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Riva Greenberg Headshot

"No" To Weight Loss Pills

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An advisory committee just warned the FDA against approving a new weight-loss pill that many were pinning their hopes on. Health advisors said safety concerns outweigh the drug's ability to help obese patients shed pounds.

Shares of Vivus, the company developing the weight-loss pill, sank 62%.

While the drug appears to work, side effects of depression, memory loss, increased heart rate and birth defects were a top worry; and as evidenced by one of the clinical trial participants losing 50 pounds on the drug, once off the drug she gained almost all the weight back.

You know the game where kids are asked to find the piece that goes into a square or round hole? Children pick up a square piece and try to jam it into a circular hole! I'm going to tell you what just happened is not so different.

Doing the wrong thing and trying to make it right
As a nation we seem to have made it a habit to do the wrong thing (like jamming a square piece in a round hole), when it comes to our health and our health care system. Then we do all sorts of things to try and make it right.

70% of Americans are overweight and a third are obese. And what are we doing? Creating obesity drugs to hold back the tide that's drowning us--disease and financial costs.

The right thing would be to invest our time, money and attention in promoting health and disease-prevention.

Rather than making "fat pills" we should be helping people to maintain a healthy weight, and not become overweight and obese.

Making healthy food cheap and unhealthy food expensive
We spend billions of dollars subsidizing foods that make us fat. This makes less healthy food affordable--the $1 fast-food hamburger. But this policy does not make healthy food affordable, as evidenced by the $1 apple you see at delis and airport cafes.

We have put people into a position where the more affordable choice is unhealthy food. Americans have also gotten used to spending little of their disposable income on food--for most families it's less than 10%. Now, trying to get people to look at healthy food as a necessity and worth the extra dollars will require a huge shift in mindset.

What we should be doing is subsidizing farmers who grow fruits and vegetables, put nutrients back into the soil, let chickens range in the sunshine, and cows feed on grass--as they were born to do. But that would require standing up to Washington lobbyists.

It would also mean creating a larger infrastructure that supports health and disease prevention. Like creating safer streets and bike lanes so we can exercise near our homes. And raise health literacy, especially for the poor who have the highest incidence of overweight and obesity.

If we continue to do the wrong thing, promoting the wrong kinds of food by making them cheap and creating more drugs to combat obesity, we will never rid ourselves of America's weight problem.

We invest in "sick care"
With people still becoming overweight and obese, health care costs, some would say "sick care" costs, will continue to soar. People will also continue to suffer obesity's side effects before they get their pills--heart disease, type 2 diabetes, arthritis, respiratory and circulation problems--or while waiting for these miracle weight-loss drugs to come to market. And people will have to hope they can afford the drugs to slim down, and that their side effects don't kill them.

Is short-term profit so attractive that we have led an entire nation to walk this plank?

I see in diabetes we are in a constant state of doing the wrong thing and then trying to make it right. We have perfected dealing with diabetes complications, the end result of poor care, yet not invested in prevention to avoid complications. The result? We have developed terrific laser surgery for advanced retinopathy and can skillfully amputate feet and legs.

This is what I also see. Imagine your health care company covers the several thousand dollar cost of an insulin pump and continuous glucose meter to help you manage your blood sugar, and then won't pay the few hundred dollars needed for someone to teach you how to use these life-saving devices. It happens regularly. It happened to a friend of mine.

This is a case of doing the wrong thing--putting money into the hands of device manufacturers--but not putting money into educating patients how to use the devices.

In a case like diabetes we need to spend more time, effort and money helping patients administer their own self care on the front end. With proper tools, education and support, patients can be helped to lose weight and exercise. And, that upfront investment goes such a long way. By losing just 5-7% of their body weight, it's been shown many type 2 diabetes patients improve their blood pressure, triglycerides and cholesterol and often get off their diabetes medications.

Yet many HMOs have robbed health care providers of time with their patients, allowing for only 12 minute office visits. We are doing the wrong thing.

Prevention or band-aids?
We do not benefit from doing the wrong thing and then trying to make it right. It causes us to be focused in the wrong place and to throw money in the wrong direction. If we don't stop doing the wrong things and start doing the right things, we will continue to pay a huge price in our health, and as a society, with our tax dollars.

For Vivus to win approval they've been told they'll have to test 10,000 patients at a potential cost of $150 million. That's throwing more money into trying to apply a band-aid to America's hemorrhaging weight problem. A very big, big band-aid.

The FDA is expected to make their decision whether to approve Vivus by October 28th. What would you advise the FDA as one of their health advisors?

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