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Medicine

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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  • Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood

    shucks, ive no idea, either that or because someone is paying someone else more for something else

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

      by Jeremiah Cornelius (137) on Saturday December 07, 2013 @12:52PM (#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...

    • Look at these AMAZING diet drugs referenced in the article, the first provides a 3.7% fat loss over a year, the second provides 7-9%. So if you're 300 pounds, you can pay a pharmaceutical company for years at a time to be 289 or maybe 263 pounds. I'm sure everyone will be complimenting you on how svelte and sexy you look.

      The original diet drugs were methamphetamines that led to addiction. Then we had heart problems and such from fen-phen and Redux. Are you really going to risk all of that so that y
      • by mspohr (589790) on Saturday December 07, 2013 @01:15PM (#45627671)

        Perhaps doctors don't prescribe them because:
        - they don't work very well in the short term and not at all in the long term
        - they are expensive
        - they have lots of bad side effects:

        Qsymia has particular risks for pregnancy, as it can cause birth defects if taken in the first months of pregnancy, even before a woman knows she is pregnant. Women of childbearing age must use effective birth control to keep from becoming pregnant while taking Qsymia.

        Qsymia should not be taken by:

                Pregnant women
                People with glaucoma
                People who have been told they have an overactive thyroid
                People taking a type of antidepressant called a MAOI
                People allergic to phentermine or topiramate

        Belviq should not be taken by:

                Pregnant or nursing women
                People taking drugs linked to valvular heart disease, such as cabergoline (Dostinex)

        Belviq should be taken with caution by:

                People taking certain medicines for depression; migraine; the common cold; or mood, anxiety, psychotic, or thought disorders
                Men with conditions that predispose them to erections lasting more than four hours. These conditions include sickle cell anemia, multiple myeloma, and leukemia
                Men with a deformed penis

        Qsymia and Belviq each come with a long list of important safety information, but this list is different for each drug.

        • by Custard (45810) on Saturday December 07, 2013 @02:31PM (#45628153)

          You might want to review the full research before posting.

          > - they don't work very well in the short term and not at all in the long term

          Qsymia gives about 10% weight loss beyond "placebo" (which was a diet and exercise program that all treatment arms got.) Weight loss was maintained out to two years, which was the end of the study. Qsymia is a combination of two medications that have been on the market for a long time. Weight loss docs have been prescribing them together for quite a while and I haven't heard any talk about them not working after a certain point. Qsymia just takes two existing meds and makes one pill out of small amounts (if you want to match the Qsymia doses with generics you have to chop tablets as small as an eighth) and uses a time release formula so the side effects (carbonated drinks taste funny and tingling in the fingers are common. I have the change in taste) aren't as bad. There is no research on Qsymia past two years, but there is experience with the components. Belviq is a 5-HT2C receptor agonist, and I'm on a SSRI. I haven't paid much attention to it, but I assume it has data out two years also.

          > - they are expensive

          True dat. And not covered by a lot of insurance. I buy mine out of pocket. About $170 per month. It's worth it to me.

          > - they have lots of bad side effects:

          Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.

          First, if I, as a 45 year old man, get pregnant on Qsymia it will be news. Much bigger news than a birth defect.

          Second, obesity also increases in risk of birth defects.

          Third, this is why they have a program to tell people that if you take Qsymia in the first few months of pregnancy there is an increased risk of cleft lip/palate. This is because Qsymia contains topiramate, a medication prescribed about 10,000,000 times a year. Interestingly you can take 400mg a day of topiramate for neurological conditions without a warning, but if you take 23mg a day for weight loss you have to be warned of the risk. Not that there is a bias against obesity or anything...

          I think I have posted more in this one topic than in all the rest of the time I have been on slashdot, but this drug has made such a difference in my life.

          • by tlambert (566799) on Saturday December 07, 2013 @03:17PM (#45628429)

            Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.

            Pregnancy studies are a high risk/low reward proposition, unless you are talking about fertility, anti-miscarriage or other pregnancy related applications, since including pregnant women in a clinical trial has a really high settlement cost if there's a problem with the pregnancy, and an even higher cost if the baby comes out with a birth defect. As an example, women with hair loss get warned against finesteride, since it acts as a 4-5 reductase suppression agent, which, when it occurs naturally (5-ARD), results in conditions from hypospadias needing surgical correction, all the way to full blown X-Y females (sterile of course).

            It's fairly common to warn pregnant women not to take a medication, even if in fact it might be perfectly safe because of the exclusionary nature of the studies. This is purely a legal liability/malpractice issue, not necessarily an issue with the medication itself.

