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Diet Drugs Work: Why Won’t Doctors Prescribe Them?

newyorker.com

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Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#3
post #2

>The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. Why would FDA approve something which it we don't fully understand?

We also don't understand the mechanisms of a very large number of the drugs we use (e.g. anesthetics).

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#4
post #2

>The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. Why would FDA approve something which it we don't fully understand?

Because you don't need to understand the mechanism of a drug to have a strong understanding of the effects of a drug. Numerous widely proscribed psychiatric drugs have at best conjectured mechanisms of action.

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#5
More relevant questions:

- Why don't we stop subsidizing corn so much?

- Why don't we teach effective nutrition and cooking in school?

- Why don't we teach effective exercise, sports, and fitness in schools?

- If we can ban alcohol and tobacco sales to children, why not things like added sugar, hydrogenated oils, corn syrup, etc?

- If we can ban alcohol and tobacco advertising to children, why not products with added sugar, hydrogenated oils, corn syrup, etc?

- Why don't we limit advertising on fast and junk "food"?

- Why don't we provide healthy lunches to school children instead of using them to subsidize agricultural conglomerates for low quality food?

- Why don't we stop subsidizing fossil fuels so much so people would walk and ride bikes more?

- Why don't we align our medical system with prevention instead of expensive and risky cures?

You can come up with plenty more questions that would mostly obviate the need to wonder about obesity and wonder drugs to cure it. The overwhelming majority of people would benefit from changes in diet and exercise requiring no chemicals needing FDA approval. Fresh fruits and vegetables seasoned with fresh herbs and spices taste better than anything, at least to me, and it's hard to eat too much of them. Few feelings feel better than the exhaustion of even moderate exercise.

EDIT: reduced cynicism based on eli's welcome comment.

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#6
post #2

>The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. Why would FDA approve something which it we don't fully understand?

I think you'd be shocked by how little we understand about the mechanism of action of a lot of the drugs out there.

The FDA's job is to ensure that approved drugs are (1) safe and (2) efficacious. Knowing the mechanism of action (MOA) of a drug can help further define the safety/efficacy parameters for a drug, but in it's absence you can still get a very good sense of the risk benefit analysis.

The best example of a lack of understanding of drug MOAs is Lyrica (epilepsy drug from Pfizer). The drug was designed to target the GABAase enzyme. It got approved and then several years later it was realized that the main MAO is the drug's impact on the glutamate neurotransmitter, an entirely different MOA.

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#7
post #5

More relevant questions: - Why don't we stop subsidizing corn so much? - Why don't we teach effective nutrition and cooking in school? - Why don't we teach effective exercise, sports, and fitness in schools? - If we can ban alcohol and tobacco sales to children, why not things like added sugar, hydrogenated oils, corn syrup, etc? - If we can ban alcohol and tobacco advertising to children, why not products with added…

Not sure why you are so cynical. It seems like there's pretty clear progressive movement on several issues. I never thought I'd see a black president in my lifetime.

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#8
post #2

>The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. Why would FDA approve something which it we don't fully understand?

There are many drugs where this is true. Antidepressants, especially.

http://en.wikipedia.org/wiki/Pharmacology_of_antidepressants

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#9
This is an interesting issue. If you're morbidly obese, a 5-10% reduction in weight could add up to significant LBs/KGs lost. So it would seem to me like this would be a great way to jumpstart and re-enforce the other aspects of weight loss. Many people give up because they don't see results fast enough.

So much of weight loss is mis-understood, but a lot of it boils down to convenience, will power (choosing to resist going through McDonalds drive thru), food choices (i.e. I don't know how to cook, and no healthy options are affordable and quick).

I am a firm believer that weight loss is 75+% diet, and the rest exercise (disclaimer: I lost 30lbs [17% bodyweight] doing the 4 hour body diet).

Re: Diet Drugs Work: Why Won’t Doctors Prescribe Them?

#10
If you want to see a biotech start-up working on a very interesting obesity drug, check out http://zafgen.com/

They just release the results from their Phase 2a trial and results are amazing. After 12 weeks on the highest dose, patients lost an average of 24 lbs, which is competitive with bariatric surgery.

If the drug makes it to approval, it could be a real game changer for the healthcare system.

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