Given the ballooning epidemic that is obesity in the UK and many other western countries, it is hardly surprising that various educational interventions are failing disastrously. Given this, the figures quoted for those who will be eligible for bariatric surgery is astonishing, but again, not surprising.
But there is an obvious medical intervention which is conspicuous by its absence which lies somewhere between the poles of health promotion and invasive surgery--drugs.
Sadly, this is one area of pharmacological advances which has consistently failed to deliver results. There is a long history of drugs which have made it to market, and indeed to be relatively effective with respect to assisting weight loss, but which have ultimately been found to be have life-threatening potential complications.
The serotonin enhancing agent, fenfluramine, was marketed in the US in 1973. It became extremely popular, particularly in combination with a noradrenaline reuptake inhibitor called phentermine (combination was marketed as Fen-Phen). After thousands upon thousands of prescriptions were issued in the US and across the world, fenfluramine was discovered to precipitate cases of valvular heart disease and pulmonary hypertension. In one study which assessed ex-users of the drug, 20% of women and 12% of men were found to have valvular damage.
The amphetamine like drug, Phenylpropanolamine, had been marketed since the 1960s, and indeed was available over-the-counter in many countries as a diet aid. It was withdrawn from the market in most countries in 2001 after it was found to be associated with a significant risk of haemorrhagic stroke.
The cannabinoid receptor (CB1) antagonist, Rimonabant, was marketed in 2006, only to be withdrawn in 2009, after studies linked it to serious psychiatric complications, including suicidality.
The serotonin and noradrenaline reuptake inhibitor, Sibutramine, was the most recent culprit. It was marketed in, only to be withdrawn from most countries in 2010 after evidence suggested it was associated with a raised incidence of cardiovascular events, including myocardial infarction and CVA.
Such has been the failure of producing an effective AND safe appetite-suppressing anti-obesity agent, that we are only left with the lipase inhibitor, Orlistat, a drug with it's own unpleasant, if not life-threatening side-effects. This year will see the re-introduction of Phentermine, this time in combination with the anticonvulsant, Topiramate (it received FDA approval in July last year). Only time will tell whether it proves to be a safe anorectic agent. If it does, it would offer a valuable option prior to having to resort to serious surgical intervention. Fingers crossed.
Competing interests:
No competing interests
13 March 2013
Aashish Tagore
SpR Psychiatry
Mersey Deanery
Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL
Rapid Response:
Re: Getting serious about obesity
Given the ballooning epidemic that is obesity in the UK and many other western countries, it is hardly surprising that various educational interventions are failing disastrously. Given this, the figures quoted for those who will be eligible for bariatric surgery is astonishing, but again, not surprising.
But there is an obvious medical intervention which is conspicuous by its absence which lies somewhere between the poles of health promotion and invasive surgery--drugs.
Sadly, this is one area of pharmacological advances which has consistently failed to deliver results. There is a long history of drugs which have made it to market, and indeed to be relatively effective with respect to assisting weight loss, but which have ultimately been found to be have life-threatening potential complications.
The serotonin enhancing agent, fenfluramine, was marketed in the US in 1973. It became extremely popular, particularly in combination with a noradrenaline reuptake inhibitor called phentermine (combination was marketed as Fen-Phen). After thousands upon thousands of prescriptions were issued in the US and across the world, fenfluramine was discovered to precipitate cases of valvular heart disease and pulmonary hypertension. In one study which assessed ex-users of the drug, 20% of women and 12% of men were found to have valvular damage.
The amphetamine like drug, Phenylpropanolamine, had been marketed since the 1960s, and indeed was available over-the-counter in many countries as a diet aid. It was withdrawn from the market in most countries in 2001 after it was found to be associated with a significant risk of haemorrhagic stroke.
The cannabinoid receptor (CB1) antagonist, Rimonabant, was marketed in 2006, only to be withdrawn in 2009, after studies linked it to serious psychiatric complications, including suicidality.
The serotonin and noradrenaline reuptake inhibitor, Sibutramine, was the most recent culprit. It was marketed in, only to be withdrawn from most countries in 2010 after evidence suggested it was associated with a raised incidence of cardiovascular events, including myocardial infarction and CVA.
Such has been the failure of producing an effective AND safe appetite-suppressing anti-obesity agent, that we are only left with the lipase inhibitor, Orlistat, a drug with it's own unpleasant, if not life-threatening side-effects. This year will see the re-introduction of Phentermine, this time in combination with the anticonvulsant, Topiramate (it received FDA approval in July last year). Only time will tell whether it proves to be a safe anorectic agent. If it does, it would offer a valuable option prior to having to resort to serious surgical intervention. Fingers crossed.
Competing interests: No competing interests