Query: medications to help maintain weight - PLEASE READ

[neurodoc]

As many of you know, I'm a physician. I have watched the rise and fall of various prescription medications for weight loss (most notably phen-fen) with skepticism and indignation- even the drugs that pass the FDA's standards for efficacy and safety seem to have little of the former (often the drug provides just 5-10 pounds more weight loss over 6 months than diet/exercise alone) and lots of concerns about the latter.

However, it seems to me that weight maintenance is a slightly different proposition- you're now at (or near) your goal, and even small calorie adjustments up or down will have a significant effect over the long run. We collectively write hundreds of posts discussing the challenges of maintenance, most of which come down to "I have to watch what I eat forever; I can never let up the calorie counting." Well, no drug past or present has ever been tested for weight maintenance - as you know, we are largely invisible to the diet community. And it seems to me that some of the medications that are virtually useless for big-time weight loss (or unsafe at the high doses required for that purpose) may work for long-term weight maintenance, if only they were tested. And in addition, some medications that currently DON'T get marketed for weight loss- because while they have a side-effect of promoting weight loss (e.g., the anti-seizure drug topiramate) they do not work consistently enough in all people, or cause ENOUGH weight loss to meet the FDA's standards.

I am in a position to collaborate with individuals at my university who are dieticians, exercise physiologists, and doctors of human nutrition. As I have read the struggles of all of you and experienced my own over the last year, I have become much more interested in the idea of using prescription medications that either restore lost sensitivity to leptin (which occurs with weight loss) or suppress appetite surges (binges) that occur due to chronic calorie restriction in the formerly overweight/obese. Because it is much easier to run a clinical trial for a medication that is already FDA-approved for another purpose, I am soliciting your experience and opinion regarding medications that you may have tried during your efforts at maintenance. These might include (but are not limited to)-
the ADHD medications (Ritalin, Adderall, Focalin, Concerta, etc)
the aforementioned topiramate (Topamax), as well as its cousin Zonegran
the antidepressants Wellbutrin, Effexor and Pristiq.
The plural of anecdote is, of course, not data. However, I think that getting the opinions of a well-educated and experienced group of long-term maintainers would be a valuable input into the background research I'm doing now.

PLEASE: I hope that no one on this board feels so strongly about this subject that they will write disparaging or denigrating comments about the idea of using medications to help with weight loss or weight maintenance. A non-judgemental attitude -whether you are militantly anti-drug or a frequent user of the same would be most helpful here.

Thank you.

[luckymommy]

Neurodoc, I find this fascinating and although I greatly dislike drugs for most ailments, I am equally intrigued by the allure of finding a pill to solve my issues of food addiction and a life time of yo-yo dieting and weight (mis)management.

The only drug I have tried from your list is Topamax. I was given this drug in an effort to control my chronic daily migraines. I had no idea that it curbs appetite and because I have a binge eating disorder, I can honestly say that I just gained weight while on it. I'm the worst person for a drug company to ever have in a study though because I tend to only exhibit the negative side effects and none of the positive ones. I ended up getting incredibly depressed and couldn't speak about my emotional state without succumbing to a lot of tears.

I hope that helps. If you have any additional questions please feel free to PM me for further details. Best of luck to you and certainly please do keep us posted on your findings.

[ncuneo]

Pretty fascinating proposition. I personally have not tried any of the drugs you've listed, or any drugs I can think of other than vitamins to allieviate sweet tooth and hunger.

While I do believe there is GREAT value in your research, I would urge you to look a little deeper. I personally believe that my maintenace struggles are not due to a changed physiology (please forgive me horrible spelling), but are due to emotional issues. I think that physiolical issues clearly exist as we have the science to back it up, but are often due to emotional issues.

I'm not sure I want to expand much more on my point as that is not the info you are looking for, but I do want to commend you for your efforts.

[caryesings]

Another chiming in to say I have tried nothing for weight loss or post loss, but am very interested if someone did develop something to give me some leptin sensitivity. Even though I've maintained weight loss for 16 months now, I still have to eat by the clock, not by hunger queues.

[saef]

When I look at your list of drugs, and see you include antidepressants, then I say, yes, antidepressants are integral to my keeping the weight off. But perhaps not for the reasons you think.

