by Kristina Lewis, MD
Although there are now several FDA-approved medications for weight loss, many physicians and patients remain hesitant to initiate therapy with these agents. A long history of horror stories from drugs like Fen-Phen, Sibutramine and others has sensitized the medical profession to the idea that some drugs may harm more than they help, especially when it comes to weight management. For patients and physicians sharing these hesitations, an alternative strategy might be to put both a patient and his/her medication list on a diet. A careful review of the patient’s history of weight gain, examining for coincident initiation of medications, is a good place to start (e.g. “It looks like you’ve gained about 30 pounds since starting on Paxil. What about a trial of Wellbutrin instead?”). Asking about over-the-counter medication use (e.g. “Are you taking Zyrtec every day?”) is also important.
Clearly, for most patients, these kinds of changes will not result in dramatic weight loss. However, they may remove unrecognized barriers to the impact of behavior changes like diet and physical activity. Helping patients start to see results from their efforts at cutting calories and getting more exercise can be incredibly motivating. For physicians treating patients with obesity, the take-home message should be, “If you’re not comfortable starting a new drug, how about stopping one instead?”