A New Breed
August 24, 2006
Like many people who struggle with their weight, Sally Krawczyk has tried everything from liquid diets to low-carb regimens to Weight Watchers. And like many dieters, each time she stopped, she gained back all the pounds she’d lost.
But the 51-year-old teacher says she’s finally discovered a successful way to lose weight. On the advice of her doctor, she’s been taking an antiseizure medication and two antidepressants — and has lost 135 pounds in 18 months.
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Sally Krawczyk lost 135 pounds after taking antiseizure medication and antidepressants.
Ms. Krawczyk doesn’t suffer from seizures or depression, but she has found the medication beneficial in another way. “The medicine helps control my need to constantly be eating,” says Ms. Krawczyk, of Murrieta, Calif., who now weighs 220 pounds and hopes to lose 40 more. “Without it I could eat and eat and never feel full or satisfied.”
In the unending quest for a miracle diet pill, Americans are trying an array of prescription drugs approved by the Food and Drug Administration to treat a variety of illnesses. None of them have been approved as diet drugs — but for many, weight loss is a side effect.
The list includes drugs meant to treat attention-deficit hyperactivity disorder (Adderall and Ritalin), depression (Wellbutrin), epilepsy (Topamax and Zonegran), diabetes (Glucophage and Byetta), sleep disorders (Provigil), smoking (Zyban) and even opiate overdoses (Narcan). Often these drugs are used alone, but sometimes they’re taken in combination with each other or with popular weight-loss medications, such as phentermine.
While there are no hard data on the trend, doctors and patients say it has been increasing for several years and that the drugs are being used by Americans — especially women — of all sizes, from obese people to anorexics. Adderall, a stimulant that was originally marketed as a diet drug in the 1970s under a different name, is said to be the weight-loss agent of choice for everyone from soccer moms to Hollywood starlets, debutantes and college kids, many of whom take it without a prescription.
“People are looking for a quick fix,” says Christine Gerbstadt, spokeswoman for the American Dietetic Association. “Taking a pill is so much easier than going to the gym or cutting back on portions.”
Though the drugs generally work to suppress appetite or food cravings, many have additional, less desirable side effects, which can include abdominal cramps, anxiety, insomnia and cognitive problems. One drug, Wellbutrin, comes with a “black box” warning that it may cause increased risk of suicide in children and adolescents.
Doctors are permitted to prescribe drugs for applications other than those for which they are approved — a use which is termed off-label. But not everyone is getting these drugs from a physician. Some are buying the drugs from Internet pharmacies or from Canada. A number admit they are taking drugs prescribed for friends or family members.
When Jacqueline Colozzi, a 20-year-old college student in New York, wanted to drop a few pounds, a friend with an Adderall prescription offered her some. “It was easier just to take a pill as opposed to working out or watching what I ate,” says Ms. Colozzi, who weighs 110 pounds. After losing 10 pounds over the course of a year, she got tired of never wanting to eat or sleep. “I realized it didn’t make me feel good,” she says.
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The Internet, too, is giving the use of off-label drugs for dieting a boost. Web sites such as FatNews.com often run articles on the latest research being done on the weight-loss effects of these drugs. Users compare the success rates and side effects of the medications in an increasingly varied range of message boards, from Web sites dedicated to information about drugs, such as Askapatient.com, to eBay.
Still, the practice of prescribing drugs off-label for weight loss is controversial. To begin with, the drugs can be expensive, and insurance companies typically don’t pay for off-label uses of drugs. What’s more, doctors have varying opinions on the weight-loss effects of these drugs. In general, they say, they may help people lose about 5% to 10% of their body weight.
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More important, these can be risky drugs, especially when taken without a doctor’s supervision. Although drug companies and independent researchers have studied the weight-loss effects of many of these drugs, including Wellbutrin and Topamax, to date the FDA hasn’t approved any of them for weight loss.
“There’s no evidence of the safety or the efficacy of going off-label for weight loss,” says George Blackburn, associate director of Harvard Medical School’s Division on Nutrition. When patients request off-label drugs to help them lose weight, Dr. Blackburn suggests that they modify their diet and exercise instead. If that doesn’t work, he will prescribe one of the approved weight-loss drugs to help them control their cravings. “We see no need to go off label,” he says. “We have zero tolerance for the side effects.”
