Diet drugs are prescribed or over-the-counter (OTC) drugs that are taken to treat individuals for obesity. They are also called anorectic drugs. Some individuals abuse prescribed or OTC diet pills, often in a rush to become slender sooner than would be medically safe. Some individuals misuse laxatives in order to lose weight, using them inappropriately as diet drugs. (It is also true that some OTC drugs have laxative-like qualities.)

Many individuals who use diet drugs are not obese or even overweight, a matter of some concern to medical professionals and others. One study reported in the Annals of Internal Medicine found that about half of the consumers using diet drugs in 1996-98 were below the recommended minimal weight before they began using them. Such people may have eating disorders, such as anorexia nervosa or bulimia nervosa. Diet drugs are inappropriate for individuals who are underweight or who need to lose only a small amount of weight.

Prescribed diet drugs may be taken legally when prescribed by a physician who carefully monitors the patient; however, diet drugs that are also amphetamines have a potential for abuse or dependence; that is why they are scheduled drugs under the Controlled Substances Act. Despite this legal control, prescribed diet pills are actively marketed and sold on illegal Internet pharmacies, which often offer such drugs to consumers without requiring any prescription from a medical doctor. Often these drugs are purchased from individuals in other countries, and they may be adulterated with other substances.

Individuals have sought to lose weight by using medications for many years. Amphetamines were first approved by the Food and Drug Administration (FDA) as treatments for obesity in 1947; Desoxyn and Hydrin were approved. In the 1960s, a variety of amphetamines were used as weight loss drugs; however, physicians discovered that when the drugs were discontinued, individuals regained weight. In addition, amphetamines were (and are) dangerous for many individuals because of the risk for addiction.

In the 1990s, on the basis of several studies of fenfluramine and phentermine, a combination of medications (often referred to as "fen-phen") used to achieve weight loss, the numbers of prescriptions for these drugs exploded, and it is estimated that 14 million prescriptions for these drugs were written from 1995 to 1997, until fenfluramine was withdrawn from the market as dangerous to those at risk for heart disease. Phenteramine may still be prescribed as of this writing.

Several nonscheduled medications may be prescribed to treat obesity in addition to amphetamines. Sibutramine (Meridia) and orlistat (Xenical) are two nonamphetamine medications that have been approved by the FDA for the treatment of obesity. Sibutramine and other prescribed or over-thecounter diet drugs are used to suppress an individual's appetite, while orlistat inhibits the absorption of some fats by the digestive system. Some studies have shown that these medications may achieve moderate weight loss (about 10 pounds) over the course of a year, particularly when combined with weight loss counseling.

Other common diet pills are benzphetamine (Didrex), diethylpropion (Tenuate, Tepanil), mazindol (Sanorex, Mazanor), phedimetrazine (Bontril, Prelu-27), and phentermine (Lonamin, Fastin, Adipex). All of these drugs are either in Schedule III or Schedule IV of the Controlled Substances Act.

New diet medications are under development as of this writing. For example, studies have shown that rimonabant, a selective blocker for the newly discovered cannabinoid CBI receptors in the central nervous system and the peripheral tissues, such as in the fatty tissue, muscle, and the liver and gastrointestinal tract, is effective for the treatment of both obesity and nicotine dependence. (CBI receptors are involved in the immune system.)

Some experts believe that the endocannibinoid system is implicated in major forms of addictive behavior, such as drug use, smoking, and excessive eating. Rimonabant (Acomplia) is under study as a possible drug therapy for individuals with drug dependence.

With regard to obesity and this system, Luc F. Van Gaal and his colleagues in a study for the Lancet in 2005 said, "Insights into the endocannibinoid system have been derived from studies in animals with genetic deletion of CB1 [a cannibinoid receptor], which have a lean phenotype and are resistant to diet-induced obesity and associated insulin resistance produced by a highly palatable high-fat diet."

The Lancet study revealed that 20 mg of rimonabant, combined with a low-calorie diet, resulted in a significant decease of weight and waist circumference over a one-year period.

Other studies, such as reported in the Journal of the American Medical Association in 2006, further indicated that rimonabant was effective in decreasing weight and improving cardiometabolic risk factors among overweight and obese patients. According to this report, treatment with 20 mg per day of rimonabant plus dietary changes produced "modest but sustained reductions in weight and waist circumference and favorable changes in cardiometabolic risk factors."

References:

Colman, Eric. "Anorectics on Trial: A Half Century of Federal Regulation of Prescription Appetite Suppressants." Annals of Internal Medicine 143 (2005): 380-385.

Joseph, Donald E., et al., eds. Drugs of Abuse. Washington, D.C.: U.S. Department of Justice, 2005.

Pi-Sunyer, F. Xavier, M.D., et al. "Effect of Rimonabant, a Cannabinoid-1 Receptor Blocker, on Weight and Cardiometabolic Risk Factors in Overweight or Obese Patients." Journal of the American Medical Association 295, no. 7 (February 15, 2006): 761-775.

Van Gaal, Luc F., et al. "Effects of the Cannabinoid-1 Receptor Blocker Rimonabant on Weight Reduction and Cardiovascular Risk Factors in Overweight Patients: 1-Year Experience from the RIO-Europe Study." The Lancet 365 (April 16, 2005): 1,389-1,397.

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