Use Obesity Drugs Long-Term

OB/GYN News, Oct 15, 1999

Prescribing medications to combat obesity is not a short-term proposition.

"Patients tell me over and over that they just want something to jump-start their weight loss and then they'll stay on their diet. That never happens," Dr. Daniel Bessesen said at the annual meeting of the Endocrine Society in San Diego.

Obesity is a chronic condition. If patients buy into a medication, they're buying into 3-6 months of therapy to see if it works. If it does, then they have to buy into long-term, perhaps lifelong treatment. If they stop the drug, the weight goes back up, said Dr. Bessesen of the University of Colorado Health Sciences Center in Denver.

It's important to alert patients that the safety of taking prescription weight-loss drugs such as phentermine, sibutramine, and orlistat for 10-20 years is still unknown. But if patients will sign a consent form to accept this risk, along with other limitations of these agents, he is willing to prescribe them long term, Dr. Bessesen said.

Among the other limitations is that the weight loss, if it occurs, will be modest at best. Even the most effective diet, exercise, or drug treatment programs available will give roughly an average long-term 10% weight loss in most individuals, he noted.

Once patients lose the poundage and reach a plateau in their weight, they often regain a slight amount of weight with time even though they continue to take the medications. That's because of the age-related weight gain that most people experience, he said.