Dr. Derrick Cetin says there’s no “miracle drug” for weight loss, but appetite suppressants can help.

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• FOF: It seems easier to gain weight and harder to lose weight after age fifty, why is that?
  • I’m not sure that we really know. Some people blame menopause and the lack of estrogen. I blame menopause but it’s not just that. We are in the middle of an obesity epidemic. My patients who are going through menopause are eating 300 to 400 more calories a day than women were eating in the 1970s.
• Do you prescribe estrogen for weight loss?
  • I don’t routinely give people estrogen because I don’t do primary care—a gynecologist or a primary care physician should really prescribe estrogen. It is a very controversial drug because it’s linked to breast cancer.
• Do you prescribe weight loss pills for women over 50?
  • I do use prescription “appetite suppressants.” (I use this term because patients are often resistant to the word “pills.”) There are only two that have been proven successful by randomized control trials: Xenical and Meridia. There are also several amphetamine groups of medications, like Phentermine and Adipex that I may use. But they are controlled substances so they have to be carefully watched and monitored.
• How do appetite suppressants work?
  • They increase chemicals like serotonin in the brain, so the body feels full.
• Would you give them to anyone? Who’s a good candidate?
  • Appetite suppressants are really for people who need to lose 20-40 pounds. And I don’t generally start people on them right away. First a patient will start a program where she sees a dietician, keeps a journal, exercises and does behavior modification. Six months into that program, we’ll have a conversation about appetite suppressants. If she's the type of person who loses weight and then gains it back, or if she's still stress eating or eating late at night then we’ll try the medications.
• If these “suppressants” work, why is it necessary to do the other stuff?
  • The pills don’t work by themselves; studies show that over and over again. They’re successful in conjunction with diet and exercise. Even commercials for over-the-counter drugs—like Dexitrim—tell you that it only works if you are very active and eat a healthy diet.
• If someone is slightly overweight--let’s say ten pounds--would you recommend appetite suppressants?
  • I had a young girl come in the other day, her Body Mass Index (BMI) was 25.5 and her mother wanted her on an appetite suppressant. She was really mad at me because I told her ‘No.’ We only use appetite suppressants for a person with a BMI between 27 and 30 and at least one comorbidity--hypertension, high cholesterol, apnea or diabetes. If you have a BMI over 30, you can use an appetite suppressant even if you have no comorbidities.
• Why don’t you give appetite suppressants to just anyone? Are their side effects?
  • For the ones I prescribe, you have to watch blood pressure and heart rate because that can go way up. You should lose roughly two to four pounds a month on it. If a patient doesn’t lose weight in the first two months, their blood pressure is high or there are other side effects, I usually stop it.
• How much can you expect to lose on appetite suppressants?
  • On average, we can only expect someone to lose 10 percent of their overall body weight. Some people are going to gain weight. Some may lose 20 percent of their weight, some may lose 1 percent. It’s an average.
• How long is too long to be on it?
  • We try to regulate the amphetamines so that people aren’t abusing them – three months on, six months off. Trials of Meridia have shown that you can use it up to two years. I had one woman on Meridia for two years who lost 98 pounds. She spent a year off of it and only gained two or thee pounds back. She’s got the diet and exercise all figured out now. She doesn’t need the medication anymore. The problem is, it’s a very costly medication—upwards of $1.50 to $2.00 per capsule.
• You talk mostly about appetite suppressants. What about fat absorption inhibitors?
  • Those are Xenical and Alli. They block an enzyme that breaks down fats so it doesn’t get absorbed in the small intestine. I write very few prescriptions for them. They’re not real popular because of the side effects – diarrhea, fatty or greasy stools. Less than 10 percent of the calories you eat can come from fat. Last time I put somebody on it, the women yelled at me because she got diarrhea. I asked her what she had for dinner the night before and she said a couple of burritos. She didn’t realize that her dinner had probably ten times the amount of fat she was allowed to have.
• So there’s no such thing as a miracle weight loss drug?
  • No—there’s no such thing as a pill that can make your obesity go away.
  • At some point you have to make some behavioral changes. All those factors that caused the weight--going to McDonalds, stress eating, eating the wrong calorie foods, not getting three vegetables and two fruits per day--could be resumed on a pill. If they resume those activities, they gain the weight back.
• What’s in the future for weight loss drugs?
  • There are a lot of drugs in stage-3 trials, such as Qnexa and Excalia, that work by using two medications combined in much lower dosages. They have been very successful in trials showing that people are losing more than 10 percent of their weight with less side effects. I’ve been waiting for a long time for a really good new medication to come out.
  What's your experience with weight loss pills? Tell us by commenting below.