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The focus on other drugs comes amid a growing obsession with weight and obesity. Many people are fed up with over-the-counter dietary supplements, which often don’t work. Some say they perceive prescription drugs — which are more strictly regulated — to be safer, especially in the wake of the FDA’s warning to consumers a few years ago to stop taking the dietary supplement ephedra, which was sold over-the-counter, in part because it could damage the circulatory system.
Part of the reason people are so eager to take off-label drugs to lose weight, according to doctors and patients, is that there hasn’t been a truly promising short-term weight-loss medication on the market since the FDA withdrew approval for fenfluramine in 1997 after it was linked to heart-valve problems. (Fenfluramine had been commonly given to patients along with phentermine, another appetite suppressant; the combination, which was never approved by the FDA, was known as fen-phen. Phentermine is still approved for short-term weight loss.)
For obese patients seeking long-term weight loss, there are just two approved drugs on the market — Meridia and Xenical. Some doctors say they are reluctant to prescribe Xenical because it can produce distasteful side effects such as abdominal cramping, gas and anal leakage. Meanwhile, Rimonabant, a medication that is showing promising results for weight loss in some people in the United Kingdom, hasn’t yet been approved by the FDA for use in the U.S.
Filling a Void
The doctors who prescribe drugs off-label for weight loss believe they fill a void. “Obesity is a chronic disease — diet and exercise aren’t enough for long-term weight loss for most patients,” says Robert Skversky, a bariatric physician in Newport Beach, Calif. “Chronic diseases need drugs to keep them under control.”
Dr. Skversky uses a combination of drugs he adjusts for each patient — a drug cocktail usually consisting of phentermine plus antidepressants such as Prozac, antiseizure drugs such as Topamax or Zonegran, or diabetes drugs such as Glucophage or Byetta. (Ms. Krawczyk, who is one of his patients, takes Adipex, or phentermine; the antidepressants Wellbutrin and Celexa; and Topamax.) A combination of these drugs could cost about $100 to $200 a month or more, says Dr. Skversky.
Dr. Skversky, who tells his patients that they will be on these drugs for life, says the benefits far outweigh the side effects. “We rarely stop anyone because they can’t tolerate a drug, because we can adjust the dose or the combination,” he says. A number of his patients, he says, have lost more than 100 pounds. He also encourages his patients to exercise and eat high-protein, low-carb diets.
Other doctors say that although they see less-dramatic results, off-label drugs can still be valuable weight-loss tools. Ann Wry, medical director of Women’s Health Services at Hackensack University Medical Center, in Hackensack, N.J., sometimes prescribes Wellbutrin — a drug she feels has minimal side effects — if she thinks it will help a patient lose weight. (She also encourages patients to follow a balanced diet and exercise program.) “It doesn’t produce a ton of weight loss, but it takes the edge off of hunger,” she says. “If someone is trying to do South Beach or Weight Watchers, this diminishes the craving enough so that they can say, ‘No, I’ve had enough.’ ”
The pharmaceutical companies that manufacture these drugs warn that they shouldn’t be taken for weight loss. Both types of Adderall — short- and long-release — carry a black-box warning against their misuse because they can cause sudden death or serious cardiovascular events. (The drug can also cause dependency or addiction.) Topamax can cause confusion or difficulty concentrating, while Provigil can cause dizziness or insomnia.
For Theresa Saleeby, the ill effects ended up overshadowing the benefits of taking a drug to lose weight. When she decided she wanted to lose about 50 pounds last year, her doctor prescribed Topamax. He told her that most patients lost between 20 to 50 pounds on the drug and that it would help prevent her migraines. But after taking the medication for seven months, she weighed in at 175, just three pounds less than when she started.
Even more upsetting, Ms. Saleeby says, were the side effects: While on Topamax, she had minor memory loss, her legs regularly fell asleep, and her hair fell out in patches, one of which was the size of a baseball.
“These minor side effects aren’t that minor,” says Ms. Saleeby, 31, a real-estate agent in South Orange, N.J. After the hair loss, she stopped taking the drug, then cried for a week. “I’d rather be chubby than bald,” she says.
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