They can help control obesity but also favor the accordion effect
The Senate approved the bill that releases the sale of appetite suppressants. The decision allows the sale of weight-loss drugs produced with the substances anfepramone, femproporex, and mazindol. The proposal also removes medicines containing the substance sibutramine, its salts, and isomers, and intermediates.
The news has caused doubts about these drugs to triple. "All the people who are going to start taking (or are taking) a weight loss drug should know that there is no magic formula, and that no drug by itself brings a satisfactory weight loss," explains endocrinologist Vânia dos Santos Nunes, from Unesp.
On one side, specialists defend that drugs are still an efficient weapon against obesity. On the other, the team condemns the indiscriminate use and the harm that these drugs can cause.
According to a recent report released by the United Nations Office on Drugs and Crime, weight loss drugs should be used only for medical treatment.
The report prepared by Jife (International Narcotics Control Board) encourages Brazil to continue adopting "all necessary measures to ensure that anorectic drugs are used only for medical purposes and to prevent their improper use and indiscriminate prescription.
The first step to understand the weight loss controversy is to learn more about them. Next, HelthyFit, together with endocrinologists Glaucia Duarte and Vânia dos Santos, clarifies these controversial remedies' main doubts.
1. What Are the Types of
Weight Loss Remedies? How Do They Act in The Organism?
There are three leading weight loss pills: anorexigenics, satiety agents, and fat absorption inhibitors.
The first group's drugs inhibit the appetite and have in their composition substances known as amphetamines. Examples are anfepramone, femproporex, and manzidol. "Currently, specialists use this class only when the other two have not been successful, since it presents more risks of side effects," says endocrinologist Gláucia Duarte, a member of the Brazilian Society of Endocrinology and Metabology.
The second group (satiety agents) includes the drugs that act to stimulate satiety, i.e., the individual feels hungry. Still, with a smaller portion of food, he/she is satisfied and stops eating earlier. Sibutramine is the best known of the group, and it may have a secondary action for weight loss: the increase in energy expenditure.
The third group is the fat absorption inhibitors, represented only by Orlistat and Cetilistat. They do not restrict the appetite because they do not act on the brain or the nervous system. "They work by inhibiting the intestinal absorption of about 30% of the fat ingested. With a good control of fat intake, they can represent a significant help, but by eating too much, the tendency is not to lose weight, because the 30% of fat that is no longer absorbed may not be a sufficient calorie deficiency for weight loss," says the endocrinologist.
2. In What Cases Should They
Be Used? Are They Valid for Both Overweight and Obesity?
All types of weight-loss medications should only be used when adopting a healthier diet, and the practice of physical exercises has not shown results in weight loss. "When the body mass index (BMI) is still above 29.9 after treatment with dietary re-education, the use of medication is indicated to help in the weight loss process," says endocrinologist Vânia dos Santos. To find out your body mass index, divide your weight in kilograms by the square of your height. Calculate your ideal weight here.
BMI table according to the World Health Organization
- Underweight - below 18.5
- Average - from 18.6 to 24.9
- Overweight (pre-obese) - from 25 to 29.9
- Mildly obese - 30 to 34.9
- Moderate obese - 35 to 39.9
- Severe or morbid obesity - above 40
3. What Are the Possible Side
Effects?
Even though these drugs are safe if used correctly, they can cause some side effects. "Each type of anti-obesity medication has specific side effects, which also vary according to the metabolism of each individual," explains endocrinologist Glaucia Duarte.
The anorexigenics (anfepramone, femproporex, mazindol) can cause irritability, insomnia or superficial sleep, tremors, depression, or alternate periods of stimulation with periods of depression, increase in blood pressure and heart rate. "All these effects are linked to the nervous and cardiovascular systems, areas where anorexics have an effect," says Glaucia Duarte.
Sacietogens, on the other
hand, which increase the feeling of satiety, usually have milder side effects
than amphetamines, causing insomnia or superficial sleep, agitation,
irritability (which is not a frequent symptom).
Even so, sibutramine, which fits into this group, was prohibited from being sold in the United States and Europe because the responsible bodies alleged that the drug accelerates the heart rate, causing arrhythmias in those who are already prone to heart disease. In Brazil, sibutramine has been classified as a controlled drug.
Fat absorption inhibitors have side effects, significantly if the fat intake is exaggerated. It is like a red light. "The person will present diarrhea with mushy or liquid stools, and may even eliminate fat drops after heavier meals. Therefore, even when taking weight loss medicine, it is necessary to have a balanced and healthy diet," says endocrinologist Vânia dos Santos Nunes.
4. Can Children with Obesity
Take Weight-Loss Medicine?
The indication of medication to lose weight must be restricted, being prescribed in cases where obesity has become a risk factor. According to Vânia dos Santos, dietary re-education and the practice of physical activities are usually alone able to bring about a considerable improvement in the health of obese children and adolescents under 16 years of age.
However, sometimes the use of medication is necessary. "The use of oslistat, a type of medicine that reduces the absorption of fat in the intestine, has already been tested and approved in children. But the drugs that act on the central nervous system have not yet been fully approved for children and adolescents," says Gláucia Duarte. And it's not for nothing. If they already provoke unpleasant effects in the body of an adult, imagine for children.
