It’s human nature to want the quickest and easiest solution to any problem. With medical issues, we would all like something simple, like taking a pill, to do the trick. And many companies prey on that desire by pitching products in pill, liquid, powder or other forms with the promise of fast weight loss.
But it’s not so simple. No pill or powder will, by itself, help you lose weight, whether it’s 5 pounds or 50 pounds. Even Food and Drug Administration-approved medications that can be prescribed by a physician to treat obesity are only one weapon in the war against the disease.
Dietary supplements, which claim to do just about everything – boost energy, aid memory, build muscle, improve sex drive, burn fat – are not medicines, according to the Mayo Clinic. They are rarely – if ever – studied rigorously, they are not monitored for quality or safety by the FDA and, as the Mayo Clinic says, “They aren’t meant to treat or cure disease.”
Take, for one example, raspberry ketone. Though marketed as a clinically proven aid for weight loss, that claim is supported by just one small, short-term clinical trial of 70 adults with obesity. Some were randomly assigned to take a supplement containing raspberry ketone, caffeine, bitter orange, ginger and garlic root extract. The others got a placebo. The supplement group did lose a bit more weight – about 4 pounds versus 1 pound over eight weeks – but who can say which ingredient, if any, was really responsible for the difference or if the weight loss benefits would continue, without any side effects, if used long term.
There are many other supplements making similar claims, including green coffee bean extract, garcinia cambogia, African mango seed and many brand-name products. “In general these dietary supplements have little supportive evidence suggesting they are effective as a treatment for obesity,” says Dr. W. Scott Butsch, director of obesity medicine at the Bariatric and Metabolic Institute at the Cleveland Clinic. “The draw for the public is they are told weight loss is simple, just eat less food. With that uneducated, simplistic statement they go to the internet to find quick fixes that generally don’t work.”
They may also be dangerous. Even so-called “natural” dietary supplements have been linked to serious health problems, such as liver damage, according to the Mayo Clinic. And a weight loss herb marketed under the name Ephedra was banned by the FDA in 2004, when it was linked to mood changes, high blood pressure, irregular heart rate, stroke, seizures and heart attacks.
Clinical obesity is “a complicated, chronic, relapsing and progressive disease defined by excessive or abnormal fat tissue that impairs health,” says Dr. Karl Nadolsky, clinical assistant professor in the Michigan State University College of Human Medicine. “The basis for obesity is dysfunctional balance of calorie intake and metabolism due to complex genetic, physiologic and environmental factors in addition to individual lifestyle habits leading to accumulation of that fat tissue.”
This dysfunction makes it “biologically more difficult to lose weight or especially maintain weight after weight loss efforts via dietary changes and physical activity,” he says. For those with clinically diagnosed obesity, there are several medications that have been shown to aid in weight loss, when used in tandem with other treatments.
Current FDA-approved medications for obesity treatment include drugs with brand names, including Qsymia, Saxenda, Contrave and Xenical. These medications were studied in randomly controlled trials, Butsch says, “so we can conclude they are effective.” They were proved to meet FDA guidelines of producing at least 5% more body weight loss than placebo, he says.
Another product, called Plenity, “is a new tool” recently approved for certain patients, Nadolsky says. “While it is a capsule, it is not a medication per se because it doesn’t have systemic absorption or pharmacological effects,” he explains. It consists of two natural ingredients, cellulose and citric acid, and requires a prescription.
They all work in different ways. Some decrease the absorption of fat, while others target the hypothalamus, an organ in the brain that controls appetite and hunger cravings.
The FDA has approved obesity pharmacotherapy for patients with a body mass index of at least 30 kg/m2, or those with BMI of 27 kg/m2 and obesity-related complications, such as diabetes, hypertension and heart disease. Plenity is approved for BMI of 25-40 kg/m2.
Medications are usually used along with other therapies, including behavioral changes – dietary, exercise, sleep improvement, stress reduction – and possibly bariatric surgery. “It’s not a one-size-fits-all approach,” Butsch says. “It really is trying to target the therapy to the individual.”
And no one should expect a quick fix from any of these treatments. “Weight loss is not easy. We set expectations too high generally, and we have to stop blaming ourselves if we are not able to lose weight quickly or sustain weight loss,” Butsch says. “It is not a short-term problem.” That’s why he recommends consulting a physician who specializes in weight loss. “We understand the struggle in a different way – as a complex disease.”