The Argument for the Rational Use of Prescription Medications for Treating Obesity
From a report in 2009, Obesity in the United States carried the hefty price tag of $147 billion per year in direct medical costs, just over 9 percent of all medical spending. People who are obese spend almost $1,500 more each year on health care — about 41 percent more than an average-weight person. The biggest driver of these excess costs are prescription drugs, the author said.
However, virtually none of these prescriptions were for the treatment of Obesity. Rather, they were for treating the health consequences, or co-morbidities of Obesity such as Diabetes, Hypertension, Osteoarthritis just to mention a few.The good news is, effective and safe prescription medicines for treating Obesity have been in existence for several decades. The not so good news is that very few of these medications are actually approved by the US Food and Drug Administration (FDA) for treating obesity, and those that are FDA approved are rarely prescribed by US physicians. As preposterous as this seems in light of the burden of the the primary obstacle to Medicalizing Obesity is the Medical Establishment. For example, it was not until July 2013 that the American Medical Association (AMA) even recognized Obesity as a disease. In October of 2010 the FDA pulled the Obesity medication, Meridia (Sibutramine) from the market because in some patients it caused a rise in blood pressure and in patients with pre-existing coronary artery disease, Meridia caused heart attacks, some of which were fatal. While, high blood pressure or a fatal heart attacks are by no means minor risks, they are risks that can easily be avoided by any prescribing physician by following standard-of-care practices, such as monitoring of Blood Pressure and the appropriate screening for Coronary Artery Disease in at-risk populations. Furthermore, the majority of patients that experienced greater than a 5% reduction in their body weight while on Meridia enjoyed a net lowering in their blood pressure. The group of people prescribed Meridia are the same group with the highest risk for developing coronary artery disease, and physicians worth their weight in salt can fully assess their patients for coronary disease before, as well as closely monitor their patients’ blood pressure after prescribing Meridia for their patients. Apparently missing from the debate over withdrawing Meridia from the market place was consideration of the outcome of doing nothing about Obesity, which is as clear-cut a case of medical negligence if there ever was one. To add insult to injury, the medication Sudafed (psuedoephedrine), an over the counter decongestant, taken by millions of Americans every day, has a similar risk as Meridia for raising blood pressure and causing heart attacks in people with pre-existing Coronary Artery Disease (CAD). Seemingly, according to the FDA the benefits of clearing our stuffy noses warrants such risks while a clinically significant reduction in our body weight does not. To further illustrate the Medical Establishment’s perspective on Obesity, Aspirin which was first introduced to the marketplace by the Bayer Corporation in 1905, and the myriad of other non-steroidal anti-inflammatory drugs, or NSAIDs, that have proliferated since, cause 7,500 deaths per year in the US from gastrointestinal hemorrhage, most of which occurred spontaneously without prior warning. Why is there no issue within the Medical Establishment about the risks of these medications, which most of the time they are prescribed it is done so to treat the co-morbidities of Obesity? Yet if a medication that actually treats Obesity poses any of these same risks, it is pulled from the market? According to the prevailing perspective in the Medical Establishment, if you have pain and fever and happen to be obese the advice you will likely get from your doctor, will be to take two aspirins and call her after you become a contestant on The Biggest Loser. Clearly this is an irrational perspective and the time for a change is long overdue. In my next post, I am going to do my first comprehensive update since 2005 on the current medications available to treat the disease of Obesity, so please stay tuned.
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Mitchell R. Weisberg, MD, MP
Internist-Psychopharmacologist-Corporate Wellness Consultant
Founder-CEO and Personal Physician at,
Optimal Performance MD LLC
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