Obesity, euphemistically known as “puffy” to my 14-year-old, is the most talked about health problem in America today.
And what a problem it is. Blame it on fast food, too much television, too little activity, or your root-gathering ancestors. Between a third and a half of us are overweight today. And every year the problem gets bigger (sorry).
Obesity is tangled up in every major cardiovascular problem and arterial disease. Heart attacks, strokes, peripheral vascular disease, kidney failure (renal vascular), eye disease (retinal vascular) – you get the idea. Anything with blood vessels are affected, but try to find a body part without blood vessels. Fingernails and hair might be the only ones. You can have good hair when you are dead!
Obesity increases plugging in the arteries, known as atherosclerosis. Other causes of atherosclerosis are high blood pressure, smoking, high cholesterol, diabetes, or poor diet. Add obesity to any of these and the damage is multiplied.
Obesity is the last bastion of “socially acceptable” bigotry (thankfully that is changing, see “puffy”). The emotional cost of obesity is unimaginable, unless you have lived it.
Fix obesity and you have really done something for the collective health of America. It might go a long way to balancing the budget. Those are the kind of healthcare dollars that a really efficient and beneficial obesity drug could save.
Enter Qnexa. Now it’s called Qsymia due to some legal mumbo-jumbo (where do they get these names?). Qsymia is a long-acting combination of phentermine (the harmless one of the Fen-Phen mess) and Topamax (topiramate).
Phentermine is an older stimulant class drug that is well tolerated and doesn’t have any dangerous habits that we know about. Topiramate is an anticonvulsant that is used to control seizures, migraines and sometimes chronic pain. This is also a drug that has been around a while, and is rather innocent as medications go.
The magic seems to be in the dose. The ratio of phentermine to topiramate is approximately 1 to 6. Additionally, both drugs are used in much less than the maximum daily dosage. They are generally well tolerated. A few people had some nausea or constipation, but not bad enough to be treatment-limiting.
Qsymia works by suppressing the appetite. The combination is a much stronger appetite suppressant than phentermine alone. This is the easiest way to lose weight because you don’t get hungry.
The FDA requires 5 percent measured weight loss in clinical trials. Qsymia managed to get well beyond that, up to 15 percent weight loss in several large clinical trials. It also seems to be useful in Type 2 diabetes.
When can I get it? That’s what everyone wants to know. It will be available by mail order with a prescription from a doctor that has some special training in this medication. If that seems unduly cautious, remember that more weight loss medications have been taken off the market, due to safety concerns, than added in the last 10 years.
Qsymia looks like a very promising medication for weight loss. If the medication is proficient enough, it might even get over the name handicap. Now that it has received FDA approval, it should be in the hands of patients in the very near future.
Take care,
Dr. B.
Thanks for posting this.. It’s been a pleasure to read