November 21, 2014

The Argument in support of the Rational Use of Prescription Medications


Treating Obesity

In  a 2009 report , 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. What that author did not say but this author believes is the upshot from this report is that virtually none of these medicines were prescribed to treat Obesity. Rather, they were prescribed to treat the health consequences (co-morbidities) of Obesity such as Diabetes, Hypertension and Osteoarthritis 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 it seems in light of this information about its medical costs,  the biggest obstacle to Medicalizing Obesity is the Medical Establishment. For starters, it was as recently as July 2013 that the American Medical Association (AMA) first officially recognized Obesity as a disease. For another example, 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 some patients with pre-existing coronary artery disease, Meridia caused heart attacks, some of which were fatal. While high blood pressure and fatal heart attacks are by no means minor risks, they are risks that can be significantly reduced when prescribing physicians practice within the “standard-of-care” such as carefully screening their patients for heart disease before prescribing Meridia and closely monitoring their patients’ blood pressures after they start taking the medication. These are already firmly established practice standards for the general medical care of Obese patients regardless if they are intending to start on a weight loss medicine. Most conspicuous by its absence from the debate over removing Meridia from the marketplace was any consideration of the benefits of Meridia or the risks of not treating Obesity.

Contrast the Meridia story with that of Sudafed (pseudoephedrine), the over-the-counter decongestant taken by millions of Americans every day, which has similar pharmacologic properties as well as risks as Meridia for raising blood pressure and causing heart attacks in some people with pre-existing Coronary Artery Disease (CAD). Seemingly, according to the FDA the benefits of clearing our stuffy noses warrants us taking such risks while a clinically significant reduction in our body weight does not.

As a last example of the Medical Establishments “Hypocritical Oath” when it comes to Obesity is aspirin, brought to the US marketplace by Bayer in 1905 and the proliferation of the myriad other non-steroidal anti-inflammatory drugs (NSAIDs) that followed. A rarely mentioned fact is that this class of medications, available without a prescription, causes 7,500 deaths annually in the US, primarily from gastrointestinal hemorrhage, most of which occur spontaneously without warning. Why isn’t the FDA suggesting we take these medicines off the market, while a medicine that actually treats Obesity that carries the same and even lower risks,  is pulled from the market? Adding to the irony, the primary reason people take NSAIDs is for the treatment of the co-morbid condition of Osteoarthritis, a co-morbid condition of Obesity. So, according to the prevailing perspective of the Medical Establishment if you are an Obese patient and you call your “Care Provider” because you are suffering from arthritis pain, the advice you will likely be given is, “take two aspirin and call me when you are a contestant on The Biggest Loser.

As you may have noticed, this author’s primary argument in support of the rational use of prescription medications for the treatment obesity is their irrational disuse. Clearly the time for changing this antiquated perspective is long overdue. In my next post, I am giving my first comprehensive update since 2006   on the current prescription medicines for the treatment of the disease, Obesity, so please stay tuned.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist-Corporate Wellness Consultant

Founder-CEO and Personal Physician at,

Optimal Performance MD LLC

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