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BREANNE BONILLACARLIN COOMBS
KIMBERLY WILLOWJANE JENSEN
Diet Drugs and Supplements
History
Late 1800’s and Early 1900’s
2nd Century AD: Soranus of Ephesus
prescribes laxiatives and purgatives for obesity
Late 1800s: The first diet pills based
off of thyroid extract were marketed as "fat reducers“
Discontinued due to causing side effects such as hyperthyroidism
1920’s: Trend of using
laxatives for weight loss.
Gimmicky weight-loss products advertised.
Early-Mid 1900’s
1933: Dinitrophenol was
introduced. It claimed that it
prevented food energy from being turned into fat.
1938: Dinitrophenol was
voluntarily withdrawn by manufacturers.
Enactment of the Food, Drug, and Cosmetics Act.
1940’s: Appetite suppressant
candy called Ayds was marketed
Mid 1900’s
Late 1930s - 1950s: Doctors began prescribing amphetamines for its side
effect of appetite suppression1950’s:
Tapeworm diet pills hit the news after opera singer Maria Callas was rumored to have ingested one for weight loss.
Unverified if there were really tapeworms in the advertised pills.
1959: Phentermine approved by the FDA
Mid 1900’s
1960’s: "Rainbow pill" regimes were being used. They were a
combination of multiple pills to help weight loss, such as amphetamines, diuretics, and laxatives.
1965: Appetite suppressant aminorex fumarate was
developed as treatment for obesity. Withdrawn from the market two years later due to
pulmonary hypertension side effects. 1970’s:
Adderall was used as a diet drug, marketed under the name Obetrol.
Late 1900’s
1973: the Food and Drug
Administration approved the drug fenfluramine
FDA began the recall of diet drugs containing amphetamines.
1979: Fenfluramine and
phetermine have been combined into Fen-Phen and gained popularity.
1990’s
1992: Fen-phen gained more popularity when a report stated
that it caused a 10% weight loss.
1994 Dietary Supplement Health and Education Act is
passed, which adds the "dietary supplement" category. Ephedra classified as a herb and use for weight loss
increases.
1995 Dexfenfluramine (Redux) was developed as an
alternative to fenfluramine with less side-effects.
1990’s
1997 Removal of fen-phen is called for by the FDA after
reports linking fen-phen with heart valve problems. Redux removed from the market due to similar
problems relating to cardiovascular health.
1998 Meridia is put on the market.
2000’s
2004: Ephedra removed from the US market from concerns
with raising blood pressure which could lead to strokes and death.
2009 Hydroxycut diet supplements pulled off the market
after reports of liver damage. Meridia (sibutramine) is removed from the US market
from concerns that it could raise blood pressure and cause stroke or heart attack.
2000’s
2010 Orlistat (prescription as Xenical, over-the-counter as
Alli) is available. Orlistat is taken to reduce the amount of dietary fat
that is absorbed by the digestive tract.
Drug Pharmacodynamics
Orlistat (Xenical)Orlistat (Xenical)
• Basic Function:• Prevents the
absorption of fats, reducing caloric intake
• Saturated version of Lipstatin
• Inhibits pancreatic lipases which break down fat molecules
• OTC version: Alli• Half the dose of
prescription Xenical
Side Effects: Oily discharge/fatty
stools Lower absorption of
fat soluble vitamins
Prescription Drug Pharmacodynamics
Sibutramine (Meridia)Sibutramine (Meridia) PhenterminePhentermine
Basic Function: Inhibits NT reuptake in
brain Serotonin Norepinephrine Dopamine
Enhances feeling of satietyIncreased risk of heart
attack and strokes Pulled from US market in
October 2010 Still present in many
counterfeit products
Basic Function: Causes release of
norepinephrine in hypothalamus
Reduces feeling of hunger
Similar structure to amphetamines
Part of Fen-Phen combination drug
Prescription Drug Pharmacodynamics
Metformin (Glucophage)Metformin (Glucophage)
Diabetes drugFor people
overweight and suffering from diabetes to aid in weight loss
Basic function: Lowers glucose levels Increase insulin
sensitivity Appetite suppressant
Prescription Drug Pharmacodynamics
Common Side Effects for Prescription Drugs
Side Effects: Nausea (minor or severe) Constipation/Diarrhea Dry mouth Headaches Insomnia Increased blood pressure and heart rate (minor or
severe) Nervousness, confusion, and irritability
Prescription Drug Results
Very minimal results without diet and exercise Most show loss of about 8-12 lbs/year
Lifestyle changes needed for more serious results
All have serious side effects should only be used in more serious cases (risk vs. reward?)
