Pound for Pound: Questioning the Benefits of Qsymia

According to the Centers for Disease Controls and Prevention, obesity in America now affects more than one third of U.S. adults. In 2008 alone, medical costs associated with obesity were estimated at almost $150 billion.

With numbers of that magnitude sketching American obesity as a potential epidemic, it is of no surprise that pharmaceutical corporations have entered the picture – with the development and soon to be marketing of prescription weight loss drugs.

In the last few months, two of these drugs have garnered the Food and Drug Administration’s blessing: Belviq and Qsymia (pronounced kyoo-sim-ee-uh).

Hyped as a prescription diet drug that is “effective therapy in a new generation of anti-obesity pills designed to help patients safely shed pounds,” Qsymia is supposed to be a new tool to help physicians’ battle the beast that is obesity.

However, while the drug may be new to the market, its foundation has a more familiar pattern.

Qsymia is actually a combination of two older drugs: phentermine and topiramate. Phentermine suppresses the appetite by triggering the release of the brain chemical norepinephrine, while topiramate, an epilepsy drug for seizures/migraines, increases feelings of fullness, makes foods taste less appealing, and increases calorie burning.

Topiramate, which is marketed under the name Topamax, already carries with it the risk of birth defects; a risk that many critics suspect will be carried over to Qsymia.

Phentermine, the half of fen-phen that's still legal, has long been prescribed by doctors for weight loss because of its appetite suppression effects. However, in 2007, Phentermine was reported by the UN International Narcotics Control Board as one of the most commonly abused prescription drugs in the world.

Qsymia comes with several warnings. First, Qsymia carries a warning that it can increase heart rate and should not be used by people who have heart disease or have suffered a stroke. Pregnant woman should also not take Qysmia because of the possibility of birth defects such as cleft lips or palates. Additional risks associated with Qysmia are an increase in the risks of glaucoma, kidney stones, mood problems such as anxiety and depression, and suicidal behavior or thinking about suicide.

Public Citizen Health Research director Sid Wolfe, stated that “it is magical and delusional thinking for anyone to believe that a drug will turn off hunger without hitting other targets where it will do harm, usually to the cardiovascular system.”

Even with approval, it’s understandable why some in the medical field are skeptical of drugs like Qsymia. The drug’s clinical studies involved 3,700 patients, where obese and overweight people who took Qysmia for one year lost 3.5 to 9.3 more pounds than those who took a placebo. Thus, the benefit is not one of incredible difference. Furthermore, Qsymia was found to be effective only when given along with a balanced diet and exercise, a combination that many fighting obesity already lack. These facts certainly give rise to skepticism.

The two drugs that make up Qysmia are no stranger to litigation. The last time phentermine was combined with another drug, the deadly fen-phen combination, the drug was outlawed because of potentially fatal pulmonary hypertension and heart valve problems the drug caused. Litigation has been mounting for topiramate as a result of birth defects from women taking it while pregnant. These are risks that cannot be ignored, and in the face of precedent, one has to wonder just what dangers will the pharmaceutical cocktail that is Qysmia present?

If you or a family member is considering weight-loss drugs, please consult with your physician before making this decision. Marginal benefits may not be enough to overcome troublesome side effects. Increasing exercise, limiting portion size when it comes to food, and eating healthy are always great starting points to battle obesity and may eliminate any need to consider medication.