"Anorexic and satiety medications should not be used by people with decompensated hypertension, cardiac arrhythmias, type 2 diabetes, and psychiatric illnesses.
5. Does This Type of Medicine
Have Any Contraindications?
Because they cause alterations in the nervous system's functioning and the cardiovascular system, anorexigenic drugs and acetogenic should not be used by people with decompensated arterial hypertension, cardiac arrhythmias, type 2 diabetes, psychiatric diseases (depression and mood disorders, compulsive impulses), and glaucoma.
"Even though the main contraindications are related to sacietogens and anorexigenics, the drugs that decrease the absorption of fat also have a risk group, which are patients with inflammatory bowel diseases," says endocrinologist Vania dos Santos.
6. May the Prolonged Use
Cause Dependence (Physical or Psychological)?
Even if the degree of support is low (they have level one on a scale of up to four), the weight loss drugs can cause physical and psychological support if used for a very long period (more than four months without further evaluation). "As these drugs should only be used as a last resort and as support to a program of dietary re-education and physical activity, after the patient is no longer obese, the use of the drugs must be discontinued," says Vânia dos Santos.
7. Do They Need to Be Taken
Constantly So That the Weight Is Kept Under Control?
"In fact, they must be used for a short period (the doctor makes a new monthly evaluation if the medication is still necessary), so as not to provoke any degree of dependence," says Vânia dos Santos. The drugs to lose weight must be part of the treatment to lose weight, not to keep it down. According to the endocrinologist, keeping in good shape must be done based on a healthy diet and physical exercises. Otherwise, the chances of regaining the weight again are enormous. It's the famous accordion effect.
8. If I Stop Taking It, Will I
Put on Double the Weight?
According to endocrinologists, those who lose weight with the help of drugs that act on the central nervous system recover all the fat loss if they don't worry about the diet and physical activities after the end of the treatment.
9. Is It Dangerous to Take
Them and Do Intense Exercises Because Of The Heart Rate?
As with food, the practice of physical activities must be controlled after the prescription of weight loss medication. The ideal is to keep a follow-up of the heart rate variations to diagnose any changes", says Glaucia Duarte.
10. Do They Cause Excessive
Sweating?
Thermogenic drugs, a type of substance that increases the body's calorie expenditure, can cause this side effect in some people. For safety and side effects (increased heart rate, increased blood pressure, grown thermogenesis), this type of medicine has been little used.
11. Are Its Results Better
Than Dietary Re-Education and Physical Exercise?
The use of medication can only facilitate weight loss, but if there are no lifestyle changes, there are chances of regaining the lost weight. "The medication alone will not bring positive results. It is necessary to control your diet and practice physical activities along with the medication to lose weight", says Vânia dos Santos.
12. Do They Accelerate the Metabolism?
According to Vânia, people with obesity tend to have a slower metabolism. Because of that, the body takes a while to consume all the energy accumulated by the meals. What some drugs cause, as a side effect, is to increase caloric expenditure. Except for thyroid medication, which is not indicated in cases of obesity, the drugs for losing weight do not affect the functioning of our metabolism.
13. How Can I Guarantee That the
Medical Prescription Is the Most Indicated For "My" Case?
According to the nutritionists, the best way to protect yourself from a prescription error is to look only for qualified professionals indicated by other reliable doctors. Another tip is always to try to hear a second opinion.
14. What Is the Danger of
Taking Those Manipulated Formulas That Make A Cocktail of Drugs? In This Case,
Is the Medicine Bought in The Pharmacy the Most Indicated?
Because this type of medicine can bring many side effects, doctors prefer pills from laboratories sold in regular pharmacies. "The doctor has no way of predicting what side effects a manipulated formula can bring to the patient. For this reason, good doctors always prescribe weight loss medications from established laboratories, which undergo quality testing," explains Vânia dos Santos.
"The doctor has no way of predicting the side effects that a manipulated formula can bring to the patient.
15. Are They Diuretics?
"Most weight loss drugs also have diuretics to increase the loss of liquids in the body, and thus increase the feeling of weight loss," says Gláucia.
16. The Weight Loss Is
Imaginary, That Is, We Lose More Lean Mass Than Fat?
A quick weight loss process without physical activities or dieting to maintain lean mass tends not to be sustained. The weight loss dimensioned in a complete treatment, with dietary re-education and physical exercises, guarantees the exchange of fat mass for lean mass", explains Glaucia Duarte.
17. As Time Goes By, Does the
Body Get Used to The Medication and The Dosages? Who Takes Medicine for A Long
Time Finds It More Challenging to Lose Weight Without It Afterward?
Over time, especially with amphetamines, the organism can develop tolerance, i.e., it may need to increase the dosage for effect to be the same. "Most likely those who become chemically dependent on amphetamines expect an easy way to lose weight, without the commitment to dietary re-education and physical exercises, which makes it difficult to sustain the lost weight," warns Glaucia Duarte.