Science progresses by small steps. If a drug like fenfluramine doesn’t work , can we make a drug specific to the receptor and have it provide no side effects? This would be analogous to the class of drugs that are known as the sartans which block the effect of angiotensin in the body and are used to treat hypertension and heart failure. The 5-HT2C receptor is what is being blocked by the compound lorcaserin and guess what? It provides weight loss.
This paper was published in the N Engl J Med 2010; 363: 245-246 and vigorously commented on in the lay press. The study known as BLOOM for Behavioral Modification and Lorcaserin for Overweight and Obesity Management enrolled 3182 obese patients who had body-mass index between 30 and 45 kg/m2 or if you had hypertension, diabetes, cardiovascular disease, impaired glucose tolerance or sleep apnea. (Just about everyone over the age of 40 years old). Just for grins go to the website http://www.nhlbisupport.com/bmi/ and calculate your own. Don’t cry. I need to become taller or lose 15 lbs.
The participants took 10 mg lorcaserin twice a day or placebo and everyone was instructed to exercise 30 minutes daily and to reduce caloric intake by 600 kcal a day. That translates into a diet roughly 1400 cal a day for most patients. Forget the doughnuts at breakfast.
At one year, 74.5% of the treated patients lost 5% or more of their body weight, not their BMI, compared to 20.3% of the placebo treated patients. If I weighed 175 and lost 8.75 lbs. over one year I would be a success. On average, patients lost 5.8 kg or 12.78 lbs. in one year. The placebo group lost 2.2 kg or 4.85 lbs. Here’s the real kicker. After one year, patients in the lorcaserin group were randomized again to continue the medication or take placebo. Those that continued the medication maintained their weight and those that took placebo regained the weight to roughly the placebo group level.
Personally, I’m not at all sure that taking a medication to achieve a 12 lb. weight loss is what we are really looking for. I will go back to my original premise that what is needed is for the American population is to “man up” and stop whining. We need to eat less far less and exercise more far more. Lifestyle modification is what is needed, and though it is hard and not sexy, you are never going to have abs like “the Situation” until you eat and exercise like him. Jack LaLanne told us this in the 1960’s “eat right and you can’t go wrong”. He is now 96 years old and still going strong.
We must remove the mind set from the population that medicine can solve all the effects of bad choices that we make. Do you really want that second helping of food, or are you willing to do the exercise that it takes to work it off.? It’s our choice and as you can see by looking around we are losing the battle.