A magic pill that makes you slim with no side-effects would be the 21st
century's goose that lays the golden egg. With 13 million people forecast to
become obese by 2010, the market for a miracle cure is huge. Dieters spent
£47million last year on pills and diet aids, just one segment of an industry
with a turnover of £1 billion a year. It's no wonder that so many companies
want to jump on this lucrative bandwagon.
“I achieved the impossible,” ran the headline after a woman in America claimed
that Alli, an anti-obesity drug to be made available in British pharmacies
this spring, had enabled her to lose 4st (25.4kg) in 18 months.
Last week came the news that we're using eight times the number of slimming
tablets than we were seven years ago. But their ingredients do not include
miracles. The singer Kelly Osbourne checked into rehab last week, rumoured
to be addicted to weight-loss pills. And the news that Alli will be
available over the counter in the UK has also sparked tales of bouts of
diarrhoea from those who have tried it, and warnings from doctors that
weight loss with the drug is likely to be small and will occur only if
people also make big changes to their lifestyles.
This follows concerns from consumer groups that other types of slimming pills,
sold at healthfood shops as herbal remedies and supplements, are for the
most part useless. Loopholes in British regulation allow the makers of such
pills to make claims about weight loss that are scientifically
unsubstantiated. Then there are pills that are available online, subject to
no controls and sometimes dangerous.
The concept of taking a pill to lose weight permanently is at best misleading
and at worse a scam, many British weight experts say. However, we are
constantly prey to marketing. Gareth Williams, Professor of Medicine at
Bristol University, has written in the British Medical Journal about his
concern that obesity drugs such as Alli will have minimal impact because
people have unrealistic expectations, thinking that pills do the work
without the need to make necessary lifestyle adjustments.
“All these preparations are peddled as miracle answers to what is an
intractable lifelong problem,” he says. “People see them as clever solutions
that scientists have come up with, and when they're available over the
counter in chemists, they're perceived as even more miraculous, more
innocuous, sitting alongside the paracetamol.”
The new Alli tablets, made by GlaxoSmithKline, are a version of a prescription
drug that has a good safety record and has been shown to help short-term
weight loss when patients are supervised by doctors. They will become the
first licensed medicine for weight loss available over the counter, joining
a confusing array of herbal diet pills and supplements. Many come with
impressive claims on weight loss. A product called Chitosan, derived from
the shells of shrimps, is available from hundreds of outlets, including
Holland & Barrett, and is marketed on one online pharmacy as “a proven
safe and effective way to control your fat intake”. Yet the trials on which
these claims are based were not independent and studies since have indicated
that Chitosan has little or no effect on controlling fat or weight.
An anlaysis by the consumer body Which? of eight herbal/supplement slimming
pills available in health shops and pharmacies last year concluded that six
did not work. Three might possibly have some effect on weight, but there was
no robust evidence to support this.
Lipobind, for example, produced by Goldshield, is claimed to be a “clinically
proven fat binder”, which “helps with decreasing food cravings, suppressing
appetite and lowering blood cholesterol”. The panel of experts, which
included a dietitian, a pharmacist and a doctor, concluded that evidence
supporting the claims was thin and that the pills were, in effect, an
expensive bulking agent.
Which? advised against taking any of the pills, saying that they could be
expensive and could have side-effects such as diarrhoea, reduction of
vitamin absorption and increased blood pressure.
Why are manufacturers allowed to make these claims? Because most diet pills
available from shops are not licensed as medicines and, therefore, are not
subject to strict controls. They are controlled by food regulations, so are
subject to far fewer rigorous controls over claims of what they can do. You
can get some clues from the label: if it states that the product is a “food
supplement”, this indicates that it has not been subject to the same
scrutiny as a medicine.
John Blenkinsopp, a doctor and pharmacist who was a member of the assessment
panel, says that he has some sympathy for drug companies, which have to
spend millions demonstrating the safety and efficacy of products such as
Alli, while other products can claim miraculous effects on the basis of
little research.
