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Can a Drug or Surgery Solve Your Weight Problem?

Successful Weight Loss
(Published first in The Huffington Post)

In a word, no. Can they help? Perhaps.

Last month I wrote an article that spoke somewhat favorably of the new weight loss drug, Saxenda. I said it was perhaps the most important weight loss medication ever developed.

Wow! Did I get lambasted! I got all sorts of email blasting me for going over to the dark side and becoming a drug pusher and lackey of Big Pharma. I even got an email from my favorite professor of counseling at the University of Massachusetts, now friend, Allen Ivey, Ph.D. Besides being a friend, he is a big shot in the counseling field, the father of Microcounseling and developer of “active listening”. He said he was “sad” to see that I seemed to be pushing drugs. He is the last person on earth that I would want to be mistaken about my views on the solution to obesity. We’ve since gotten that misunderstanding corrected, but I want to make sure it is clear with everyone who reads my blogs.

I am still the world’s staunchest advocate of the behavioral therapy I teach to reverse the condition of obesity. It works -like a miracle, some say. But not 100% of the time. For some, it is not enough.

After 30 years successfully helping people to lose weight permanently, I am convinced that a percentage of the population is dealing with a physiological condition that creates more persistent and intense degrees of craving and compulsion than the rest of us have to deal with. My approach teaches people how to overcome the habits and feelings that make them overweight but sometimes those cravings and compulsions are so strong that nothing on God’s natural earth will quiet them.

If you’ve ever had a blister on your foot or a pebble in your shoe, you’ll remember that your brain is getting the message loud and clear that you need to relieve that pressure and you need to relieve it right now. You will feel the drive to relieve it until you do. It won’t go away until you do whatever it takes. There is no “will-powering” it away. Something is going on in the body, physiologically and chemically, that is triggering a response in your brain that will bother you until you satisfy it. It isn’t exactly the same with the food cravings that some have, but it gives you an idea of what some people are dealing with. Hold your breath for as long as you can and see how powerful the urge to breathe becomes. This is the kind of relentless drive that a small percentage of the population is fighting in their attempts to stop eating too much.

For them, some sort of intervention or tool that would make it easier for them to eat less would be a Godsend. Then, perhaps what they learn in a good behavioral approach would be enough. Self-programming and cognitive techniques like I teach work like magic for many people, but they would be so much more productive for these folks with eating hyperdrive if we could reduce that drive, which the pharmaceuticals can do. Or in the case of surgery, an additional tool to use behaviorally.

Make no mistake about it, drugs or surgery will not by themselves solve your weight problem. To solve your weight problem, you need to make a permanent change in your behavior, made possible with behavioral therapy, taught in my book and by my therapists. Success comes with learning how to eat what you like in ways that keep you at your desired weight and it becoming habitual and a new “normal” for you. Now, with these new medical interventions, success may be possible even for those who have suffered from an abnormally intensive eating drive. Weight loss drugs or surgery may now enable them to overcome the obstacles that prevented them from being able to make those behavioral changes.

What is Belviq, the New Weight Loss Drug?

Belviq is a new weight loss drug that just became available by prescription this past week, one of only two new weight loss drugs approved by the FDA in the last 13 years. (The other is Qsymia, which I have already written about.) It is made by Arena Pharmaceuticals. Belviq is the trade name, Lorcaserin is the generic name, and it was called Lorqess during its development.

Belviq affects the serotonin receptors in the brain, changing the neurotransmitter action of serotonin, the brain chemical you hear about related to mood. SSRIs (Selective Serotonin Reuptake Inhibitors) are a group of drugs that are mainly used to treat depression, but it has been found that many of the drugs that affect neurotransmitters have lots of other affects, change in appetite among them. Drugs that change the action of the neurotransmitters serotonin, dopamine and norepinephrine are used to treat many psychological conditions, even psychotic disorders, because they change the way we think and feel. They can create experience in the psyche like hallucinations, expansive thoughts or euphoria (good mood or feeling), or quell it, like reducing cravings and dark thoughts, or quieting hallucinations and mania. The antidepressant Wellbutrin was found to quiet the cravings of people trying to quit smoking and was then marketed also as Zyban. Some of these drugs were found to increase appetite, cravings, and drive to eat, and some have been found to reduce appetite and cravings. Pharmaceutical companies create new drugs, experiment with them, then market them for the effects that they produce. Belviq is sold as a weight loss drug, a drug to reduce appetite.

Does it work?

Reliable clinical studies have shown that people given the drug lost weight slightly more than people given a placebo, even without instruction in weight loss protocols. In studies where people were instructed in weight loss technique, people taking the drug did about twice as well as those taking the placebo. In all cases, the weight loss was slight, and the weight was regained after the trials. I have seen no reports that relate the subjective experience of appetite or craving suppression by the study subjects, which is the main thing I would like to know about. One would assume, based on the results of the clinical studies, that eating drive was reduced by the drug.

What value would any weight loss drug have?

Everyone familiar with my work knows that there is no mystical magic to successful weight loss. We must establish new behavior where we eat less, to the degree that we lose weight and keep it off. My method has been so successful because of the use of psychological techniques that are so effective in managing thoughts and feelings and so effective in changing habit –deleting damaging habits and installing healthy habits.

I know, from personal experience, as well as my work with clients and patients, that we are all different in many ways, and we have different psychological experience, like appetite, cravings and compulsion.

For those who experience uncontrollable drive that results in life threatening bingeing and uncontrollable compulsive eating, I pray that we find a drug that can mitigate outrageous eating drive without presenting unwanted and dangerous side effects. People would still have to manage their behavior with the methods I teach, but it would be so much easier if one were not tormented by the compulsion that I know some people experience. Is Belviq such a drug? I hope to find out.

Is Belviq safe?

There are so many bad side effects being reported that it is scary, even to a mental health counselor who has seen it all. Not only are psychological side effects being reported, but risk of medical problems seems high. Both the University  of California’s Wellness Letter and Consumer Reports have published critical reviews that would discourage just about anyone but the most desperate from taking it.

The Anderson Method recommendation:

To solve your weight problem, you will have to create new habits of behavior and thinking, no matter what. You will need to maintain them for the rest of your life. Many people have used The Anderson Method to do just that, some saying it was easy. If you can do that without drugs, that will be the best solution. After all, you don’t want to be taking these drugs for the rest of your life, even if they are safe.

If you are unable to manage compulsive eating and bingeing and the experience of craving is an absolute torment, drugs might help. There are a number of drugs that have helped people with unwanted eating drive, such as Wellbutrin, Lexapro and Topamax. And they have been around for a while. My advice, if you want to try a drug to help with weight control, is to find an expert in these drugs (Psychiatrists or Psychiatric Nurses) and try one that is known to be safe. Remember that no matter what, no drug is going to make you lose weight or solve your weight problem. The solution is in behavioral therapy science. A drug may make it easier to do the work, but you will still need to do the work. If you want to try a drug, try one that’s known to help some people and been around for a while. Let someone else be the guinea pig with Belviq.