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The answer is yes. Metformin can help you lose weight. But there's some scary (and, um, unsavory) info in the fine print. REDBOOK tells you what you must know about weight-loss drugs.
Diet drugs have come a long way since the addictive amphetamines of the
1950s. And while each new generation of skinny pills has so far proven
more dangerous than effective — remember fen-phen and ephedra? — experts
continue their search for a safe diet pill that works.
But while these pills offer hope for trimming America's ever-expanding
waistline, experts caution that there's no miracle potion out there to
automatically shrink you back into your college jeans. "These diet drugs
work only if you also change your lifestyle, and that means following
the same old advice of dieting and exercising," says Caroline Apovian,
M.D., of the Nutrition and Weight Management Center at Boston University
Medical Center. The medications also come with some real health risks,
ranging from nausea and diarrhea to hypertension and depression. Here's
the scoop on the five newest weight-loss pills on the market.
Alli (orlistat)
THE SKINNY: Created originally as the prescription drug Xenical,
orlistat is now available in a lower-dose, over-the-counter version
called Alli. The drug, which you take up to three times a day with
meals, prevents you from digesting 25 percent of the fat you consume (by
attaching to some of the enzymes responsible for breaking down fat from
food). The amount of fat calories blocked will depend on how much fat
you eat, but most patients block 100 to 200 calories per day.
So, how does that play out in pounds? Subjects who took Alli for six
months lost 50 percent more weight — say, 15 pounds versus 10 — than
those who only dieted, according to a study done by GlaxoSmithKline
(GSK) Consumer Healthcare, the drug's manufacturer. It also appeared to
inspire positive lifestyle changes: "We found that 80 percent of
Alli-takers really stuck to a reduced-fat diet, and 50 percent started
exercising for longer periods of time," says Vidhu Bansal, director of
Medical Affairs at GSK Consumer Healthcare. A starter pack of Alli —
which includes a month's supply of pills, a dietary guidelines guide, a
calorie and fat counter, and a food journal — costs about $54.
THE RISKS: If you eat too much fat (more than 30 percent of your
calories, or roughly 15 grams of fat per meal), you'll likely experience
loose, oily stools, since the excess fat that is blocked from
absorption is quickly excreted. "My patients on Xenical often find that
when they eat a high-fat meal, several hours later they may have
diarrhea or loose stools. In extreme cases, they can't control their
bowels — they'll leak all over their pants," says Caroline Cederquist,
M.D., a spokesperson for the American Society of Bariatric Physicians
(ASBP). (People who took Alli were less likely to experience these side
effects.) Taking either drug may also put you at risk for vitamin loss.
"You need enough fat in your diet to absorb fat-soluble vitamins such as
A and D," adds Loren Wissner Greene, M.D., an obesity specialist at the
New York University School of Medicine in New York City.
IS THIS PILL FOR YOU? Alli is intended for people who are
overweight, generally defined as those with a body mass index (BMI) — a
measure of body fat based on height and weight — of at least 25. (You
can calculate your BMI at nhlbisupport.com/bmi.)
"Alli, like Xenical, will be useful for people who eat out often and
don't have much control over the amount of fat they are served," says
Cederquist. "So if you eat more fat than you intended, you'll get rid of
it." The drug also works as a splurge deterrent — the side effects are
so unpleasant that you'll want to avoid fatty foods. But experts do have
fears about misuse: "I worry that a slim woman who just wants to lose 5
pounds to fit into her bikini will use it as a way to eat anything she
wants while still getting skinnied up," says Greene. The problem with
this? A normal-weight woman who takes Alli places herself at an
unnecessary risk of suffering side effects such as loss of bowel control
and vitamin loss, whereas for an overweight woman, the health risks of
carrying around extra pounds — such as heart disease and diabetes — may
outweigh these side effects.
Meridia (sibutramine)
THE SKINNY: This prescription weight-loss drug acts on the
brain's appetite-control center to make you feel fuller faster — so
you'll likely eat less, says Madelyn Fernstrom, Ph.D., of the Weight
Management Center at the University of Pittsburgh Medical Center. It
works by altering levels of serotonin and norepinephrine, two chemicals
that help regulate satiety. People on sibutramine lost about 10 pounds
more in a year than those taking a placebo, according to a study review.
THE RISKS: Meridia can raise blood pressure, increasing the risk
of heart attack or stroke. In fact, it was temporarily banned in Italy,
after 50 adverse reactions. And in 2002, the nonprofit group Public
Citizen petitioned the FDA to ban it in the United States, citing
evidence that Meridia was associated with 29 deaths and hundreds of
reactions such as rapid heart rate, high blood pressure, and heart
palpitations. The FDA stated that while it wouldn't ban the drug, it
would monitor the pill's safety. (Abbott, Meridia's manufacturer,
maintains that the drug is safe, based on clinical trials of more than
12,000 patients.)
IS THIS PILL FOR YOU? Meridia is approved for obese people
(having a BMI of 30 or higher) and those who are overweight (with a BMI
of 27 or higher) who also have other health risk factors such as
diabetes or high cholesterol. (Meridia may help these conditions by
facilitating weight loss.) "It's most effective in people who complain
of never feeling full," says Fernstrom. "It takes away that
bottomless-pit feeling." Since Meridia may increase blood pressure, some
doctors prescribe it to those under the age of 40 with no other heart
disease risk factors. "I'll put patients on Meridia — but I'll check
their blood pressure once or twice a month," says Michael Steelman,
M.D., a spokesperson for the ASBP. "I also often lower the dose
initially to reduce side effects."
The drug isn't cheap — it's about $120 per month. And Meridia, like
other diet drugs, often isn't covered by insurance. As a result, some
doctors prescribe antidepressants such as Effexor, Cymbalta, or
Wellbutrin instead, since they also work by altering brain chemical
levels and are more likely to be covered by insurance. But
antidepressants might not have the exact same effect: "They help ease
any depression that may cause overeating, but they won't necessarily
control cravings," says Fernstrom.
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