The first time I was put on Fluoxetine (the generic version of Prozac), oh, man, what an immediate difference. It was like chugging a huge thermos of coffee. I felt it kick in after the first pill. During my first week or so on this drug, my apartment was never cleaner, I was never more energetic about going to the gym and I even lay awake at night with thoughts racing, but never seemed to tire. But if I took the pill after my morning cup of coffee, it made my hands shake. My doctor adjusted the dosage. And now I don't feel that physical kick any more. But I really believe that it has helped me tremendously with focusing on weight loss and on getting up in the morning and moving. It puts me at neutral, rather than my feeling inert and sluggish.

But what is the mind/body connection here? I have never been able to figure out where the mind ends and the body begins.

All I know is that I expect to be on antidepressants for the rest of my life. In exactly the way that I expect I will have to be careful about food choices and diligent about exercise for the rest of my life. My feeling is, I am dealing with two chronic conditions, which are undoubtedly interrelated, but that the interrelationship is complex, I can't begin to fathom it simply through my own perceptions and introspection on the condition.

[Lori Bell]

I've tried a couple of the drugs you have mentioned throughout the years for weight loss/quitting smoking and depression. Back in 2000 I used Phentermine, (by it's self) and lost around 40 pounds. Never reached my goal, and became insane while on it. It was disastrous for me. I also used Wellbutrin in the form of Zyban SR to stop smoking in 98' and had great success with the quitting smoking (for awhile) and also lost weight while I was on it. Sadly, my insurance didn't cover it, it was really expensive and my doc wouldn't prescribe the drug with the Wellbutrin name because he didn't think I was depressed, So after a few months I quit taking it and started gaining weight back, although I did manage to stay quit smoking for around 2 years before I picked up the nasty habit again....

Later down the road he did prescribe Wellbutrin XL for real depression and it made me feel insane just like the phentermine did. The extended release just seemed different than the SR did, and made my anexiety out of control. Looking back, I think the Zyban SR worked so well because maybe it helped with the addiction side of my eating problems. I don't know really, and I don't know why there was such a strange reaction between the SR and the XL. Just a side note, I did quit smoking cold turkey when I started my weightloss and havent smoked in 3.5 years now.

Anyway, my theory on drugs for weight loss/ maintaince is with limited knowledge. I think that my food issues are addiction related and if I were to try any drug to make the maintaince process eaiser it would be something formulated to be like antabuse, that would make me deathly ill if I ate sugar. Or maybe a drug like naltrexone that would help reduce cravings...or both...lol

[Mudpie]

What a great idea Andrea. I'm not much help though. I have taken various herbal/vitamin supplements which purported to help maintain constant blood sugar levels. I'm pretty sure blood sugar surges are what's causing my bingeing. If someone could find a supplement/med that works to maintain constant blood sugar levels I'd be the first to sign up!

I did take the antidepressants Elavil and Zoloft. Elavil helped me sleep, which does have an effect on how much I eat. Zoloft didn't do anything other than what it was supposed to - help lift the depression - but I had to stop taking it after about 6 months due to extreme stomach upset.

Please keep us posted (we're all here for a lifetime ) about your findings on this.

Dagmar

[Karen925]

Interesting idea.

I have not taken drugs for either weight loss or maintenance. I am currently experimenting with JUDDD which I am enjoying quite a bit, especially the down days which I use as an IF.

Vigiliance is a price I am willing to pay for success in those areas of my life which are important. My health is one such area but by no means the only one- family, spirituality, money, etc... are others.

I currently take Vit D3 and K2. My lab work is great and health fabulous. Much to be grateful for:-)

[RedPanda]

Originally Posted by Mudpie

What a great idea Andrea. I'm not much help though. I have taken various herbal/vitamin supplements which purported to help maintain constant blood sugar levels. I'm pretty sure blood sugar surges are what's causing my bingeing. If someone could find a supplement/med that works to maintain constant blood sugar levels I'd be the first to sign up!

Dagmar - I've had fantastic results from taking cinnamon and chromium picolinate. I take one cinnamon capsule around 11.00 when I start to feel a bit hungry, and another before heading home from work. They have really helped to even out my blood sugar and hunger levels; before starting the cinnamon I would be really hungry, crabby and distracted when I got home.

I take one chromium picolinate capsule with my evening meal and I think this helps too.

[ncuneo]

^ditto

Haven't tried chromium, but have had some success with cinnamon.

