Published Thu, 2010-10-28 18:57; updated 4 years ago.
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It's a problem that has weighed heavy on people's minds for many years - how to shift those stubborn extra pounds...
Wishing someone could produce a pill to make the weight just fall off.
Then you stumble upon these miracle claims:
“...Within a day and a night of taking a first dose there will be a reduction in weight varying between 8oz to 3lb, in extreme cases even more. The subsequent daily decrease will be persistent until normal weight and dimensions are attained...”
“In a very short space of time, say 24 hours, a considerable quantity of the most unhealthy fat will have been removed from the part of the system most in need of relief from the adipose matter oppressing it (the quantity varies from 2oz-2lb or even more)..."
These are just two adverts for so called weight loss pills published at the turn of the last century.
The first statement is a claim made in 1907 by the company behind a product called Antipon.
Antipon was made up of citric acid, red food colouring, water and alcohol (none of which have any effect on weight loss) and it sold for more than twenty times the cost of its ingredients.
The second claim was about Russells’ Anti-Corpulent Preparation.
Sold in pill form and taken daily it contained citric acid, iron, alcohol and water and sold for more than thirty times the cost of its ingredients.
Do these claims sound outlandish?
Although they were made more than 100 years ago, if you change the grammar and vocabulary a little you can find the same claims being made about weight loss products today.
How many times have you found your eye drawn to an advert which promises a simple solution to weight loss?
A solution with no side effects that requires no effort - no need for dieting or exercising.
Unfortunately, in most cases, the only pounds corpulent Edwardians were likely to lose were the ones that rattled in their pockets.
Although at least they were unlikely to suffer any side effects.
Many medications that advertise weight loss today are similarly unproven when it comes to shedding pounds. They are often expensive but ineffective.
Most worryingly, unlike their predecessors, some of today's weight loss medications may cause much more significant side effects.
The importance of regulation
Weight loss medications from 100 years ago were marketed in a different and unregulated era.
Anyone with good or bad intentions could box up pills and make claims about them without any evidence.
Companies were not even obliged to list the ingredients.
Nowadays, before a medicine can be sold in the UK, a number of trials and licences are essential.
The Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for granting licences to carry out the clinical trials required to collect data on the safety and effectiveness of new products.
Evaluation of the beneficial effects of any medication against possible side effects has to take into account:
- The nature of the active ingredients and the dose
- The nature of the disease or condition to be treated
- The type of patient (for example, age and sex)
- The duration of treatment
Once all the above criteria have been met the product receives a Marketing Authorisation licence and it can leagally go on sale.
The MHRA Medicines Inspectorate also ensures that the premises and procedures of companies supplying medications reach required quality standards.
Trials, regulations and subsequent monitoring ensure that doctors prescribing medications are aware of the expected benefits, possible side effects, interactions with other medications and contra-indications to their use.
By contrast, unregulated medicine use provides none of these safeguards.
Richard Seal, Programme Consultant in Medicines Management for NHS West Midlands says: “The issue with diet pills is part of a broader issue about obtaining medication from sources other than a reliable pharmacy with a doctors’ prescription.
"Many of these medications have been illegally imported and may contain weird and wonderful ingredients.
"They may have no licence and there is no check on the quality of the product.”
Regulating appetite, weight and metabolism in the human body is a complex system.
Attempts to manipulate them using drugs is therefore understandably fraught with potential pitfalls and side effects – even when done according to proper safety regulations.
The history of prescription diet pills is littered with promising starts and disappointing or dangerous ends.
One approach to weight loss was the use of laxative preparations.
These do not produce the desired weight loss at the expense of complications such as altered blood salt balance (which can affect the rhythm of the heart), skin pigment changes, kidney stones, and weakening of bones and muscles.
Products containing thyroid extract may cause weight loss, but taking it can have side effects such as developing a condition called hyperthyroidism.
Other complications include:
- Altered heart rhythms
- Heart failure
- Bone thinning or osteoporosis
- Changes to periods and fertility
- High blood pressure
- Mood changes
- Hair loss and
- Muscle weakness
In the 1930s researchers noted that workers in the dye industry lost weight when handling aniline dye products.
Dinitrophenol, an aniline derivative, was prescribed for weight loss until it was abandoned after trials showed it caused cataracts and nerve damage.
Amphetamine was approved for use in obesity in the USA in 1947.
Once it was shown to be addictive (and now illegal) its use declined in the 1970s.
Amphetamine use can result in psychotic illness.
Phentermine and fenflurmine are structurally related to amphetamine and were used until they were found to cause heart valve disease and pulmonary hypertension leading to heart failure.
More recently in 2008 rimonabant (or Accomplia) was withdrawn from use due to concerns about its psychiatric safety.
It was also shown to have more frequent and intense psychiatric side effects compared to those identified during clinical trials, emphasising the importance of continued monitoring.
Even despite proper monitoring in hospitals and GP clinics, the risk of significant psychiatric reactions was found to outweigh the benefits.
Depression was twice as likely in obese patients taking rimonabant as in patients taking dummy pills.
A review of sibutramine (or Reductil) in 2010 resulted in the suspension of the licence for this medication.
The cardiovascular effects of the medication once again outweigh the benefits.
Studies showed that obese patients, who are already at high risk of heart disease, had a 16% increased risk of cardiovascular problems such as heart attack and stroke when using sibutramine compared to patients taking dummy pills.
So despite responsible and appropriate clinical trials, sometimes it takes some time before the effects of medication taken by larger groups of the general population become apparent.
Ongoing monitoring and regulation is vital.
In the meantime the internet and unscrupulous private clinics continue to supply medications to the unwary.
These medications are either known to be dangerous, proven to be ineffective for weight loss or have not been fully tested at all.
The last word goes to Richard Seal.
“There is no such thing as a “wondercure” for obesity. Pharmacological therapies can help to support weight loss but there is no magic bullet.”
If you are considering losing weight and in particular if you are considering medication to do this then your best advice is to see your doctor to discuss this.
Due for review October 2013