Over-the-counter (OTC) diet products promise to help you shed pounds by
raising your metabolism or suppressing your appetite. Their side
effects, however, can be dangerous.
Here's a look at some of the more popular OTC diet medications and what
they will and won't do for you:
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Ephedra (ma-huang).
One of the most popular OTC weight-loss products has been Metabolife,
an herbal dietary supplement. There are similar products, but the
main ingredient is ephedra. Ephedra is used in asthma medicine. It's
also used to make the street drug methamphetamine, commonly known as
speed. Chemically, there's only a slight difference between
methamphetamine and ephedrine, the synthetic form of ephedra. This
drug can slightly suppress your appetite. However, it can also cause
high blood pressure, heart rate irregularities, insomnia,
nervousness, tremors, seizures, heart attacks, strokes and death. In
late December 2003, the Food and Drug Administration announced the
ban of ephedra from the marketplace because of health concerns.
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Chitosan.
This is a dietary supplement made from chitin, a starch found in the
skeleton of shrimp, crab and other shellfish. Because chitosan (KI-to-sun)
isn't digested, it passes through your intestinal tract unabsorbed,
so it adds no calories. The chemical nature of chitosan makes it
bind with fatty foods you eat, removing some of this fat from your
body rather than allowing it to be absorbed. One study, however,
found no more weight loss from chitosan than from a placebo.
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Garcinia (hydroxycitric
acid).
A common ingredient in herbal weight-loss products, hydroxycitric
acid (HCA) comes from a plant native to India: Garcinia cambogia.
Popular brand names of this herb include Citrimax and CitriLean. A
study in the Journal of the American Medical Association in
1998 found the herb ineffective for weight loss.
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St. John's wort.
This is an herbal medicine derived from the Hypericum perforatum
plant. European studies suggest it may work for relieving
depression. But the Food and Drug Administration (FDA) says this
herbal medication hasn't been proved safe or effective for weight
loss, and it can interact with some prescription medications.
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5-hydroxytryptophan (5-HTP).
Sold under brand names such as Natrol, Natural Balance and Solaray,
this extract from a plant seed contains a contaminant linked to a
rare and potentially deadly blood disorder. Chemically, 5-HTP is
closely related to L-tryptophan, a dietary supplement banned in 1990
after researchers found the same contaminant that has since been
discovered in 5-HTP.
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Herbal
laxatives and diuretics.
They cause you to lose water, and thus lose weight, but not fat.
They can lower your potassium levels, causing heart and muscle
problems. Also, if you use laxatives too often, your bowels start
depending on them.
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Caffeine.
A few studies indicate that in people who exercise and eat a low-fat
diet, consuming large amounts of caffeine or other stimulants may
slightly enhance weight loss. But taken in large doses, caffeine can
cause jitters, irritability, insomnia and high blood pressure. And
if combined with other stimulants, such as ephedrine, the side
effects may be more serious.
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Appetite
suppressants.
Some appetite suppressants have contained phenylpropanolamine (PPA)
— a stimulant that has been linked to an increased risk of stroke.
The FDA warns consumers to avoid using products containing PPA, and
has asked drug companies to discontinue marketing products with PPA.
As the discontinuation process continues, the FDA urges consumers to
check labels of OTC products to see if PPA is an ingredient. Even if
PPA is not an ingredient in an appetite suppressant, thereby making
it safer to use, you still face the issue of controlling your
appetite once you stop taking these pills. Otherwise, you'll gain
back whatever weight you may have lost.
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Pyruvate.
This popular weight-loss dietary supplement may have a slight effect
in helping you shed pounds, according to studies in the American
Journal of Clinical Nutrition. Pyruvate, in the form of pyruvic
acid, is found in various places. It's formed in the body during
digestion of carbohydrates and protein. It's also in several foods,
such as red apples, cheese and red wine. Pyruvate seems safe, but
its claims of boosting metabolism, decreasing appetite and aiding in
weight loss need further study.
People tend to take OTC drugs and herbs less seriously than they do
prescriptions and often take too much or mix them with other drugs.
Also, because the manufacturing of herbs is unregulated by the FDA, you
can't be sure what you're getting.
