Commonly asked questions & answers about obesity.

Q I've been overweight most of my adult life. I've heard there are medications you can take to help you lose weight. Do they work and are they safe?

A You are correct. There are several medications approved by the U.S. Food and Drug Administration for obesity, including Xenical (orlistat), and Meridia (sibutramine). Some antidepressants can also help with weight loss, as can stimulants like phentermine, dexamphetamine and methamphetamine. The drugs either help you reduce the amount of food you eat, alter your metabolism so you burn more calories, or increase the amount of energy you expend. Used properly in combination with lifestyle changes, including reducing calories and increasing physical activity, they are safe, although all have side effects. I think as we recognize that obesity is a disease, just like hypertension and low levels of HDL cholesterol (the "good" cholesterol), we're going to have to have the helping hand of medications to help people get to a healthier body weight. To remain there may require prolonged use for some people. As for which is the best ... just as there is no "best" diet, there is no "best" medication. It depends on the individual.

Q When should I consider taking a weight-loss medication?

A Just because you're overweight is no reason to start taking a medication. You have to consider your quality of life. How rested are you when you wake up in the morning? How energetic are you with your family, at work and at play? Clearly, if you're gaining weight--such as a five-pound weight gain when you're already obese--you should run, not walk, to talk to your doctor. Also make sure you talk to your doctor about the risks and benefits of any weight-related medication.

Q What about the weight loss surgery I've heard about?

A This is a serious surgery, although studies find it the most effective means of treating severe obesity. It involves restricting the storage capacity of the stomach (gastroplasty), using a band to divide the stomach into a small pouch and a large remnant (gastric banding), or altering the stomach to create a small pouch that prevents you from eating a large meal (gastric bypass). Several studies find that gastric bypass has the lowest rate of health risks. (25,26) Having had the surgery, however, patients have to take nutritional supplements and follow a strict eating plan for the rest of their lives. If you're interested in this procedure, you will have to undergo a comprehensive analysis by several health professionals, including a mental health therapist. Most centers won't do the surgery unless you are very obese (a BMI over 40) and have other weight-related conditions, like diabetes and hypertension.

--George L. Blackburn, MD, PhD

Associate Professor of Nutrition

Harvard Medical School

Boston, MA

References

25 Howard L, Malone M, Michalek A, et al. Gastric bypass and vertical banded gastroplasty-a prospective randomized comparison and 5-year follow-up. Obes Surg 1995;5:55-60.

26 Sugerman HJ, Londrey GL, Kellum JM, et al. Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment. Am J Surg 1989;157:93-102.