
Diet Drugs Work: Why Won’t Doctors Prescribe Them? - dsr12
http://www.newyorker.com/online/blogs/elements/2013/12/diet-drugs-work-why-wont-doctors-prescribe-them.html
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spodek
More relevant questions:

\- Why don't we stop subsidizing corn so much?

\- Why don't we teach effective nutrition and cooking in school?

\- Why don't we teach effective exercise, sports, and fitness in schools?

\- If we can ban alcohol and tobacco sales to children, why not things like
added sugar, hydrogenated oils, corn syrup, etc?

\- If we can ban alcohol and tobacco advertising to children, why not products
with added sugar, hydrogenated oils, corn syrup, etc?

\- Why don't we limit advertising on fast and junk "food"?

\- Why don't we provide healthy lunches to school children instead of using
them to subsidize agricultural conglomerates for low quality food?

\- Why don't we stop subsidizing fossil fuels so much so people would walk and
ride bikes more?

\- Why don't we align our medical system with prevention instead of expensive
and risky cures?

You can come up with plenty more questions that would mostly obviate the need
to wonder about obesity and wonder drugs to cure it. The overwhelming majority
of people would benefit from changes in diet and exercise requiring no
chemicals needing FDA approval. Fresh fruits and vegetables seasoned with
fresh herbs and spices taste better than anything, at least to me, and it's
hard to eat too much of them. Few feelings feel better than the exhaustion of
even moderate exercise.

EDIT: reduced cynicism based on eli's welcome comment.

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tocomment
I've been looking for a way to make vegetables like brocoli or green beans
palatable. What's your secret?

~~~
nkoren
Two suggestions, slightly contradictory, but either will work:

1.) Spices. there are loads of really interesting, amazing spices out there,
but even a simple sautée of olive oil, lemon juice, garlic, salt, and black
pepper can make almost any vegetable taste amazing.

2.) Stop eating over-flavoured foods. Doritos etc. have a ridiculous amount of
flavouring; if you eat foods like this consistently then you'll desensitise
your palette to the subtler but still absolutely lovely tastes of vegetables,
in the same way that staring into a spotlight makes it difficult to appreciate
the aesthetic qualities of twilight. You can't re-sensitise your palette by
simply cutting down on hyperflavoured food; you need to eliminate it almost
completely. After a while, you'll discover that brocoli and green beans are
wonderful, and Doritos are absolutely brutal on the tongue.

~~~
visakanv
This is great advice, and worked for me beautifully since I stopped smoking
and started eating at home with my wife. +1

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7Figures2Commas
It's worth pointing out that "losing weight" isn't a panacea for health. Yes,
it would almost certainly be a very good thing for significantly overweight
and obese individuals to shed pounds, period, but the article doesn't address
the fact that in and of itself this is unlikely to make them "healthy."

There are _lots_ of people who are _not_ overweight who have many of the same
cardiovascular issues commonly associated with obesity (high cholesterol and
blood pressure, insulin resistance, etc.).

If the goal is overall health and well-being, the title of this article is
arguably misleading. Diet drugs might "work" when it comes to weight
reduction, but it would be unrealistic to ignore the fact that without real
lifestyle changes (diet, exercise), many of those who use them will likely be
plagued by the same serious health issues.

~~~
Killah911
Finally a well thought out comment. One of the big issues I see with obesity
is that the problem is oversimplified, as are the solutions. I know of several
people on whom counter-obesity problems have had a significantly detrimental
effect.

I've seen ineffective gastric bypass surgery which led to a friend gaining
even more weight and watched helplessly as he slipped into a very depressed
and negative state. As the article points out, if someone said there's a drug
that just cures cancer it would be laughable. It is indeed so with weight
loss. Phentermine will have minor side effects with impulse control,
addiction, paranoia etc.

Interestingly enough, obesity is typically not associated with the "poor" in
the rest of the world. I have often heard it mentioned as an anecdote to how
"wealthy" Americans really are. But therein lies a very interesting problem to
which I simply haven't seen a very good answer. Unfortunately the sigtma
associated with obesity and the well entrenched and highly profitable "weight-
loss" industry gets in the way of significant advances being made in this
arena. Again, as is mentioned in the article, there is even a stigma
associated with "diet doctors", which surely has dissuaded more than a few
brilliant minds to explore the field more.

Ofcourse, as a programmer who is very familiar with a sedentary lifestyle and
the pizza culture, obesity is a serious issues that does affect more than just
the poor. And for crying out loud, I hope someone figures out more about it
than pseudo science of obesity we have now. It's not as simple as it looks at
first glance.

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brianbreslin
This is an interesting issue. If you're morbidly obese, a 5-10% reduction in
weight could add up to significant LBs/KGs lost. So it would seem to me like
this would be a great way to jumpstart and re-enforce the other aspects of
weight loss. Many people give up because they don't see results fast enough.

So much of weight loss is mis-understood, but a lot of it boils down to
convenience, will power (choosing to resist going through McDonalds drive
thru), food choices (i.e. I don't know how to cook, and no healthy options are
affordable and quick).

I am a firm believer that weight loss is 75+% diet, and the rest exercise
(disclaimer: I lost 30lbs [17% bodyweight] doing the 4 hour body diet).

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cLeEOGPw
I have the opposite problem - can't gain weight. Doesn't matter if I eat more
or less, what kind of food, how many times a day and if I am training or not -
it just stays the same no matter what. Recently it's been even worse - a
simple 2 hour exercise would leave me with -1 kg and I had to wait like 4 days
to gain back that 1 kg lost in one exercise. I think the hormones almost
singlehandedly decides what you look like. I knew people that were obese and
gained weight simply by drinking water and not eating anything. I thought
maybe "survival instinct" would help me gain at least fat, where it supposedly
activates when you are eating very little, and that is supposed to be the
reason why not eating does not help fat people lose weight, but my weight even
then just stays the same. I occasionally go for a whole day without eating
(not intentionally) and never start to gain fat. It's really frustrating.
Sometimes I just wish I could be fat and just go to gym.

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johnward
Honestly most people I know who say they have this problem aren't eating as
much as they believe. We call these people "hard gainers". If you have that
much trouble gaining weight then try eating 6000 calories a day and tell me
you don't put on any weight.