If you're troubled by your weight, talk to your doctor. OTC diet drugs
can't help you with anything beyond short-term, temporary weight loss —
if that. These diet products are more harmful than helpful.
Surgery for weight loss
If
you've tried diet and exercise to lose weight but remain seriously obese
(a BMI of 35 or higher) and have weight-related health problems as a
result, weight-loss surgery (bariatric surgery) may be the next best
step.
Since the 1950s, when surgery for obesity began, doctors have used
various operations to produce weight loss. Today, the most common
operations fall into one of two categories.
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The first uses a
band or staples to create a small pouch at the top of your stomach,
where food enters from your esophagus — the tube from your mouth to
your stomach. The stomach pouch can hold only about an ounce or two
of food, though this can later expand to several ounces. After the
operation, you can eat only small portions of food at a time without
feeling nausea or discomfort.
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The second type of
surgery also creates a small pouch, but adds a bypass around part of
your small intestine, where most of the calories from foods that you
eat are absorbed. This surgery does double duty. It reduces what you
can eat, and it reduces the calories your body absorbs.
Here are some of the specific operations, representing these two
categories:
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Vertical banded
gastroplasty (VBG).
This is an example of the first category of weight-loss surgery,
which is designed to partition the stomach into two parts. Using a
surgical stapler, the surgeon divides your stomach into upper and
lower sections. The upper pouch is small and empties into the lower
pouch, which is the rest of your stomach. At the dime-sized opening
where the upper pouch empties into the rest of your stomach, the
surgeon wraps the tissue with a piece of nonexpandable plastic. This
banding of the opening between the upper stomach pouch and the rest
of the stomach helps prevent the opening from stretching.
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Gastric bypass.
This is the weight-loss surgery most often recommended by doctors.
It's an example of the second category of surgery — creating a small
pouch and adding a bypass around part of your small intestine. The
surgeon staples your stomach all of the way across the top, leaving
a tiny pouch. Then the surgeon cuts the small intestine and sews a
part of it directly onto the upper pouch. This redirects the food,
bypassing most of your stomach and the first section of your small
intestine. Food flows directly into the middle section of your small
intestine, limiting your body's ability to absorb calories. Even
though food never enters the lower part of your stomach, the stomach
stays healthy and continues making digestive juices that flow into
your small intestine. Most surgeons prefer this procedure because it
appears to be most effective. Some surgeons can perform gastric
bypass by inserting laparoscopes — tiny, tubular instruments with a
small camera attached — through small incisions made in the abdomen.
This is called laparoscopic gastric bypass. Performing the operation
laparoscopically can help decrease your hospital stay and lead to a
quicker recovery. There also appear to be fewer wound-related
problems with laparoscopic gastric bypass than with the traditional
"open" gastric bypass. Not everyone is a candidate for laparoscopic
gastric bypass, so consult your doctor.
When appropriate, weight-loss surgery can result in dramatic
improvements in weight and health. In the first year or two, most people
lose 50 percent to 60 percent of their excess weight. Generally, those
who follow dietary and exercise recommendations keep most of that weight
off long term.
However, weight-loss surgery does have side effects. Complications such
as pneumonia, blood clots and infection can occur with any type of
surgery. Rapid weight loss can result in fatigue, dry skin and temporary
hair loss. A hernia or weakness, which may require surgery to correct,
may develop at the site of your incision.
For the first six months after surgery, if you eat too much or too fast,
you'll experience nausea and other symptoms, called dumping syndrome.
Over time, you'll be able to increase your food intake.
Surgery for weight reduction isn't a miracle procedure. Though you can
expect to lose weight and keep it off, you still need to eat healthy
foods and remain active.
Liposuction: Not a weight-loss plan
Liposuction is cosmetic surgery, not a weight-loss plan. The surgeon
inserts a narrow tube under your skin through tiny incisions, and then
suctions out fat cells. It's most commonly used to trim the outer
thighs, abdomen or love handles. Though liposuction has improved to
allow surgeons to remove several pounds during one procedure, this
body-shaping procedure isn't a treatment for obesity.