  • by Anonymous Coward on Saturday December 07, 2013 @08:30AM (#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.
    • Re: (Score:3, Interesting)

      For the long term, I would agree. But some people need to get rid of the weight fast, for example if they are to have elective surgery in the near future. Drugs like these (assuming they work) help get the weight down which would then make surgery safer. Long term though the patient needs to increase their exercise and watch what they eat. Plain and simple.
      • by pepty (1976012)
        A big problem with keeping weight off is it takes a long time for your body to adjust to the new normal. Losing 10% of your bodyweight can adjust the levels of appetite-related hormones so that they resemble those of someone who is truly starving, and they can stay like that for 6 months or more. Basal metabolism is also decreased after weight loss, so that for someone to maintain their new weight they have to eat less than a twin of that same weight/activity level who hadn't recently lost weight. A drug th
    • by mwvdlee (775178)

      In a way, food is like drugs too. Sugars, fats and salts are addictive and the more you eat them, the more you crave for more.
      Using pills to suppress that effect to a point where the craving itself has been reduced to a more manageable level sounds like it might work.

    • by kheldan (1460303) on Saturday December 07, 2013 @12:51PM (#45627507) Journal

      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.

      This.
      You can shovel pills down someone's throat all you want, and sure, they'll lose all sorts of weight, but if they're not building the life habits necessary to maintain their weight, they'll stuff their faces with shitty food all over again, and gain the weight back in a matter of months. The very fact that people want a Magic Pill to make them lose the caboose is evidence that they lack the skills, knowledge, and personal discipline necessary to successfully control their own weight. These people need to be told the truth: Losing weight takes work to achieve, and it takes real change of your lifestyle and habits to maintain, and most of all it takes stark honesty with yourself about what you eat and drink, who you are, and how you live your life.

      Oh, and before anyone starts attacking me with the "thin privilege" and "fat hatred" crap: I used to weigh greater than 300 pounds once upon a time, had completely ruined my knees, and just didn't give a damn anymore. It took years, but I'm below 200 pounds, can leg press more than 3 times my bodyweight, and participate in a competitive endurance sport, and it was a damned hard road getting to where I am full of wrong turns and hard lessons, so don't sit there and tell me you've "tried everything", or "it's your genetics", or "it's impossible!", or any of the other excuses I see day after day after day. Don't sit there and claim you can be "healthy at any size", because that's utter bullshit. Stop trying to turn your sloth and lack of discipline into some sort of twisted virtue, because it most certainly is not! They say "Denial ain't just a river in Egypt", and your denial of the problem and it's implications is also going to wreck your children's lives as they grow up thinking it's OK to ruin their bodies, and being sabotaged by the poor dietary choices you make for them when they have no choice in the matter but to eat what is put in front of them.

      So please, stop being in denial, stop ruining your health, stop ruining your bodies, and stop passing on your lack of discipline and poor choices to the next generation. It's all on you.

      __________________________________________

      Yes, I gave everyone both barrels with this one. Can't handle the truth? Not my problem. Deal with it.

    • Re: (Score:3, Insightful)

      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.

      • Re: (Score:3, Interesting)

        by Custard (45810)

        I wish /. had a like button.

        I remember when I realized that not only had a chosen to take the stairs because the elevator was taking too long, but I had run up the last flight.

        I disagree about only allowing special people to get treatment, but I can totally validate the intangible of losing a bunch of weight after having been stuck for a couple years.

        It is all very subtle and nuanced. Slashdot, alas, is not a good forum for intelligent discussion.

        The problem, as I see it, is that we are all speaking from o

  • by stenvar (2789879) on Saturday December 07, 2013 @08:38AM (#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 trout007 (975317) on Saturday December 07, 2013 @08:58AM (#45626131)

      I lost 40 pounds by drastically increasing my saturated fat intake while reducing my refined carb intake.

    • by LordLucless (582312) on Saturday December 07, 2013 @08:59AM (#45626139)

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

      • by Jah-Wren Ryel (80510) on Saturday December 07, 2013 @09:54AM (#45626439)

        or whatever the next fad diet to come along is

        It is funny how for every fad diet there are tons of people who say it worked for them. That seems to be proof right there that whatever it is that works must be common to all of the diets. My guess is that simply being on a diet makes people more aware of what they are eating and that consciously or unconsciously causes them to eat less. Some people probably find it easier to do that with a specific type of diet, but the underlying mechanism is still the same.

