Phentermine is recommended for long term use to lose weight and to maintain weight loss
Note: Much of this material and recommendations are derived from a report by the American Society of Bariatric Physicians TM, entitled “Overweight and Obesity Evaluation and Management.”
Weight loss maintenance
Although phentermine has been used for more than fifty years as a weight loss aide, only recently has its benefits for long-term maintenance been recognized. Appetite suppressants act primarily by lowering the body’s weight set point and only secondarily by suppressing appetite.
As one author noted: “There are strong positive indications for the long term use of appetite suppressants.” Another noted: “The major promise of pharmacotherapy lies not in its ability to improve the amount of weight loss, but in its potential to enhance longer-term maintenance of weight loss with conventional therapies.”
Even small amounts of excess fat can affect your health. There has been a failure to recognize that adverse metabolic conditions may develop with even small amounts of fat gain or abnormalities in fat cell function. Further, the positive psychological effect of weight loss and maintenance as an additional benefit of anorectic usage is often overlooked or ignored.
*Overweight, over-fat, and obesity are variations of a recurrent life-long disease that carries a high risk of diabetes, pre-diabetes, metabolic syndrome, cardiovascular disease and ultimately a risk of premature death and debility if left untreated. Overweight and obesity in the U.S. have increased by more than 75 percent in the past three decades.
Furthermore, “obesity is a chronic relapsing disease for which there is no foolproof cure. Therefore pharmacological therapy should be viewed as a useful adjunct to lifestyle modification.”
Phentermine is Safe
*“Anorectic medications (appetite suppressants) have one of the lowest drug misuse/abuse rates per 100,000 emergency room visits — even lower than Ibuprofen.”
“… as far as the perceived potential addictive properties of phentermine, in 49 years of world-wide use, there has never been a case of addiction reported in the peer-reviewed medical literature.” (PubMed search 6/17/2008)
Phentermine has been proven to be a safe, cost effective and highly successful medication in the treatment of overweight and obese patients. Unfortunately, many of the current guidelines for prescribing it reflect recommendations that are more than 50 years old rather than current evidence of efficacy and safety. There has been an unrealistic and unjustified fear that phentermine is a highly addictive medication.
The Drug Abuse Warning Report of 2006 (DAWN) illustrates that anorectic medications have one of the lowest drug misuse/abuse rates per 100,000 emergency room visits — even lower than Ibuprofen.
DAWN REPORT 2006
Drug # of visits Rate/100,000
Antidepressants 98,789 32.7
Opiates/opioids specified 279,510 92.5
Opiates/opioids, unspecified 55,674 18.4
Amphetamine-Dextroamphetamine 5,608 1.9
Ibuprofen 25,774 8.5
Naproxen/combinations 8,080 2.7
Acetaminophen/combinations 53,835 17.8
Anticonvulsants 36,467 12.1
Antimigraine agents 1,391 0.5
Anorexiants* 1,327 0.4
Total ED visits 1,742,887
Total Drug Reports 3,086,984
Is overeating the problem? Maybe not. The Human and Nutritional Evaluation Survey I (HANES I) surveyed, among other things, the eating habits of 20,749 individuals across the U.S., and found that the obese actually ate less than their normal-weight counterparts. To lose weight and to maintain a reduced weight by means of caloric restriction, these individuals must reduce their food intake even further in relation to energy expenditure. To reach and maintain a normal weight, many obese people are forced to live with chronic hunger. Enduring this level of discomfort on a long-term basis is often more than the patient can bear and the weight is regained.
For many patients, the provider’s advice that eating less will cure obesity is about as helpful as telling hypertensive patients that relaxing will take care of their problem. Without additional help, change usually does not happen. Over the past several decades obesity has moved from being considered a problem of gluttony to that of being an illness or a disease.
Long-term lifestyle changes are necessary for long term success. Medical treatment for weight loss and maintenance includes advice and recommendations for dietary management, behavioral modification, counseling, exercise and appropriate use of medications when indicated, as part of a long-term weight control maintenance program (“weight control” refers to
managing excess adipose tissue).
Pharmacologic Therapy in Overweight and Obesity
“Evidence Based Standard of Care”
Position Statement: Obesity management should be treated similarly to Attention Deficit Disorder (ADD) in which schedule II controlled substances are frequently prescribed yet no special or detailed rules exist. Similarly, we believe that no specific rules are necessary for treatment of overweight or obesity with the much safer schedule III or IV anorectic medications.
Years of experience and additional research have shown these medications to be both effective and considerably safer than was recognized when the scheduling of anorectic medications was initially instituted.
