Phentermine
The hoped-for benefits
Different people react differently to every medication. For some, the medication will not work at all. For others it will be a modest success. The remainder will find significant results (clinical research confirms that the majority of people respond well to phentermine). The same is particularly true for weight loss medications. For this reason you will often see weight loss expectations expressed as a wide range, say from 5-22lbs more than you would expect when using a treatment regime not relying on medication. This is a "piece-of-string" average because it does not tell you what the starting point is. Who knows how many pounds you might have lost using a diet alone. So adding 5lb to an unknown number becomes no better than a guess. This is the pharmaceutical companies hedging their bets. They need to encourage you because they only make a profit if you buy their medications, but they cannot give you any accurate guarantee.
The calculation is further complicated by two additional elements. Obviously, people start off from completely different weights. A small individual weighing in at 200lb would feel a significant improvement and considerable satisfaction if there was a 10% reduction in overall weight. A heavier person starting at three hundred pounds might find the same 20lb loss less satisfactory. Hopes and expectations are difficult to manage if hard numbers are given. Some companies therefore use body weight percentages as a guideline to expectations, saying that users may expect up to a 10% loss of their body weight. This allows potential benefits to be translated into figures that are more meaningful for each individual.
The second complicating factor is time. Most people peak around six months. The usual explanation is that this reflects two well-verified facts. Those who begin with the best intentions rarely manage to sustain an exercise program for more than three months. Activity burns off some calories and helps to sustain a trend of weight loss. But more critically, most people tire of their diet after six months. They have been so good. They reduced their calorie intake. But the habit does not become permanent and so, with no exercise to burn off the calories, they slowly begin to put weight on again. This happens even though they continue taking the medication as prescribed. This can further undermine confidence in whatever was left of the dieting regime and, by the time one year comes around, all the weight gain may have been lost. The danger is that, if those people attempted to rely on a medication such as phentermine to prevent the weight gain and increased the dosage, there may now be problems of dependence to worry about as well as the weight. So, when considering projections of weight loss, the numbers you will see quoted are the maximum average expected at around six months. What happens after that is entirely up to you.
Again speaking only of the short term, those individuals who reduce their body weight also reduce the associated health risks for so long as their weight remains lower. So there are a significant number of clinical studies that show real improvements in blood pressure, the levels of cholesterol and triglycerides, and in the body's production and use of insulin. The risks of Type 2 Diabetes are reduced and the heart disease profile becomes less threatening. We are waiting for more research to establish the long-term effects of weight loss medications on weight and health but, if weight loss can be maintained, long-term health should be improved. This means that the benefits of taking a medication like phentermine usually outweigh the disadvantages.
The possible problems
The medications including phentermine are designed to achieve weight loss and have been routinely prescribed to millions of people around the world for decades. When people begin to take a medication, many of them are healthy, i.e. they have no existing medical condition other than the fact that they are overweight and therefore at risk of contracting one or more conditions later in life. Some of the medications have side effects. We are therefore looking to balance the risks of side effects now against the long term health benefits of prevention. The theory is that because the risks of heart disease and diabetes are so high among the population that is overweight, the fact that the majority will reduce their risk profile is worth the price paid by the few individuals who may experience the medications' side effects. So precisely what are the short-term issues to consider?
1. All the medications including phentermine made available on prescription for weight loss except Orlistat are "controlled substances", i.e. the law considers them potentially dangerous because of the risks of abuse and requires physicians to take greater care when prescribing them. If you have any history of alcohol or substance abuse in your own medical history or among your immediate family, you should only take these medications when your physician approves. 2. The performance of almost all the medications in producing weight loss levels off after six months. The most usually advanced explanation for this is that people stop their diet and exercise regimes. An alternative explanation is that your body has developed a tolerance for the medication and it is losing its effectiveness. The cause and effect at work is unknown, but the evidence does show that you will put the weight back on again more quickly if you stop taking the medication. Do not be tempted to keep taking phentermine over a long period of time. This can produce dependence. 3. Most of the side effects experienced by those taking these medications including phentermine are mild and usually diminish as the treatment continues and your body adjusts to the active chemicals. But we have to admit that, in rare instances, the side effects can be serious. In cases of overdose, they can be fatal if not treated immediately. The most general side effects are headaches, a dry mouth, constipation and insomnia. There can be an increase in levels of anxiety or you may feel unusually pleased with life. Some slight increases in blood pressure may also be expected. The side effects for Orlistat include intestinal discomfort, passing more gas than usual, occasional diarrhoea, and the sometimes embarrassing leakage of loose stool. These side effects are more common if you continue to eat a high fat diet. People who take Orlistat should also take a vitamin supplement.
There is resistance to the idea that obesity is a chronic disease (we should explain that the word "chronic" is a reference to time, i.e. the disease lasts a long time). Society tends to consider excessive weight as a symptom of poor willpower or a lifestyle choice to eat too much and and exercise too little. This lack of sympathy translates into a certain degree of social stigma and some active discrimination. This builds into social pressure to reduce weight and may push people into inadvisable choices about medication. You should remember that none of the on- and off-label medications are "magic bullets". Phentermine is not a simple pill you can take that will make this chronic disease go away. The most reliable way to achieve this result is to eat a more healthy diet and to exercise more.
Thus, before resorting to phentermine or any of the other weight loss medications, you should make a serious and sustained attempt to lose weight the "healthy" way. Only if you are struggling to meet your expectations should you even begin to consider taking any of these medications.
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