An Interview with Dr. Anne Peters (Continued)
Obesity Therapies and Bariatric Surgery
Joseph: What do you think about prospects for the obesity drugs that have recently been approved, Qsymia (phentermine and topiramate) and Belviq (lorcaserin)?
Dr. Peters: Obesity drugs do not seem to me to have been wildly successful historically. Now fen-phen, for instance, worked like gangbusters, but it also obviously had problems. (diaTribe Editor's Note: fen-phen contained fenfluramine, which was pulled off the market by FDA in 1997 because it caused heart valve problems.) I still need to see the side effects of the drugs coming down the pipeline. A lot of my patients have tried Topamax (topiramate) and phentermine as a combination, but it's not the extended-release form that's in Qsymia. Topamax is a really effective weight-loss drug, but it often makes patients feel foggy or confused when used in high doses. I don't know what the slow-release form does. I think these drugs might help some, but they are not really going to change the face of type 2 diabetes.
I think a true diet pill has to somehow work by way of the hypothalamus — somewhere up in the eating centers of the brain. But the problem is that eating is such a conserved biological process. It is one of the two functions we must maintain to survive as a species. It is such an amazing mechanism, hunger. If I get too hungry, like if I miss a meal, it just agitates me. I can turn that off somewhat, but not fully. It's like, "Well, what's going to happen; am I going to die because I can't eat for a few hours?" Still, there's something about not being able to eat when you want to eat that upsets the whole system. I think there's a disordered sense of that in people who are overweight, and I don't know if it's induced or it's a part of them, but whatever it is, food is part of the issue.
As an investigator, when I look at a trial, I think it's really important to change people's habits. Currently the only real way to change your habits is bariatric surgery. It's a very effective tool. I haven't been very impressed by gastric banding, but Roux-en-Y gastric bypass and the other bypass procedures have struck me as very effective. The problem is that people can out-eat those too, eventually. It's not really that they changed their habits, just that a change was forced upon them, which is interesting because they can revert back to whatever their bad habits were. I end up taking care of a lot of the complications of post-gastric bypass surgery. It's kind of discouraging.
I like the idea of something that fixes type 2 diabetes, but a lot of people don't want to go through bariatric surgery, and we don't know the very-long-term side effects. It worries me to rearrange people's anatomy. On the other hand, it works. I think it takes away a certain amount of the hyperglycemic load over lifetime if you at least have some response for five or 10 years, which is good.
Joseph: Dr. Peters, thank you for taking the time to talk to us today.
Dr. Peters: You're very welcome.
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