National Institution of Health: “Since obesity is a chronic disorder, the short-term use of drugs is not helpful. The health professional should include drugs only in the context of a long-term treatment strategy.”
Furthermore, “in some cases, weight loss therapeutic agents may even affect metabolic parameters and adipocyte function independently of weight loss alone, suggesting that the benefit of these agents in improving EFRMD may go beyond their efficacy in weight reduction.” (Reference: Expert Rev. Cardiovasc. Ther. 4(6), 871–895 (2006).
This modern approach to the treatment of obesity incorporates medical intervention, dietary, behavioral, and pharmacologic (when indicated) treatments at an earlier stage of the disease and continues therapy for a longer duration of time.
NOTE: Use of BMI understates obesity, particularly in women.
Benefits of weight loss
Weight loss leads to improvement of sleep apnea, diabetes, arthritis pain, improvement of lipids, reduced cardiovascular risk and an increased life expectancy. Also, it may be reasonable to continue some medication for a longer time in selected patients to assure maintenance of weight loss.
It is self-evident that putting time limits on use of medications used in treating a chronic illness is inappropriate when the risk of taking the medication is less than the risk of leaving the illness untreated. In the case of chronic diseases, the FDA does not dictate how long a provider can use insulin in a diabetic, an antihistamine in a patient with allergies, an anti-hypertensive in a patient with hypertension, or a benzodiazepine in a patient with anxiety, etc.
Based on a national survey of ASBP membership, providers report that anorectic medications are one of the more effective tools available to the clinician. In another recently published study these medications were noted to be safe and effective over the long term.
*Studies exist in the medical literature that support longer-term use of phentermine than the treatment recommended in the PDR. One such study suggests “Long-term pharmacotherapy when combined with appropriate behavioral approaches to improve diet and increase physical activity, helps some obese patients lose weight and maintain weight loss for at least a year.
In another study, 12 patients were treated safely for more than 10 years of continuous use with phentermine. There was no abuse noted. Even the NIH states that as long as medicine is working, there is no time line on how long one should prescribe it.
For some patients stopping or at least slowing age related weight gain may in and of itself constitute a clinical response
Barriers to Appropriate Use
Currently, there are certain barriers to the appropriate use of anorectic medications. These include the following:
- The perception by the public and some medical professionals that obesity is caused by lack of willpower.
- Anorectic medications are held to a higher standard in defining desired outcomes than are other medicines.
- The Schedule III and IV anorectics have a tarnished reputation because of their structural relationship to amphetamines and because of inappropriate prescribing by ill-trained or inexperienced providers using the medications without a comprehensive program.
- There is an inappropriate fear of the “dangers” of anorectics and their potential for abuse by patients.
- Outdated information and rigid adherence to PDR labeling prevent appropriate “off-label” use of anorectics.
- Many providers, because of a lack of treatment guidelines and the existence of outdated and/or antiquated federal and or state laws, fear regulatory retaliation if they prescribe anorectic medications.
- There has been a failure to recognize that adverse metabolic conditions may develop with even small amounts of fat gain or abnormalities in fat cell function.
- The positive psychological effect of weight loss and maintenance as an additional benefit of anorectic usage is often overlooked or ignored.
- Barrier: Anorectic medications are held to a higher standard in defining desired outcome than are other medications.
- Barrier: The positive psychological effect of weight loss and maintenance as an additional benefit of anorectic usage is often overlooked or ignored.
The myth of tolerance seems to have prevented use of appetite suppressants in precisely those situations in which they are indicated which is over the long term. “There are strong positive indications for the long term use of appetite suppressants. Many overweight hypertensive and diabetic patients can control their conditions by weight loss.
Unfortunately, however, many of them cannot lose weight by diet alone (as is true of many of us). As a result, they are forced to rely on long term use of medication to control their hypertension, diabetes, and other conditions. If these patients must receive long-term medication, they may well be better off on appetite suppressants than on the usual remedies. At the very least, weight loss will control their complications in a more physiologic manner.
Dr. NBH, Ph. D. is the Director of Education & Research for Natural Bio Health. He has a Doctorate Degree in Natural Health and has been designated a Diplomate of Anti-Aging Medicine and a Fellow and Advanced Fellow of Anti-Aging, Regeneration & Functional Medicine.
NBH has been awarded a Certificate in Brain Fitness and Weight Management from the Academy of Anti-Aging Medicine. He is certified by World Link Medical in Advanced Bioidentical Hormone Replacement Therapy and has completed the expert level education in the Mastering the Protocols of Hormone Replacement Therapy.
He is a fourteen year member of the American Academy of Anti-Aging Medicine.