Health – No quick fix for weight loss

Weight loss medications have a chequered history. Most of them have turned out to be useless, dangerous or uncomfortable in the extreme. 

My particular favourite was the craze for mail order tapeworms, as shown by magazine ads from 100 years ago (and some modern internet ones). Nobody really knows if they worked, or even if there was an active organism in the capsules, but it goes to show how far people will go in search of ‘the body beautiful’. 

When I first qualified, Xenicalwas being promoted. This worked by blocking fat absorption in the gut, therefore reducing total calorie intake. The irony was that it was meant to be used with a “low fat, calorie-controlled diet”. In any case, the side effects were so disgusting, namely loose oily motions and wind, that almost nobody carried on with it. 

Then came Ponderax, which was withdrawn after a few years because it caused heart problems. Likewise, Reductil. In fact, a recent study showed no less than 25 diet medications were taken off the market between 1964 and 2009, though to be fair during that time the drug companies were getting spooked and took defensive action even if there were only a few case reports of adverse effects.

One can understand, then, a degree of scepticism about any new product which comes on the scene. But, with an obesity epidemic in most developed countries, there is an ongoing demand for the holy grail of an effective diet pill, preferably one which is also safe, affordable and convenient. 

The latest candidates are Saxendra (liraglutide) and Contrave, which is a combination of naltrexone and bupropion. Saxendra is given as a daily injection whereas Contrave is in tablet form. They can both achieve a weight loss of 5-10 percent over a four-month period but for many patients cost will be a barrier at a RRP of $499 per month and $240 per month respectively. 

The real survivor in this field is Duromine, a 40-year veteran drug in NZ, though it is not approved in some other countries. I find it a reasonable option, well tolerated and capable of “kickstarting” weight loss for a motivated patient. However, it’s important to see it as a short-term intervention and to have a reasonable expectation of modest weight loss over a three-month course. Without lifestyle changes, unfortunately, most people drift back to their original weight after they stop this medication. There is also a cost factor– approximately $80 per month, although it varies between pharmacists. 

This brings us back to the fact that weight loss is not easy. There is a many a time that my resolve to eat less on a particular day failed by morning tea-time, particularly if gingernuts were involved! There has to be a commitment to a long-term change in dietary habits, plus the hard work of things like exercise, all of which need to be supported (or at least not sabotaged) by cultural pressures. 

Our relationship with food is complex, including emotional, social and physiological elements. Not something a pill can fix, usually.