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Fad Diets, Thyroid Medication, and Other Inappropriate Weight Management Approaches

Fad diets

There are innumerable types of diets that circulate in offices, beauty parlors, the local gym, and popular magazines. It is common for magazines, especially women's magazines, to have articles that show an 18-year-old anorexic actress in tight workout clothes describing how she lost 10 lbs. in five days with a varied diet of birdseed and bird droppings, the latter being the nutritional component!

Obviously, this is an exaggeration, but it is not too far off the mark. These fad diets are nutritionally unbalanced and do not work in the long-term. These magazines, however, give you an insight into our society. Frequently, on the opposite page of the diet article will be an advertisement for a cheesecake with that "special" chocolate sauce. People, especially young women, get the mixed message of having their cake and eating it, too. These messages from the media have helped lead to the large increase in anorexia and bulimia in the United States over the past 20 years.

A variant of the fad diet involves intermittent fasting, usually with a testimonial on how you can lose five pounds in one day on a water fast. What these diets fail to state is that when you are on a total fast, the first thing you lose is water. Therefore, it is very feasible to lose five pounds of water weight in one day. However, five pounds of water is not the same as five pounds of fat. One pound of body fat is approximately 3500 calories; whereas 1 pound of water has 0 calories. A sedentary middle-aged woman who weighs 180 lbs. may require approximately 1800 calories per day to maintain her body weight.

If you do the math, you will see that in one day of total fasting, assuming you were only using your body fat for your energy requirements (which does not happen in the human body), you would lose slightly more than one-half pound of fat per day, not five pounds. The difference is water weight; and the water re-accumulates once you resume eating.

An additional risk of a total fast is that with certain medical conditions or with the use of certain medications, a person can develop severe electrolyte (or salt) abnormalities, which can lead to irregular heartbeats, passing out, and, in rare instances, death.

Fad diets where you intermittently fast, rotate foods, eat certain food groups for several days, and then return to your usual eating habits will, at best, lead to a small weight loss initially, but will not result in long-term weight loss. Such fad diets can be risky and detrimental to your health and should be avoided.

Appetite suppressants

Appetite suppressants are medications that help decrease a person's hunger and lead to anorexia (loss of appetite). Some of these medications are available without a prescription and may result in some weight loss. However, they sometimes lead to very serious cardiac (heart) problems, elevations in blood pressure, strokes, and even death. Recently in the United States, two of these medications, PPA (phenylpropanolamine) and ephedrine, were removed from the market because of these problems. Other appetite suppressants are available by prescription and are similar to amphetamines, but with fewer side effects.

Appetite suppressants cause you to lose weight initially. However, once you go off the medication, your appetite returns to its previous level and you regain the weight. Additionally, all of these medications, including the non-prescription ones, can have significant side effects resulting in increased blood pressure, nervousness, rapid heartbeat, and insomnia (inability to sleep). Some professionals suggest that one should stay on weight-loss medications indefinitely. One of the problems that occurs when you stay on the medication is that the loss of appetite diminishes with time. Additionally, the long-term consequences of some medications are unknown.

Previous studies (Weintraub) combining two medications (phentermine and fenfluramine) with diet, professional behavior modification, dietary instruction, and exercise showed some success in helping people maintain an (initial) 30-lb. weight loss with what was initially thought to be generally mild side effects. However, these medications resulted in cardiac, pulmonary, and neurologic complications. Fenfluramine and dexfenfluramine were removed from the market in September, 1997. (For more information on this combination, please see my section on Phentermine and Fenfluramine or click here)

In summary, and to quote from the National Task Force on the Prevention and Treatment of Obesity (Long-term Pharmacotherapy in the Management of Obesity, JAMA, 18 December 1996), "until more data are available, pharmacotherapy cannot be recommended for routine use in obese individuals, although it may be helpful in carefully selected patients."

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