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Potential Qnexa Users Better Off With a Salad Spinner and Walking Shoes

UPDATE 7/17/12: Qnexa was approved by the FDA on July 17, 2012. This marks the second weight loss drug approval in 2012; the first weight loss drugs approved since Alli in 1999. The prescription drug will be sold as Qsymia.

The inmates are running the asylum. Reversing an earlier decision, the medical experts on FDA’s Endocrinologic and Metabolic Drugs Panel cleared the way for approval of the new diet drug Qnexa. Qnexa (PHEN/TPM) is a combination of phentermine and topiramate (PHEN/TPM). Topiramate is used to treat seizures and prevent migraine headaches and phentermine is approved for the short-term treatment (i.e. a few weeks) of obesity. PHEN was half of PHEN/FEN, the discontinued diet drug that led to valvular heart disease and potentially fatal pulmonary hypertension, primarily in women. Qnexa is indicated for “BMI greater-than or equal to 27 kg/m2) with weight-related co-morbidities such as hypertension, type 2 diabetes, dyslipidemia, or central adiposity (abdominal obesity),” the group with the highest heart disease risk.

The panel decided that the complications of obesity outweighed the risk of heart problems. It’s hard to believe they were swayed by the research. The 2010 study published in the Lancet reported that people who took the highest dose of Qnexa (not the lower approved dose) lost at least 10% of their body weight and showed improvements in their risk cardiac factors. Clinical trials by the manufacturer showed 45% of subjects treated at the low dose lost > 5% of baseline body weight following one year of treatment. No one seems to care that we’re talking about a 10 to 15 pound weight loss on a 200 pound person. Do we need a drug for that, especially one that comes with heart disease risk? No matter because the results showed statistical significance in a placebo control study.

Everybody knows that it’s the weight loss and not the drug that improves blood pressure, lipid levels, glucose and insulin metabolism, and joint pain, and a host of other medical problems. The manufacturers maintain that the product treats obesity co-morbidities through a mechanism that is independent of weight loss, but I don’t believe it. Allied health professionals who work closely with obese populations know that diet pills do not work. Diet pills remove a person’s locus of control, and that spells weight loss failure. ‘Locus of control’ is the belief that an individual controls the events that affect them. Diet pill takers are more likely to say things like, “It didn’t work.”

And on-again, off-again restrictive dieters regain weight lost by over-eating in-between periods of dieting. The human body is simply programmed to work that way. I expect Qnexa to perpetuate that reality of dieting, and for that reason in addition to the heart disease risk, it is not worth the risk. The panel members who voted for Qnexa do not understand obesity treatment.

Also Read:

Dr. Oz’s Raspberry Ketones Dismissed by Dietitian as TV Hype

Qnexa’s Side Effect Profile Has Critics Concerned

Diet Supplement to Blame for JetBlue Pilot Outburst?

April 6th, 2012

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(Page 1 of 1, 4 total comments)


I've never taken an obesity drug and I don't have an obesity-related condition such as diabetes or high blood pressure.

As a matter of fact, I have owned a salad spinner for many years. I consider lettuce to be non-nutritive so I eat spinach salads. I use olive oil or low fat dressing. I use trans-fat free margarine.

I have owned walking shoes and used them most days of the week for YEARS --- and it hasn't stopped me from putting on more and more weight as I enter my 40s.

In my 20s I was walking 2 miles a day and/or doing 45 minutes of exercise a on an exercise bike regularly while following a vegetarian diet. I had never been overweight but I had an older sister, 10 years my senior, who had suddenly become heavy after 30. I didn't want the same to happen to me but for all my knowledge of diet and nutrition --- in fact I managed this section of a book store for five years --- I gained weight and then some after hitting 30. (And no, I can't blame "baby weight".)

