In a recent essay in The New Yorker, Dr. Suzanne Koven from the Massachusetts General Hospital in Boston explores the reasons why primary care physicians (herself included) are unlikely to prescribe weight-loss medications to their obese patients. Dr. Koven points out that there are now four drugs specifically approved for weight loss by the FDA, but doctors, especially primary care physicians, either aren t aware of them or just don t want to prescribe them.
Currently approved weight loss drugs include phentermine and orlistat, which have been in use for over a decade, as well as Belviq and Qsymia, which have both been approved recently for long-term use. All have demonstrated utility, providing modest weight loss in the neighborhood of 5 to 10 percent. Such weight loss, while not restoring a morbidly obese person to normal weight, can still be effective in reducing the risk of type 2 diabetes and other ills.
So why aren t these drugs being used more often? Dr. Koven suggests factors that may have a negative influence on physicians prescribing habits. First, she acknowledges that past negative effects of older diet drugs are still worrying prescribers. Amphetamines, widely used in the 1940s were highly addictive, and the more recent phen-fen was linked to serious heart defects in users. Current medications, however, are not linked to such problems.
ACSH s Dr. Josh Bloom thinks the latter explanation is the real reason here. He says, The phen-fen debacle of 1997 scared a lot of people, and rightfully so. There were bona fide cases of heart valve damage and a smaller number of cases of primary pulmonary hypertension (PPH), which is often fatal. The fact that these problems arose from the fen component (fenfluramine) which is no longer sold has apparently not eliminated concern over the pharmacological treatment of obesity as a whole.
You can read Dr. Bloom s op-ed entitled Qysymia is not Fen-Phen, which goes into more detail here.
Another factor Dr. Koven cites may be bias on the part of prescribers. They may think that they shouldn t be treating obesity at all that it s simply a matter of willpower. Dr. Koven notes, however, that obesity is in part a neurological disorder, and quotes experts stating that the hypothalamus, the part of the brain involved with appetite regulation, can actually be damaged by consistent overeating.
Further, a body of research has demonstrated that the risk of obesity is greater in the poor. Thus, she suggests, some physicians may see obesity as a socioeconomic problem, and not a medical one.
It is to be hoped, ACSH s Dr. Ruth Kava suggests, that as research into the causes and treatments of obesity continues, more primary care physicians will step up to the plate and be more actively involved in helping their patients deal with their weight issues. More effective drugs will surely be developed but they won t help if they are not prescribed.