The popularity of weight loss drugs and supplements are on the rise, but according to the first federal guidelines for the treatment for weight loss and obesity, about 55 percent of adult Americans, or 97 million people, are either overweight or obese. Quick-fix diets, pharmaceuticals, and even "natural" weight loss formulations don't promote good eating habits because they are not a life-long plan. "When you talk to me, we're talking the 90-year plan," says Houston-based nutritionist Anne Dubner, R.D., L.D." You need to establish eating patterns that work long-term, and incorporate foods that allow you to lose, and then maintain, body weight."
Do Weight Loss Drugs Work?
Dubner, whose specialty is weight loss, found that her clients didn't want to learn anything about diet, they just wanted to take a pill and lose weight. But when they went off the drug they gained the weight back. "I do not recommend weight loss drugs. I'm sure they work, but they are temporary." Dubner believes that if weight loss drugs are used they should be a part of a multi-disciplinary approach. "See a dietician, psychiatrist, or psychologist, if necessary." Weight loss drugs can serve as a jump start for an individual who is significantly overweight, or someone who has to lose weight before undergoing surgery.
Both Fen-phen and Redux were found to cause damage to heart valves and were taken off the market in 1997. The newly hyped weight loss drug, Meridia, released last April, acts on serotonin and norepinephrine, another brain chemical to make users feel full, like Fen-Phen and Redux, but not in the same way. Researchers at Knoll Pharmaceutical, who produce Meridia (sibutramine), say Meridia works on two neurotransmitters instead of just on serotonin.
What's coming down the road in the way of weight loss drugs? Orlistat, which will be marketed as Xenical, received FDA advisory committee approval in May of 1997, but Hoffmann-La Roche, its manufacturer, has decided to do more analysis before releasing it for final approval. Orlistat is a lipase inhibitor, which means it works on lipase, an intestinal enzyme that breaks down fat. Xenical cuts fat absorption in the intestine by about 30 percent.
None of the weight loss drugs on the market now, or any that might be available in the future, are going to solve the problem of excess weight. And serious health effects were found with the drugs that have been removed from the market.
Searching for a Natural Solution
Each year Americans spend billions of dollars in the hopes of finding the magic pill(s) for weight loss. In fact, according to the National Council Against Health Fraud, a whopping $8.9 million are spent annually on vitamins and dietary supplements alone. And, because vitamins, herbs and other supplements are not officially regulated by the Food and Drug Administration, consumers are often unaware of the proper dosage amounts, efficacy and product safety. Then, add to that the fact that an incredible amount of diet supplements are introduced each year, making it virtually impossible for government officials to keep up.
Herbal Phen-Fens
According to many health food store operators, herbal phen-fens in all forms-from teas to pills-are by far the biggest sellers of herbal weight-loss products. And, store operators and experts agree, the reason for their popularity is probably due in part to slick marketing tactics by manufacturers that compare their products to the banned fen-phen prescription drug. The big difference, according to herbal phen-fen marketers, is that unlike the prescription drug, their herbal phen-fens are completely safe because they use "natural" ingredients.
"Some of the most potent toxins are 'natural'...even poison is natural...the word 'natural' does not guarantee safety," says Dr. Kathy Kapica, PhD, RD, associate professor of nutrition and dietetics at Chicago Medical School. And, according to Dr. Kapica, another major problem is that due to the lack of government standards for botanicals and herbs, consumers can't always be sure that the products they are getting are pure, or even contain what the labels say. "It's very scary to think that consumers invest in products that they think will help them when they'll actually be lucky if they don't harm them," adds Dr. Kapica.
Most herbal phen-fens contain a mixture of herbs which often include ephedra, St. John's wort, chromium picolinate and others. Some ingredients like ephedra, which is addressed below, can be dangerous when abused, while others, such as St. John's wort and chromium picolinate, show no clinical evidence of being beneficial for weight loss.
Ephedra
Ephedra, also known as ma huang, is a strong stimulant found in popular herbal phen-fen diet aids. While the efficacy has been well researched and substantiated for relieving nasal congestion and some allergic disorders, Varro E. Tyler, an authority of the medicinal use of herbs, states in his book, The Honest Herbal, that "there is no substantial clinical evidence that [ephedra] is either a safe or effective promoter of weight loss in obese patients." And, ephedra can be very damaging to the body, especially when abused. Its active ingredient is ephedrine, a stimulant that works in the body much the way that adrenaline does in what is known as the "fight or flight" response. The danger is that when taken regularly, your body stays in an unnatural high gear and there is risk for heart palpitations, heart attacks, and strokes; particularly for those with a history of heart disease, hypertension, diabetes, or thyroid disease.
To date the FDA and Centers for Disease Control Prevention have received more than 900 complaints about products containing ephedrine, including 17 deaths. The FDA has plans to regulate ephedrine levels in dietary supplements in the future.
St. John's wort
Many herbal phen-fen combinations with ephedra contain St. John's wort as well. Manufacturers of diet supplements containing St. John's wort claim it may increase the production of the brain chemical serotonin, possibly having a positive influence on mental wellness, which could help suppress overeating that may be linked to depression.
St. John's wort has been one of the most scientifically researched medicinal herbs in history. Many clinical trials using standardized St. John's wort preparations have confirmed its safety and effectiveness in treating depression. However, there is no clinical evidence to substantiate that St. John's wort has weight loss benefits.
Chromium picolinate
Chromium picolinate, another popular ingredient in many diet supplements and teas, is sometimes paired up with ephedra and St. John's wort, but is also sold as a dietary supplement on its own. Chromium picolinate is a synthetic compound that contains chromium, a nutrient necessary for regulating blood sugar. Chromium can be found naturally in vegetables like potatoes, broccoli, and mushrooms. In his book, Chromium picolinate-Everything you need to know, Dr. Gary Stevens says that, "Chromium picolinate plays a vital role in any program for fat reduction because it keeps insulin working properly."
While its true chromium is an essential trace mineral that aids a number of body functions, it is only required in small amounts. And while countless proponents claim it does everything from help you control blood glucose to burn fat and build muscle, none of these claims has been substantiated clinically. "While chromium shows promise in the treatment of adult-onset diabetes, I have not seen any good evidence that it can help people lose weight. Although it has been marketed for weight loss, the evidence is simply not there," says Veggie Life Nutrition Editor John Westerdahl, MPH, RD, CNS.
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