For the first time since 1999, the FDA Advisory Board has recommended a weight-loss drug for approval. The drug, Qnexa, has been a hot topic in obesity for a few years now, after it was turned down by the FDA back in 2010. Like many other weight-loss drugs before it, it causes a bevy of side-effects, including heart problems and birth defects like cleft palette. On the other hand, it has the highest effectiveness of any weight loss drug thus far, boasting a 10% reduction of weight over the course of a year—more than enough to reverse many health problems linked to weight.
One of the most frequent arguments against treatments like Qnexa, Orlistat (the last drug approved by the FDA), or even various forms of bariatric surgery is that the treatments attempt to create “magic bullets” that kill the proverbial werewolf named Obesity in one fell swoop, with no effort on the patient’s part. As one blogger on Blisstree.com puts it, “We’re still not teaching people how to take responsibility for their bodies if giving pills is the answer for obesity. As anyone who has lost weight knows, there is no easy fix. It takes a lot of hard work and a total restructuring of their lifestyle. Giving people a pill to do this is just setting them up for failure.”
Many members of the media, health professionals, and others like to discuss modes of weight loss that do not depend solely on diet and exercise as an attempt to find an “easy fix” for obesity. The general assumption with this argument, of course, is that the individual just isn’t trying hard enough to get healthy on her own. She’s taking a shortcut when the rest of us are stuck in traffic during rush hour. Little does she know, that shortcut will most likely have a detour on it that actually brings her back to where she started, or worse, maybe spits her out on a road even a few more miles off path—she may lose weight while on the drug, but because she never learned to take care of herself properly, it will creep back on. Serves her right, we believe as we sit in traffic, thinking she could get out without all the suffering we’re going through.
Take the latest “shortcut,” Qnexa, a combination of the appetite suppressant phentermine and the anti-convulsant topiramate. Phentermine was part of the ill-famed Fen Phen, a popular weight loss drug that caused many heart problems to outweigh the benefits of the weight loss and get the drug pulled from the market. Topiramate, as the brand name Topamax, has been used in the treatment of binge eating, migraines, and bipolar disorder for years now. While it, too, has appetite suppressant qualities, the actual usefulness of the drug seems to stem from the fact that it causes the urge to binge to disappear; in other words, this isn’t a drug for just anybody looking to lose weight, it’s a drug for people with actual issues with binge eating (eating more than a thousand calories at one time, more than twice a week, for at least six months). Individuals prescribed Topamax have been all shapes and sizes because binge eating affects all sorts of people; it’s not an obesity-specific treatment. In the process of getting Qnexa approved, the company producing it had to outline safeguards such as means of monitoring patients using the drug as well as ways to limit access to the drug. Essentially, it’s not meant as a drug for anybody who needs to lose some weight, but instead as a treatment for folks who, even when attempting to maintain healthy habits, find their eating uncontrollable often enough that it’s inhibiting their efforts.
This last bit is the hardest to empathize with, as well as the most difficult to judge the validity of. How do you tell when a person really cannot control her urge to eat, and when it’s just a “lack of motivation,” so to speak?
I first heard about Topamax well before the Qnexa crisis; I was seeing a therapist for binge eating. I wasn’t obese, had talked to enough specialists to come to discover that a) I apparently missed my calling, and should have gone to school for my MSW rather than my MFA b) I have a remarkably healthy view of my body and taking care of it and c) I have a remarkably good grasp on pretty much all non-medication treatments for bingeing. That is, I can eat my regularly-spaced nutritious meals and snacks, I can exercise, I can recognize when I’m lonely and need to talk to a friend or when I’m stressed or haven’t slept enough or just plain bored. After a few sessions of trying to pull apart triggers and break down all the thought processes and causes and what-have you that could lead me to fall headfirst into more chocolate than I’d like to admit, he said to me, “You know, I really don’t think you need therapy. I think it sounds like a chemical imbalance.” And then he brought up Topamax, how it had been a miracle for a couple of his other patients who could tolerate its side effects. “Worst case scenario, you stop taking it,” he said. “But it might give you the opportunity for the rest of what you’re doing to take hold better.”
