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Will Qnexa cure Tennessee’s obesity ills?

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The FDA has announced the approval of the first new weight loss medication in years. While many less medically educated corners are celebrating this announcement, your Intrepid Pharmacist is annoyed and dismayed at what will be embraced by the general public as the next magic pill since he knows it is anything but. Those of you wanting the full story on this “new” weight loss drug in the larger perspective of weight loss drug history, read on. Those of you wanting to just know about Qnexa, skip to the thrid to last paragraph.

Your Intrepid Pharmacist has discussed the issue of obesity previously, a problem that plagues much of the South including Tennessee. The links to those columns may be found at the bottom of the page. Tennessee, as he has noted before, ranks as one of the very worst states in the nation for obesity among adults as well as children. And in a state with a weight management problem, a weight loss drug sounds like a promising cure. Not so, though.

The problem with diet pills is they are treated as a miracle quick fix and they do not fix anything—ever. Every time a new over-the-counter weight loss supplement hits the shelves and the television ads appear, people clamor for bottles of the new miracle. Never mind the over-the-counter supplements are not FDA reviewed. Nor, if one looks at the contents of the pill, are they ever anything more than caffeine mixed with random herbal supplements, many of which have nothing to do with weight loss. And, of course, since the purchasers of these products never really change anything else (i.e. what’s causing the obsesity), the effects are minimal at best.

Prescriptions products are not much better. Consider the following history: The drug Xenical, which is easily the best of the lot, was put over-the-counter in 2009 in a half strength form called Alli. The drug blocks fat absorption and is probably the only thing close to a worthwhile weight loss drug since you cannot cheat without disaterous results. That is, the oily fats are not absorbed so they stay in the intestines and create a very oily stool. So, if you take a Xenical and then hit McDonald's for a Big Mac and fries, bet you will be running for the bathroom. No wonder that 23% of Xenical users experienced “flatulence with discharge.”

Weight loss drug Meridia was pulled from the shelves in 2010 due to concerns over adverse cardiac events. Prior to that, in 1997, the combination drug fenfluramine and phentermine, known as fen-phen, was pulled from the market due to heart valve damage issues. Well, the fenfluramine part was pulled. The phentermine half, an amphetamine deriviative, stayed on the market. Amphetamines (including Adderall, Vyvanse, phentermine and dextroamphetamine) tend to cause decreased appetite as a side effect. And though phentermine is labeled for short term use, your Intrepid Pharmacist has seen numerous patients put on phentermine and left on it. And therein lies the problem.

If you have never seen the comedy movie Ruthless People (19887): a) you have been deprived of a brilliant comedy and b) your Intrepid Pharmacist will fill you in a key lesson on the film (SPOILERS!). In the movie, Bette Midler’s kidnapped heiress is a hell on wheels woman obsessed with the fact she can’t lose any weight. During her captivity in a basement room containing a bed and a television a tipping point occurs when she comes across an exercise show and decides to get up and get exercising. By the end of the movie she has lost 25 pounds and tearfully confesses to one of her captors that she had been to fat farms and had urine injections for weight loss and only lost 2 pounds. And here, just adding in exercise and a more controlled diet she lost 25 pounds.

Herein lies the problem with weight loss pills: if the patient does not make any diet or exercise modifications no significant weight well be lost. And worse—yes, worse!—is that when the drug is discontinued the weight will return.

Qnexa is merely the next drug in the long tragic line of weight-loss-in-a-bottle thinking. Worse still, this new drug is not even new: Qnexa is a combination of phentermine (discussed above) and topiramirate (brand name Topamax), which is an anti-seizure medication being repackaged for the fact it causes appetite suppression/anorexia in up to one third of all users. (If you click on the hyperlink for Topamax be sure to read through the precautions and side effects. All those potential issues for the sake of a little weight loss?) Never mind that the cost for this new brand drug will be high and insurers will not cover it because a) most insurers do not cover weight loss drugs and b) both parts of the drug are available as generic drugs for far less money.

The ugly truth is weight loss pills are not going to solve any obesity problem. They are merely a band-aid placed over a festering sore that will only get worse because the cause of the sore is not being addressed. Weight loss truly comes from exercise and proper diet. Yes, the drug makers tell you about diet and exercise and they even set prescribing guidelines for the drug, but if physicians and patients do not follow them, as is often the case, such information is useless. Your Intrepid Pharmacist also holds certification from the National Academy of Sports Medicine for personal training and as a gym rat type person, he can tell you the belief many carry that those of who are in shape are because it "comes more naturally to them" is false. Very false.

In no way does weight loss ever “come naturally or easy” to anyone, anymore than muscle building and growth does. Those who are not obese and/or who have muscles are that way because they make the effort to show up at the gym or the local park or school track several times a week to exercise, to enjoy junk food and soda in moderation, to watch the portion sizes of their meals in an age when restaurants bring you enough food and dessert as a single portion to feed a family. And, most importantly, the weight loss transformation does not happen in 30 days like the television ads promise. It happens over many months—plural . That is how weight loss is done people. Tennessee’s obesity problems will not be solved by Qnexa or any other weight loss pill. The underlying issues involving diet and exercise must be fixed for any meaningful long term weight control to be achieved.

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