[LisaTcan]

I think it's a really interesting idea! I'm in school for health research and my thesis is focused on obesity. This kinda of research is really important, with the clients I see come into a the hospital I work at a lot of them gain back the weight they have lost, even after bariatric surgery.

I have taken prozac for 4 years, I went on it to treat my bulimia and it worked really well. Since then I don't binge or have trouble with food. Like saef said it makes me much more alert and focused and able to study and exercise. There is NO way I'd be working towards a phd if I hadn't started taking it.

[weebleswobble]

Perhaps my experience is atypical.

I began taking topirimate at 266lbs to control chronic migraines. Weight loss was not a goal. it works amazingly well for me, although along with the occasional migraine that creeps through (one every 2 weeks or so as opposed to every other day without treatment), I am one of those people that gets hit with a significant amount of the side effects--metallic taste with pop, tingling of the limbs, occasional dizziness, and the worst two side effects: aphasia (an inability to grasp the word I am looking for) and "anorexia" (total loss of interest in eating in the clinical definition)

I started calorie counting to ensure I would EAT enough calories in a day because there were days I realized I hadn't eaten anything at all. I lost 80 pounds in the first 14 months and kept it off for a year (185 is my size 10)

In an effort to get rid of the fog/aphasia and complete my graduate work I took myself off topirimate last year. I gained back quite a bit (in one of the most stressful years of my life). I'm done with school now and would rather have the migraine free days so I went back on topirimate.

At some point after starting to take topirimate, my physical health became important to me (perhaps after I was not in constant pain all the time I realized there was a reason to take care of my body)

Thanks for doing this work.

[neurodoc]

Thanks to all of you who have shared your experiences with me. I'm a bit surprised that there aren't more of you out there, but I think the maintenance forum is not one of the most high-traffic sections of this site.

I do have a friend, not on 3FC, who claims that when she was put on a combination of Wellbutrin and Focalin by her psychiatrist to control adult ADHD several years ago, she was finally able to kick her binge episodes "once and for all" and stopped fighting the lose/regain cycle she'd been in for over 10 years. She claims she now maintains her size 4 figure almost effortlessly, because she rarely has cravings and is always satisfied with "just a little" of her former trigger foods. Yeah, I know, seems way to good to be true. You'd think if the combo worked that well, it would already be in testing by Big Pharma.

Anyway, keep posting, and if you know others elsewhere on the board who have experience with losing/maintaining on these meds, please ask them to add their voices to this thread. Thanks.

Andrea

[jeminijad]

I think this is an important idea. There may be a tendency amongst folks here that lost their weight "the hard way" to resist to notion that a pill could help in any way.

But when there reasons that some of us experience more hunger, cravings, lower metabolism than others or WHATEVER, why wouldn't we want to address that?

I for one would love to naturally/intuitively be happy with 1800 calories a day to maintain wait indefinitely (like folks without disordered eating habits can do,) rather than it being a conscious effort on a daily basis.

[JayEll]

But when there reasons that some of us experience more hunger, cravings, lower metabolism than others or WHATEVER, why wouldn't we want to address that?

With a pill?

I really have trouble with the idea of paying big pharmaceutical companies for the rest of my life for a pill that will "fix me" (and make them rich).

If all we really want is a pill to solve the problem, there are legally prescribed amphetamines that can do that.

I am not a fan of the serotonin reuptake inhibitors such as Prozac. The question is, WHY is not more serotonin being produced? That is a complex question. Stress reduces serotonin production, for example, so if someone leads a highly stressful life, they will feel depressed. Is the answer really a pill? Also, Prozac was originally intended for treating major depression, a psychiatric condition, and not for situational depression--for example, after a death in the family, divorce, etc. But doctors increasingly hand it out to people with situational depression.

The human body is the product of literally millions upon millions of years of refinement--way before the frontal lobe of the human brain appeared. In my opinion, as someone who has studied biology all my life, we are just not smart enough to understand all the effects of biochemical alterations on this complex system.

And besides, we're not talking only about people with genetic problems who underproduce leptin, overproduce ghrelin and cortisol, etc. We're talking about people with metabolism that is within the range of normal for the human species. People who now live mostly sitting in chairs in front of computers, who are chronically sleep deprived, and who have fattening foods literally at their fingertips any time of the day or night. It seems to me that approaches other than drugs would be a better choice.

But of course, there will always be people who would rather take a pill than stop eating half a pizza and a carton of ice cream twice a week...

Getting off soap box now.

Jay