Dear DOCTOR Owen:

I have diabetes and high blood pressure, and am on four medications to control these diseases. My insurance doesn’t cover drug costs. I spend more than $300/month on medications, but still have a hard time controlling my blood sugar and pressure. I was able to get off all the medications with weight loss, but then put the weight back on. My doctor refuses to give me a diet pill. I priced them and they are cheap. I have called other doctors and they also do not prescribe diet pills. Why not?

Pill Popper

Dear “Popper”:

Why not indeed! I have often wondered the same thing, except I know the answers:

· The Drug Enforcement Agency (DEA) considers diet pills to be in the same class as addicting medications. Even though the data don’t support that classification, diet pills are classified as narcotic. (Yet, pediatricians are prescribing the same medication for children with attention deficit disorder.) The lobbying momentum to change the classification has just not happened. Therefore, doctors would be under scrutiny by the DEA, and their colleagues would unfavorably frown upon their reputations as “diet doctors.” It is just not worth the cost and the risk to physicians. The government now has “bounty” payoffs to “get” physicians, who don’t need more reasons to be paranoid!

· Data supporting the long-term use of classic diet pills such as Phentermine simply are sparse. Recent data suggest that—alone or in combination— classic diet pills may be effective at maintaining weight loss. It was once thought that these pills would lose their effectiveness when taken for long periods of time, but this does not appear to be the case. People appear to maintain their weight loss so long as they take the drugs. Therefore, people would have to take these “diet pills” forever. How would that feel? In our Western culture, it is perfectly acceptable to take four powerful “disease” medications a day, but taking diet pills is frowned upon. Isn’t that ludicrous? What a double standard!

· The safety in taking diet medications over long periods of time is yet to be proven. Never mind that the pills you are currently taking have not been tested for more than five years; “diet pills” (which have been around for more than 40 years) just carry too much implied negativity. Consider the Phen-fen debacle. Even though no deaths and many benefits were seen with this combination, the “Fen” company (Fenfluramine) was refused a $4 billion settlement from lawyers representing the “injured.” The same with silicon breast implants—even though no damage was proven, a company making money on “vanity” is held to a higher standard and greater liability than one that treats an “unfortunate” disease like cancer—even if the cancer is self-induced by cigarettes. No one wants to risk prescribing a pill without “mountains” of research. Even then, it didn’t help the makers of Fenfluramine.

· You have fallen prey to the thinking of a majority of ignorant people in our society, who make the following implications: (1) The obese lack character and will continue to be flawed because they have proven that they can lose weight. (2) Why can’t they just keep the weight off and continue their diets? (3) They are weak-willed, spineless, gluttonous, slothful, lazy, stupid—I’m running out of words—you know what I mean! People can be very mean.

Well, here is a great study. Researchers at Pennington Research Center in Baton Rouge, Louisiana, reporting in Obesity Research, Vol. 7, No. 6, 523–531, compared the effectiveness and the cost of using standard medications vs. diet pills (called anorectic medications) and diet to control diabetes, high blood pressure, and high cholesterol. The results were nothing short of incredible. The diet pill group had perfect control of blood sugar among the diabetics, a reduction in cholesterol, and control of blood pressure that was equal to or better than with the standard medical treatment. Weight loss was considerable and maintained as long as the diet medication was continued.

The most significant finding was the cost savings. Diet pills cost between $9 and $37/month, but the standard medications for treating diabetes, blood pressure, and cholesterol averaged approximately $300/month. That amounts to a 1000% saving with improved treatment outcome—incredible! What is even more incredible is that if insurance companies paid for medications, they would exclude diet pills or diet counseling! Why? Because of the good implication: The obese should be expected to “will” control over themselves!

Many people in this field consider Pennington Research Center “the” world leader in obesity research. I hope that this study is extended and expanded. In the meantime, I do not like to prescribe diet pills. My days of “martyrdom” are over, so I’ll just report—and spread— the facts as I read and see them.

It is up to you to “whip up” the political support.