Dear DOCTOR Owen:

I live in South Texas. I don’t know if you know what Tex-Mex food is, but it is certainly not low fat. I have read about the new weight-loss drug, Meridia®. Is it safe? Does it work? Are there any differences in racial or ethnic effects of the medication? Does the drug affect everybody in the same way, despite ethnicity or race? I love our food—just a little too much! I keep gaining.

Hexed Mex

Dear “Hexed”:

Meridia® is an agent that has been released as an additional treatment (along with diet and exercise) for weight management. Are the changes in weight accompanied by changes in health risk factors? It appears so. Does the medication cross social and ethnic barriers? This is not known. Most of the studies to date have taken place in the United States and with Caucasians of West European descent.

Hispanic, African American, Native American, and Polynesian populations have a higher incidence of obesity and obesity-related diseases such as diabetes, high blood pressure, and atherosclerosis. The reasons for this are quite complex because cultural, social, economic, and genetic influences are different in these populations compared to those of West European Caucasians. Diet intervention programs in these populations have also been difficult to carry out and are historically less successful.

An article published in Obesity Research, Vol. 8, No. 1, 71–82, by researchers in Mexico City, tested Meridia® in a population of Mexicans with obesity-related diseases compared to patients who were not treated with Meridia. The subjects received oral and written diet instructions from their physicians, did not participate in any formal behavior modification, and were not counseled on their office visits.

The following results were seen with the group that took Meridia®:

• Substantial weight loss.
• Reduction in risk factors associated with obesity.
• Twice the perceived reduction in appetite as subjects who took the placebo.
• Same percentage for satiety as subjects who took the placebo.
• Few side effects.
• No other intervention—such as intense diet counseling or participation in behavioral education programs.

These outcomes are obviously from the medication.

My clinic has been involved in a five-year Meridia® study. I cannot say that I have identified any side effects in the patients who are taking this medication compared to those who are taking the placebo. The patients do not seem to be able to tell if they are on the medication or the placebo. Prior studies show only slight elevations in blood pressure in a small percentage of patients taking Meridia®.

Like any intervention that treats obesity, people must be made aware that they will need to take Meridia® forever. It is possible to make lifestyle changes while the medication is helping; but, from my observations, people who are seeking a “magic pill” to cure their obesity have little interest in participating in a behavioral education program to change lifestyles. Few good long-term education programs exist (relative to need); therefore, patients who use Meridia® may resist participating in education programs based on their prior unfavorable experiences in diet programs.

Of course, I cannot pass up the chance to say that your insurance company may not pay for Meridia® because those institutions—as well as much of our society—have the mind-set that obesity is a character flaw: “If you weren’t such a glutton, you would not need medication or any other help.” (I simply cannot help my sarcasm. But it “blows me away” to know that so many others also believe that obesity is a character flaw.)

I strongly believe that a medication such as this can be helpful to people who want to remain focused on a diet plan and keep their weight off over the long term—provided that it is taken forever.