Diet pills

Both prescription and non-prescription substances are marketed with the promise of helping people to lose weight. According to the NHLBI guidelines, weight-loss drugs should be considered as only part of a comprehensive treatment plan for patients with BMI over 30, or over 27 with accompanying obesity-related disease. Weight-loss drugs should never be used without concurrent lifestyle modification efforts (evidence level B).

The two drugs approved by the Food and Drug Administration(FDA) for long-term use are sibutramine and orlistat. Sibutramine is an appetite suppressant, working to promote weight loss by decreasing appetite or increasing the feeling of satiety. Orlistat is a lipase inhibitor; it works by reducing the body's ability to absorb dietary fat.

Many over-the-counter medications and dietary supplements are marketed with similar promises. Some pose significant health risks:

• Phenylpropanolamine was previously used in many over-the-counter weight-loss products. It was withdrawn from the US market in 2000 because of findings of increased risk of hemorrhagic stroke.

• Ephedrine-containing products are often marketed for weight loss. They are commonly labeled as "natural" or "herbal" and use common names for herbs as the source of active ingredients (ma huang, Chinese ephedra, Sida cordifolia). Reported adverse events range from tremor and headache to death. Stroke, myocardial infarction, chest pain, seizures, insomnia, nausea, and vomiting, fatigue, and dizziness were among the problems reported. Seven of the eight reported fatalities were attributed to myocardial infarction or cerebrovascular accidents.13

Other dietary supplements promoted for weight loss include conjugated linoleic acid, 7-keto-dihydroepiandrosterone (DHEA), and garcinia. There is insufficient evidence to support effectiveness of any of these for weight loss.

Weight-reduction diets alone usually do not result in maintenance of weight loss. Behavior modification, sustainable lifestyle changes, and exercise are usually required to maintain the new lower weight. A program consisting of dietary therapy, physical activity, and behavior therapy should be continued indefinitely (evidence level B).10

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