Autor: markyoung

~ 11/07/12

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On June 27th the FDA approved Arena Pharmaceuticals’ new drug Belviq (lorcaserin) making it the first weight loss drug to be approved by the FDA in 13 years.  Following this announcement I wrote an excited post on Facebook and Twitter with a link to the press release.

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Not surprisingly, people responded with a variety of thoughts and opinions and, of course, asked for mine….which I withheld…at least until I had a context/framework for the discussion.  Now I do.

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Yesterday I wrote a post (one of my most popular ever) about the fact that I think the process of losing weight and becoming healthy is like attempting to swim up a raging river.  The river represents the current of our society pushing us towards eating too much, exercising too little, and generally everything that is the complete opposite of living a healthy lifestyle.  Upstream we have the factors creating that current which obviously need to be addressed and this is most certainly something we all need to start becoming concerned about if we are to ever conquer obesity and fat gain.

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But caught in the current are a variety of different people at different distances down the river.  There are those who have only been moderately affected.  This constitutes what I would guess is the majority of the population.  Through either good genetics, a little effort in the kitchen and the gym, or some combination of the two they’ve managed to either be in good shape or only moderately overweight.  It might be argued that these folks could/should be encouraged to continue what they’re doing or make lifestyle changes respectively.  Generally speaking, I would agree with this.

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Further downstream, however, there are a growing number of people who are at a desperate point where, if not helped, they might reach the end of the river…the waterfall.  While exercise and dietary change are most certainly needed, these folks are in urgent need of a life jacket and a pharmaceutical intervention like Belviq (or Qnexa which is up for approval on July 17th) is exactly that.

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The research on Belviq suggests that it represents the likelihood of a reduction of 5% body weight which has been shown to have meaningful effects in people who have health issues related to their weight.  It gives them an edge…like a life jacket in a river, but it doesn’t do the swimming for the people that take it.  It is NOT meant to be a replacement for lifestyle change, but used in conjunction with it.

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Like any drug, of course, there are potential side effects which is why treatment must be limited only to those who actually need it.  If the risks of not treating the problem outweigh the risks of treating, then you treat (just like any other medication).  A person who wants to drop 20 pounds for his highschool reunion would likely not be a good candidate.  Another person who was bordering on being diagnosed as Diabetic and carrying a little extra weight might be considered.  THAT is what it is for.

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And looking even further down the stream might be the place where I’d say it is appropriate to consider gastric bypass.  Again, without lifestyle change the benefits of gastric surgery are limited and weight/health issues will return in many who don’t make them.  But for some, the risks of the surgery are less than those of not treating so for them this is a last safety net before the water fall.  At least this way we’re still giving them a chance to swim.

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What do you think?

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3 Comments »

  1. “At least this way we’re still giving them a chance to swim.”

    Exactly…

    What I find concerning is the amount of people that will bash this drug and then go and get plastered on the weekends. The irony and displacement of advice has become a trend of it’s own. The most important thing is their “chance” to swim. Again, as you said, this isn’t for the ‘vanity pounds.’ Rather, it’s for a population of people who are literally drowning not only in weight but in a wide variety of internal emotional struggles- most of which the general population with good enough genetics never experiences.

    Comment by Danny Matos — July 11, 2012 @ 6:35 PM

  2. Now that you have a clear position I sorta see your point. As long as the users are qualified I’m ok with it. I need to do a little bit of my own reading and investigate your blog a bit more. For some reason in the back of my mind I’m still not a fan.

    I guess you can say I’m 50/50.

    Comment by Brian — July 11, 2012 @ 7:52 PM

  3. I’m with Brian on this. I think you’re right in that it’s purpose is to give folks a fighting chance but at this point I’m not willing to give up my skepticism.

    My concern is folks knowing the safety net is there and being dependent on that to save them rather than actually trying to swim. It’s our nature to rely on something to save us or do the work for us even if it’s really not meant to do that.

    Also, if losing 5% of your bodyweight has such meaningful effects in folks who have health issues due to their weight wouldn’t liposuction also be a viable “life jacket”? It seems that we already have enough options for life jackets and safety nets that we’re making them more of a substitute rather than a last resort.

    Comment by Tim Arndt — July 13, 2012 @ 9:57 AM

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