Pharmaceuticals
General Principles
Obesity is a chronic metabolic disease and thus the treatment is long term akin to the management of hypertension, diabetes, arthritis, etc. Pharmacotherapy is the mainstay of obesity treatment. In fact, many patients benefit from long-term, perhaps life-long treatment with medications. This is a departure from the previously long held assumption that medications should only be used for a few months.
Now that evidence suggests there are multiple pathways in the obesity condition, different medications in combination with diet and exercise have been found to have the best effect. The main mediators of hunger, appetite, and binge or nighttime eating are: nor-epinephrine, serotonin, and GABA.
Currently Utilized Drug Therapy Agents
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Phentermine
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Bontril (phendimetrazine)
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Tenuate (diethylpropion)
Phentermine
In general, the most widely prescribed class of medications is the noradrenergic drugs. Phentermine is the oldest in this group. It is a Class IV agent with a low potential for abuse. However, if you have a history of mood disorder, severe psychiatric disturbance, and/or bipolar condition the physician may elect to avoid this class of agents entirely. Previously prescribed for short periods, the new thinking is that phentermine can be prescribed longer term. Phentermine helps to maintain food avoidance, which is a key aspect with longer term use of the drug. Food avoidance is best described as a lack of interest or urge stop at fast food restaurants or engage in mindless eating associated with stress. Phentermine can be safely combined with other medications (i.e. anti-epileptic drugs and satiety promoters). Obesity is skyrocketing in the 12-19 year old age group and has been estimated to affect 1/3 of this population. These medications can be used in conjunction with lifestyle and diet changes and is safe and effective in younger patients as well.
Topiramate (Topamax)
This medication is widely used to manage binge eating, stress eating, and nocturnal eating disorders. Topamax is great at decreasing carbohydrate cravings and helps to prevent plateau effects seen with stimulant use alone. Low starting doses and gradual titration improve tolerance and decrease side effects. Regular eye exams are necessary when taking topiramate and patients are advised to drink a minimum of 64oz of water daily.
Enhanced 5-HTP (5-HTP, L-Tyrosine, L-Glutamine)
5-HTP has been used in Europe for many years to treat obesity and depression. 5-HTP is a naturally occurring amino acid which is converted to serotonin in the central nervous system (serotonin plays an important role in mood, sleep, appetite, and metabolism). L-Tyrosine has been shown to help suppress stress-based hormone release, which helps prevent stress eating and other unhealthy effects, as well as activate the thyroid to boost metabolism. L-Glutamine stimulates metabolism at the cellular level and also helps with muscle growth.
AVOID ALCOHOL, CAFFEINE AND OVER-THE-COUNTER MEDICATIONS CONTAINING ANTIHISTAMINES
Alcohol may interact unpredictably with the appetite suppressants. Caffeine needs to be limited to less than four (4) caffeinated beverages per day. Beware of artificial sweeteners as they can stimulate food cravings. Antihistamines can interfere with the action of appetite suppressants. Check with your Glimpse medical provider regarding all over-the-counter medications you are taking.