Combo-Pilling for Weight Loss: Is it a Good Idea?

While watching the news this morning, I was alerted to the practice of "combo-pilling," taking supposedly unrelated medications together to produce more powerful results toward a desired outcome. Combo-pilling diet drugs went mainstream in the 1980s, with the pairing of phentermine and fenfluramine (later known as "fen-phen"). This pairing, as well as a commercial related version, was heralded as the first effective weight loss drug treatment. Later, when it was discovered that the commercial drug was associated with potentially fatal pulmonary hypertension and heart-valve problems, it was withdrawn from the market and the manufacturer was sued to the tune of more than ten billion dollars.

Combo-pilling remains, in part because single diet drugs have not yielded the results many seek. After sibutramine (Meridia) was removed from market late last year, the only FDA-approved drug for treating obesity for more than a few weeks is orlistat. However, if dieters eat fat-heavy meals, the results are some less-than-pleasant side effects (oily stains on one's underwear, being one).

So combo-pilling continues.

Of late, the blend of Topomax, an anticonvulsant approved for the treatment of epilepsy and migraines; and phentermine, the above referenced appetite suppressant, are making their way into the collective dieters' consciousness. It appears that Topomax effectively "shuts off" the desire to eat. When combined with phentermine, the results can be downright staggering. I monitored some on-line discussion groups and found it not uncommon for participants to claim weight losses of four or five pounds a week for extended periods. (A healthy sustainable weight loss is considered to be one to two pounds per week.)

Using medicine for what it is not intended is called "off-label" use. Although no official data exist as to the extent of this practice, a March 2009 study published in Obesity found that 65 percent of weight specialists belonging to the American Society of Bariatric Physicians who responded to a survey do indeed prescribe "off-label" combinations. The practice is legal; in fact, according to a 2006 analysis in the Archives of Internal Medicine, approximately 20 percent of common adult drugs are prescribed as such. (Since the drug is approved and on the market, physicians may use it as they see fit.)

While some doctors are unconcerned, many are raising red flags, pointing out that these medical "cocktails" might be taken for years, causing long-term adverse interactions and unexpected side effects. Since the FDA is not monitoring such usage, authorities might never find out about such problems; and even if they do, it could lead to catastrophic results for those experimenting with untested combinations.

Referencing the aforementioned Internet discussions, the danger seems to be of little concern to some who insist on doing "whatever it takes" to achieve their correct weight; consequences be damned. Said one post, "I started ... one week ago and I've lost eight pounds already. I agree with the post above that this may not be 'healthy' weight loss, but being overweight isn't healthy either. If this gets me to a healthy weight, then so be it." Alarming, isn't it?

Of greater concern to me is not the threat of obesity, but that being overweight is considered such a stigma and so abhorrent that some would literally risk life and limb to drop pounds. If it is indeed so vital to lose the weight, wouldn't it seem like it might be important enough to rearrange one's life to eat a less and walk a little more? It's a slower process, yes; but the worst side effects in that situation are a growling belly and sore feet.