Studies show many doctors tend to overestimate the amount of weight loss caused by obesity drugs or were simply clueless.
Are Weight-Loss Pills Effective?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Current options for weight-loss medications include the ridiculously named Qysmia, a combination of phentermine (the phen in fen-phen) and topiramate, a drug that can cause seizures if you stop it abruptly. It was “explicitly rejected” multiple times for safety reasons in Europe, but remains for sale here in the USA—or at least at the time I made this video. Belviq is in a similar boat, allowed here, but not in Europe, out of concerns about it possibly causing “cancers, psychiatric disorders, and heart valve problems.”
It’s sold in the U.S. for about $200 a month, but if you think that’s bad, there’s Saxenda, which requires daily injections, listed at the low, low price of only $1,281 dollars—and don’t forget the 96 cents—for a 30-day supply. It carries a black box warning, FDA’s strictest caution about potentially life-threatening hazards, for thyroid cancer risk. Paid consultants, and employees of the company that makes it, argue the greater number of breast tumors found among drug recipients may be due to “enhanced ascertainment,” meaning easier breast cancer detection just due to the drug’s effectiveness.
Contrave is another option, if you ignore the black box warning about a potential increase in suicidal thoughts. And then there’s Alli. It’s the drug that causes fat malabsorption, and thereby causes side effects with names like “flatus with discharge.” It can be your “ally” in “anal leakage.” The drug evidently “forces the patient to use diapers and to know the location of all the bathrooms in the neighbourhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.” A Freedom of Information Act exposé found that though company-sponsored studies claimed “[a]ll adverse events were recorded,” one trial apparently conveniently failed to mention 1,318 of them.
What’s a little bowel leakage, though, compared to the ravages of obesity? As with anything in life, it’s all about risks versus benefits. But in an analysis of more than a hundred clinical trials of anti-obesity medications lasting up to 47 weeks long, drug-induced weight loss never exceeded more than nine pounds. That’s a lot of money and risk for just a few pounds. Since you’re not treating the underlying cause—a fattening diet—when people stop taking these drugs, the weight tends to come right back; so, you’d have to take them every day for the rest of your life. And, people do stop taking them. Using pharmacy data from a million people, most Alli users stopped after the first purchase. Most Meridia users didn’t even make it three months. Taking weight loss meds are so disagreeable that 98 percent stopped taking them within the first year.
Studies show many doctors tend to overestimate the amount of weight loss caused by these drugs, or were simply clueless. One reason may be that some clinical practice guidelines go out of their way to advocate prescribing medications for obesity. Are they seriously recommending drugging a third of Americans—more than 100 million people? You may not be surprised to learn that the principal author of the guidelines has a “significant financial interest or leadership position” in six separate pharmaceutical companies that all (coincidentally) work on obesity drugs. In contrast, independent expert panels, like the Canadian Task Force on Preventive Health Care, explicitly “recommend against” weight loss drugs, given their poor track record of safety and efficacy.
Please consider volunteering to help out on the site.
- Diet, drugs, devices, and surgery for weight management. Med Lett Drugs Ther. 2018;60(1548):91-98.
- Woloshin S, Schwartz LM. The new weight-loss drugs, lorcaserin and phentermine-topiramate: slim pickings?. JAMA Intern Med. 2014;174(4):615-9.
- Rodríguez JE, Campbell KM. Past, Present, and Future of Pharmacologic Therapy in Obesity. Prim Care. 2016;43(1):61-7, viii.
- Nuffer W, Trujillo JM, Megyeri J. A Comparison of New Pharmacological Agents for the Treatment of Obesity. Ann Pharmacother. 2016;50(5):376-88.
- Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015;373(1):11-22.
- CONTRAVE (naltrexone HCl and bupropion HCl) Extended Release Tablets [package insert]. Reference ID: 3625476. Orexigen Therapeutics, Inc; 2014.
