Do Appetite Suppressants Work?

Losing weight is hard. What if you ALWAYS feel hungry? Can appetite suppressants help? Do they work?

The answer is: some products, for some people, some of the time.
To understand this somewhat vague answer, we need to look at the categories of products – which vary widely in their demonstrated efficacy, and purity/safety.

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Our body protects itself and its need for calories – hard-wiring a stimulation of appetite – so our response is to EAT, for survival. It's VERY hard to find any compounds that reduce appetite without doing a lot of other things to the body. It's a main reason there are so few prescription weight loss medications - it's certainly not for lack of trying!

There are 4 categories of products claiming appetite suppression:

1. 1. Dietary supplements (not approved by FDA; available over the counter) My bottom line: avoid these. No evidence of safety, purity or dosage - no monitoring. At the very least a waste of money, at the very worst, illness and/or death. Natural doesn't mean safe: arsenic is natural! It is not surprising in nature that there are compounds that stimulate, sedate, increase appetite, and reduce appetite. These are all actions of plants - and if you chew the leaves or plant parts, you get the effect. You cannot translate these actions to a pill or capsule you know nothing about. Plus, the placebo effect is very big - we like to "think it's working", so it does.
   2. Prescription medications (approved by FDA for weight loss). Approved by the FDA for safety and efficacy. Only two medications are available to support appetite control. Phentermine, which is only approved for use for up to 12 weeks and is a major body stimulant (older drug from the 1950s) and Meridia, which is approved for up to 2 years (first approved in 1993). Meridia has a much gentler effect on the brain, and helps people feel fuller on a lot less food. My bottom line? Talk to your doctor about your own needs. Many people have no response to medication at all, or only for a limited time. For the right people, Meridia can sometimes be of long term support. Only use these under a physician's care, and do not buy these online. These medications do not promise a lot, and the claims are more modest, due to FDA rules.
   3. "Off-label" prescription medications (approved by FDA for use, but NOT for weight loss; weight loss is a side-effect of treatment). This is an alarming trend. Off label drug use means: using a prescription medication for a reason other than what it is approved for. It IS FDA approved, for another reason. People get these online, from relatives, friends, and sometimes even from their own doctor. There are about a half dozen drugs used as off label treatments for obesity. These include Topamax (for seizures); Adderall (for hyperactivity); wellbutrin (for depression); glucophage and byetta (for diabetes); provigil (for chronic fatigue and sleep disorders). Most of the evidence of these for weight loss comes from observing patients who are taking these for FDA approved use. My bottom line: Stay away!! If these were appropriate for weight loss, they would have an approved and indicated use for it. Talk to your doctor about your weight issues to start.
   4. Medication awaiting FDA approval (not many!). Many brain pathways are involved in appetite. One is the cannabis-related pathway – where marijuana acts. Marijuana stimulates this pathway, and improves mood and stimulated appetite. If you block this pathway – that’s the drug Rimonabant, you suppress appetite. Approved for use in 14 European countries, Mexico, and other areas, it's still NOT approved in the US. The FDA feels there is too much of an effect on mood lowering – ie, depression. It's quite controversial, and further study is underway. This may be a good option for some people, but as for Meridia, it will likely only really benefit a small percentage of people. While many are seeking this drug over the internet, it is not approved for use in the US. A related compound, Taranabant, is also under study. My bottom line? Not ready for prime time in the US, so wait for approval here, under your doctor's supervision.

So, lifestyle remains the foundation of weight loss in 2018. There are few, if any, compounds that can help with appetite suppression over the long term. That's our bodies protecting us from starvation - a pretty smart built-in mechanism for survival.