By Kathleen Goodwin, RD

Read the following pages/chapters in your text, Dieting For Dummies this week: Chapter 17-20, pages 201-247

Part Six, Weight Loss methods, continued

Currently available prescription diet medications

The FDA advises that you should have a BMI of at least 30 or more in order to take prescription weight loss medications. Since these medications have potential side effects, your potential health risks due to obesity need to outweigh the potential health risks of the side effects of the medications. These drugs are not to be taken by those with only a few pounds to lose. Most of these medications lose their effectiveness over time, so you must also follow a good diet and exercise program and learn behavior modification techniques while taking them.

1. Orlistat (trade name Xenical)

This drug reduces the amount of fat that the body absorbs by 30 percent. If you don't absorb fat, it doesn't provide any calories. The problem with fat not being absorbed, however, is that it must exit elsewhere. That's where the potential side effects of this medication come in - diarrhea and decreased absorption of the fat-soluble vitamins (A, D, E and K). Studies show that those taking orlistat can lose about 10 percent of their initial weight during the course of a year. It's not nirvana, but it can help in losing modest amounts of weight for those who qualify.

2. Sibutramine (trade name Meridia)

Sibutramine alters the levels of certain neurotransmitters in the brain, such as serotonin. It promotes reduced appetite and increased feelings of fullness. Studies show an average weight loss of about 10 percent of starting weight with this medication. It's no panacea, but it can help support weight loss on a good diet and exercise program. It can also help curb bothersome cravings. Common side effects of sibutramine are constipation, dry mouth, headache, and insomnia.

3. Phentermine/Mazindol/ Phendimetrazine

These medications are appetite suppressants that also alter levels of neurotransmitters in the brain. Because these medications are similar chemically to amphetamines, they have the potential for psychological dependency and should be used with caution. You might recall phentermine as the first half of the phen-fen combination. Many news reports mistakenly report that phen-fen has been taken off the market. What they really mean to say is that fenfluramine, (also known as pondimin or redux) the "fen" part of the drug combination, has been taken off the market. Phentermine, however, is still alive and well. According to studies, the best you can expect with these medications is a 5-15% weight loss from your original weight. Common side effects include nervousness, irritability, insomnia, dry mouth, and increased blood pressure.

4. Anti-depressants/Prozac

Some anti-depressant medications, particularly prozac, have been studied for their appetite suppressing effects. This is because these medications promote increased circulation of serotonin in the brain, which can cause increased feelings of fullness. The FDA has not approved the use of these medications specifically for weight loss. Still, some studies show that patients taking these anti-depressants experience modest amounts of weight loss for up to 6 months. Common side effects of prozac include drowsiness, nausea, restlessness, and tremors.

For additional information on drugs for obesity see the following article from TheDietChannel: Overview of Drugs & Surgeries for Treating Obesity.

Herbal and non-prescription weight loss preparations

Be aware of the following information about herbal preparations and nutritional supplements little known to the consumer:

• Unlike prescription medications, neither the Food and Drug Administration nor any other governing body oversees the manufacturing of these products. The supplement manufacturers currently have the advantage - their products don't have to be tested for their safety, quality, effectiveness, or appropriate dosage. The public tends to believe that over-the-counter herbal products and nutrition supplements have been researched, tested, and inspected.

• Many times, what the manufacturer claims is in the product is not actually present in the quantities labeled.
• Manufacturers do not have to fund studies to prove the effectiveness, side effects, or appropriate dosage of these products as manufacturers of medications do. Since studies can cost millions of dollars, and studies on “nutritional supplements” are not legally required, most manufacturers, for financial reasons, choose not to do studies. Those that do choose to conduct research, generally do "in-house" studies, which are not reliable. Independent organizations, not product manufacturers with a vested interest in the product, should conduct research on a product, in order for research to be valid. Many manufacturers rely on anecdotes from users who claim the product works. Anecdotes are not valid research. The manufacturers fail to tell you about any negative customer testimonials associated with the product or any potential side effects. They also fail to research the reason behind how the product works if it does appear to work or makes you feel better – many times the product “working” is due to significant pharmacological and physiological actions in the body which produce terrible long-term side effects. Many times, what makes us feel better (or in this case, lose weight) can take a terrible toll on the body in other ways (consider the "all natural" marijuana, and cocaine). Natural does not necessarily equal safe and harmless.
• You can't tell if one brand is superior to another unless studies are done to compare each product's effectiveness. Expensive brands do not guarantee quality, but they do fatten pocketbooks.
• Manufacturers can make numerous claims for what these products can do, even if research has never been done to substantiate the claim. Because various claims are legal to make, many manufacturers do make outrageous claims.
• The salespeople who promote these products generally have little to no medical or nutritional background, and cannot and do not offer sound advice about how the product works or its potential side effects.
• Due to strong public interest in natural remedies and herbs, we see more and more research done on these products, which is a very good thing. Many products show quite promising effects. On the other hand, many appear to be simply expensive, useless, and overly hyped. Of course, without the proper research done, you can't know the difference.

