empty platitudes about diet and exercise, need to be loaded up into a pit, have gasoline poured on them, and set on fire. All us overweight people that struggle to just maintain ourselves on a day to day basis can stand over top and tell them to "walk it off" while they scream in agony.

  • Anger and obesity (Score:3, Insightful)

    by ManicMechanic (238107) on Saturday December 07, 2013 @12:27PM (#45626901)

    Im always amazed at the level of anger when the topic of obesity comes up. If there is a pill that helps fat people get skinny, so what? The logic must go like this "I put so much work into being fit, I am upset when someone else gets similar benefits without that same effort."


  • by bmo (77928) on Saturday December 07, 2013 @01:17PM (#45627261)

    > which for 98% of the population is solved with willpower and determination alone

    Spoken like someone who's never had to deal with weight issues.

    You're a complete asshole. No, really.

    >food isn't a addictive as heroin

    It's worse, actually. You don't need heroin to live. You need food to live. It's always around. There is no putting it away. There is no removing yourself from the environment that triggers it.

    And that's what you don't effin' get.

    This calvinist shit really has gotten old.

    But hey, you keep going with your preconceived notions about how things "should" work instead of how they do.


  • by s.petry (762400) on Saturday December 07, 2013 @01:27PM (#45627329)

    Fat != Lazy, there are countless factors involved. Been a single parent? Been in poverty where you can't afford groceries so live off of dollar menu fast food? Been injured where you can't exercise? How about combinations of these things?

    In _YOUR_ experience being lazy was why you are fat. Your experiences are seemingly useless when discussing the real issues with obesity in the US.

    The primary reason for obesity in the US from numerous studies is Poverty.

  • by kamapuaa (555446) on Saturday December 07, 2013 @01:35PM (#45627371) Homepage

    His basic assertion that if people eat less calories than they expend they will lose weight is 100% correct. Saying "it's a complex disease and the body wants to store fat and there's different metabolic pathways" is irrelevant - if you eat less, you will lose weight.

  • DIET OF THE POOR (Score:4, Insightful)

    by Jeremiah Cornelius (137) on Saturday December 07, 2013 @01:52PM (#45627521) Homepage Journal

    It is the cause. It IS a social one.

    It is because of corporate food production, factory farming and industrial "recipes" that make cheap and plentiful Soylent Soy or Corpulent Corn - with added glutimate to overstimulate appetite generation.

    These are the product of an agribusiness that has made this production a part of public policy, through the US Farm Bill and other legislative manipulation.

    If you are deliberately misinformed, marketed to death, and underpaid, the last thing you need to solve for the attendant health effects is more pills. It's like plugging your nostrils, because you have a cold.

    But I bet the pharmaceutical and health-insurance rackets love the idea...

  • by DuckDodgers (541817) <> on Saturday December 07, 2013 @02:05PM (#45627601)
    It's even worse than that, many of the people spouting hate didn't put as much work, or any work at all into being thin. They blanket assume every fat person has the same naturally appetite as they do but decides to eat an extra chocolate cake or extra pizza the way they might decide to watch an extra episode of Looney Tunes or have another ice tea.
  • by iMadeGhostzilla (1851560) on Saturday December 07, 2013 @03:20PM (#45628087)

    I used to think so too but realized there is a nuance (as always) -- drugs may help some people to experience for the first time in many years what it means to be not obese, and that feeling may help them work on their own later on to get there. But I agree, drugs should be used in one-off and extreme cases.

  • by camperdave (969942) on Saturday December 07, 2013 @04:05PM (#45628365) Journal

    You can get all the nutrients you need to be healthy entirely from plants.

    Well... physically healthy, anyway. I'm not making any claims about the emotional or mental health of people who refuse to eat bacon.

  • by drinkypoo (153816) <> on Saturday December 07, 2013 @05:12PM (#45628751) Homepage Journal

    Face it, if you're fat, you're most likely lazy too. Stop trying to find scapegoats and start accepting responsibility.

    Just as 10/$1.00 Top Ramen and fast food dollar menus promote obesity, the anonymous posting option on Slashdot promotes shitheelery.

  • by causality (777677) on Saturday December 07, 2013 @07:31PM (#45629483)
    I've always found it both disgusting and a bit amusing, the way people get so angry and upset when you dare to suggest that maybe they are not victims, maybe they actually could assert some control over the problem they're having. The earlier posts in this thread did not deserve a "-1, Troll" moderation. Stating what you actually believe in a sincere manner is not trolling. It's not a "-1, MakesMyDenialUncomfortable" mod for fuck's sake.

    Everyone I know who successfully lost weight and kept it off for years did it by making permanent, sustainable, healthy changes in their lives. A few of them learned to like veggies and other healthy foods. Others did that and also formed the habit of regular exercise. The point is to consume fewer calories than you burn until you reach a new equilibrium. Like so many other things that upset people, this works every time it's properly tried.
  • by causality (777677) on Saturday December 07, 2013 @07:41PM (#45629525)

    Yes - and it can also make you very sick at the same time. People have starved themselves to death whilst remaining obese. To simply say "eat less, you'll lose weight!" makes as much sense as saying "just remove all the microorganisms from your blood stream, and you'll be cured!" Simple, right? Whilst technically correct, unfortunately it is not at all a useful suggestion. The sooner people stop deluding themselves with trivial knee-jerk responses that tacitly blame the patient, the sooner we can make progress to finding an actual solution for a real problem. Remember: if it was that easy, nobody would be fat.

    "Eat less" isn't the same thing as saying "eat nothing or nearly nothing while failing to obtain the nutrients you need".

    "Blame" is also a small-minded concern. When I personally needed to lose some weight, there was no concern with fault or blame. I (get this) *took responsibility* for my own condition and made some adjustments to it. Some sustainable, permanent adjustments that did not involve neglecting the nutrition I needed. It was never a problem after that. In fact it was one of the easiest things I've ever done. That's because I took responsibility and accepted that the power to change it was within myself, the exact opposite of victimhood. This is exactly what I never see from fat people. They're victims and they are hostile to the idea that they don't need to be. That's because they don't understand the difference between fault/blame and responsibility/power. That's the part that is "not that easy" for so many because we have such a shallow, small-minded culture that doesn't like to think too deeply about much of anything no matter how much better life can be.

    All you are saying is that doing something the stupid and careless way won't yield a good result. This was already known.

  • by bill_mcgonigle (4333) * on Sunday December 08, 2013 @12:19AM (#45630727) Homepage Journal

    People will reflexively scoff at this, but it's Puritanism. If you're a good God-fearing person, you'll have willpower and be able to lose weight. If you're fat, it's because you're a bad person. Doctors have prescription power because they're a different kind of better person. Why should a good person give a bad person something that will encourage them to still be a bad person?

    Americans (at least) refuse to accept how pervasive the basic concepts of Puritanism are in our society. The "head & up, good, below the head, bad" attitude is everywhere and irrational. Read some Thaddeus Russell [] before you disagree.

  • by kheldan (1460303) on Sunday December 08, 2013 @02:20PM (#45633631) Journal
    Do you keep accurate track of everything you eat every single day without fail, and avoid eating anything you can't at least know the caloric content of? Are you completely honest with yourself about what and how much you're eating every single day? Perhaps not. I also think that your "dancing" isn't burning anywhere near as many calories as you think it does, and that perhaps you're eating/drinking things when you go out "dancing" that have way more calories in them than you think they do.

One good suit is worth a thousand resumes.