Many people abuse (OD, use of non-diet prescription drugs)
OTC Supplement PharmacodynamicsEphedra/Ephedrine
Ephedra: plant with 2 active constituents: Ephedrine Pseudoephedrine
Ephedrine is normally paired with caffeine in OTC diet supplements
Basic function of Ephedrine: Appetite suppressant Acts on adrenergic
receptors
Side Effects: High blood pressure Heart attacks, strokes
(can be fatal) Tremors/seizures Insomnia
Banned by FDA Drugs now contain
“legal ephedra” Epehdra without
ephedrine
OTC Supplement PharmacodynamicsEphedra Replacements
Bitter orange Essential oil from an
type of orange Similar health
concerns as ephedrine Lack of evidence about
effectiveness
Hoodia gordonii South African spiny
succulent plant Increases
hypothalamic ATP No published scientific
evidence demonstrating use as appetite suppressant
Celebrity Endorsements
Celebrity Sponsors
Marketed products claim weight loss through celebrity endorsements
Much of the popularity of diet drugs is due to clever marketing and ad campaigns… such as TrimSpa
Anna Nicole Smith
“LIKE MY BODY”Lost 69 lbs. In 2005, TrimSpa was sued for Anna's erratic
behavior at a concert- associated with slurred speech and behavior
http://www.youtube.com/watch?v=A4GsS5ua4MEht
TrimSpa Baby!
Potential TrimSpa Side Effects and Concerns Original TrimSpa formula contained the stimulant herb
ephedra Expensive (>$48/month) No longer individually lists the ingredients Side effects may include anxiety and insomnia (rec. amount
of 4 pills/day = two 8-ounce coffee) May trigger migraines (tyramine) Shouldn’t be taken with Monoamine Oxidase
Inhibitor(MAOI) antidepressant drugs
What’s good about TrimSpa? Contains glucomannan, a water-soluble dietary fiber
derived from konjac root
Keeping Up With the Kardashians
“How HOT Can You Be?”Kim claims to have lost 15 lbs, Khloe 25
lbs(some of which she gained back)Advertises “to help burn calories, support
energy levels, and supercharge workouts” (getquicktrim.com)
Pressures women receive: Temptation of getting that bikini body Kim and Khloe Kardashian use sex to sell their
QuickTrim diet pills
http://www.youtube.com/watch?v=Q69Igo7xcGA
QuickTrim
“This product isn’t intended to be a complete replacement for having a reasonably healthy diet and lifestyle” (kardashiansquicktrim.com)
Dangers of Kardashian-Endorsed QuickTrim 4 QuickTrim products
Sculpting gel for cellulite 14-day "burn and cleanse“ 48-hour cleanse 8-hour weight loss formula that burns calories 300% x
faster All of which are advertising fast weight loss. Most
experts recommend effective weight loss to be gradual and just 2 lbs/week for safe and long-term weight loss, even with the help of diet drugs.
QuickTrim Weight Loss Supplement
Burn & Cleanse 14-Day Diet System- burns calories by day and cleanses by night Daytime pills are mostly
caffeine: contains thermogenic complex, black pepper, white willow bark
Nighttime supplements are laxatives: contains stimulant laxatives (senna, cascara, rhubarb) and bulk laxatives (fig extracts, oat fiber)
May get diarrhea, loss of nutrients, dehydration
Iso-Flush- taken along with Burn & Cleanse Herbal diuretics to shed
water from body: contains horsetail extract, juniper berry
If taken for long periods can be toxic.
Can reduce kidney function & may suffer from severe dehydration.
Lose it on the QT!
Fast Cleanse- “48-hour Super Diet Detox” to drop a dress size Fiber-rich drink 4x/day
b/w meals Primarily a digestion-
resistant polysaccharides Extreme Burn- supposed
to be used long term after finishing 14-day plan Contains a lot of caffeine
and herbs to boost potency
Powerful stimulants, laxatives, and diuretics.