The following list describes some of the most common ingredients in many of today's marketed weight loss supplements:

• Ephedra (Ma Huang)
  The active ingredient in ephedra (also known as ma huang) is ephedrine, which is structurally similar to amphetamines. Ephedra has been linked to hundreds of incidents, including high blood pressure, abnormalities in heart rhythms, seizures, heart attacks, and even death. Some states have laws that ban the sale of ephedra because of its demonstrated serious side effects. Ephedra is in products such as metabolife and "herbal phen-fen."

• St. John's Wort
  Here's an example of an herbal preparation that actually has been researched extensively overseas in independent studies and shows promise. Studies show that St. John's Wort can raise serotonin levels and treat mild depression. But, if you don't suffer from depression-related weight gain, significant food cravings, or an alteration in serotonin levels, St. John's Wort might not help in your weight loss quest. Thus far, there have been few reports of weight loss associated with St. John's Wort. St. John's Wort has shown some side effects such as light sensitivity. St. John's Wort is the accompaniment to ephedra in "herbal phen-fen" preparations. Due to the side effects of ephedra, however, don't take this combination.
• Chromium Picolinate
  Despite the hype and claims, chromium picolinate is not a miracle pill that helps you lose weight, burn fat, and build muscle. It is a prime example of a supplement manufacturer extrapolating false theories from poorly done research and turning it into a weight loss panacea. Some flawed studies done in the 1990's suggested that chromium might help build muscle mass. From this research, the manufacturers extended the list of claims for what this supplement could do from metabolic rate increases to weight loss and beyond. This old research has since been shown to be inaccurate by better, more extensive studies. In order to put an end to the false claims touted by chromium picolinate manufacturers, the Federal Trade Commission (FTC) stepped in. The FTC ruled that companies that distribute chromium picolinate do not have sufficient scientific evidence to substantiate that chromium picolinate could increase metabolic rate, promote weight loss, or reduce body fat.
• Pyruvate
  The claims made about pyruvate run just as far and just as false as the claims for chromium picolinate. Again, it's a case of manufacturers' extrapolating from flawed research studies, inconclusive studies, or no studies at all to make a profit. No established connection exists between pyruvate and weight loss.
• Guarana
  Despite being touted as a metabolism booster and fat burner, Guarana's active ingredient is caffeine, which can cause a temporary increase in metabolic rate. Save your money and have some coffee instead.
• Phenylpropanolamine (PPA)
  Phenylpropanolamine (PPA) is the active ingredient found in over-the-counter weight loss pills like Dexatrim and Acutrim. PPA has been shown in studies to help increase weight loss but not significantly. In studies, PPA, along with diet and exercise increased weight loss by only an average of three pounds, compared to diet and exercise alone. Taking more than the recommended dosage has been linked to elevated blood pressure, stroke and heart palpitations. The FDA has now banned the use of PPA in over the counter remedies due to many potential documented serious side effects.
• Herbal weight loss teas/Senna
  Herbal teas, many of which contain senna, aloe, buckthorn, and other plant-derived laxatives, can cause diarrhea, vomiting, nausea, stomach cramps, chronic constipation, fainting, and even death if you take excessive amounts. These products that you can buy in health food stores and through mail-order catalogs, are used for weight loss based on some consumers' belief that increased bowel movements prevent absorption of calories, thus preventing weight gain. However, a special committee of the FDA concluded in 1995 that studies show that laxative-induced diarrhea does not significantly reduce absorption of calories. Laxatives do not work on the small intestine, where calories are absorbed, but rather on the colon, the lower end of the bowel.
• Chitosan/Chitin
  Chitosan is a fiber that comes from the skeletons of crabs and other crustaceans. Lately, there have been a slew of claims that chitosan "traps fat" and can help you lose weight. Some research on mice shows that chitosan can be helpful in reducing blood sugar and cholesterol levels. But, it does not show that it reduced the weight of obese mice. The European Journal of Clinical Nutrition printed an article that told of a well-controlled study of 34 overweight people. It showed no correlation between chitosan intake and weight loss. Thus, weight loss claims associated with this product appear to be unsubstantiated.

If a miracle pill existed, obesity rates would decline or at least remain the same. Keep this is mind next time you're tempted when you hear claims of easy, magic, quick weight loss. Be especially wary of the following claims for products:

• Fat burner/Burn fat/Fat trapper/Fat Blocker
• Quick and easy weight loss
• Secret formula or ancient formula
• Weight loss breakthrough or scientific breakthrough
• Weight Loss without dieting or exercise
• New revolutionary method
• "Secret," "magical," or "synergistic" ingredients

For further information on what to look out for when buying supplements see the following article from TheDietChannel: How to Protect Yourself When Purchasing Supplements and Herbal Supplements: General Info.

Activity for Part Six

Based on the reading in Part Six, answer the following questions for yourself.

• Which kinds of diet books or group diet programs have you tried in the past?

• What were your successes or failures with the programs or books you've tried? Could you keep the weight off permanently?
• What are some important questions you should ask before signing up for a group weight loss program?
• Are you considering trying out any over the counter or herbal weight-loss remedies? What do you know about these products? Is the source of information about these products reliable? What should you look for to know if the information you are getting is reliable? What kinds of credentials should you look for in those dispensing nutrition or weight loss advice?

Be sure that you are continuing on with your food diary and physical exercise goals this week and every week!

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