Dear DOCTOR Owen:

I recently asked my doctor about using a new weight-loss medication called Meridia®, or Sibutramine. I am overweight, and have diabetes and a bad back. I know that it will help to lose weight. What’s the latest? Is it safe? How much will I lose? How long can I take it? Are there any serious side effects? What’s the cost?

Diet Pill

Dear “Pill”:

Meridia® was released by the Food and Drug Administration (FDA) as an adjunct* (aid) in treating the seriously obese with medical problems. The FDA recommended that Meridia® be used for people with a Body Mass Index (BMI) of 27 with medical problems, and a BMI of 30 and above without obvious medical problems. (See the Appendix in the back of this book for the BMI chart.)

Developed as an antidepressant, similar to Prozac or Effexor, Meridia® was found to induce weight loss in the patients being studied. It was little better as an antidepressant than other drugs on the market, so an indication for weight loss was sought from the FDA. (The weight-loss indication was also less expensive to prove.) In most studies, subjects responding to the medication lost about 10% of their original weight. Subsequent studies revealed similar results. Tested patients were able to keep their weight off as long as they took the medication, but gained the weight back as soon as the drug was discontinued after two years.

My clinic is currently participating in a study that looks at five-year weight maintenance in 60 patients who have lost weight in a Behavioral Education Diet program. Keeping weight off is the “gold” standard of any Diet Therapy—behavioral, medical, or surgical.

There are few side effects with Meridia®. So far, neither the patients in the study nor I can tell who is on the drug or the placebo. Other studies have shown similar results. Meridia® may raise blood pressure and pulse in a very small percentage of patients. It is not similar to Phen-fen and should not have similar adverse effects or side effects.

A recent article in The American Journal of Medicine, Vol. 106, 179–184, showed that there was sustained, even further, weight loss in patients who used Meridia® after weight loss on a very low calorie diet (VLCD). These are hopeful findings, as almost anyone can lose weight on such diets. Keeping it off, however, is the key to good health. If the clinic’s study confirms these findings, Meridia® may become a long-term player in the obesity-related disease battle.

I ask all of my patients who request diet pills: “Are you ready to take this pill for the rest of your life if it is helpful?” If the answer is “no,” then it’s not worth using them in the first place. I also find that patients want to take pills—but may not be ready to take the steps necessary for long-term weight control. Sometimes medical professionals need to consider medication to help control food intake—with selected patients—because it is the food that is making them sick. However, most physicians and medical control boards resist using medication for this purpose.

Patients have abused available medication for cosmetic weight losses of 10 or 20 pounds. Physicians also have abused these medications, prescribing them for very flimsy indications and with little prior clinical assessment or follow-up. In the past, our culture—both medical and lay—has resisted using medications that cause changes in behavior—especially if it appears that a medication “will” or could cause similar changes. “Willpower” is part of the American heritage. You are probably getting tired of hearing this, but I’ll say it again: Obesity is not a character flaw!

The health insurance industry and managed care companies sometimes do not cover diet-related drugs or diet programs because they still consider obesity a character flaw (in my opinion). That same attitude used to apply to mental illness and addictions. It makes economic sense, therefore, to use Meridia® after weight loss and after other medications have been discontinued because diabetes, high blood pressure, GERD (gastro esophageal reflux disease), high cholesterol, and so on respond to healthy dietary changes—as revealed in my professional experience and in studies.

*In addition to diet and exercise, and with medical supervision.