At best, these diet pills will produce short-term weight loss because they stimulate or speed up metabolism and act as diuretics
Since under "supplements" instead of “medications”, they are NOT required to undergo rigorous FDA testing to ensure they are safe and do what their manufacturers claim they do
Problems with Diet Drugs
Diet Pill Makers Misleading Consumers
Federal Trade Commission says some diet companies make false advertising claims ranging from rapid weight loss to reducing risk of cancer, Alzheimer’s, osteoporosis
FTC challenges marketing of claims -> required to back up claims with the science
Fines levied against 4 over-the-counter non-prescription diet pills: Xenadrine, One a Day Weight Smart, CortiSlim, TrimSpa A combined $25 million Receive money back when consumers have been deceived
Ex: Bayer Corp. paid $3.2 million civil penalty to settle claims and agreed to stop ads that say “multivitamins can increase metabolism”
Trying to lose weight? Don’t turn to pills!
FTC claims there are NO scientific evidence that diet pills cause weight loss
Testimonials from individuals are not a substitute for science
FTC also said that customers using the products and providing testimonials were paid as much as $20,000 for their “endorsements.”
The media and women’s magazine have been “urged” to refuse or remove these type of ads from their magazines, or investigate the claims being made. But doesn’t because they want the revenues!
Counterfeit Diet Pills
Booming trade in counterfeit slimming pills
Medicines and Healthcare Regulatory Agency(MHRA) sited 2 prescription-only anti-obesity pills: Xenical, Reductil Very commonly
counterfeited in UKThrough illegal
pharmacies and illegal websites where demand is high and maximum profits are made
Fake prescription obesity pills contain little active ingredient, some may cause harm
Made in substandard conditions, contain impurities
No true regulation (no prescription necessary)
Problems
There is NO medical or other supervision of any kind
May be easily abused. Ex: In fact, teenage girls are some of the
heaviest users of retail diet pills, because they’re easily accessible.
“A SKINNY MAN HASN’T A CHANCE”
POP SOME PILLS AND WATCH THE FAT MELT AWAY -- THAT’S NOT FAR FROM THE TRUTH
Advertisements for Male Audiences
Apolo Ohno and 8 Zone
Apolo Ohno Founder/owner of 8
Zone Pills for each 8-hour
segment of day
Apolo Ohno and 8 Zone
Step 1: Aggressive (Red Zone) For the most active part
of your day (during work)
For healthy, sustained energy
And for thermogenic fat-burning
Step 2: Subtle (White Zone) To keep you going after
work For wholesome nutritional
replenishment To promote anti-aging and
combat oxidative stressStep 3: Downtime
(Blue Zone) For full rest and recovery For great sleep For muscle recuperation
Some of the DisclaimersSome of the Disclaimers
22.4 - We do not guarantee that You will have any specific or particular result or benefit from the Product, or that your experience will match those of others who use the Product(s). Individual results will vary from person to person. Apolo Ohno is a professionally trained athlete and 8zone makes no guarantee or warranty that taking 8zone alone will produce the same results as a professionally trained athlete like Apolo Ohno.
22.5 - Any and all testimonials and/or statements from users of the Product(s) are those of the respective user. 8zone does not endorse any such statement and/or warrant that any such statement is true or accurate. 8zone likewise does not investigate the accuracy of any testimonial.
Apolo Ohno and 8 Zone
Xenadrine
Since Ronnie has started, his GTL routine is now XGTL-Xenadrine. Gym. Tan. Laundry.
Xenadrine
Xenadrine ULTRA, “these ingredients have not been evaluated by the FDA. These products are not intended to diagnose, cure or prevent any disease”
Sold at GNC where various diet supplements are sold.
1990’s, Xenadrine EFX contained ephedrine and synephrine (similar to amphetamines)
Now, Xenadrine ULTRA contains yerba mate, guarana, 1,3,7-trimethylxanthine
Contain 200 milligrams of caffeineExcite body functions, result in short-term weight
lossVitamins in Xenadrine don’t impact weight loss
Xenadrine
From Ronnie’s Facebook page (linked from Xenadrine website): “You heard? I got a new
workout partner: Xenadrine. Gives me the energy I need. Love that I'm endorsing something that really works!”
A response to Ronnie’s Post: CSP- I truly use Xenadrine
cuz of ONLY one reason and that reason Ronnie.thank You Ronnie for be their Spokes Man cuz of You and Xenadrine I`am finally lossing the weight I want.so thank You Ronnie and Xenadrine
We are sure that Ronnie is happy CSP is “lossing” the weight with Xenadrine.
