Anti-Obesity Drug

I feel like I MAY be the ONLY dietitian NOT at the Food and Nutrition Conference and Expo this week. Sad! The timing just didn't work out for this year, but I'm feeling very left out of the loop! Instead, I'm home answering the door for every Boy Scout within a ten mile radius...buying chocolate caramel corn - ahhhh! I sold way too many Girl Scout Cookies back in the day to turn down any kiddo going door-to-door selling some delicious goodies!

Anywho, in nutrition news....

Three small California companies (Arena Pharmeceuticals, Orexigen Therapeutics, and Vivus) are planning to submit their anti-obesity drug for FDA approval in the coming months, becoming available on the market as soon as late 2010 or 2011 [1].

Jack Lief, chief executive of Arena Pharmeceuticals, believe anti-obesity drugs to become "bigger" than statins (such as Lipitor) which generated $12.4 billion in global sales last year [1].

The new drug being formulated is aiming to avoid unpleasant side effects which have deterred users from using other FDA-approved weight-loss drugs, such as Alli. The new weight loss drug will include a combination of two drugs, which many experts deem more effective than a single medicine [1].

In clinical trials of the three new weight-loss drugs, patients have lost an average of 3-10% of their starting body weight after just one year. Vivus's drug (Qnexa) produced the greatest weight loss in clinical trials, and the company's stock is up 90% this year [1]!

Some experts are stating these latest weight loss drugs as no better than current weight loss drugs, and that overall, weight loss is modest. The new drugs work through the central nervous system to influence appetite. The leading concern from the FDA is the psychological side effects of such drugs [1].

Interesting, none-the-less. Any thoughts for or against weight-loss drugs? Concerns?  

While I can consider weight-loss drugs an "aid" in weight-loss efforts, similar to gastric bypass and gastric banding, the behavior and lifestyle changes are still necessary for long-term weight maintenance. I see SO MANY gastric bypass patients who go through the "honeymoon phase" of weight-loss in the months following their operation, watching the weight just melt away. In the years following, however, poor and excessive food choices and a sedentary lifestyle lead back to rapid weight gain. Whether a weight loss aid of drugs or surgery, the need for diet and lifestyle changes are still of utmost importance in my mind.

Yesterday's diet looked like this...

Breakfast:

1 cup prepared steel cut oats (2 carbs)

1 Tbsp pumpkin butter (1 carb)

1 tsp Splenda brown sugar (0 carbs)

     Total: 3 carbs

Lunch:

1 serving Chicken Tamale Casserole (2 1/2 carbs)

1 small apple

     Total: 3 carbs

Dinner:

1 medium toss salad with 2 Tbsp ranch dressing, 1 ounce cheddar cheese, green peppers, egg whites, mushrooms, carrots, tomatoes, and banana peppers (1 carbs)

1 small slice deep dish pizza (2 carbs)

     Total: 3 carbs

Snack:

2 graham crackers with low-fat cream cheese (1 carb)

     Total: 1 carb

Exercise: 90-minute hockey game

[1]. Pollack, Andrea. Medicine's Elusive Goal: A Sage Weight-Loss Drug. The New York Times. October 16, 2009.

Alli for weight-loss?

Does Alli (Orlistat) work? In one word: yes. However, weight loss in addition to the results of calorie restriction and exercise alone are not (yet) proven to be dramatic. Additionally, most research conducted on the drug has been performed on Alli's prescription-strength cousin, Xenical [1].

Donald Hensrud, a preventative medicine and nutrition specialist at Mayo Clinic, explains the mechanism by which Alli produces additive weight-loss effects to the traditional "diet and exercise" regimen . By blocking lipase reactions in the digestion process, Alli prevents some fat from being broken down which results in lower calorie "absorption" [1]. While Alli is designed to work in this manner, it is not a miracle drug; the instructions state that when taking Alli, consuming more than 15 grams of fat per meal can lead to unwanted side-effects such as diarrhea, urgent bowel movements, and flatulence with oily spotting [1]. According to my recent poll, the side effects alone were enough to keep the majority of my blog readers from using Alli to aid in weight-loss effects. Obviously oily anal leakage and discharge can put a damper on...a lot. G-ross.'

Dr. James Anderson at the UK College of Medicine Metabolic Research Group piloted the first study of its kind on the effects of Orlistat (Alli, 60 mg) on mildly to moderately overweight adults desiring weight loss. Over the course of 16 weeks, participants were given 60 mg of Orlistat three times/day, or a placebo. The affects were faborable for the FDA-approved weight-loss drug -- those receiving Alli did lose more weight than their placebo-taking counterparts. Those taking Orlistat lost almost 5% of their initial body weight, averaging between 7 and 15 pounds. Dr. Anderson notes the vital role of exercise and a low-fat diet used in conjunction with Alli for desired and sustained effects [2].

15 grams? Well, that's probably a lot, right? Um, wrong. To prevent those unpleasant side effects, one would likely want to comsume 15 grams of fat or less at each meal...so, let's get some facts on fat.

4 ounces lean beef = 21 grams of fat
1 ounce pepperoni = 13 grams of fat
1 beef hot dog = 17 grams of fat
1 slice cheddar cheese = 9.5 grams of fat
Starbucks latte = 14 grams of fat
1 tablespoon mayonnaise = 11 grams of fat
1 large egg = 5 grams of fat
2 tablespoons peanut butter = 16 grams of fat
14 walnut halves = 17.5 grams of fat
3 slices bacon = 12.5 grams of fat

Knowing that, does 15 grams per meal sound doable? If so, you're my hero. A typical 2,000 calorie a day diet comprised of 30% fat (a typical average) would include 66.7 grams of fat daily. Knowing very well that fat is essential in the diet...raises red flags for me. Yet, the mechanism of action works because fat is the most calorically dense component of food -- 9 calories per gram versus the 4 calories per gram in carbohydrates and proteins.

In short, knowing what you're getting into. Alli is not meant to work miracles, but to be an assistive device. As always, I recommend the old-fashioned "eat less, move more".

Author's note: There's plenty one should know about any pill they're popping, particularly so for weight loss and nutritive effects. Because supplements, including vitamins, are not FDA inspected, they are not tested for purity, potency, or safety. To ensure the quality and safety of your over-the-counter supplements, please refer to the US Pharmacopoeia website for guidance.

[1]. Alli weight-loss pill: Does it work? Mayo Clinic Staff. June 11, 2008.
[2]. University of Kentucky. Does OTC Diet Pill Alli Live Up to Its Name? June 15, 2007.