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Monday, February 27, 2012

Qnexa: the Wonder Working Diet Pill or Else?

As a doctor, I am usually happy when a new pill comes around. With this one though and I mean Qnexa,a new weight lowering drug, I have mixed feelings.

Here is the issue: There is an epidemic of obesity in the United States. The small print implication of "epidemic" is that we are looking at a medical problem. Meaning, simplistically put, a problem rooted in some biology gone astray.

The implicit message: As we are looking at a medical problem, a medical intervention is warranted.

Therefore the solution: If pill that can contain this epidemic would come along, we shall approve it.

And of course, if all this were to be true, Qnexa, which has been proven to decrease weight, sounds like a great idea, doesn't it?

But what if, those premises that I just stated, are only half-truths?

Let me re-phrase it...

Here is the real issue: While there is an epidemic of obesity, which no one disputes, epidemic only indicates that the number of cases of a certain disease in a population is hight; however, there is no indication if the observed phenomenon is the result of biological, psychological, social or cultural factors.

And then here is the real question: Is obesity a medical (read biologically based only) problem and as such an appropriate target for medical interventions, including medications?

And the real answer? While there are patients with a diagnosis of morbid obesity, a medical condition, thus an appropriate indication for a medical treatment, for the majority of patients obesity is the final result of a complex inter-play of psycho-social contributors.

Thus a pure medical solution to non-morbid obesity is unilateral, does not address the root causes of obesity and conceivably increases the risk of masking the original psycho-social causes of obesity.

If we agree that symptomatic treatments should be temporary and always second-line when etiologic treatments are available, any medical solution for non-morbid obesity should follow the implementation of solid preventive medicine and health education policy changes.

My concern is that with the approval of Qnexa we will see patient who will want to take the "wonder died pill" while keeping up their unhealthy dietary and/or sedentary habits.

Food for thought: Our biology does not change in the course of a century. If we have an epidemic of obesity now, that cannot be the result of altered biology. It is rather the result of a change in our life habits that now overwhelm a system designed for a much higher caloric output with a much lower caloric intake. In other words, a much more active life style with significantly lower food intake.

My concern is that Qnexa will not make it any easier for doctors to persuade their patients that good dietary habits, an active and balanced life style and responsibility for saying no to the too many dietary temptations need to always come first.

Suggested Reading:
The Fattening of America: How The Economy Makes Us Fat, If It Matters, and What To Do About It
Food Fight: The Inside Story of The Food Industry, America's Obesity Crisis, and What We Can Do About It

© Copyright Adrian Preda, M.D.

1 comment:

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