Are Weight-Loss Pills Safe?

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.

Despite the myriad menu of FDA-approved medications for weight loss, they’ve only been prescribed for about 1 in 50 obese patients. We worship medical magic bullets in this country. What gives? One of the reasons anti-obesity drugs are so “highly stigmatized” is that historically they’ve been anything but magical, and the bullets have been blanks, or worse.

Most weight-loss drugs to date that were initially approved as safe have since been pulled from the market for unforeseen side effects that turned them into a public threat. As you may remember, it all started with DNP, a pesticide with a promise to safely melt away fat—but instead melted away people’s eyesight. (It was one of the things that actually lead to the passage of the landmark Food, Drug, and Cosmetic Act in 1938.) Thanks to the internet, DNP has “made a comeback…, with predictably lethal results.”

Then came the amphetamines. Currently, more than half a million Americans may be addicted to amphetamines like crystal meth. But “[t]he original amphetamine epidemic was generated by” drug companies and doctors. By the 1960s, drug companies were churning out about 80,000 kilos a year, which is nearly enough for a weekly dose for every man, woman, and child in the United States. Billions of doses a year were prescribed for weight loss. Weight-loss clinics were raking in huge profits. A dispensing diet doctor could buy 100,000 amphetamine tablets for less than $100, and turn around and sell them to patients for $12,000.

At a 1970 Senate Hearing, Senator Thomas Dodd (father of “Dodd-Frank” Senator Chris Dodd) suggested America’s speed freak problem was no “accidental development.” He said the pharmaceutical industry’s “[m]ultihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have, pill by pill, led, coaxed and seduced post-World War II generations into the ‘freaked-out’ drug culture.”

I’ll leave drawing the Big Pharma parallels to the current opioid crisis as an exercise for the viewer.

Aminorex was a widely-prescribed appetite suppressant—before it was pulled for causing lung damage. Eighteen million Americans were on fen-phen before it was pulled from the market for causing severe damage to heart valves. Meridia was pulled for heart attacks and strokes; Acomplia for psychiatric side-effects, including suicide… and the list goes on.

The fen-phen debacle resulted in “some of the largest litigation pay-outs” in the industry’s history, but it’s all baked into the formula. If you read the journal PharmacoEconomics—and who doesn’t—sure, a new weight-loss drug may injure and kill so many that “expected litigation cost” could exceed $80 million. But Big Pharma consultants estimate if successful, the drug could bring in over $100 million. So, do the math.

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• Xia Y, Kelton CM, Guo JJ, Bian B, Heaton PC. Treatment of obesity: Pharmacotherapy trends in the United States from 1999 to 2010. Obesity (Silver Spring). 2015;23(8):1721-8.
• Halpern B, Halpern A. Why are anti-obesity drugs stigmatized?. Expert Opin Drug Saf. 2015;14(2):185-9.
• Wharton S, Serodio JK. Next Generation of Weight Management Medications: Implications for Diabetes and CVD Risk. Curr Cardiol Rep. 2015;17(5): 35.
• Rodin FH. Cataracts Following the Use of Dinitrophenol: A Summary of Thirty-Two Cases. Cal West Med. 1936;44(4):276-9.
• Colman E. Dinitrophenol and obesity: an early twentieth-century regulatory dilemma. Regul Toxicol Pharmacol. 2007;48(2):115-7.
• Rasmussen N. America's first amphetamine epidemic 1929-1971: a quantitative and qualitative retrospective with implications for the present. Am J Public Health. 2008;98(6):974-85.
• Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. 2017.
• Graham JM. Amphetamine politics on Capitol Hill. Society. 1972;9(3):14-22.
• Hadland SE, Rivera-aguirre A, Marshall BDL, Cerdá M. Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses. JAMA Netw Open. 2019;2(1):e186007.
• Mcgee M, Whitehead N, Martin J, Collins N. Drug-associated pulmonary arterial hypertension. Clin Toxicol (Phila). 2018;56(9):801-809.
• Kassirer JP, Angell M. Losing weight--an ill-fated New Year's resolution. N Engl J Med. 1998;338(1):52-4.
• James WP, Caterson ID, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905-17.
• Christensen R, Kristensen PK, Bartels EM, Bliddal H, Astrup A. Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials. Lancet. 2007;370(9600):1706-13.
• Lagerros YT, Rössner S. Obesity management: what brings success?. Therap Adv Gastroenterol. 2013;6(1):77-88.
• Haslam D. Weight management in obesity - past and present. Int J Clin Pract. 2016;70(3):206-17.
• Chawla A, Carls G, Deng E, Tuttle E. The Expected Net Present Value of Developing Weight Management Drugs in the Context of Drug Safety Litigation. Pharmacoeconomics. 2015;33(7):749-63.
• Greger, M. Brown Fat: Losing Weight Through Thermogenesis

Image credit: e-Magine Art via flickr. Image has been modified.

Motion graphics by Avocado Video

• body fat
• FDA
• heart disease
• industry influence
• obesity
• pesticides
• stroke
• weight loss