When will we have a safe and effective prescription diet pill?

The first company that comes up with a effective drug for obesity is bound to make billions.

Prior failures notwithstanding, a trio of small pharmaceutical companies are trying to come up with the next great obesity pill. That means clinical studies are ongoing.

So, what’s it like to participate in such a trial? Ed Susman, a contributing writer at MedPage Today, was involved in one, and chronicled his experiences over the past year.

He still doesn’t know whether he was prescribed the active drug or placebo, but his BMI over the past year went from 36.8 to 30.1.

Here’s the piece:

And subsequently, his experience was also featured in a CNBC news report.

That said, it’s somewhat of a shame that patients are hoping that America’s obesity problem can be solved with a pill, when in fact, it’s both an improvement in diet and an increase in exercise that’s really needed.

It’s too bad that the incentives that motivate doctors today all encourage prescribing a pill, rather than spending the time to provide the counseling needed to institute these lifestyle changes.

Comments

Sharon
So much money goes into research for these medications, when we have interventions right in front of us that are inexpensive, effective, and side effect free. If somehow we could get insurance to pay for Weight Watchers, I think it could make a huge difference. Membership is $40 a month. I’m sure whatever pill anyone manages to come up with will be hundreds of dollars a month. Add to that more parks with walking/running areas, cooking classes, changing food policy to favor fresh fruits and vegetables over corn and soy products, and building community centers with fun exercise classes that are inexpensive, and we could have a huge change for a relatively small sum of money. Too bad our medical system isn’t built in such a way to allow this!
Dr. IKE
Find the no-work choice instead of the one that requires commitment and effort (with only positive side effects)? Hey, it’s the American way!
I wrote something along these lines a little while ago. Nothing will change until we take responsibility for ourselves.
And Sharon, insurance companies are looking to ditch responsibility for things as opposed to picking up new costs. Nice idea, though. Lower premiums for gym membership? Maybe.
Bad Medicine, Good Solutions
No one will make billions.
Our country hates drug companies.
We are already besieging them to the point where innovation is likely to stagnate.
Anonymous
Prescription drugs can lead to weight gain, and there are some popular drugs that can increase one’s weight in excess of 30 lbs!
Until there is a CURE for diabetes or cardiometabolic risk, there will not be an effective weight loss pill.
In regards to the comment about Weight Watchers, Weight Watchers is not the solution. Watchers is just expensive processed food. Once dieters are off this diet, dieters are likely to gain back the weight. If effective, Fergie will not be on Weight Watchers anymore. The Duchess has been on this diet for 20+ years.
Anonymous
“Until there is a CURE for diabetes or cardiometabolic risk…”
Like a healthy diet and exercise?
While I agree that lifestyle would be a better way to deal with obesity than a pill, it is naive to say exercise is side effect free. Just ask my physical therapist.
Dr. Matthew Mintz
Sharon’s sentiment is right on target. We need to pay for things other than medications. As long as McDonalds is cheap and easy and fresh fruit and vegetables are expensive, we will continue to have problems.
Dr. Ike is also correct, that insurance companies will not pay for these things. However, employers may.
There will never be ONE pill for obesity. The metabolic processes that put on the pounds are complex and hard wired after millions of years of evolution. There may be a pharmacologic solution, but it will likely take multiple agents of which some will be injectables. The question is whether or not insurance companies will be willing to pay for these expensive regimens and whether patients will be willing to take a few pills and shots, along with diet and exercise to help lose weight.
Anonymous
Where is the evidence that the doc spending more time counseling leads to sustained significant weight loss? It isn’t there.
What does the fat person not know? That it is killing them? That people laugh at them? Exactly how many calories are in a potato chip? I promise you they know more about how much of what is in what than you do.
Dieting in general doesn’t work. Very few obese people maintain substantial weight loss over the long run. On the order of 5%. Many of these patients are highly motivated. Why do we continue to push people to do something with such and incredibly low success rate, and then blame them when it fails?
The drive to eat is so strong, and due to the critical role of eating in survival so wired in by various redundancies, that once the regulatory mechanism sets to drive an excessively high caloric consumption level that is beyond what the average modern lifestyle can consume, it will eventually override most people’s strongly motivated cognitive strategies for controlling it with or without counseling, gimmicks, programs, group support, etc. Very few people can maintain supression of action on the drive to eat 24/7, which is what is required for dieting to continue to work. 23.5 hours a day of hunger supression is not adequate as 30 minutes is an adequate time for someone whose neuroendocrine system thinks they are starving to death to consume thousands of calories.
Surgery works for more, probably by disrupting the hormonal factors rather than the mechanical reasons originally postulated.
Ultimately the solution, if one is found short of a new dark age, will probably be a pharmaceutical answer that disrupts the drive to eat that ramps up so dramatically at around 10-15% body weight loss.
Some of those found so far are really not so bad. They are realively safe and partially effective. Safer than being morbidly obese. The problem is that our society sees obesity as a moral issue with medical consequences rather than a medical issue. As a moral issue they feel that a phamaceutical solution is itself somehow immoral–pandering to a simple lack of ordinary self-control. We therefore pounce on any deficit in the pills (just as fundamentalist do any deficiencies in condoms as a solution to STD’s) and exagerate them, becoming intolerant of any adverse effects rather than leaving it to be an individual risk benefit calculation like any other medical treatment.
We accept the administration of all sorts of relatively toxic psychotropics to help people escape the misery of depression, but condemn the doctor and patient who accept relatively small risks to combat the misery and risk of being fat.
Likewise with pharmaceuticals that have been proven effective in ameliorating the morbidity of substance abuse–moral prudishness about “taking a pill” for these conditions result in little use, rather continued pursuit of treatments that after generations of use, do little.
quiltmidwife
Counseling is important and I totally agree that it should be reimbursed appropriately. It's necessary, but not sufficient, for weight loss. Others have mentioned the high cost of fruit & veggies relative to junk; that's one issue. Getting people to exercise is the other really big one, and there are so many obstacles: long hours at work with no real breaks; inadequate public transport, and lack of safe sidewalks and bike paths to encourage people to leave cars at home; gyms available only to those who can afford the membership fees; limited or nonexistent child care for mothers who want to exercise — these are just a few. Not insurmountable, but they'd require some societal investment that doesn't seem imminent.

When will we have a safe and effective prescription diet pill?

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