Appetite Suppressant in a Bottle? Closer than you think but farther from learning true fullness

The FDA has approved Belviq (Lorcaserin)- the US’s 1st weight loss drug in 13 years.  Belviq is thought to work by decreasing the appetite via serotonin levels.  Belviq is approved for people who are obese or overweight with a BMI >27 and a related health condition (including high blood pressure, high cholesterol, or diabetes).

In a country where only one third of the population are able to maintain a healthy weight, it’s hard to turn a blind eye to possible use of medications to promote weight loss for health.  But I simply have too many apprehensions to see Belviq as a healthy solution to weight loss.  In 2010 Belviq was rejected due to possible heart problems as a side effect, however the manufacture submitted further studies ans the drug was passed.  It is also important to note that Belviq works in the same way as 1 of the ingredients in Fen-Fen did which was pulled from the market in the 90s due to health complications.

From my standpoint on weight management and healthy eating, if a person is taking a drug short-term to suppress their appetite, what will be the result when they stop taking the drug?  The true measure of success in weight management is not losing weight, it is maintaining the weight losss for life.  In order to maintain something for life, you need to develop the habit for life not as a short term fix.  So, if the person is not able to learn hunger and fullness during the course of their weight loss because their appetite is suppressed by a short-term fix (Belviq), how will they switch to eating and trusting their hunger/fullness cues once they have lost weight and are off the drug?


6 thoughts on “Appetite Suppressant in a Bottle? Closer than you think but farther from learning true fullness

  1. Very well stated! I am having a similar problem with the use of meal replacements in medically-supervised weight loss programs. I recognize the convenience of “ready-made” meals and I also see how they can benefit people short-term, but what happens when the patients go off the meal replacements? The research shows they tend to re-gain any weight that was lost. I definitely think long-term, lifestyle changes are necessary for any kind of weight loss maintenance. In addition, I think the maintenance of overall healthy habits should trump the decreasing number on scale when identifying or evaluating a patient’s progress and success. It’s sad when my patients get so discouraged by a slower-than-expected weight loss rather than being encouraged by the improvement in their lipid levels, blood pressure and overall fitness.

    • Alexandra thank you for making this blog post interactive. I find this to be a common struggle among RDs. Perhaps as a society we are just too number focused and place more value on weight than other markers of health, even numeric ones like triglycerides and blood pressure. Unfortunately this does not align with much of the research I have encourage there’s where achieving desired lab values, blood pressure, and improved fitness are more closely tied to health than the scale.
      When counseling clients I explain that weight changes are not the “behavior/symptom” we are targeting. Weight changes are a byproduct of the behavior/symptom. Therefore if the client learns to eat intuitively and develops healthy habits to suit their lifestyle, their weight will respond in due time and remain the result. I focus on reinforcing positive changes especially learning hunger and fullness, which an appetite suppressant would interrupt. The client looking for the quick fix weight loss might get just what they desire, rapid weight loss with rebound weight gain if they do not learn “normalized intuitive eating” along the way.

  2. Surprise! This medication also indicates the need for a healthy lifestyle (healthy food choices, regular exercise and stress reduction). Thus far my best plan of attack for my weight, that has worked best, has been small changes I have made in my lifestyle (especially how I handle stress) and the weight is coming down slowly but I definitely feel that the change is permanent. I do have my off days but I remember the improtance of a healthy lifestyle.

  3. Getting in touch with hunger and fullness are indeed paramount to a successful weight maintenance yet many of my patients have lost connection to the signals of leptin and ghrelin. Utilizing the many tools we have in our weight loss toolkit may mean regulating portion sizes, amping the plant-based foods like fruits, veggies and whole grains, and eating on a regular schedule. Add a dollop of mindful eating and in time, the connection will return. It’s challenging – as manager of a major weight management clinic in an academic healthcare setting, I too struggled with the full liquid meals, partial liquid diets. Our RDs counseled the need to stay with us longer term so we could seque them back to real food, real time, real hunger and fullness. Lifetime changes … from intrinsic motivation to be the closest to your true essence even if that’s not at your ideal or dream weight.

    • Diane,
      Do you find that insurance coverage dictates a client/patient’s compliance with the program. For example, some of the Bariatric programs in my area seem to have a very involved nutrition component for before the surgery, but afterwards the programs do not have long term follow ups with an RD. I am wondering if your patient’s tend to lose interest when their payments become out of pocket?

      • Of course, insurance reimbursement plays a huge part in a patient’s motivation. But, on the flip side, when you pay for something yourself, you seem to place higher value to it. For instance, the bariatric program at MGH, managed by Sue Cummins RD, requires an out-of-pocket payment for the pre-bariatric surgery program and I think it’s close to $1,000. If you don’t attend, you don’t get surgery. I’m unsure about the long-term care by RDs afterwards. At the Boston Medical Center surgical program, pre-surgery RD visits are mandatory as are within the first year. The protocol in place when I left to go into private practice was alternating monthly visits s/p 3 months with surgeon, RD, medical doc. Surgeon/RD visits were weekly, bi-weekly the first 3 months. That’s a lot of contact, done right, taught right, more success.

I am excited to read your thoughts/questions!!!

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