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Weight Loss Drugs: Let's Get Real

Posted Jul 25 2012 8:30am

by Barbara Berkeley, MD

Two new weight loss drugs, the first to be approved since 1999, are about to go to market.  

Let's start by saying that a magic bullet has not yet been found.

I have found it interesting that since the FDA's recent approvals of Belviq and Qsymia, there has been little shouting from the rooftops.  I would have expected a great hue and cry when these drugs got the nod.  Instead, it has been rather quiet out there.  

Within my own patient population, there has been an odd indifference to the new drugs.  Only an occasional patient is asking about them.  No one seems to care much.   Instead of the line out the door, the phone ringing off the hook, there has been relative silence.  Neither do I hear much excited chatter among doctors. 

Why?

Perhaps we have come to the point where we have observed weight loss drugs long enough to know that they are not solutions.  Maybe we've finally figured out that a drug that caused real, lasting weight loss would be leading the world's headlines by now.  I think that maybe these new drugs are damned by faint praise. 

Our pharmaceutical efforts at controlling the growing obesity epidemic are almost completely limited to one strategy: desensitizing the subject to food.  In other words, decreasing appetite.  This approach is shorthand for a larger and much more disturbing truth.  We would rather alter and do potential harm to the human body than alter and in any way impact the overwhelmingly harmful production and marketing of modern foods.

For most of Americans, weight loss is about "melting", "shrinking", lower scale numbers, and size change.  But weight loss, done correctly, is much more about healing than it is  about getting into smaller pants.   The obese body is often sick or about to become so.  The body is struggling with a physical burden.  The heart and vascular system are taxed.  The blood pressure rises in response to increases in insulin.  The production of lipids is altered.  And the body is often in a pro-inflammatory state with irritating chemicals being generated by the fat mass and then entering the blood stream.  Weight loss is inevitably produced by caloric restriction but such restriction also necessarily decreases the number of harmful foods the dieter eats each day.  Removed from the stimulus of aggressive, inflammatory foods and from the unnatural state of constant eating, the body almost audibly sighs with relief.  Healing begins quickly. 

Pills for weight loss play directly into the "melt" mentality.  They are inevitably perceived as a way to shrink rather than to heal.  And, they introduce a further complication to getting well, that is the drug itself, which may well have side effects or its own disruptions to normal body process.  

Where can medications be helpful? They can help act as supports to enable someone to get past initial struggles.  They can help maintainers solidify their new weight while working on their new habits.  They can push stalled dieters past a plateau.  But we must remember that the new medications and all of those on the horizon do not fundamentally alter our metabolic processes.  They simply make us slightly less interested in eating.  When we stop taking the medication or become tolerant to it, we will be the same vulnerable person in the same overwhelming world.  Thus, the most crucial test of a good weight loss plan is whether it teaches you to believe in a different food reality, whether it provides you with the tools to adopt a new food "religion", and whether that conversion takes.   

No one would suggest that we throw away our crutches while our leg is still broken, but no one would suggest that we consider those crutches our new permanent way of walking.  Use crutches when needed--- judiciously, and always with the underlying goal of allowing your body to do what it does best:  heal itself when we stop doing things that cause it harm. 

 

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