“It's even worse if you go on the internet, where you have no protection and
you don't know what you are buying,” he says. Products purchased on the
internet, unlike in shops, are not necessarily governed by British law. In
December American medicine authorities warned about 28 types of fat-buster
pills available online that could land users in hospital. Many of the
products originated from China and contained dangerous amounts of a powerful
appetite suppressant called sibutramine, which can cause heart attacks if
used incorrectly. Dr Ian Campbell, the medical director of the charity
Weight Concern, was on the Which? panel and says that almost all
non-prescription slimming pills create the impression that they are a magic
bullet and understate the necessity of changes to eating and exercise habits
for long-term success. With Alli coming on the market in pharmacies, he
says, it is important to make a distinction between this and the food
supplement slimming products available over the counter, a distinction that
might not be obvious to customers. The evidence for Alli is good, Campbell
points out, with trials indicating that people taking it in addition to a
low-fat diet have lost 50 per cent more weight than dieting alone.
“The trouble is that when it's available over the counter people will take it
ad hoc and not as part of a diet. They could have unpleasant side-effects,
and give up, and it will be another thing that's failed. They'll have lost
money [Alli costs £1 a day] and will feel more despondent.” If pharmacists
make sure that the right people get the drug, and are properly supported,
some people might lose weight with it, he adds.
But even if this particular diet pill does help some to lose weight in the
short term, there's virtually no evidence that it will help to keep them
slim. According to Campbell, the research indicates that the single most
successful strategy for losing weight and keeping it off is not diets, or
slimming pills, but cognitive behavioural therapy; having counselling to
understand why you eat, why you don't exercise, and how to think differently
about these things. Pills don't change the reasons you overeat.
That's why Professor Robert West, from the Health Behaviour Research Centre at
University College London, believes that, for all their superficial allure
as a quick fix, slim pills can fix things only temporarily. Something else
has to happen to make you keep the weight off. “If you want long-term weight
loss, something major and structural has to change in your life,” he says.
“That's going to be either gastric surgery, which for most of us is not an
option, or something changing in your head. If that doesn't happen, you are
inevitably going to give way to all those pressures to eat, or not exercise,
that we're subject to every day. Something has to click in your head that
says, This a new rule for the rest of my life, and it's going to work
because it's part of who I am.' ”
Professor Williams, the editor of the forthcoming book Obesity: Science to
Practice (Blackwell) agrees that slimming pills are ultimately a distraction
from the serious business of losing weight long-term. “Obesity is a life
sentence, and even if a drug like Alli works for a couple of years, the dent
it makes on your life and health is very small. We should be pedestrianising
cities, building cycle tracks, getting people moving - not dumping all the
responsibility on to a drug.”
Diet pills: the facts
Diet pills divide into three groups
Pills licensed as medicines in the UK Approved by the Government and rigorously
tested for safety and effectiveness, these can normally be prescribed only
by doctors to aid weight loss in the severely overweight. The most commonly
prescribed are sibutramine (which works by altering hunger messages to the
brain) and orlistat (which prevents fat absorption). Alli, a version of
orlistat, will be available from chemists without prescription this year -
but theoretically only if you talk to a pharmacist.
Herbal remedies/food supplements
Available from pharmacies and health food shops, there are many pills which
are not licensed as medicines, including ingredients which (for example) are
supposed to increase your metabolic rate or reduce the amount of fat you
absorb. These have been less rigorously tested, and can make claims about
weight loss on the basis of little research, but are still subject to
British/European laws on safety and efficacy. They are generally available
without talking to a pharmacist.
Slimming pills available on the internet
Alongside many legitimate medicines, the web offers dozens of unregulated,
potentially dangerous products. Some are powerful drugs, many originating
from Asia, which without supervision by a doctor can cause addiction, and
devastating physical and psychological side- effects. Others will be
useless. All can make claims based on little evidence.
