FDA Approves New Weight Loss Drug

By Dr. Madelyn Fernstrom

In a long awaited move, the FDA approved a “new” weight loss drug, Qnexa, this past July 18. Renaming it Qsymia (cue-sim-ee-a), it’s actually a lower-dose combination of two drugs already on the market. Not for casual weight loss, or those “last ten pounds,” Qsymia is approved for use in adults who are obese (BMI of 30+), or adults who are overweight (BMI 27+) and have at least one major illness, like high blood pressure, sleep apnea, or diabetes. This drug, intended for use along with a reduced calorie diet and increased physical activity, is a combination of an appetite suppressant (phentermine) and an anti-seizure medicine (topiramate), which has weight loss as a “side effect” of epilepsy treatment.

While weight loss after one year of Qsymia — plus lifestyle changes — produced an average weight loss of 6 to 9 percent (an impressive outcome), many people lost a lot more, but some lost much less. There’s no guarantee of weight loss, and Qsymia is far from a “magic pill.” 

And, like other prescription medications, it has side-effects. Two major concerns are an increase in heart rate and a risk of birth defects (cleft lip/palate). Other side effects include insomnia, dry mouth, constipation, and tingling in the hands and feet. But the FDA decision supports the evidence that the benefits outweigh the risks.

Could it be a good power tool for your weight loss toolbox? Obesity is a medical illness of epidemic proportions. With two-thirds of the U.S. population overweight or obese, there will be a subgroup of people who DO need some medication to adjust their hunger and fullness thermostat. But there are many reasons people overeat that have nothing to do with biology, and they won’t be helped by any weight loss drug. A medication can support, but not replace, a reduced calorie diet. It makes the lifestyle effort more manageable (easier, but not easy!) for the long term. 

Qsymia will be available before the end of the year, but availability will be limited. To ensure careful and appropriate use, the company (Vivus) will restrict who can prescribe this medication, and the once-a-day pill would only be available through mail order. An experienced bariatric (weight-loss) physician or psychiatrist are two specialties to check with if you want a consultation. 

Is Obesity the New Normal?

There’s an old joke that goes something like this: “If you want to feel thinner, hang around with heavier people.” Maybe that’s not so funny anymore. With two-thirds of the U.S. population overweight or obese, the “look” of Americans has changed. We’re sizing ourselves up not by personal health, but by how we look compared to others. In discussing their weight, people often tell me they’re a lot slimmer than most of the people they know — as if this removes personal responsibility for their own weight concerns. It’s a defensive posture, implying things could be a lot worse. While often true, it doesn’t make the individual’s weight less important as a personal health risk.

And that view is not limited only to body size perception. As a nation, we’ve changed our view of what a single serving looks like and what “family size” servings mean. What was perfectly acceptable as a single serving a decade or two ago, now looks puny in comparison to the “new” scale of serving size. And a family sized package for four servings, often becomes a meal for two. This is glaringly apparent when we look at federal guidelines (developed years ago) for what “counts” as a serving size. Most of us laugh when we hear about a serving of protein the size of a computer mouse, or palm or your hand. How could anyone fill up with that, many people ask?

We are living in a different world, where our eyes are now accustomed to viewing larger people and larger servings as the new normal. To me, this updated — but skewed — way of looking at the world can only lead to a future with increasing weight-related health problems.

 Do you agree?

Is Obesity “Contagious”?

By Dr. Madelyn Fernstrom

Can you actually catch obesity from someone else, like a cold? No, of course not! What I mean by obesity being contagious is the presence of a giant social component to lifestyle habits that strongly contributes to obesity.

Scientific studies continue to document that both health-promoting and health-damaging habits are fostered by our social connections. And when it comes to lifestyle behaviors like eating and physical activity, most of us are strongly influenced by what our friends and family are doing. The good news is that you can learn to recognize what I call “lifestyle sabotage” and choose another path for yourself.

I’d like to share the story told by one of my patients. She had lost about 30 pounds and had a strong commitment to making lifestyle changes. She came to see me one day, very forlorn, after meeting some friends at a restaurant the evening before. She chose vegetable soup to start. While she opted out from their usual order of a large fried onion loaf, she encouraged her friends to order whatever they wanted. When it came time to order dessert, she suggested they share two desserts among the four friends (this restaurant had hefty portions!), as she didn’t want a whole one for herself (she had pre-planned a few bites).

At the end of that meal, her friends told her, “You’re no fun anymore – you don’t like to eat.” This lady was very hurt, since she believed the friendship and socializing were the key features, not the food. Sadly, her friends, who had their own weight struggles, felt the opposite way and expressed discomfort that she wasn’t eating “like she used to.”

You may have found yourself in a similar situation, demonstrating how easy it is to get in a pattern of accidental sabotage. This can make it harder to both create and sustain positive lifestyle change.

Such lifestyle sabotage also pertains to physical activity. You might want to go for a long walk, but others discourage you in favor of a new movie or “can’t be missed” TV show.  

You can only control your own behavior. If you see yourself in these examples, try to create an environment of positive health patterning with people who are like-minded. This is one sure step to continued engagement in a healthy lifestyle, and it will almost certainly help support your long-term effort.

How have you changed your social networking to avoid lifestyle sabotage and promote good health?