Obesity & Pharmacology: Simplicity or Best Outcomes

Obesity is an epidemic in every sense of the word. As the waists of the people of the United States continue to grow, the Food & Drug Administration (FDA) has assessed two new weight loss drugs in the hopes to curb this disturbing weight trend. Obesity, for its seeming simplicity, is an extremely complex, multifactorial disorder that has a cultural, genetic and environmental basis and the purpose of this post is to respond to the perspective section of the New England Journal of Medicine's recent perspective article in the October 25, 2012, Volume 367, Number 17 edition (right next to Halloween and candy!)

The second paragraph of the narrative states, "However, numerous once-promising weight-loss drugs have been abandoned because of serious toxic effects: aminorex (pulmonary hypertension), fenfluramine and dexfenfluramine (valvulopathy), phenylpropanolamine (stroke), rimonabant (suicidal ideration and behavior) and most recently (sibutramine (myocardial infarction and stroke). The removal of sibutramine from the market left orlistat as the only prescription drug approved for the long-term treatment of obesity.

These drugs (tradenames: Belviq and Qsymia) as prescribed, are adjuncts to a reduced-calorie diet and increased physical activity lifestyle for patients who are defined as obese. They both act to inhibit or reduce appetite and in some people, produce a negative-energy balance. In reading the of the article, it is mentioned that there was a time in which an increased incidence of brain and mammary tumors were a possibility in Belqiv. Later in the article, it is stated that the administration of Belqiv can also possibly lead to increases in psychiatric, cognitive and serotonergic adverse effects.

The reason I bring this up is due in large part to posit the question: How do people feel about the prescription of drugs to combat any, and all health concerns? 

I ask this because as a practitioner who has counseled patients in weight loss, exercise and eating healthier I wonder if medication provides the best outcomes for obese patients who are seeking, or are mandated to lose weight. I fully understand that weight loss is a complicated endeavor combining emotional, psychological, physiological and biomechanical factors. Is prescribing a patient a weight loss drug like Orlistat just easier than counseling them? Or does pharmacological intervention simply provide better outcomes? It's a question that I struggle with often as the secret to weight loss is not a mystery, but the path can be so difficult for people.