Long story short, I did a whole lot of research and didn’t go that route. The drug has too many terrifying side effects (loss of memory, strange tingling in the extremities, changes in the ability to taste certain foods) and I wasn’t entirely sure I was that desperate yet. For me, dealing with bingeing was nerve-wracking because I was doing everything RIGHT. When I had a therapist tell me to stop before a binge to pat my arms and legs to bring me back into the moment, even if it meant looking like a moron standing in the middle of a sidewalk, I—well, I didn’t do the patting thing, but I thought about it, and thought, This is when I’m supposed to pat myself like a moron. Pat, pat. Pat, pat. Then went on my merry way to the candy aisle at Walgreens. (I talked about it to couple other therapists later, and they thought it was a silly idea, too.) (Lord, this account makes me sound like a therapy whore. I like chatting and self-reflection. Okay? Don’t judge.) After all that, it was a compelling argument to have one pill fix whatever was causing my brain to undermine my efforts for self-care.
Reading patient reviews opened my eyes to the entire idea of why people take drugs like these—compulsive overeating can be downright debilitating. For the people who didn’t find the side effects overwhelming (and even for some who did), the medication turned off the compulsion to binge so they could do everything they were supposed to—eat their healthy meals, go exercise, etc. When you’ve been living in a state of complete lack of control, the promise of normalcy, at whatever cost, can be really tempting.
Now, there is plenty of evidence we live in a culture that thrives on efficiency, from assembly-line cars to fast food drive-thrus and beyond. But I’m not entirely convinced that we’re doing obesity treatment—medical and otherwise—justice if we call any attempt at this point an “easy fix.” You see, we like to talk about these treatments as though they’re shortcuts, but, going back to the driving metaphor, they’re meant to be a way to help the individual get from their dirt road in rural Iowa to the highway in the first place. Then she gets to sit in traffic, like the rest of us.
So, yes, an attempt at reducing obesity-related illnesses and health risks without actually working on living a healthy lifestyle is impossible, but we need to stop viewing obesity treatment as a stand-in and more as a stepping stone. And by “we,” I don’t mean the just the folks undergoing obesity treatment, I mean the rest of our society as well, particularly the people in the mode of talking about diet and health and weight loss. There’s not much of an argument in saying that a person won’t be able to have a healthy lifestyle if they don’t put in the effort: of course not. We’re also likely not going to have some Soylent Green-like substance to help nourish ourselves without thinking about what we put in our bodies. The question is in how we judge the amount or quality of effort an individual puts into maintaining healthy habits, and how we view their level of control.
Of the clients I’ve worked with who are working on major weight loss and have undergone or are considering undergoing major therapies—diet pills, weight loss surgery, or otherwise—none have used the singular treatment as a “quick fix.” Now, granted, I haven’t been training quite long enough to see a complete cross-section of the population, and, of course, if they’re in the gym with me, chances are they understand the importance of the whole “stepping stone not magic bullet” concept because they’re working on building up an exercise habit. Yet I’ve also met with countless women who, because of their weight, feel invalidated in the gym—they don’t believe they’re as talented athletically as they actually are, they feel self-conscious around their thinner peers, they worry about the quality of the exercises they’re doing (ie, “I bet you make your thinner clients do harder stuff than this.”). Part of me wonders if this magic bullet syndrome of our culture—this judgement of the means of how people make themselves healthy—has actually made it much harder for overweight individuals to build healthy habits. Rather than being able to feel happy with making steps in the right direction, they instead must live with the knowledge that others are vocally judging the quality of their efforts.
Health and fitness professionals like the blogger on Blisstree argue that we need to understand that medical obesity treatments are no magical bullet, that weight loss is a long and difficult challenge with or without a pill for help. Yet the majority of people undergoing these treatments probably understand better than anyone else how difficult living under the stigma of being overweight is and understand how difficult changing lifestyle habits is. Thus, perhaps rather than aiming this message at those undergoing the treatment, the health pundits should take to heart the message themselves and empathize with how difficult developing healthy habits are, even with Qnexa.