This document discusses the history and current state of weight loss medications and supplements used by adolescents. It outlines several FDA-approved prescription medications for obesity including orlistat, lorcaserin, and phentermine/extended-release topiramate. Common side effects and efficacy rates are provided for each. The document also notes that weight loss supplements are not reviewed or approved by the FDA in the same way as drugs and lists some popular supplements including raspberry ketones, green coffee bean extract, and Garcinia cambogia. It emphasizes that lifestyle changes including diet and exercise should always be the cornerstone of obesity therapy.

1. Safety and Efficacy of Weight Loss
Supplements and Medication Used by
Adolescents'
M.S Phrm D Norah Al Johany

4. • Laxiatives (2nd Century)
• Thyroid extract (Late 1800s)
• DNP (1933 -1938)
• AYDS (1940) Benzocaine
• Tapeworm diet pills 1950’s
• CNS Stimulant
 Amphetamines (1930s - 1950s )
 Aminorex 1965 ,Phentermine 1959 ,Fenfluramine
 Sibutramine (1997-2010) Meridia
HISTORY Diet & Weight Loss Pills

5. • First significant guidelines since 1998!
• American College of Cardiology / American
Heart Association
• Very limited in pharmacotherapy
• Stopped input in 2011, newer medications
approved in 2012
• Diet / Exercise always cornerstone therapy
Recent Guidelines!!!

6. Medications Reserved For:
Not achieving / sustaining weight reduction with
adequate lifestyle modifications and:
BMI 27+ kg/m2 with significant weight related
comorbidities (diabetes,hypertension)
ACC/AHA Obesity
Medication Recommendations

7. Orlistat – Inhibits gastric and pancreatic
lipases >> reduced fat absorption
Rx (Xenical): 120 mg three times daily (up to 1
hour prior to meals)
• LOTS GI ADRs: flatulence, oily stool, loose stool
• FDA 2012: Increased risk for kidney
stones/liver injury
• KSA
FDA Approved Drugs /Obesity
Therapy

8. Lorcaserin (approved 2012)
• Selective serotonin 2C agonist
• ADRs: HA, dizziness, nausea, dry mouth,
• constipation, memory disturbances, hypoglycemia
(in diabetes)
• Efficacy: ~46% attain 5% wt loss, ~23% 10% loss
• (good A1c reduction in patients with diabetes)
• Avoid use if also taking serotonergic agents (e.g.
• SSRIs)
• Stop if < 5% weight loss after 12 weeks
• (60)239$

9. Phentermine/extended-release topiramate
Short term(approved 2012)
ADRs: dry mouth, constipation,
insomnia, memory disturbances, increased heart rate
Efficacy: 60+% attain 5% wt loss, 35-45% 10%
loss
Women of childbearing age must have negative
pregnancy test before and monthly after starting
Stop if < 5% weight loss after 12 weeks of higher doses

10. FDA approves weight-management drug
Contrave 2014
Naltrexone is approved to treat alcohol and
opioid dependence.
Bupropion is approved to treat depression and
seasonal affective disorder and as an aid to
smoking cessation treatment.

12. Off-label Drugs /Obesity Therapy
• Zonisamide
• Metformin
• Pramlintide

13. • How long to treat for???
• No head to head comparative studies
• Long-term safety
Obesity Therapy Issues

14. Supplements

16. • weight-loss supplements differ from over-the-
counter or prescription medications
• FDA does not classify them as drugs.
• Unlike drugs, dietary supplements do not
require premarket review or approval by the
FDA. Supplement manufacturers are
responsible for determining that their
products are safe and their label claims are
truthful and not misleading
Supplements

23. FDA has issued over 30 public notifications and
recalled 7 tainted weight loss products in 2014.

26. 1. Garinia cambogia exract
2. CLA
3. Raspberry Ketones
4. Apple Cider Vinegar
5. Green Coffee Bean
6. Fiber
7. Colon Cleanse
Amazon Best Sellers Weight Loss
Supplements

27. Raspberry Ketones

28. CLA

29. Green Coffee Bean

30. Garinia cambogia exract

31. Fiber

32. Colon Cleanse

33. Patient Case
A patient is taking the maximum dose of
phentermine/topiramate for obesity.
Baseline BMI is 36 kg/m2 and weight 255 lb.
What is minimal weight loss expected to
consider continuation of therapy after 12
weeks?
a. 7 lbs
b. 13 lbs
c. 17 lbs
d. 26 lbs
1-

34. “We’re raising our children the way we
raise calves for veal - keep them in
boxes, feed them too much, and allow
them no exercise.”
Rich Killingsworth
Center for Disease Control and Prevention

35. Outline Summary