AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. November 2002, Volume 4, Number 11.

Did You Know?

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Weighing the Risks of Weight-Loss Aids

Little-know medical facts about weight-loss aids.

Colleen Danz

  • The herbal alkaloid ephedra is a central nervous system (CNS) stimulant that acts on the appetite control center of the brain, the hypothalmus, suppressing the desire to eat. Like all CNS stimulants, ephedrine causes the heart and blood vessels to constrict, increasing blood pressure and heart rate.
  • Sixty percent of deaths reported from dietary supplements between January 1993-February 2001 have been linked to the ephedrine alkaloids (EA) [1].
  • An FDA study from January 1993-February 2001 shows the EA dietary supplements are associated with more deaths, myocardial infarctions, cardiac arrhythmias, hypertension, stroke, and seizure events than all other dietary supplements combined [1].
  • EA is contained in more than 200 hundred dietary supplements used by an estimated 12 million people last year [2].
  • Some appetite suppressants can create psychological dependence because they contain phentermine, which is chemically similar to amphetamines. Others can cause insomnia, drowsiness, irritability or depression.
  • Drugs that prevent fat absorption can cause cramping, diarrhea, flatulence, and intestinal discomfort.
  • Dietary supplements are classified as foods under federal law and they are assumed to be safe. They are subjected to limited regulatory oversight.
  • Under the Dietary Supplement Health and Education Act of 1994 (DSHEA): [3]
    • The dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product only after it reaches the market.
    • Manufacturers do not need to register with FDA nor get FDA approval before producing or selling dietary supplements.
  • Unlike dietary supplements, all prescription and over-the-counter drugs must be proved effective and safe before the FDA approves the them for marketing. A drug is deemed safe when the benefits outweigh the risks [4].

Dietary supplements like the ones that suppress the appetite may be widely used in the US because obesity is a serious health concern.

  • Results from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 64 percent of US adults are either overweight or obese [5].
  • Among children and teens ages 6-19, 15 percent (almost 9 million) are overweight according to the 1999-2000 data [6].

Those seeking to lose weight should consult a physician before taking weight-loss pills or appetite suppressants.



References

  1. Petition to the Food and Drug Administration (FDA) requesting the ban of production and sale of dietary supplements containing ephedrine alkaloids. Available at: http://www.citizen.org/publications/release.cfm?ID=7053. Accessed October 14, 2002.
  2. Irby HE. Health hazards and abuse with herbal dietary supplements. Journal MSMA. 2002;43:241-242.
  3. U.S. Food & Drug Administration: center for food safety and applied nutrition.Dietary supplements. Available at: http://www.fda.gov/opacom/laws/Dshea.html. Accessed October 22, 2002.
  4. From test tube to patient. U.S. Food and Drug Administration. http://www.fda.gov/fdac/special/testtubetopatient/default.htm. Accessed January 30, 2009.
  5. Prevalence of Overweight and Obesity Among Adults: United States, 1999-2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm. Accessed January 30, 2009.
  6. Prevalence of Overweight and Obesity Among Children and Adolescents, 1999-2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm. Accessed January 30, 2009.

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