This past year two newly approved weight-loss drugs, Qsymia and Belviq, became available. Neither drug produced substantial weight loss in the studies submitted to the FDA. 1 Nevertheless, approval was given because it was understood that many obese individuals need an appetite suppressant to decrease their hunger and adhere to a diet.
These drugs do help some dieters to attain their weight loss goals. And some manage to maintain their lower weight after cessation of treatment with these drugs. Patients have reported that they are content with smaller portion sizes because their stomachs are smaller and they can then exercise more easily as their weight loss improves their aerobic capacity. Improvements in their overall health, from lower blood pressure to less strain on their joints, may be sufficient motivation to permanently keep the weight off. But what about the rest? Those who failed to achieve their weight-loss goal, or lost only trivial amounts of weight while taking these drugs? Some may start re-gaining weight weeks or months after the end of their diet, a phenomenon known from previous generations of weight loss drugs. Presently there is no systematic way of helping such individuals cope with factors that cause them to regain their weight. They certainly don’t have access to weight loss drugs and most weight loss programs are not set up (Weight Watchers may be the exception) to support people who want simply to stop gaining. Moreover, this weight gain affects not only the newly slim, but those who are already overweight or obese. Being fat does not prevent one from becoming fatter.
People often gain weight for years, shifting from moderate obesity to morbid obesity, because recurring situations trigger excessive food intake. Stress, toxic work environments and schedules, family problems, financial worries, sickness, and social isolation are but a few of the reasons behind repetitive overeating and weight gain.
A friend, a tax accountant, gains 20 pounds between February and April every year. He works 7 days a week on income tax returns, eats take- out, and snacks on candy bars to keep himself awake when working late at night. A relative who is on the roster to take care of an ailing relative every summer also gains weight. She is more or less housebound because the relative is in a wheelchair, and so she eats her way through the kitchen because of boredom and frustration.
A neighbor studying for her Bar Exam gained 15 pounds in 6 weeks because munching on cookies was the only way he could stay at his desk for hours. These three people were already struggling with their weight, and the stress made them gain more. Sometimes overeating and subsequent weight gain are not due to external stress, but biology. Women suffering from premenstrual syndrome and/or menopause often find themselves eating excessively. Winter blues brought on by reduced hours of sunlight from the late fall into the early spring may cause substantial weight gain, year after year. Shift workers adjusting to a new wake-sleep cycle often gain weight. The problem is so prevalent that this has become a major health risk among such graveyard shift workers.
Medications such as antidepressants, prednisone and even medications for the pain of fibromyalgia are also known to cause weight gain. All of these traps for weight gain can leave one asking what they can do to stay slim.
Might drugs now used to support weight loss be useful for preventing weight gain? If they can stop overeating in the dieter, could they stop overeating in those who are rapidly gaining weight? Someone who is already considerably overweight might not feel so hopeless about being able to lose the pounds she gained over the winter, or after taking care of her elderly relative if her weight gain was minimized by these drugs. It is easier to go on a diet with 30 pounds to lose rather than 80. Are pharmaceuticals the answer?
Of course before using weight-loss drugs to prevent weight gain, the efficacy of doing so must be studied, and populations identified who may benefit from this new use. And it also may be important to change our attitude toward allowing obese people to use weight loss drugs ‘as needed’ to prevent weight gain. There is a belief that weight loss drugs are a crutch. Some claim that if obese people rely on a pill rather than willpower to prevent overeating, they will never learn how to control their food intake. This may be true for some but for others who simply cannot stop their overeating because of their situational and/or biological stresses, why not give them some help?
People with back pain are not told that just because they received a steroid injection, they can’t receive any more even if the pain comes back. People with recurring sinus infections every winter are not told that they can’t have antibiotics this winter because they took them last winter and one winter was enough. And someone battling years of depression does not have medication withheld because it was used for many months a few years earlier. Nor is that person told as he might have been years ago to, “…pull himself out of his depression and get on with life.”
Weight-loss medications should also be used as needed. If they are taken as weight begins to be gained (again), then their control over food intake may stop further weight gain. And when the stress, or hormones, or season of the year causing the weight gain passes, losing the weight will seem an achievable goal rather than something beyond reach.