WEIGHT-LOSS DRUGS
HISTORY/EXISTING CONDITION:
The term "weight-loss drug" within this policy refers
to any over-the-counter medication or prescription drug used for
weight loss, whether or not it is designated as such by the manufacturer.
Weight-loss drugs include benzene derivatives, laxatives, herbal
preparations, amphetamines, appetite suppressants, serotonin reuptake
inhibitors, neuropeptide-y inhibitors, hormones, beta-3 adrenergic
receptor stimulants, and any others in the research and development
phase. Weight-loss drugs have long been promoted as an effective
treatment for "obesity," even though they very rarely
produce long-lasting weight loss or improved health status, and
often have serious side effects.
In 1893, thyroid extract was marketed under the brand names Frank
J. Kellogg's Safe Fat Reducer, Corpulin, and Marmola. The weight
loss it produced was mostly in lean tissue, and thyroid extract
carried the risks of osteoporosis, increased heart rate, palpitations,
sweating, chest pain, and sudden death. Laxatives for weight loss
began being used extensively in the 1920s, and in 1936, dinitrophenol,
a benzene-derived ingredient in World War I explosives, insecticides,
and herbicides was used by 100,000 people. By increasing metabolic
rate, dinitrophenol caused users to suffer skin rashes, cataract
blindness, lost sense of taste, and death by hyperpyremia (fever
due to increased metabolism). payday loans online
In 1940, digitalis was used for weight loss. The use of amphetamines
for weight loss was introduced in 1937, and by 1948, the drug
was prescribed to two-thirds of weight-loss patients. In 1970,
dieters consumed two billion amphetamine pills. They were prescribed
to children until the late 1970s. The risks of amphetamines include
accelerated heart rate, increased blood pressure, heart palpitations,
dry mouth, blurred vision, hallucinations, psychiatric disorders
(including paranoid psychosis), light-headedness, tremors, addiction,
withdrawal problems, congestive heart failure, seizures, and sudden
death.
Phenylpropanolamine (PPA), marketed as Dexatrim, Accutrim, Dex-a-Diet,
Diadex, Prolamine, Propagest, and Unitrol became available over
the counter in 1979. Poison Control Centers reported 47,000 complaints
related to PPA use in 1989 alone. The risks of PPA include anxiety,
disorientation, palpitations, headache, hallucinations, insomnia,
nausea, vomiting, a rebound effect of fatigue and hyperphagia,
dangerously high blood pressure, abnormal heart rhythm, heart
and kidney damage, heart attack, strokes, psychosis, and death.
Approved by the Food and Drug Administration (FDA) in the 1970s
for use individually, fenfluramine and phentermine (also known
as fen-phen) became widely prescribed in combination in 1994 as
a result of a single research study. By 1996, 18 million prescriptions
were written for this off-label use of the drugs. Dexfenfluramine,
marketed under the trade name Redux, was approved by the FDA in
1996. According to studies on file at the NAAFA office, the risks
of these three drugs include primary pulmonary hypertension, valvular
heart disease, and neurotoxicity. Under fire from NAAFA and other
consumer advocates and following studies which indicated that
one-third of users of dexfenfluramine and fenfluramine had contracted
valvular heart disease, the FDA strongly recommended halting the
sale of these drugs, and drug companies withdrew dexfenfluramine
and fenfluramine from the U.S. market in September, 1997.
After discontinuing the sale of fenfluramine and dexfenfluramine,
some weight-loss centers and physicians immediately began prescribing
ephedrine-based "herbal fen/phen," and distributing
the combination of phentermine and Prozac, an SSRI anti-depressant
(also known as fen-Pro).
Historically, weight-loss drugs have been subjected to very little
testing; almost no long-term studies have been produced. Research
indicates that risks of drugs such as fenfluramine, phentermine,
and dexfenfluramine increase dramatically the longer the drugs
are used. In addition, the drugs produce minimal weight loss,
and upon discontinuing the use of any of the drugs, the weight
is virtually always regained. For example, amphetamines produce
an average loss of 10-20 pounds before the drug loses effectiveness,
and dexfenfluramine produces an average of six pounds of weight
loss when compared to a placebo. Further, anecdotal evidence suggests
that consumers eager to speed weight loss frequently take multiple,
more dangerous doses of weight-loss drugs. Vulnerable consumers
have also been misled and harmed by unregulated herbal, so-called
"natural," weight-loss drugs.
Despite the lack of effectiveness and the risks associated with
every past weight-loss drug, over 50 new weight-loss drugs are
currently up for approval, or are in the research and development
stage. Xenical, which blocks intestinal enzymes from absorbing
30% of dietary fat, may be approved, and sibutramine, which slows
dissipation of serotonin in the brain, was recently approved.
A drug to regulate leptin, a satiety hormone secreted by fat tissue,
is being developed. In addition, a drug to decrease appetite by
blocking neuropeptide-Y and a drug to regulate metabolism by stimulating
beta-3 adrenergic receptors are being researched.
Diet companies, obesity researchers and drug manufacturers continue
to tout weight-loss drugs as a viable and desirable path to weight
loss. Promoting and manufacturing weight-loss drugs is profitable,
as evidenced by the over 300 million dollars consumers spent on
dexfenfluramine alone in 1996. As long as fatness is stereotyped
and derided, and as long as discrimination against fat people
exists, consumers will continue to seek a "magic pill,"
and there will be a market for weight-loss drugs.
Weight-loss drug promoters emphasize the drugs' supposed health
benefits and minimize risks related to taking the drugs, so that
consumers cannot truly give informed consent prior to taking the
drugs. People of all sizes are misled about the extent and severity
of the health risks associated with being fat and are told that
losing weight is the only way to attain good health. But scientific
research on file at the NAAFA office has demonstrated that many
fat people are already healthy, and that a person's health status
can be improved independent of weight loss by making positive
lifestyle changes in exercise, stress management, healthy eating,
and positive social support.
Currently, the agency responsible for regulating weight-loss
drugs, the Food and Drug Administration, appears to bow to pressure
from drug companies to approve weight-loss drugs without requiring
sufficient long-term testing, and has not demonstrated a commitment
to guard the public's health.
NAAFA'S OFFICIAL POSITION:
Since weight-loss drugs fail to achieve permanent weight loss
and can result in negative health consequences, since the governmental
agency responsible for regulating weight-loss drugs has not protected
consumers from dangerous weight-loss drugs, and since people taking
diet drugs are rarely given sufficient information to allow them
to give true informed consent, the National Association to Advance
Fat Acceptance strongly discourages people of any size from taking
drugs for the purpose of weight loss. Further, NAAFA condemns
obesity researchers and drug manufacturers who profit from inadequately
tested weight-loss drugs. In addition, because many consumers'
motivation for weight loss is to escape size discrimination and
weight-related social stigma and such motivation necessitates
a political rather than medical response, and because health status
can be improved independent of weight loss, NAAFA demands that
the Food and Drug Administration denies approval of any weight-loss
drug presented for approval that does not show clear health benefits
apart from temporary weight loss.