    • Re: (Score:2, Insightful)

      by DogDude (805747)
      #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.
      • by punker (320575)

        Calories in, calories out is true, but the form of the calories is also significant. We are not simple systems. The starch issue is about glycemic response. Essentially, when your body digests starches, it produces insulin. More sugars, more insulin. When the insulin falls off, your body tells you that you're hungry again. It's sort of like a boom/bust cycle, and the result is an urge to overeat because of the hormone response. It's significantly more difficult to maintain proper portions when you're hungry

      • by stenvar (2789879)

        You're absolutely right: it's balancing calories in/out. Since you're not obese, your appetite control is working and your experience isn't relevant. People who actually are obese and trying to lose weight have a problem stopping to eat when they have already consumed enough calories. That is strongly influenced by the kinds of foods they eat. It happens frequently with starchy foods, foods containing lots of saturated fats, and meats, so any serious dieter should start by cutting those and see whether it h

      • Tons of food (Score:4, Interesting)

        by Runaway1956 (1322357) on Saturday December 07, 2013 @09:53AM (#45626427) Homepage Journal

        You can eat tons of stuff that isn't so good for you, right? Cool. And, how old are you?

        I was underweight for much of my life. Around age 25 or so, I FINALLY "bulked up" to 160 pounds. I stayed near that weight right up to about age 47.

        Age has some nasty surprises for some of us. One day I looked down, and realized that I had a pot belly. Wow, man! That ain't me!

        At the same time, my knees started giving out on me. I don't run any more, can't run. Oh - to be honest, I CAN run, but a quarter mile jog is going to leave me suffering for a week or more.

        So, I got a pot belly, I'm far less active, and that pot belly now tips the scales at ~195, has actually reached 200 a couple of times.

        At six foot tall, 200 pounds isn't "obese" - but it's unhealthy. For me, at least, YMMV depending on your body build.

        When you're over 50, getting close to 60 years old, let us know how easy it is to lose those unwanted pounds. If taking a pill could reduce the number of fat cells for me, I would seriously consider getting some.

        However, I do understand the equations very well. Those pills aren't going to do anything good that is permanent. About the only way to remove fat permanently, without serious exercise and diet, is surgery.

        I'm NOT willing to go that route.

      • by beelsebob (529313) on Saturday December 07, 2013 @10:50AM (#45626681)

        Not true at all. An extreme example would be 1 teaspoon of sugar, and 2 lego bricks. Both contain a fairly similar amount of energy. Only one of these will actually make it into your body if consumed.

        This example is obviously dumb, but it's true of all foods –varying amount of the energy in those foods will actually make it into your body. Worse, varying bodies will get varying amounts of energy from them. This can be caused by bacterial fauna, metabolic rate, genetic efficiency of processing, the body's current state and hence it's desire to store or dispose of foods, etc.

      • Sorry DogDude, but you've barked up the wrong tree. Calories in, calories out is a gross simplification that glosses over the most important factors of biochemistry.

        Fat accumulation is driven by insulin, and the specific insulin resistance of fat cells versus other cells. You may be one of the lucky folks who is particularly insulin sensitive, allowing you to eat whatever you want without fat accumulation. Bully for you. On the other hand, anyone who is obese is suffering from a biochemical problem, not

    • by Lumpy (12016)

      Exactly.

      Step1 - Stop going to ANY restaurant or delivered food. All of it is utter crap, stop eating it.
      Step2 - Buy only foods that are from the fresh food section and meat section. Veggies+Meat and only dark brown breads with whole wheat/grains
      Step3 - download and install myfitness pal and do it religiously.
      Step4 - repeat.

      The biggest is to abandon restaurants completely. Every place from McDonalds to a 5 star bistro only make low grade dog food. Stop eating that crap. This step alone will make a HUGE

    • I eat all the meat I want and I never gain weight. It's the starches and sugars that cause problems - meat and fat doesn't make you gain weight if you're not eating a bunch of sugar and starch.

  • Fat mice, when fed fecal matter from thin humans, lose weight. It seems much less expensive to me than pharmaceuticals, and there are no known side effects. http://www.nytimes.com/2013/09/06/health/gut-bacteria-from-thin-humans-can-slim-mice-down.html?_r=0 [nytimes.com]
  • Many conditions that are treated with pills could as effectively be addressed with proper diet, nutrition and exercise. Curiously, doctors are rarely averse to prescribing medications for most of these; it is noteworthy that obesity is treated differently. On the other hand, maybe it's time the pills were left on the shelf and patients were required to take responsibility. Big pharma wouldn't like it, but a host of side effects would be avoided, billions of dollars would be saved, and "survival of the fitte
  • by PeterM from Berkeley (15510) <petermardahl.yahoo@com> on Saturday December 07, 2013 @08:56AM (#45626113) Journal

    Hello,

        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!

