Jul 17, 2013 17:49 The battle against OBESITY The battle against OBESITY AMA, new drugs weigh in on the fight by ELLYN COUVILLION| Advocate staff writer July 17, 2013 Comments June was something of a landmark month for the treatment of obesity: the American Medical Association officially recognized it as a disease and a new medicine to treat obesity came to market. With the AMA’s new stance on obesity, which affects more than two-thirds of adults in the U.S., broader insurance coverage might follow. “It makes one think that, potentially in the future, we may have some of these drugs covered (by insurance) and their use go up,” said Dr. Frank Greenway, chief of the outpatient clinic and professor at Pennington Biomedical Research Center. Belviq (pronounced “bell veek”) is one of those new drugs. It is the second such new, FDA-approved product to become available in pharmacies in less than a year. While such a prescription sounds like a wonderfully simple solution to an extremely difficult health challenge, the reality is it’s not. “I’m not comfortable prescribing these medicines. I believe the amount of weight loss is not worthwhile,” said Dr. Diana McDermott, assistant professor of clinical medicine at the LSU Health Sciences Center, New Orleans. Belviq’s manufacturer, Arena Pharmaceuticals, notes the medicine is to be used with a reduced-calorie diet and increased physical activity — the basic tools of weight loss. Compared to patients only taking a placebo pill, patients on Belviq lost about 7 pounds more over a one-year period. Belviq works in the brain to decrease appetite and promote a feeling of fullness. The Food and Drug Administration asked physicians to instruct patients to stop using Belviq if they haven’t seen a 5 percent weight loss after 12 weeks of taking it. The picture for insurance coverage for the medication is unclear — and Belviq costs approximately $200 per month, McDermott said. To maintain the weight loss, she said you would have to take the medicine the rest of your life. Another FDA-approved prescription for obesity, Qsymia (pronounced “q-sim-ee-uh”), became available in pharmacies last September. Qsymia is a combination of two medications, phentermine, a stimulant, and topiramate, an anti-seizure medicine. Compared to patients only taking a placebo pill, patients on Qsymia lost about 8 to 20 pounds more over a year. Both of the medicines, according to their literature, are indicated for patients at a high body mass index. And both of them have side effects and risks. According to the manufacturer, some people taking medicines like Belviq have had heart valve problems, and taking too much Belviq may cause hallucinations. A common side effect is headaches. Neither of the medicines should be taken by pregnant women or women planning to become pregnant. Qsymia can cause birth defects, according to the manufacturer, and its other possible side effects include numbness or tingling of the face and extremities, insomnia and suicidal thoughts. Pennington Biomedical Research Center was one of the research sites in the multi-center clinical trials for both of the medications. “We’ve been involved in most of the obesity-related pharmaceutical trials. We’re involved in some now,” said the center’s Greenway. There are other anti-obesity drugs on the market, McDermott notes, such as orlistat, which is sold in a prescription form called Xenical and, at lower dosages, as Alli over the counter. The concept of a pharmaceutical answer for weight loss has been around a long time. Phentermine, one of the ingredients of the new Qsymia, was approved by the FDA as an appetite suppressant in 1959, Greenway said. McDermott said the appropriate candidate for using anti-obesity medicines would be those using it short-term “as part of a comprehensive weight-loss strategy, to jumpstart” weight loss. “Consider looking for a physician certified by the American Board of Obesity Medicine, which ensures an extra level of training in weight-loss management,” McDermott said.