Xenadrine
Studies published on website all have reduced calorie diet…
Mentions that Xenadrine is best combined with diet and exercise!
Promotes the unachievable body
Promotes weight management with minimal effort
Study showed placebos more effective than Xenadrine
Children and Teens
Advertisements
Obesity drug ads misleading teens “Xenical” Ads aired during
popular show, Australian Idol.
ControversialThe Australian
National Drugs and Poisons Schedule Committee banned OTC commercials as they were targeted to average weight people
Effects in Society
Questioned UCSF study that 80% of fourth-grade girls were dieting
At a school in Illinois (1986) 75% of 9 year old girls said they weighed too much and afraid boys wouldn’t like them if they got fat
Results have not changed much
TV Shows and Media Icons
90210 stars although labeled by magazines ‘too skinny’ still very popular show
Dr Aric Sigman’s article in The Biologist The media is a causal
risk factor for body dissatisfaction
Studied female reactions to TV shows with thin characters around the world
Cost/Common Statistics
US weight loss market 1992 $30 billion Now estimated $40-60 billion Prescription and over-the-counter diet drugs
altogether took in $381.5 million in 2009, according to data from IMS Health.
Diet Pill for Dogs…
Substitute for exercise and food reduction
Slentrol is the first FDA-approved diet pill for dogs
Final Thoughts
Rule: Do NO harmQuestion: Do benefits
outweigh the risks?No Quick fixNot for people who
want to lose 5-10 lbsFor morbidly obeseMust include lifestyle
change; diet and exercise!!!!!!
Works Cited - History
"Diet Pills - Overview." Encyclopedia of Drugs and Addictive Substances. Ed. Barbara C. Bigelow. Gale Cengage, 2006. eNotes.com. 2006. 9 Mar, 2011 <http://www.enotes.com/drugs-substances-encyclopedia/diet-pills/overview>
Whittemore, Frank. (January 18, 2010). The History of Diet Pills. In
Livestrong.com. Retrieved March 2011, from http://www.livestrong.com/article/74336-history-diet-pills/.
Grabianowski, Ed. "Have people ever really eaten tapeworms for weight loss?"
16 December 2008. HowStuffWorks.com. <http://health.howstuffworks.com/wellness/diet-fitness/weight-loss/tapeworm-weight-loss.htm> 09 March 2011.
Jones, A. R. (2002). FDA vs. Ephedra: Dietary Supplement Regulation Under DSHEA, pp. 2.
Citation. (2011, March). In Wikipedia, The Free Encyclopedia. Retrieved from http://en.wikipedia.org/wiki/Anti-obesity_medication
Works Cited - Pharmacodynamics
Zhi, J., Melia, A. T., Eggers , H., & Joly, R. (1995). Review of limited systemic absorption of orlistat, a lipase inhibitor, in healthy human volunteers. Journal of Clinical Pharmacology, Retrieved from http://jcp.sagepub.com/content/35/11/1103.long
Morris, J. (2006). Little research behind claims that hoodia is safe, effective for losing weight. The Seattle Times, Retrieved from http://seattletimes.nwsource.com/html/health/2002850423_healthhoodia08.html
Haller, C. A., & Benowitz, N. L. (2000). Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. The New England Journal of Medicine, 343. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM200012213432502#t=articleTop
Gurley, B. J., Wang, P., & Gardner, S. F. (2000). Ephedrine-type alkaloid content of nutritional supplements containing ephedra sinica (ma-huang) as determined by high performance liquid chromatography. Journal of Pharmaceutical Sciences, 87(12), Retrieved from http://onlinelibrary.wiley.com/doi/10.1021/js9801844/pdf
The pharmacokinetics of phentermine and chlorphentermine in chronically treated rats. (1973). Journal of Pharmaceutical Pharmacology, 25(3), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/4146324
Guerciolini, R. (1997). Mode of action of orlistat. Int J Obes Relat Metab Disord. , 21(3), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9225172
Bray, G. A. (1999). Sibutramine produces dose-related weight loss. Pennington Biomedical Research Center, 7(2), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10102256
