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Weighing In: Costs and Benefits of Appetite Suppressants
The adage "You can never be to rich or too thin" seemed to go out of style in the 1960's. A generation of feminist bra-burners tried to unseat the oppressive standards established by a patriarchal domination, and civil rights activists fought for racial and economic equality in the face of cultural hegemony and social stratification. However, despite the fight to divert focus from the homogenizing standards of aristocratic white culture, the pressure to be thin is as prevalent as ever in today's society. At the same time, obesity rates continue to rise, earning America international accolades as "the world's fattest nation." As a deluge of media messages equating thinness with beauty and success amplifies the desire to fit a standard body shape and size, consumers turn to medical technology for help losing weight.
After fad diets and ambitious exercise plans fall through, more and more Americans choose pharmaceutical appetite suppressants to shed ten, twenty, fifty, or up to hundreds of pounds. These drugs are clinically prescribed for patients suffering from "obesity," but many are also available over-the-counter for general weight loss. However, many critics claim, "Nowhere has the question of risk versus benefit come under greater scrutiny than with anorectics," (1) as the potential side-effects or anorexctics may pose dangerous and even fatal health risks. How much will Americans pay for a size six figure?
Anorectics, also known as anorexigenics or appetite suppressants, are substances that reduce the desire to eat. These medications are generally stimulants of the phenylamine family, which work by increasing the neurochemicals that affect mood and appetite: serotonin and catecholamine. (2) The most notorious phenylamine is amphetamine, or speed, which was sold commercially as an appetite suppressant until the late 1950's, when it was outlawed in most parts of the world due to concerns regarding drug abuse. (1) Physicians no longer prescribe amphetamine, but some of its derivatives also classified as anorectics remain on the market. (4)
The multi-purpose nature of commercial anorectics complicates questions of efficacy and desirability. Appetite suppressants can be prescribed for clinical obesity, which is often attributed to genetic factors; casual weight loss, instigated by a personal decision on behalf of the patient; and some are even prescribed for mental health problems. For example, sibutramine inhibits the reuptake of neurochemicals such as monoamines, noradrenaline, serotonin and dopamine, performing the same function as many current antidepressants. Furthermore, "in addition to its appetite suppressant effect, sibutramine increases thermogenesis and fatty acid catabolism," (1) fighting obesity by jointly increasing metabolic functions and reducing appetite. While these functions can certainly induce weight loss, they are accompanied by a range of negative side effects.
The use of prescription anorectics decreased during the 1970's and 1980's as the public became more aware of the very real dangers these medications pose. However, medical scripts for phentermine and fenfluramine ("phen-fen") skyrocketed in the 1990's, after a small but well-timed study demonstrated phen-fen's efficacy in treating 121 obese individuals. (1) Although less than one third of the patients completed this study, and most regained weight during its latter stages, the findings paralleled a growing concern with American obesity and fueled an anorectic frenzy.
Despite the recent popularity anorectics enjoy, the purported benefits come at a high cost. Principal adverse effects include increased heart rate, increased blood pressure, sweating, constipation, insomnia, excessive thirst, lightheadedness, drowsiness, stuffy nose, headache, anxiety, and dry mouth. (2) This extensive list is complemented by the grave possibility of drug addiction during treatment and a similarly somber likelihood of depressive tendency at discontinuation. (4) While weight loss is often linked with lower cholesterol, such a boon must be compared with disadvantages such as pulmonary hypertension and valve defects. (1) Many patients using anorectics experience a racing heartbeat or corollary cardiac complications, again detracting from the appeal anorectics initially present.
Furthermore, many studies show that the benefits anorectics offer may not be as dramatic or lasting as drug manufacturers claim. Patients often experience a weight loss plateau after 6 months while taking a weight-loss medication, and many regain significant amounts of weight upon terminating treatment. (2) It is unclear whether this leveling off is due to a developed tolerance or if the medication has reached its limit in effectiveness; in any case, most anorectics are intended for use as a short-term treatment for people with obesity. "Appetite suppressants can help you to lose weight while you are learning new ways to eat and to exercise," (5) but changes in eating habits and activity level must be developed and continued to ensure long-term weight loss.
Critics of the pharmacomania accompanying commercial anorectics qualify, "appetite suppressants typically affect hunger control centers in the brain. However, hunger is not the only trigger for eating." 6) Our instant gratification society relies on technology for quick-fix solutions to deeper individual and societal problems. Weighing costs and benefits, it seems that anorectics fail to provide the ticket to health and happiness initially promised. The prevalence of appetite suppressants thus ought to be accompanied by a close examination of societal standards of both body weight and general health. The polarized division of obesity and obsessive eating habits indicates a fundamental problem in the way Americans view diet and exercise, a conundrum evidenced by a willingness to sacrifice long-term health for quick and easy weight loss.
1) Anorectics on Trial: A Half Century of Federal Regulation of Prescription Appetite Suppressants -- Colman 143 (5): 380 -- Annals of Internal Medicine , Information about the history of anorectics in American medicine
2) WebMD with AOL Health - Prescription Weight Loss Medicine, A physician's interpretation of anorectics
3) Information about Diet Pills (Appetite Suppressants), Advice on choosing and utilizing anorectics
4) Pharmacorama - CNS stimulants and anorectics , Information on the biochemical functions of anorectics
5)MedlinePlus Drug Information: Appetite Suppressants, Sympathomimetic (Systemic), Anorectics and the central nervous system
6) Appetite Suppressants to Reduce Hunger and Help Weight Reduction , Information on common functions and usages of anorectics
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