~~~
cLeEOGPw
Honestly the problem is I don't have time to eat that much. I'd have to devote
all the time to this single one activity - eating, making food and thinking
what to eat next. Others just live eating same as me and gain weight no
problem. Besides, if there's not enough growth hormones in the blood, you can
eat as much as you want, nothing will stay in your body.

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pessimizer
Because they "cause side effects and yield undramatic results."

Doctors are protected from the consequences of prescribing statins and SSRIs
because everybody else does it too. If you could get a critical mass of them
to start prescribing diet pills by directly generating consumer demand, the
floodgates would open. We're one good advertising campaign from everybody 5%
overweight having a bottle in the bathroom - of a 'new' formulation of course,
because I'm sure a lot of these are going out of patent.

Then we'll find out that they really don't work any better than placebo and
cause nerve damage, but the lawsuits will drag until all patents expire.

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power2u
>The drugs work by suppressing appetite, by increasing metabolism, and by
other mechanisms that are not yet fully understood.

Why would FDA approve something which it we don't fully understand?

~~~
pgrote
There are many drugs where this is true. Antidepressants, especially.

[http://en.wikipedia.org/wiki/Pharmacology_of_antidepressants](http://en.wikipedia.org/wiki/Pharmacology_of_antidepressants)

~~~
johnward
I was going to say this. Most antidepressants are not really understood. Also
I have central sleep apnea (brain forgets to breath when sleeping). They give
me a machine but they don't know exactly why the machine helps but it does.
It's approved for use.

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riahi
Another reason that's not touched upon in the article is that many of these
drugs are Schedule IV drugs. While prescribing a Schedule IV isn't
theoretically more onerous than prescribing antibiotics, often pharmacy
chains, insurances, and the government can combine to make busy primary care
doctors less likely to prescribe them.

I know many a PCP that rage at the fact that Phentermine is schedule IV, which
adds extra complexity to prescribing it.

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refurb
If you want to see a biotech start-up working on a very interesting obesity
drug, check out [http://zafgen.com/](http://zafgen.com/)

They just release the results from their Phase 2a trial and results are
amazing. After 12 weeks on the highest dose, patients lost an average of 24
lbs, which is competitive with bariatric surgery.

If the drug makes it to approval, it could be a real game changer for the
healthcare system.

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tocomment
Couldn't another part of the problem simply be lack of marketing for these
drugs?

Everyone is aware there are goto drugs to toenail fungus and restless leg
syndrome from all of the commercials. Shouldn't drugs like these that apply to
even more people be all over the airwaves?

~~~
rubberband
I suppose it is potentially, but I have to assume that the people in the
pharmaceutical industry understand which drugs they should market (and how,
and when) to make the most money. To me it seems that "diet drugs" would
basically print money from them, but my point is I believe there is a reason
for them doing what they are doing, and that if they calculated they would
make _that_ much money, you better believe that they would pour truckloads of
money into advertising.

Still, it just seems so odd, given the rather... large potential market.

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skittles
The answer is simple. A doctor won't be sued for not giving an obese person
diet pills. These drugs aren't very effective, and they have side effects such
as raising blood pressure. A typical doctor will just tell you to be more
active and eat less.

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gaius
Because there's nothing wrong. The ability to store energy as fat is a natural
survival mechanism. Your body doesn't care about looking good on the beach, it
knows that Winter Is Coming and it's tooling up to deal with it.

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wil421
Because the markets have been flooded with either snake oil products or
unproven chemicals like ephedra. Nothing is a replacement for diet and
exercise. Diet drugs should be used in _tandem_ with proper diet and exercise.

~~~
hackinthebochs
>Nothing is a replacement for diet and exercise.

I don't know why people say this. The benefits of exercise are simply
initiating biochemical processes that cause your body to grow and become more
efficient (drugs that target the SIRT1 gene are an example). There's
absolutely no reason why we can't develop drugs that initiate that same
process. Same goes for preventing fat accumulation. Claiming that there's no
substitute is a cop-out and its an unfounded assumption.

~~~
wil421
For some people its simply an over indulgence problem. You could easily
counter by saying why don't people just throw up after eating problem solved.
Yet in my experience quick fixes often have other consequences that may not be
immediately known. I don't believe you can simulate complex bio mechanical
processes like muscle tearing but you may be able to allow you body to be more
efficient when you do these things.

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tocomment
Would anyone be able to give or link to a summary of the four drugs it
mentions? How would a person evaluate which would be the best one to try?

~~~
memracom
Here is what Dr. Joel Fuhrman, M.D. has to say about weight loss:
[http://www.drfuhrman.com/weightloss/](http://www.drfuhrman.com/weightloss/)

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Dirlewanger
Articles like these are so sad to see. They're on the same level of reporting
how large the shit was of some celebrity's dog when a national crisis occurred
the day before. If journalism isn't dead it's certainly being slowly
strangled.