I worked hard through my 20s to eat right. I didn't eat more than 20 grams of fat per day (I was a fan of Pritikin). My cholesterol was 120. Today my cholesterol is on the high side of normal and I'm exercising less than I should be. What happened? I injured my ankles, knees (MCL and Miniscus, respectively), got in a car accident that hurt my neck, endured a lumbar spine injury on the job, and with each new setback put on weight. (To give you some kind of idea what shape I was in, even physical therapy managed to land me in the hospital.)

In my early 30s --- before I became obese but around the time the many injuries began to hit me --- I developed plantar fasciitis in both feet. Even with the aid of orthotics, which I wear religiously, I have one heel that hurts so bad and swells so badly that I am reduced to walking at a brisk pace only a handful of times a week for 15 minutes --- and increasingly far less. Due to asthma, I can't tolerate the chlorine fumes from indoor pools so that's out too. I'm at a loss for how to stay thin and fit with the body I have now --- one worn out and broken down at the grand 'ol age of 40.

I really, truly resent the implication on the part of health writers, doctors and the media at large that obese people are always heavy snackers and despise physical activity. I hate Oreo cookies, I rarely buy candy of any type, ice cream in my fridge often gets thrown out with ice crystals on it because I forget it's in there, and I've never finished a bag of cookies or chips in a fit of depression or boredom. I don't drink alcohol and rarely do I drink soda of any type. I limit my consumption of juices to one glass per day! I don't buy bacon, I rarely eat red meat --- I only buy chicken, pork or ground turkey --- and I struggle to consume enough dairy to meet my calcium needs. I dislike snack foods like granola bars and processed cookies, and I eat very little bread (when I do, it's "double fiber" and rarely white). Likewise, I consume very few grains but when I do, it's ONLY brown rice. (Thanks to my pre-existing condition of reactive hypoglycemia I have long been aware of the poor blood-sugar effects of simple carbs.)

I am NOT a binge eater but I AM a chronic pain suffer and my BMI is over 30. To look at me you would never know that I get out and walk, that I love soups and salads or that I rarely even consume pre-packaged, frozen foods.

Truth be told, I am absolutely livid at the assumption that all fat people have a taste for junk food, don't know how to cook healthful meals and loath exercise. I miss my old, active life. My husband eats the same way I do and he is as thin as a rail. I eat salads, fruits and veggies every single day, I almost never finish my dinner when out at a restaurant (I bring home a portion in a doggy bag), and yet I look like a glutton. Will somebody please lay off the "fat hate"? There are genetic and ubiquitous environmental pollutants that play a role too.

Let me tell you one last story. I've owned cats all my life and every single one of them has been an outdoor-only feline. I've fed all my cats the same exact amount and all of them were skinny --- until I adopted one particular cat that had been abandoned after the owner's left the neighborhood. This cat is a tabby, built like Garfield. I KNOW I only feed him what he should be able to eat --- once a day --- and he still manages to top the scales out at 17-20 lbs. Do cats "stress eat"? Do cats that live exclusively outdoors, without constant access to a food bowl, have a "sedentary lifestyle"? I don't thinks so. Even for our feline friends, obesity would appear to be a lot more complex than calories in vs. calories out.

posted Jul 21st, 2012 10:07 pm

thomas morgan

So what gets rid of extra abdominal fat? Is there actually a REAL solution beyond all of the gimmicks and hype that you see in ads and on commercials for "miracle" fat loss products?

posted Apr 20th, 2012 9:17 am


Well, the good news is that I've spent over a decade researching this topic, analyzing the science, and applying it "in the trenches" with myself as well as thousands of my clients from all over the world to see what works to really stimulate abdominal fat loss.

posted Apr 20th, 2012 7:41 am


I think the whole problem Dieticians and Trainers don't want this pill approved is because it really does work and they will lose business. I took the pill for a year during the study and the side effects were minimal and the benefits were great, i not only lost weight (which i have a very hard time doing) but my liver function improved along with my cholesterol, blood pressure and i no longer needed medicine for GERD. I think all you skeptics need to talk to the people who actually participated in the study and get their feedback.

posted Apr 9th, 2012 2:41 pm


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