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Mon September 24, 2012
Two New Drugs May Help In Fight Against Obesity
Originally published on Tue September 25, 2012 9:59 am
The Food and Drug Administration approved two new medications this year to help obese and overweight individuals lose weight.
Diet drugs have been around in different forms for a while, but now researchers hope one of these two might actually help make a dent in the obesity epidemic.
Both of the drugs — Belviq and Qsymia — were approved in July. Belviq works in a similar way to the fen-phen appetite-suppression drug combination that was pulled from the market in 1997 because of a link to fatal heart valve problems. The new drug, at a lower dose, has been shown to be safe.
"Belviq was developed specifically to avoid the receptor on the heart valve which had been associated with heart damage, and there's no evidence in our research that heart valve problems will develop," says Dr. Donna Ryan, a researcher and obesity specialist at the Pennington Biomedical Research Center, which conducted studies of the two medications for the drug makers.
Qsymia is a time-released combination of two older medications: topiramate, an anti-seizure medicine, and phentermine, a stimulant. It is more powerful than Belviq but works in a similar way to stave off the body's "starvation response" to weight loss. Most of us who have tried to lose weight are familiar with that: Hormones are released to stimulate appetite, and metabolism slows down in order to conserve energy, adding up to an unfortunate recipe for regaining weight.
Dr. Judith Korner, an obesity specialist at New York's Columbia University Medical Center, says her patients know this well.
"I have one patient who came in and said he's lost the weight of a Volkswagen during his lifetime," she says. "It's like 2,000 pounds; he's lost 100 pounds and gained it back, and lost and regained."
Ryan says the drugs work to make you feel satisfied with less food — and not as hungry between meals.
"The medications are working through biology ... to reduce appetite and to diminish hunger," she says, adding that people still have to diet.
The drugs don't work magic in the body. They simply help people eat less.
"Patients must intentionally go on a diet, try to reduce food intake and increase physical activity," Ryan says.
The new prescription-only medications don't do anything to boost metabolism. Only exercise helps with that. There are side effects from the medications, including dry mouth, constipation and a slight tingling in fingers and toes.
But Qsymia can also have serious side effects. It can increase heart rate, and it can cause birth defects. So, women who want to become pregnant should stay away from the drug. Both drugs must be prescribed by a doctor. Women of childbearing age are advised not to become pregnant.
Belviq may interfere with treatments for migraine headache or depression. Patients should consult with their doctor to see if either drug is right for them. Neither is right for people "who want to lose weight for a wedding or get into their bikini for summer," Ryan says. They were approved to treat people who are obese (body mass index over 30) or who are overweight (body mass index over 27) and who suffer from at least one weight-related problem such as high blood pressure, cholesterol or blood sugar.
Decreasing blood sugar, in particular, says Ryan, is the drug's biggest benefit.
"We know if we can get that modest weight loss, we can prevent the development of Type 2 diabetes. Type 2 diabetes is a chronic disease, and it's reaching epidemic proportions in the United States, and we really need to get the jump on that," she says.
In studies, patients lost between 4 percent and 8 percent of their original body weight, and diabetes risk was reduced.
Korner says the new medications are a welcome option for her patients, most of whom do not want to have surgery to reduce the size of their stomach.
"We're slowly starting to come around to treat obesity as we treat other chronic diseases, just like we do for controlling blood pressure, cholesterol and a multitude of other diseases," she says.
But Cindy Pearson, with the National Women's Health Network, cautions that those benefits may not be enough to justify potential risks.
"Both of these drugs have met a very modest test of maybe around about 5 percent weight loss, and there's hope that over the long term, if you can maintain 5 percent weight loss, you would start to get some health benefit, but we actually don't know if that's true," she says.
Pearson says long-term studies are needed to ensure both drugs' safety.
"We really think women and all consumers deserve better information before these drugs are marketed widely," she says.
Qsymia became available this month, but only by mail-order. Belviq is expected to become available around the beginning of next year.
DAVID GREENE, HOST:
It's MORNING EDITION from NPR News. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep.
Today in Your Health, we'll look at grueling workouts for kids and ask if they're safe. We start with grownups looking to lose weight. There are two new medications coming to the market soon. NPR's Patti Neighmond asks who should take them and who should not.
PATTI NEIGHMOND, BYLINE: Most people who lose weight are pretty familiar with the body's frustrating starvation response - increase appetite, slow down metabolism, gain the weight back fast. Dr. Judith Korner is an obesity specialist at New York's Columbia University Medical Center.
DR. JUDITH KORNER: I have one patient who came in and said that he's lost the weight of a Volkswagen during his lifetime. It's like 2,000 pounds, you know. So he's lost 100 pounds and gained it back and lost and re-gained.
NEIGHMOND: A vicious cycle experienced by most of Korner's patients, including 65-year-old Barbara Robinson, who's 5-foot-2, 250 pounds.
BARBARA ROBINSON: I've been on Weight Watchers. I've been on Jenny Craig. I've been kind of creating my own kind of diet, being on my own. So I've been this journey before. This isn't my first rodeo, as they call it.
NEIGHMOND: Because Robinson's obese, she's a good candidate for the new weight loss medications. Dr. Donna Ryan is a researcher with Pennington Biomedical Research Center in Baton Rouge, where she's worked on a number of drug companies' studies of both medications.
DR. DONNA RYAN: The medications are working through biology. They're working to reduce appetite and to diminish hunger.
NEIGHMOND: The drugs don't work magic in the body. They simply help people eat less.
RYAN: Patients must intentionally go on a diet, try to reduce food intake and increase physical activity.
NEIGHMOND: The new medications don't boost metabolism. Only exercise does that. The brand names are Qsymia and Belviq. Qsymia's a time-released combination of two medications. Belviq is a lower dose single medication. Both have side effects, like dry mouth, constipation, a slight tingling in fingers and toes. But Qsymia can have serious side effects. It can increase heart rate and cause birth defects.
RYAN: So you absolutely do not want to become pregnant while you're taking Qsymia. It's important.
NEIGHMOND: Both drugs must be prescribed by a doctor. Women taking Qsymia are required to have a monthly pregnancy test.
Now, these drugs aren't for people who want to lose 15 pounds to fit into that bikini. They're for people who are obese or overweight, with a health problem like high blood pressure, cholesterol or blood sugar. And decreasing blood sugar, says Ryan, is the drug's biggest benefit.
RYAN: We know if we can get that modest weight loss, we can prevent the development of Type II diabetes. Type II diabetes is a chronic disease and it's reaching epidemic proportions in the United States. And we really need to get the jump on that.
NEIGHMOND: In studies, patients lost between 4 and 8 percent of their original body weight, and diabetes risk was reduced. But Cindy Pearson, with the National Women's Health Network, cautions those benefits may not be enough to justify potential risks.
CINDY PEARSON: Both of these drugs have met a very modest test of maybe around about 5 percent weight loss, and there's hope that over the long term, if you can maintain 5 percent weight loss, you would start to get some health benefit. But we actually don't know if that's true.
NEIGHMOND: Pearson says long-term studies are needed.
PEARSON: And we really think women and all consumers deserve better information before these drugs are marketed widely.
NEIGHMOND: Qsymia is expected to be available this month and Belviq around the beginning of next year.
Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.