Weight loss center pinning hopes for fat profits on diet drugs – and doctors hired to prescribe them on demand.
So. You’re determined to lose those 20 pounds this year. Okay, maybe a little more. Really. Once and for all.
You go to your friendly family doctor, who’s been badgering you for years to gets those pounds off with diet and exercise.
You explain that you’ve tried. And tried. And tried. You beg for some of those trendy prescription diet pills like the recently-approved Redux or the two-drug combo “fen/phen.”
To your dismay, your doctor says no, you’re not that fat – you don’t have a body mass index, or BMI, of 30 or more.
Not fat enough? With 300,000 Americans dying every year from obesity and you on your way to joining them? With everyone from your once-favorite doctor to your nearest and dearest begging you to slim down lest you face some medical disaster?
Vowing to get your pills elsewhere, you march straight to the nearest Jenny Craig, Diet Workshop, or Nutri/System center.
The question is, should you?
Weeeellll, maybe. But there are a few things that you, or any other frustrated, well-padded American, should know about the commercial weight loss industry before you plunk down your hard-earned bucks – usually hundreds of them. Such as:
The desperation factor – theirs, not yours. The commercial weight loss industry has been struggling for years because of public discouragement about dieting and consumer resistance to the high price of programs, says industry analyst John LaRosa, director of Marketdata Enterprises, Inc. in Tampa.
And that means that the big chains are extremely eager – caveat emptor – to woo customers back. And, like you, they are pinning many of their hopes on diet pills.
So far, Weight Watchers International, Inc., the industry leader, has resisted jumping on the pill mill bandwagon because, as spokeswoman Linda Carilli puts it, “We are not a medical organization. Our primary focus is on behavior modification and it will continue to be that.”
But the other big chains have no such qualms. Jenny Craig, Nutri/System and Diet Workshop have recently added diet pills to their programs and hired doctors to dispense them. Locally, centers like Doctors Weightloss Program and Medical Weight Loss Center have also sprung up to meet the consumer demand for the newly respectable weight loss drugs.
Misleading ads. The Federal Trade Commission doesn’t believe ads that say or imply you can lose lots of weight fast and keep it off – with or without pills – and neither should you. That goes double for ads that make you think that pills alone – without exercise and better eating habits – will work.
A case in point: One ad for the Medical Weight Loss Center in Chestnut Hill, which runs regularly in the Globe, touts “Hot New Diet Pills! Fen/Phen & Redux. Lose 20 lbs in 4 weeks.”
“There is absolutely no evidence in the medical literature that people can lose 20 pounds of body fat in four weeks safely on these drugs,” says Dr. George Blackburn, medical director of the center for the study of nutrition and medicine at Beth Israel Deaconess Medical Center. You might lose 20 pounds if you were severely obese, he says, but it would be water, not fat.
In recent years, the FTC has cracked down on misleading advertising, forcing Diet Workshop, Nutri/System and Physicians Weight Loss Centers, among others, to change some ads. Complaints are still pending against Weight Watchers and Jenny Craig, says FTC spokeswoman Mary Haley.
So if the ads tempt you, keep in mind this reasonable expectation: If you take the pills and stick to a behavior modification and exercise program, you’ll probably lose about 10 percent of your body weight, then level off.
There certainly are medical benefits to be had from losing even just 5 percent of body weight, Blackburn notes, but it is “rare indeed” for people to lose more than 10 percent, and many regain weight when they stop the pills. Although Redux is approved for long-term use, there are no data on its safety for more than one year.
Pre-signed prescriptions. You might think you could assure yourself decent medical care if you picked a weight loss center with a medical-sounding name, and there are plenty to choose from, including Medical Weight Loss Center, Doctors Weight Loss Program and Physicians Weight Care Associates.
But that is not necessarily the case. In fact, a major problem occurred in just such a center, Medical Weight Loss Center in Chestnut Hill.
Last fall, WBZ-TV 4’s Liz Walker caught Dr. Richard Cohen of that center using pre-signed prescriptions for diet pills, which nurse-practitioners then handed out to patients. The center also prescribed diet drugs for a WBZ producer who had been told by Blackburn that she did not need them.
It is against federal Drug Enforcement Administration guidelines to pre-sign prescriptions. In a recent interview, Cohen said, “I did it because I didn’t know you weren’t supposed to.”
He added that he was “just trying to do the best for people. What I did was technically not proper, but it had nothing to do with their care.” Cohen added that he no longer pre-signs prescriptions and tries to individualize care. But he remains under investigation by the Board of Registration in Medicine.
Outside the commercial diet centers, many doctors acknowledge that patient demand for pills is growing – and hard to resist.
Dr. William Dietz, director of clinical nutrition at Boston Floating Hospital at the New England Medical Center, worries about the ease with which patients get pills at some centers.
“It certainly is a bad idea,” he says, for doctors to prescribe diet pills “without a review of whether a patient needs it or whether a patient needs to lose only five pounds.”
Dr. Carl Aselton, a general practitioner in rural Maine, echoes that, but he acknowledges that some patients “get mad” when he refuses to write diet pill prescriptions. “My wife, my secretary and my nurse all bring up the question, too.”
Some doctors in commercial weight loss centers insist they do screen patients and prescribe pills only when they are medically necessary, that is, when a person has a body mass index of 30 or more or has obesity-related medical problems and a BMI of 27.
One of those is Dr. Robert Nierman, medical director of the Doctors Weightloss Program in Lexington. He insists that some centers are not truly “physician-based,” but his is.
“Ninety-five of people on medications are seen by me each time,” he says. “This is a legitimate medical practice with a large volume. It’s not a business, it’s a practice.”
Still, the mere idea of being hired by a commercial weight loss center to prescribe diet pills is anathema to many doctors.