- Igel LI, Kumar RB, Saunders KH, Aronne LJ. Practical Use of Pharmacotherapy for Obesity. Gastroenterology. 2017;152(7):1765-1779.
- Hollywood A, Ogden J. Taking Orlistat: Predicting Weight Loss over 6 Months. J Obes. 2011;2011:806896.
- Shepherd RW. No evidence for benefit of medication for obesity. Can Fam Physician. 2017;63(4):276.
- Schroll JB, Penninga EI, Gøtzsche PC. Assessment of Adverse Events in Protocols, Clinical Study Reports, and Published Papers of Trials of Orlistat: A Document Analysis. PLoS Med. 2016;13(8):e1002101.
- Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diabetes Care. 1998;21(8):1288-94.
- Bourns L, Shiau J. Rebuttal: Should family physicians prescribe medication for obesity? YES. Can Fam Physician. 2017;63(2):e82.
- Haddock CK, Poston WS, Dill PL, Foreyt JP, Ericsson M. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes Relat Metab Disord. 2002;26(2):262-73.
- Hemo B, Endevelt R, Porath A, Stampfer MJ, Shai I. Adherence to weight loss medications; post-marketing study from HMO pharmacy data of one million individuals. Diabetes Res Clin Pract. 2011;94(2):269-75.
- Glauser TA, Roepke N, Stevenin B, Dubois AM, Ahn SM. Physician knowledge about and perceptions of obesity management. Obes Res Clin Pract. 2015;9(6):573-83.
- Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-62.
- Yeh JS, Kushner RF, Schiff GD. Obesity and Management of Weight Loss. N Engl J Med. 2016;375(12):1187-9.
- Brauer P, Gorber SC, Shaw E, et al. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. CMAJ. 2015;187(3):184-195.
Image credit: lecic via adobe stock photo. Image has been modified.
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Current options for weight-loss medications include the ridiculously named Qysmia, a combination of phentermine (the phen in fen-phen) and topiramate, a drug that can cause seizures if you stop it abruptly. It was “explicitly rejected” multiple times for safety reasons in Europe, but remains for sale here in the USA—or at least at the time I made this video. Belviq is in a similar boat, allowed here, but not in Europe, out of concerns about it possibly causing “cancers, psychiatric disorders, and heart valve problems.”
It’s sold in the U.S. for about $200 a month, but if you think that’s bad, there’s Saxenda, which requires daily injections, listed at the low, low price of only $1,281 dollars—and don’t forget the 96 cents—for a 30-day supply. It carries a black box warning, FDA’s strictest caution about potentially life-threatening hazards, for thyroid cancer risk. Paid consultants, and employees of the company that makes it, argue the greater number of breast tumors found among drug recipients may be due to “enhanced ascertainment,” meaning easier breast cancer detection just due to the drug’s effectiveness.
Contrave is another option, if you ignore the black box warning about a potential increase in suicidal thoughts. And then there’s Alli. It’s the drug that causes fat malabsorption, and thereby causes side effects with names like “flatus with discharge.” It can be your “ally” in “anal leakage.” The drug evidently “forces the patient to use diapers and to know the location of all the bathrooms in the neighbourhood in an attempt to limit the consequences of urgent leakage of oily fecal matter.” A Freedom of Information Act exposé found that though company-sponsored studies claimed “[a]ll adverse events were recorded,” one trial apparently conveniently failed to mention 1,318 of them.
What’s a little bowel leakage, though, compared to the ravages of obesity? As with anything in life, it’s all about risks versus benefits. But in an analysis of more than a hundred clinical trials of anti-obesity medications lasting up to 47 weeks long, drug-induced weight loss never exceeded more than nine pounds. That’s a lot of money and risk for just a few pounds. Since you’re not treating the underlying cause—a fattening diet—when people stop taking these drugs, the weight tends to come right back; so, you’d have to take them every day for the rest of your life. And, people do stop taking them. Using pharmacy data from a million people, most Alli users stopped after the first purchase. Most Meridia users didn’t even make it three months. Taking weight loss meds are so disagreeable that 98 percent stopped taking them within the first year.
