In the last few months, the FDA has approved two new drugs to treat obesity: Belviq and Qsymia. These two drugs are the first weight-loss drugs to be approved by the government agency in more than 13 years. So in the prescription drug world, it's a pretty big deal. But what are the pros and cons of these two weight-loss drugs? Who are they intended for? Do they work? And are they safe?
Although the drugs are being marketed to the same patient population — obese patients with a BMI over 30 or overweight patients with a BMI over 27 who have weight-related diseases such as diabetes or hypertension —Dr. Tania Dempsey of Armonk Integrative Medicine in Armonk, New York, says that the two drugs are quite different.
"It is important to understand how they work because there are associated side effects, and patients need to be screened carefully before being prescribed either of these drugs," she says.
Belviq, which was approved last month by the FDA, works as an appetite suppressant by working on one of the serotonin receptors in the brain. Because of this, the drug needs to be taken with caution in patients taking other drugs that effect serotonin levels, such as anti-depressants, as the combination could lead to serotonin syndrome — a life-threatening condition caused by very high serotonin levels, Dempsey says.
"In clinical trials, patients lost about 5 percent of their weight after a year, which averaged out to be about 12 pounds, which is really inconsequential when you look at most obese patients who need to lose 50 pounds or more," she says. "And there are some concerns regarding side effects, which include memory issues, depression and migraines."
Qsymia, which was just approved by the FDA last week, is a combination drug of phentermine and topiramate. It is thought to work by both suppressing the appetite and increasing the sense of fullness. In clinical trials, Qsymia resulted in a 10 percent weight loss, making it possibly more effective than Belviq. However, there may be even more concerns regarding safety. Qsymia's side effects can include cause depression and suicidal thoughts, as well as impaired cognitive function, Dempsey says.
"One of the components, phentermine, is an amphetamine and was part of the combination fen-phen until fenfluramine (the fen) was taken off the market. It has been associated with increased heart rate," she says. "The topiramate was initially FDA-approved for seizures and then migraines, and has been used off-label to help with weight loss. Topiramate is associated with birth defects, so women of childbearing years should not use this drug."
The two weight-loss drugs aren't cheap either. Both drugs will hit pharmacies later this year and their cost is expected to be about $100 to $200 a month.
Dempsey, who helps her patients lose weight by addressing the underlying issues that lead to obesity, such as food sensitivities, hormonal imbalances, heavy metal toxicities and changes in the normal bacteria of the gut, calls these drugs a "Band-Aid" approach to the obesity epidemic. She sometimes prescribes medications, but she says that it's rare that an appetite suppressant needs to be used if the problem causing the increased appetite is addressed first.
"So here we have two drugs that show modest affects on weight loss and have significant side effect potential and yet have sparked the interest among doctors and patients alike," she says. "The FDA does recommend that the drugs be used with diet and exercise, but the truth is that most patients, and even doctors, are not aware of the what the best diet and exercise regimen is and without focusing on that, we will never cure the obesity epidemic.
So the bottom line? These drugs result in moderate to minimal weight loss but aren't without their side effects. It's best to be informed and ask your doctor (who should preach the virtues of a healthy diet and exercise first!) to see what's right for you.
Would you ever take one of these weight-loss drugs? Do the side effects freak you out? Let's discuss!