Questions and Answers about Appetite Suppressant Medication

Q: Can medications replace physical activity or changes in eating habits as a way to lose weight?

A: No. The use of appetite suppressant medications to treat obesity should be combined with physical activity and improved diet to lose and maintain weight successfully over the long term.

Q: WilI I regain some weight after I stop taking appetite suppressant medications?

A: Probably. Most studies show that the majority of patients who stop taking appetite suppressant medications regain the weight they had lost. Maintaining healthy eating and physical activity habits will increase your likelihood of keeping weight off.

Q: How long will I need to take appetite suppressant medications to treat obesity?

A: The answer depends upon whether the medication helps you to lose and maintain weight and whether you have any side effects. Because obesity is a chronic disease, any treatment, whether drug or nondrug, may need to be continued for years, and perhaps a lifetime, to improve health and maintain a healthy weight. There is little information on how safe and effective appetite suppressant medications are for more than 1 year of use.

Q: What dosage of appetite suppressant medication would be right for me?

A: There is no one correct dose for appetite suppressant medications. Your doctor will decide what works best for you based on his or her evaluation of your medical condition and response to treatment.

Q: I only need to lose 10 pounds. Are appetite suppressant medications appropriate for me?

A: Appetite suppressant medications may be appropriate for carefully selected patients who are at significant medical risk because of their obesity. They are not recommended for use by people who are only mildly overweight unless they have health problems that are made worse by their weight. These medications should not be used only to improve appearance.

What To Discuss With Your Doctor
Before choosing appetite suppressant medication treatment for the long-term management of obesity, you should talk to your doctor about any concerns you may have. In addition, it is important that you discuss the following issues with your doctor.

How will I be evaluated to determine if I am an appropriate candidate for appetite suppressant medication treatment?

Your physician will look at a number of factors to determine if you are a good candidate for prescription appetite suppressant medication treatment of obesity. He or she will determine how overweight you are and where your body fat is distributed. Your doctor may do the following:

• Take a careful medical history and perform a physical examination.
• Look at your personal weight history.
• Ask whether you have relatives with illnesses related to overweight, such as noninsulin-dependent diabetes mellitus (NIDDM) or heart disease.
• Discuss the methods you have used to lose weight in the past.
• Evaluate your risk for obesity-related health problems by measuring your blood pressure and doing blood tests.

If your doctor determines that you have obesity-related health problems or are at high risk for such problems, and if you have been unable to lose weight or maintain weight loss with nondrug treatment, he or she may recommend that you use prescription appetite suppressant medications.

Appetite suppressant medications may be appropriate for carefully selected patients who are at significant medical risk because of their obesity. They are not recommended for people who are only mildly overweight unless they have health problems that are made worse by their weight. These medications should not be used only to improve appearance.

What other medical conditions or medications might influence my decision to take an appetite suppressant medication?

It is important that you notify your physician if you have any of the following conditions or circumstances apply to you:

• Pregnancy or breast-feeding.
• History of drug or alcohol abuse.
• History of an eating disorder.
• History of depression or manic depressive disorder.
• Use of monoamine oxidase (MAO) inhibitors or antidepressant medications.
• Migraine headaches requiring medication.
• Glaucoma.
• Diabetes.
• Heart disease or heart condition, such as an irregular heartbeat.
• High blood pressure.
• Planning on surgery that requires general anesthesia.

What type of program will be provided along with the medication to help me improve my eating and physical activity habits?

Studies show that appetite suppressant medications work best when combined with a weight-management program that helps you improve your eating and physical activity habits. Ask your doctor any questions or concerns that you may have about good nutrition and physical activity.

Appropriate Treatment Goals If you and your doctor believe that the use of appetite suppressant medications may be helpful for you, it is important to discuss the goals of treatment. Improving your health and reducing your risk for disease should be the primary goals. For most severely obese people, achieving an "ideal body weight" is both unrealistic and unnecessary to improve their health and reduce their risk for disease.

Most patients should not expect to reach an ideal body weight using the currently available medications. Even a modest weight loss of 5% to 10% of your starting body weight can improve your health and reduce your risk factors for disease. Use of appetite suppressant medications for cosmetic purposes is not appropriate.

Appetite suppressant medications should be used with a program of behavioral treatment and nutritional counseling, designed to help you make long-term changes in your diet and physical activity. You should see your physician regularly so that he or she can monitor how you are responding to the medication, not only in terms of weight loss, but how it affects your overall health. Again, if you experience any serious symptoms, such as chest pains or shortness of breath, contact your doctor immediately.

Long-term use of prescription appetite suppressant medications may be helpful for carefully selected individuals, but little information is available on the safety and effectiveness of these medications when used for more than 1 year. By evaluating your risk of experiencing obesity-related health problems, you and your physician can make an informed choice as to whether medication can be a useful part of your weight-management program.

This article is based on information provided by the National Institutes of Health.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.