Dr. Richard Levy,, an internist and emergency medicine physician at the Boston Veterans Administration Medical Center in Jamaica Plain, was recruited recently by a representative for Jenny Craig. He declined.
“I think in the hearts of most physicians, we don’t enter the profession to act as hired guns to write prescriptions for diet pills,” says Levy. “I think if somebody is hired specifically to promote prescriptions for a particular medication, they are already compromising themselves.”
- AS SALES SOAR, SO DO THE COMPLAINTS
Keith Van Gasken, 45, a Lynn man who works in a health management company, swears by fen/phen. He says it has helped him trim down to 195 pounds, from 270 a year ago.
The pills, which contain two drugs called fenfluramine and phentermine, are “an absolute godsend,” he says, because they curb his hunger so he can stick to his diet without much agony.
A different drug, Redux, gets raves from a 35-year-old Medford woman who requested anonymity because she is “very, very overweight.” She has lost 20 pounds in three months and hopes “to finally get the weight off and keep it off.”
Americans are in love, once again, with diet drugs – not the old addictive amphetamines that gave diet pills a bad name, but the current crop of non-addictive appetite suppressants.
Compared to their precedessors, these drugs, which also act on the brain and are considered controlled substances, are relatively safe. But as the popularity of diet pills soars, so do reports of side effects, some minor, some not.
Electronic chatters on American Online, for instance, trade worries about “phen brain,” or short-term memory loss.
“My first experience with this side effect was horrible,” complained one dieter. “It happened at about the five-week period on meds. I couldn’t find my accordion file that held my checkbook and billing statements, which I am usually extremely organized with. By the time I located it, the bills were all past due.”
Others complain of unusually vivid dreams, hair loss, heavy menstrual periods and mood changes, such as becoming, as one writer put it, “incredibly depressed and crabby.”
Redux, too, gets its share of complaints, including dry mouth, mild drowsiness and diarrhea. Except for dry mouth, these usually subside in a few days.
But both Redux and fen/phen also raise the risk of a more serious side effect, pulmonary hypertension, which can be fatal.
In August, European researchers reported in the New England Journal of Medicine that dexfenfluramine (a molecule in both Redux and fen/phen) increases the risk of this condition, in which blood vessels to the lungs become thickened and scarred.
The risk is 23 times higher in patients using diet drugs for three months or more. But because pulmonary hypertension is rare, even this means only 28 of every million people taking dexfenfluramine will get the lung problems every year.
Even so, some people on diet drugs get so worried they rush to the emergency room when they needn’t, says Dr. George Blackburn, medical director of the center for the study of nutrition and medicine at Beth Israel Deaconess Medical Center.
Their fears could hardly have been helped by the credibility problem that developed when it turned out that two authors of an editorial in the New England Journal of Medicine, which was favorable to diet drugs, had been paid consultants to companies that stood to gain from robust sales. The Journal apologized for the mess in October.
Still, worries about side effects haven’t dampened sales. Just seven months after its approval by the Food and Drug Administration, Redux has captured 11 percent of the market with 2.4 million prescriptions to date, though sales have leveled off recently, says Bill Noonan, a spokesman for IMS America, a firm that tracks pharmaceutical sales.
Fenfluramine and phentermine, which have been on the market separately for decades but are not FDA-approved for combination use, are doing well, too, boosted by a 1992 study showing the potency of the pairing. Two generic versions of phentermine alone accounted for 11 million prescriptions last year.
That’s because the pills really work, at least for the first six months. After that, weight loss mysteriously tapers off.
Both Redux and fen/phen work by acting in the brain to reduce carbohydrate craving, says Judith Wurtman,, a cognitive scientist at the Massachusetts Institute of Technology and co-inventor of Redux.
Specifically, dexfenfluramine boosts the activity of a brain chemical called serotonin, she notes, adding that a serotonin deficiency underlies both carbohydrate craving and depression.
In fact, researchers have wondered whether anti-depressant drugs like Prozac, called SSRIs or selective serotonin reuptake inhibitors, might also help people lose weight. But they don’t – and the FDA warns ary control with helping him lose 75 pounds, agrees.
Diet pills “can be powerful tools but only if you do the behavioral stuff, too,” he says. “If you don’t, I’d recommend that you don’t even start.”
People who need to lose 55 to 90 pounds who are interested in participating in a free, 12-month study on Redux at MIT may call 617-253-3437.
- Body mass index
To learn your body mass index click HERE to visit the National Institute of Health web site. Just follow the directions and enter your height and weight, then click the Conpute BMI button.
- Are you overweight?
There are various ways to gauge whether you are overweight, but one of the best is the body mass index, which uses a formula that takes into account both height and weight.
In general, if you are 35 or older, you are considered obese if you have a BMI of 27 or more. If you are younger, a BMI of 25 or more indicates obesity. To qualify for Redux or fen/phen you should have a BMI of 30 or more, or a BMI of 27 along with health problems like diabetes or high blood pressure.
These rules of thumb are not absolute. If you are a body builder with lots of muscle and no fat, you can have a high BMI and still be healthy. On the other hand, a BMI as low as 25 can elevate your risk of diabetes or heart disease, notes Dr. William Dietz, a nutritionist at New England Medical Center.
If your BMI is high, do something about it, but take comfort in the fact that you are not alone. Based on a BMI of 25, half the country is overweight; based on a BMI of 27, one third is.
Some doctors and commercial weight loss centers also use body fat analysis to gauge who should qualify for weight loss drugs. According to the National Institutes of Health, women are considered obese if they have more than 30 percent body fat, and men, more than 25 percent fat.
But it can be difficult to measure body fat accurately, so beware of any center that tells you your BMI is okay but that you qualify for drugs only on the basis of body fat analysis.