Studies show many doctors tend to overestimate the amount of weight loss caused by these drugs, or were simply clueless. One reason may be that some clinical practice guidelines go out of their way to advocate prescribing medications for obesity. Are they seriously recommending drugging a third of Americans—more than 100 million people? You may not be surprised to learn that the principal author of the guidelines has a “significant financial interest or leadership position” in six separate pharmaceutical companies that all (coincidentally) work on obesity drugs. In contrast, independent expert panels, like the Canadian Task Force on Preventive Health Care, explicitly “recommend against” weight loss drugs, given their poor track record of safety and efficacy.
Please consider volunteering to help out on the site.
- Diet, drugs, devices, and surgery for weight management. Med Lett Drugs Ther. 2018;60(1548):91-98.
- Woloshin S, Schwartz LM. The new weight-loss drugs, lorcaserin and phentermine-topiramate: slim pickings?. JAMA Intern Med. 2014;174(4):615-9.
- Rodríguez JE, Campbell KM. Past, Present, and Future of Pharmacologic Therapy in Obesity. Prim Care. 2016;43(1):61-7, viii.
- Nuffer W, Trujillo JM, Megyeri J. A Comparison of New Pharmacological Agents for the Treatment of Obesity. Ann Pharmacother. 2016;50(5):376-88.
- Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015;373(1):11-22.
- CONTRAVE (naltrexone HCl and bupropion HCl) Extended Release Tablets [package insert]. Reference ID: 3625476. Orexigen Therapeutics, Inc; 2014.
- Igel LI, Kumar RB, Saunders KH, Aronne LJ. Practical Use of Pharmacotherapy for Obesity. Gastroenterology. 2017;152(7):1765-1779.
- Hollywood A, Ogden J. Taking Orlistat: Predicting Weight Loss over 6 Months. J Obes. 2011;2011:806896.
- Shepherd RW. No evidence for benefit of medication for obesity. Can Fam Physician. 2017;63(4):276.
- Schroll JB, Penninga EI, Gøtzsche PC. Assessment of Adverse Events in Protocols, Clinical Study Reports, and Published Papers of Trials of Orlistat: A Document Analysis. PLoS Med. 2016;13(8):e1002101.
- Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diabetes Care. 1998;21(8):1288-94.
- Bourns L, Shiau J. Rebuttal: Should family physicians prescribe medication for obesity? YES. Can Fam Physician. 2017;63(2):e82.
- Haddock CK, Poston WS, Dill PL, Foreyt JP, Ericsson M. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes Relat Metab Disord. 2002;26(2):262-73.
- Hemo B, Endevelt R, Porath A, Stampfer MJ, Shai I. Adherence to weight loss medications; post-marketing study from HMO pharmacy data of one million individuals. Diabetes Res Clin Pract. 2011;94(2):269-75.
- Glauser TA, Roepke N, Stevenin B, Dubois AM, Ahn SM. Physician knowledge about and perceptions of obesity management. Obes Res Clin Pract. 2015;9(6):573-83.
- Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-62.
- Yeh JS, Kushner RF, Schiff GD. Obesity and Management of Weight Loss. N Engl J Med. 2016;375(12):1187-9.
- Brauer P, Gorber SC, Shaw E, et al. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. CMAJ. 2015;187(3):184-195.
Image credit: lecic via adobe stock photo. Image has been modified.
Motion graphics by Avocado Video
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Are Weight-Loss Pills Effective?
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Content URLDoctor's Note
In case you missed the previous video, check out Are Weight Loss Pills Safe?
As with all lifestyle diseases, it’s better to treat the underlying cause, which in the case of obesity is a fattening diet. Here’s an example of what’s possible with a healthy diet intervention: The Weight-Loss Program That Got Better with Time.
After this video came out, I did a couple videos on weight-loss supplements: Are they safe? Or effective?
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