James, Philip. (2000). Effect of sibutramine on weight maintenance after weight loss: a randomised trial. The Lancet, 356(9248), Retrieved from http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T1B-4221FXX-9-6&_cdi=4886&_user=4429&_pii=S0140673600034917&_origin=gateway&_coverDate=12%2F30%2F2000&_sk=996430751&view=c&wchp=dGLzVzz-zSkWA&md5=c8f66276ed614b035e95c691f53b50b8&ie=/sdarticle.pdf
Duenwald, M. (2005). Bitter orange under scrutiny as new ephedra. The New York Times, Retrieved from http://www.nytimes.com/2005/10/11/health/policy/11cons.html?_r=1
Shekelle, P. G., & Hardy, M. L. (2003). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance. JAMA, 289(12), Retrieved from http://jama.ama-assn.org/content/289/12/1537.full.pdf+html
Gokcel, A., & Gumurdulu, Y. (2002). Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity. Diabetes, Obesity and Metabolism, 4(1), Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j.1463-1326.2002.00181.x/pdf
Lee, A., & Morley, J. E. (1998). Metformin decreases food consumption and induces weight loss in subjects with obesity with type ii non-insulin-dependent diabetes. Obesity Research, 6(1), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9526970
Works Cited – Celebrity Endorsements and Problems with Diet Drugs
Ashton, J. (2010, September 16). CBS News Health Watch. New Diet Drugs Await Approval. Retrieved from http://www.cbsnews.com/video/watch/?id=6871953n
Blatner , D., & Bauer, J. (2007, October 5). Weight Loss Drugs: How Much Do Diet Pills Help? . American Dietetic Association, Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=56559&page=2
Blatner , D., & Bauer, J. (2007, October 5). Weight Loss Drugs: How Much Do Diet Pills Help? . American Dietetic Association, Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=56559&page=2
Bowdler, N. (2010, July 7). BBC News Health. The booming market in counterfeit slimming pills. Retrieved from http://www.bbc.co.uk/news/10258849
Diet and Nutrition. (2007, January 4). Diet pill makers fined millions for false claims . Retrieved from http://www.msnbc.msn.com/id/16467558/ns/health-diet_and_nutrition/
Diet Pills Report & Review [The Use of Retail (non-prescription) Diet Pills & Appetite Suppressants]. (2010). Retrieved from http://www.bestdietforme.com/dietpills.htm
Kardashians QuickTrim Resource [Online forum post]. (2010). Retrieved from kardashiansquicktrim.com
Kotz, D. (2010, January 19). The Dangers of Kardashian-Endorsed QuickTrim. U.S. News & World Report of Health on Women, Retrieved from http://health.usnews.com/health-news/blogs/on-women/2010/01/19/the-dangers-of-kardashian-endorsed-quicktrim
QuickTrim. (n.d.). Retrieved March 6, 2011, from getquicktrim.com Wong, C. (2007, September 19). Does Trimspa Work? Trimspa Review. Retrieved
March 6, 2011, from http://altmedicine.about.com/od/popularhealthdiets/a/Trimspa_Review_2.htm
Works Cited – Ads for Male Audiences and Children and Teens
Zaslow, Jeffrey. (2009). Girls and Dieting, Then and Now. Wall Street Journal online. http://online.wsj.com/article/SB10001424052970204731804574386822245731710.html
Beauty and Body Image in the Media (n.d.) Media Awareness Network, CA.http://www.media-awareness.ca/english/issues/stereotyping/women_and_girls/women_beauty.cfm?RenderForPrint=1
Erfurt, Barbara. (2010). How Does Xenadrine work? Livestrong.comhttp://www.livestrong.com/article/74416-xenadrine-work/#ixzz1G30vDgcD
A Skinny Man hasn't a chance. Picture fromhttp://farm4.static.flickr.com/3167/3009875959_b3273af86f_o.jpg
Ronnie Magro facebookhttp://www.facebook.com/pages/Ronnie-Magro/114953338537646
Wall Street Journal. Picture fromhttp://www.wasauna.com/wallstreet.html
90210 Stars: Too thin for TV? (2008) http://justjared.buzznet.com/2008/09/17/90210-stars-too-thin/
Marris, Sid. (2007). Ban on Weight Loss Drug Ads. The Australian online.http://www.theaustralian.com.au/news/nation/ban-on-weight-loss-drug-ads/story-e6frg6nf-1111114303350
Xenadrine information:http://www.xenadrine.com/
8 Zone information:http://8zone.com/about.php
Extreme Weight Loss Techniques. Askmen.comhttp://www.askmen.com/sports/health_150/154b_mens_health.html