October 24, 2006
Americans are constantly reminded about the dangers of obesity, so many of us who are heavier are trying to lose weight to stay healthy. But shedding those pounds is hard; it takes daily focus and discipline. It’s easy to become overwhelmed by the challenges of eating less, exercising more, managing stress, and getting enough sleep — all important parts of an effective weight-loss program. No wonder it’s tempting to look for a quick-fix surgery or a magic pill to make the process effortless.
Prescription medications approved for weight loss and obesity surgery can help make these changes easier for some people. But many patients at my weight-loss center ask me if there are any problems taking prescription drugs, which aren’t specifically approved for obesity treatment, to help them lose weight. In a word, yes. The risks of using what are called “off-label� drugs to lose weight can be harmful to your health. It all comes down to safety (is the drug safe?) and efficacy (does it work?). Since this is an alarming trend, I want to discuss the issue openly and honestly.
What is an off-label drug?
An off-label drug is one that’s prescribed by a doctor to treat a condition other than one that has been approved for by the U.S. Food and Drug Administration. A doctor can prescribe a drug with a side effect that can treat another illness. This is not illegal and occurs with a number of different drugs, not just obesity-related compounds. While some people get prescriptions from their physicians for such drugs, others get them from friends or relatives, and others buy them from the Internet. Buying drugs online is the worst-case scenario, since there is no guarantee of authenticity or purity of what you are buying.
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What off-label drugs are being used for weight loss?
There are about a half dozen drugs regularly used as off label treatments for obesity. These include: Topamax (approved to treat seizures and migraine headaches), Glucophage and Byetta (for diabetes), Wellbutrin (for depression), Adderall and Ritalin (for attention deficit hyperactivity disorder), and Provigil (for chronic fatigue and sleep disorders). Most of the evidence suggesting these drugs work for weight loss comes from observing patients taking the medicine for an FDA-approved use. For example, the anti-seizure medicine Topamax is often associated with unintended weight loss in patients taking it to treat their epilepsy.
Do these off labels drugs actually work?
Reported effects from people taking these drugs range from a reduction in appetite and fewer food cravings to greater energy and less focus on food. There are no scientific studies showing that these drugs are effective treatments for weight loss, though, and you can actually put yourself at a high risk for damaging side effects by taking some of these drugs. For example, Topamax has very strong effects on the brain and many side effects, including headache, severe fatigue, and a general sense of not feeling well.
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So, while there may be anecdotal evidence about how effective these compounds are for weight loss, personal testimonials are highly variable. And the risks are just not worth any possible small benefits. On top of that, many of these drugs have been studied in a medical setting and have shown a lack of effect on weight loss. Finally, most insurance companies require documentation for this group of drugs to make sure they are being used for the approved indication.
Most doctors will not prescribe these drugs to treat obesity (although a small group of physicians actually encourage this use). Still, this does not stop many patients from seeking these medications to lose weight. My advice: Stay away for these drugs. Whether used alone, or in weight-loss “cocktails� — mixtures of several different medicines — these drugs are quite medically risky. Instead, get some help for a healthy, effective plan to lose those extra pounds. Go on a diet with a friend, or join a group. Network with other people who want to lose weight and have already embraced healthy lifestyle changes and found effective tools for their own weight management. If you think you need professional guidance, go to your family doctor, therapist, or a weight-loss specialist at an academic medical center.
Are there any prescription drugs for weight loss?
There are two prescription drugs approved by the FDA, for up to two years of continuous use, for the chronic treatment of obesity: Meridia, which affects hunger and fullness levels, and Xenical, which blocks about one third of the fat you eat at each meal. While many people get some short-term benefit from these medications, only about one third of people treated find these medicines to be of sufficient help to stick with these drugs for the long term. While these medicines are not miracle pills (nothing is for weight loss, since the drive to eat is hard-wired and ingrained in our biological makeup), they are safe and effective when they are used under a doctor’s care. An older medicine, phentermine, is still approved for short-term use of up to 12 weeks.
Dr. Fernstrom’s Bottom Line: Using prescription medications that are not approved for weight loss to treat obesity is a really bad idea. The health risks are just not worth the small potential benefits. Off-label medications should not be part of your weight management program.
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