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Weight Loss Drugs: Help or Hype?

A Pill a Day?  Or How About Just Eat Better and Exercise?

A Pill a Day? Or Eat Better and Exercise? Image:

With the recent FDA approval of two new weight-loss drugs, Qsymia and Belviq, I wanted to briefly discuss the potential benefits and risks of the existing FDA-approved weight loss medications (yes, by prescription) which are:

  1. Qsymia

  2. Belviq

  3. Xenical (Orlistat) and its smaller-dosed, over-the-counter (OTC) equivalent: Alli.

Yep, until about two months ago, the only other weight-loss drug on the market was approved thirteen years ago.  And here’s an article I wrote for that discusses the benefits and risks of the OTC version, Alli.  Xenical is just a higher dose of the same medication.

While three are currently on the market, there have been a number of others in the past, now banned by the FDA due to life-threatening side effects such as heart attack, pulmonary hypertension and stroke: ephedra (Chinese herb), Fenfluramine (the “Fen” of Fen-Phen), Aminorex, Sibutramine (Meridia).

Now, let’s get to the two new players soon to be on the market:


  1. A combination of two drugs: Phentermine (the “Phen” of Fen-Phen) and Topiramate (an anti-seizure/migraine medication).  The medications are “designed” to suppress appetite, increase fullness, make food taste less appealing (nothing like avoiding chocolate by making it taste lousy!) and increase caloric expenditure.

  2. A federally “controlled substance” due to the use of phentermine.  In other words, too much is not safe so they need to restrict it so people take too much and have serious side effects.

  3. Currently designed to be “taken forever, or until you develop a side effect or have other reasons to stop.”


  1. Increases levels of serotonin in the brain, which is known to suppress appetite.  Unfortunately it also does a lot of other things, such as act as a hallucinogen (LSD) when used in too high of a dose.

  2. A federally “controlled substance” due to the fact that taken in too high of a dose, it’s effects could be similar to a hallucinogen (so the DEA is involved).

  3. Currently designed to be “taken forever, or until you develop a side effect or have other reasons to stop.”

Both have a laundry list of precautions, a summary of which can be found at the WebMD article that served as the inspiration for this summary:

So how did these new drugs perform?  Anywhere from about 4% to 8% more results than placebo over the course of a year.  How much is that?  Well, for a 150 pound person, that’s an extra 6 to 12 pounds in one year.  Not shabby, but not earth shattering.  And there’s a catch to getting those results (it’s at the end of this article).

Despite these potential results, consider at what cost: the potential side effects such as increased heart rate, suicidal thoughts, glaucoma, attention/concentration deficits, hand/feet tingling, change in taste, trouble sleeping, constipation, etc.  You can check out full lists of precautions and side effects for Qsymia ( and Belviq ( at the links listed.  And here as well, for Qsymia.

So what’s the catch?  The final line question from the WebMD article says it all:

If I take Belviq or Qsymia, do I still have to diet and exercise?

Absolutely. In clinical trials, the drugs were effective only when given along with a balanced diet and exercise.”

In other words, diet drugs only help if you live healthfully to begin with.  Otherwise, it’s just another pill that you have to take forever, until you develop side effects or choose to stop taking it.  So why not make some gradual, permanent changes to your eating and physical activity habits and allow your weight loss to take a couple months longer, without the potential for hallucinations or constipation?

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Shivam Vishwakasrma
Shivam Vishwakasrma
11 Kas 2022

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