nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Saturday, October 9, 2010

FDA Withdraws Obesity Drug: Thoughts On 30 Years Treating Overweight Patients

The FDA decided that, on balance, the modest weight reduction didn't justify the low incidence of heart risk.

As we learn more and more about drugs we are able to better define "benefit" and uncover one-in-a-million level "risk."  I predict we'll see more and more of these complex situations where there is no black-and-white solution.

But the request to Abbott (the manufacturer) by the FDA to stop marketing the anti-obesity drug, Meridia, culminates a long battle over this drug, and illustrates one aspect of our search for a reliable, long-lasting, and safe treatment for obesity.  We aint got one.

Over the last 3 decades of clinical practice, I've found obesity to be one of the most difficult conditions to treat....actually, "treatment" is not the term, maybe "influence" is the right word.  If I could influence the development or persistence of obesity, I would be happy.

But I admit it's been a losing battle.  Every modality has been tried, and most are still going strong:  (1) drugs, (2) liposuction, (3) bariatric surgery (banding the stomach), (4) psychotherapy, (5) behavioral conditioning, (6) diets (Lord...the diets), (7) calorie labelling, (8) restricting foods in schools, (9) dietary laws (10) nurtritional counselling, (11) herbals (all crap)....and on and on.

The percentage of overweight citizens continues to grow.  In medical school we were taught that the "cure rate" for obesity was lower than that for cancer; in a sense thats true.

I almost never used drugs for my patients.  When Meridia came out, I prescribed it a handful of times, then quit.  I think the approach is wrong, even as a "stimulus" or "kick start" to further behavioral change.  There were too many side effects (blurred vision was most common in my experience), and any weight loss didn't persist.

Our bodies were engineered to survive with a subsistence diet.  We never adapted to abundance.  So, there's a physiological roadblock to success in weight loss.

Psychologically--in my experience--my overweight patients were stressed, or depressed, or unhappy, or trapped, or had lost faith.  In a word, it was a loss of well-being.  Without waxing philosophical, there was always an element of "what's the point?" to their struggles.  They were desperate to find an external fix to an internal problem.

By contrast, those rare successful cases (I mean keep it off for the rest of their life) all had a sense of purpose, self-direction, and optimism.  They couldn't be diverted to comfort food, or pleasure-eating, because their lives were filled with other engaging and fulfilling things.

That's why I don't think all those diets and pills and surgery will ever really succeed.

It's about building a life that means something.

Doc D

UPDATE:  You understand, of course, that I'm not talking about people who have another disease that causes obesity, or a genetic defect, one component of which is obesity.  I'm talking about garden variety overweight.

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