    --PeterM

    • by swb (14022) on Saturday December 07, 2013 @10:29AM (#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?

    • Re: (Score:3, Informative)

      by RedBear (207369)

      Hello,

      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!

      --PeterM

      Health is something that isn't nearly as simple as almost everyone seems to love to believe. The truth, based on current medical evidence, is that something like 60% of "obese" people are by all metrics besides BMI perfectly "healthy", while something like 60% of the people who are part of the epidemic of diabetes and afflicted with massive amounts of cardiovascular disease are people of normal body weight who everyone assumes are "healthy" solely due to their "normal" BMI. It just plain isn't that simple.

      O

  • They are scared (Score:5, Insightful)

    by Matt_Bennett (79107) on Saturday December 07, 2013 @09:09AM (#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 [wikipedia.org] debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.

    • Re:They are scared (Score:5, Interesting)

      by meander (178059) on Saturday December 07, 2013 @09:38AM (#45626343)

      Nah, as a doctor (in Australia, but i suspect most places are the same), we prescribe them only when a patient goes on & on, "but honestly, I dont eat much...", especially when the waiting room queue is getting longer.

      We know they work, for a few months, before becoming less and less effective.

      I'm guilty, I prescribe them to turn off a patients demands and get them out of my room, knowing they will see that the response is poor after the first few months.

      Eat less, do more. That is reality, everything else is bullshit, or very temporary.

      After 3 or 4 months, when the drugs stop working, some are ready to face reality. Those I can work with.

  • Most doctors education is lacking, Once the leave med school I don't see them going back for more education. My family doctor of 45 years graduated med school and became a GP in 1955, he even delivered me when I was born, and I saw him regularly until he died this past year. I know his education in medicine was way out of date but he was smart enough to refer me to a different doctor or specialist when It was needed. GP's need to do the same and refer patients to specialists that have more recent educ

    • by Luckyo (1726890)

      Most doctors are educated on constant basis by various pharmaceutical companies. Basically company pays for a weekend trip to a nice spa, that includes lectures on their lines of drugs, and what they do.

      This is pretty much international phenomenon, and it's often frowned upon as it's seen as a form of bribing. As a result it's often legislated just how much companies can offer doctors, and how long such "vacations" can last and so on.
      But these are also viewed as pretty much mandatory to keep doctor's knowle

  • by neilo_1701D (2765337) on Saturday December 07, 2013 @09:14AM (#45626223)

    My wife is morbidly obese. She for years has tried to lose weight with various diets and drugs. These had temporary weight loss effects, but all ultimately failed.

    Why? Was my wife of inferior moral fiber and simply unable to follow through? Is she simply someone who needs to eat from a smaller plate, sit further away from the table, exercise more, eat less sugar, eat less carbs, eat more carbs, follow some arcane points system?

    Nope. None of that works.

    I'm a software engineer. Failure is a daily occurrence, and when we fail and study the failure, we learn the underlying problems and then we have success; and I've constantly encouraged my wife to keep trying. And she has; for over 10 years.

    Two years ago, she contacted a weight counsellor / psychologist in Florida. In that time, they have peeled back the layers of her life, looking for the real, underlying problems. And, they found them. Who knew, for example, that being sexually abused as a 4yo child for years would cause problems? Who would have thought that when the attacker (a family "friend" next door) said things like "you would look prettier if you lost a bit of weight", it causes problems like gaining weight to try and make the pain go away? Why on earth would a narcissistic mother cause problems - especially when a 4yo comes to her bleeding from the vagina and covered in semen, and the mother simply wipes it away and says it never happened?

    My wife's weight is far from something to be ashamed of. Instead, it's the mark of a person who came through some of the most horrendous things you can imagine - and lived.

    The reason all the diets and drugs failed? Denial of the past and the problems in it. Simply becoming an adult doesn't mean the past will not affect you.

    The future? Looking good. Since breaking through and working through all of her past, the underlying need to eat compulsively has gone. Guess what? She's loosing weight without a restrictive diet, drugs, surgery - whatever.

    Obesity isn't a "disease" or anything like that. It's the symptom of something else. Medical dollars are best spent for people who are ready to lose the weight AND deal with their pasts by supplying them with competent psychologists, not the latest diet pills.

  • by meander (178059) on Saturday December 07, 2013 @09:18AM (#45626241)

    As a primary care physician, I gave in years ago. I now prescribe assorted appetite suppressants whenever some one asks me, it saves me lots of arguments, and a lot of time.

    However, I get them back monthly for weigh ins. The drugs work great for a couple months, losing 4~8kg a month, then tapering off to nothing. Folk then realise that this is not a wonder cure.

