Hunger zappers
Phentermine (also called Adipex-P or Ionamin), another brain-chemical-altering drug that works only on norepinephrine, is available but rarely prescribed in Canada. When prescribed with fenfluramine (Fen-Phen, as the combined drug was known) it caused serious heart damage; it was pulled off shelves in the late 1990s.
Balancing risks and benefits
Padwal is more skeptical about effectiveness and safety than many other physicians when it comes to sizing up the risks versus benefits of prescription drugs. His research, published in the International Journal of Obesity last year, showed very poor long-term usage rates of the two leading drugs -- sibutramine and orlistat. On average, the drop-out rate in studies on the leading prescription drugs is between 30 and 50 per cent -- not a very encouraging sign, adds Padwal.
But Dr. Arya Sharma, a professor of medicine at the University of Alberta, says that prescription drugs are safer than natural products because they are "generally better studied before being marketed." Balking when asked about cost, Sharma asks, "What's the cost of long-term obesity?"
Padwal says he's not against anti-obesity medication. He says he'd even like to see more well-researched treatments at the disposal of physicians such as himself who are trying to treat obesity.
Cravings? What cravings?
Rimonabant (called Acomplia in the U.K., where it is sold) is another brain-altering medication that blocks cravings. It was under review in the U.S., but the American Food and Drug Administration recently denied approval for the drug. There is concern about at least one foreboding side-effect: depression.
"Usually by the time I explain to patients that the drugs are expensive, that there are adverse reactions and that the weight loss is only three to five kilos, they say ‘no thanks,'" says Padwal. Instead, they may consider surgery such as stomach stapling, when advised.
Natural doesn't always equal safe
The problem then is that patients who don't like the sound of the prescription drugs' side-effects or surgery are likely to turn to over-the-counter supplements, not realizing that "natural" doesn't mean side-effect free. That irks a lot of physicians.
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