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Ask the Mental Health Expert Archives 2001-2004

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Diet Pills

Q. Are there any new diet pills on the market with few side affects? Would you recommend these for people with a food obsession or overeating compulsively?

A. As a general rule, I urge people to stay away from so-called "diet pills". The reason is two-fold: there are many risks associated with taking such pills, and their benefits over the long term are at best unclear. Most such over-the-counter preparations have led to increasing dependency and even abuse of the drug, over many months or years. Recently, the drug phenylpropanolamine (PPA)-used in diet pills such as Acutrim---was taken off the market, owing to reports of increased stroke risk. (Persons with high blood pressure are especially at risk from PPA).

On the other hand, for patients with genuine obesity (roughly, 30 or more lbs. over ideal body weight), there are some new prescription medications that may be of benefit. Orlistat, for example, reduces absorption of fats in the intestine, and can help obese people lose weight. Side effects may include cramping and perhaps reduced absorption of some nutrients. Sibutramine (Meridia) is another anti-obesity agent that may be effective, but which may also have serious side effects in some individuals. As far as food obsessions or compulsive over-eating to the extent that some of these problems may relate to obsessive-compulsive disorder, the use of serotonergic antidepressants, such as fluoxetine (Prozac) or sertraline (Zoloft) may sometimes be helpful.

So-called binge eating disorder may also respond to antidepressant treatment. Of course, non-medication therapies, such as group therapy and self-help weight reduction classes may also aid individuals with obesity or binge-eating disorder, if conducted by knowledgeable professionals. For people who are simply overweight but not obese, the best approach is one that incorporates sensible dietary changes and increased exercise, both over the long-term. The Mayo Clinic website (http://www.mayohealth.org/home?id=HQ01239) suggests some common-sense weight loss strategies, including:

  a. Eating plant-based foods.
  b. Watching your fat and cholesterol intake.
  c. Watching your total calories.

Exercise is also critical. Finally, remember: small changes over the long haul will pay off much more than quicky strategies like fad diets or weight loss pills.

April 2001

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