New weight-loss pills come with warnings

Overweight people have dreamed for decades of taking off pounds by just taking a pill -- hopes that may have been heightened since a new generation of diet drugs recently hit the market.

Not so fast, say Long Island doctors who treat obesity and are familiar with the medications.

Like similar drugs of the past, these newcomers can cause serious side effects, should be used over the short term and may not work properly if taken without other weight-loss efforts, they say. And the drugs aren't appropriate for everyone, including those who take some other medications and those who have certain medical conditions.

"Many people think these are magic pills that should be used in lieu of diet and exercise," said Dr. Keneth Hall, a bariatric surgeon at Winthrop-University Hospital in Mineola. "That's far from the truth." However, he said, the medications can give people an "extra push" when they're starting to try to lose weight.

The two new medications, known by the brand names Belviq and Qsymia, are the first new weight-loss drugs to appear on the market in more than a decade. The U.S. Food and Drug Administration approved both last summer -- Belviq in June 2012, Qsymia in July. The drugs were approved for obese and overweight adults with other weight-related health conditions, such as hypertension, diabetes and high cholesterol, and for whom weight management is a chronic problem.

Side effects

In the past, obesity drugs have been withdrawn from the market because they turned out to cause severe side effects, said Dr. Kenneth Hupart, chief of the endocrinology, diabetes and metabolism division at Nassau University Medical Center in East Meadow. One obesity drug (known as Xenical or Alli) is still available but can cause diarrhea and bowel accidents if users eat high-fat foods, he said.

Belviq, a pill, "seems to work as an appetite suppressant without the side effects seen with other medications that also work by stimulating brain receptors," Hupart said. In research studies, he noted, people who took the drug lost six to eight pounds more over a year than dieters who didn't take it.

However, it comes with a long list of possible different side effects, including serious allergic reactions, fever, long-lasting erections, suicidal thoughts and more. It also can interact with drugs used to treat such conditions as depression, anxiety, erectile dysfunction and migraine. Pregnant women also are advised not to take it.

Qsymia, also a pill, combines a seizure medication that has weight-loss effects (topiramate) and an appetite suppressant (phentermine).

"The medication seems to cause greater weight loss than Belviq, but many of the study volunteers did not tolerate the medication and stopped taking it before the end of the study," Hupart said.

Qsymia also is accompanied by a list of side effects, including dangerously high blood pressure, severe back pain, and depression and suicidal thoughts. Those who are advised not to take it include people with glaucoma or thyroid problems, pregnant women and people who've recently taken an older type of antidepressant, known as monoamine oxidase inhibitors (MAOIs).

The drug doesn't cause as many cognitive problems as one of its components, phentermine, does on its own, said Dr. John Angstadt, a bariatric surgeon at St. Charles Hospital in Port Jefferson. Phentermine became known as the "stupid drug," he said, because it caused thinking problems that made people "feel like they weren't all there."

A jump start

Research has shown that it's crucial to diet and exercise while taking the new drugs, Angstadt said. But even a combination of one of the drugs and a routine weight-loss plan might not be enough to make people feel like they're progressing. "Most of my patients get frustrated with the modest weight loss," he said.

On the other hand, as a bariatric surgeon, Angstadt sees patients who are very obese. "I don't know that there's a big role for these medications for patients like mine, who need to lose 100 to 120 pounds," he said, but they may help give a "jump start" to those who are looking to drop 30 to 40 pounds.

Insurers don't always cover the drugs, and costs can run $150 to $200 a month or more.

Hupart said he's "proceeding cautiously" when it comes to prescribing the new drugs to his patients because major side effects may not become obvious for years.

"Doctors and patients should maintain a healthy skepticism," he said, "balancing the potential risks of new medicines against the potential benefit of weight loss."