    The only stuff that works long term is eating less +/- exercising more, or surgery to shrink your stomach (actually the latter works pretty well, better than pills long term, in my experience. little change out of $10K, but probably worth it)

    Pills are short term appetite suppressants. The following year, you are back to your previous weight, but your wallet is much lighter. Look to advice that you already know about for long term losses.

  • by Reliable Windmill (2932227) on Saturday December 07, 2013 @10:31AM (#45626613)
    Stop starving your body by living on quick rushes of carb, and get off your ass.
  • by Kr1ll1n (579971) on Saturday December 07, 2013 @11:27AM (#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?
    etc....etc.

    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.

    • Re: (Score:3, Informative)

      by Anonymous Coward

      Hi mate, I'm a type 1 diabetic in my mid thirties and I empathise completely with your comments and hope you're looking after yourself and keeping your HbA1c levels as low as possible.

      In my experience I am constantly surprised by the lack of actual knowledge and education about diabetes. Sure, there's lots of awareness, which is good, but nobody seems to actually know anything. And unfortunately, I have to include doctors in that category. I've had the good (or bad) fortune to have my condition assessed in

  • Anger and obesity (Score:3, Insightful)

    by ManicMechanic (238107) on Saturday December 07, 2013 @11:27AM (#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."

    Manic

  • by Custard (45810) on Saturday December 07, 2013 @01:24PM (#45627737)

    (tl:dr The drugs work. People think about obesity wrong.)

    To those that say they don't work, I would suggest you look at the trials. One of the differences between these regulated prescription drugs and supplements or (most) diets is that there are actual double-blind placebo controlled studies behind them. They do work. There is very good research to show that they do.

    Qsymia, which I am on, gives an average of ten percent body weight loss beyond placebo, and the weight stayed off out to two years, which was the end of the study. I went from 269 to 253 in my first six weeks (13 pounds or 4.8%.) I feel much better now, and I have taken up weight lifting again. My weight isn't dropping, but I am clearly losing fat and gaining muscle. My weight is pretty stable, but I can feel ribs that I haven't felt since the nineties. None of my leather belts fit anymore. I'm wearing a belt with a friction buckle until I stop shrinking.

    I also just got my quarterly labs back and my A1c is down 1.2% and my lipids are great. I'm getting lightheaded when I stand up too fast (orthostatic hypertension;) I have an appointment next week to talk to my doctor about reducing my blood pressure medication. You don't just lose weight, but the comorbidities go away with about 5% weight loss.

    The main problem with obesity drugs can be seen in the comments here. People for whom obesity is not a disease don't understand what it is like to fight the disease. I'm old enough to remember when depression was treated the same way as obesity is treated now. Polite people said "try to think happy thoughts." "Just snap out of it" was a more common response. Today most people understand that some people have broken brain chemistry, and telling a depressed person to work harder at being happy isn't going to work. The researchers understand that obesity is a disease, and telling people to work harder at being healthy isn't going to work either. But most people don't understand that yet.

    To the person who said diet pills are short term only, you are right and wrong. When a person who is on medication for a chronic condition stops taking their medication, the condition returns. That is how you know the medication is working. Obesity is a chronic condition. Because obesity was once thought of as something that could be cured, like an infection, pills used to be given for a short period. People would lose weight on the meds, the doctor would pronounce them cured, they would stop the meds, and they would regain the weight (and the high blood pressure, and the diabetes, and the dislypidemia, and all the other fun stuff that goes along with central body fat.) The researchers and educated doctors now understand that obesity is a chronic condition that responds well to medications. (It also responds very well to *intensive* lifestyle modification and surgery. Most doctors miss the word "intensive" in that sentence, which is the subject of another rant.) The current expectation is that you stay on the drug the rest of your life, possibly with drug holidays.

    For me, Qsymia has been life changing. I had lost about 100 pounds of fat over about six years, but I was stuck and I still had type 2 diabetes, high blood pressure, and horrible lipid numbers. I was working out, hard, at least eight and a half hours a week plus two 50 minute weight lifting sessions with a private trainer. I watched what I ate, but I was still obese and I still had the health problems. Eventually I got discouraged and stopped working out hard. I still did 300 minutes a week on a treadmill, but I wasn't killing myself in the gym or lifting. Interestingly, I lost muscle and gained a little fat, but it made very little difference to my overall health. With Qsymia my eating changed dramatically, I lost a bunch of fat, and my lab numbers got better.

    Whether you prefer anecdote or data, the result is the same. Qsymia is a game changer.

    (Some disclosure. I'm a computer guy with no medical training. My girlfriend is an MD wh

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