Source : Arch Intern Med 2003;163:1046-1050.
“Medication therapy is not as popular now [as it was in 1996 and 1997], probably because there is a good deal of skepticism about anti-obesity meds in the aftermath of the withdrawal of ‘fen-phen’ and recognition that these drugs don’t have all the answers,” lead author Dr. Randall S. Stafford, of the Stanford Center for Research in Disease Prevention in Palo Alto, California, told Reuters Health.
Dr. Stafford, and David C. Radley of the Yale University School of Epidemiology and Public Health in New Haven, Connecticut, searched the 1991-2002 National Disease and Therapeutic Index to identify physicians who reported treating patients for obesity.
Based on their findings, they estimate that 55 million patient visits were made during this time period for clinical obesity. More than three quarters of the visits were to primary care physicians.
Because 60% of patients saw their physicians on multiple occasions, the authors suggest that “a substantial fraction of medication therapy may have been sustained, rather than short-term,” running counter to recommended guidelines from the National Institutes of Health and FDA labeling.
The likelihood of drug treatment increased from 50% of patients diagnosed with obesity in 1991 to a peak of 85% in 1996. Afterward, even though drug use fell after fenfluramine and phentermine were withdrawn from the market, medications were still more commonly prescribed than they were in the early 1990s, the report indicates. During the latter period, drugs prescribed included phentermine (still the most frequently prescribed in 2002), orlistat, sibutramine and amphetamine.
The good news, Dr. Stafford told Reuters Health, is that “physicians are more willing to define obesity as a clinical problem, in contrast to how they thought about it 10 or 15 years ago.”
He and his co-author are concerned, however, that the use of such agents rose so sharply in 1996 and 1997, despite early reports of adverse events.
“Even though [pulmonary hypotension and valve disorders] affected a relatively small fraction of patients, so many people were exposed that the risk was unacceptable,” Dr. Stafford added.
While acknowledging that physicians are already overburdened at work, he advocates that they “look at obesity and weight management in much the same way that physicians now view smoking cessation, something that is a legitimate medical concern.”
Fonte: Archives of Internal Medicine