Seeking the Perfect Diet Drug: Meridia


Another Round in the Story: Seeking the Perfect Drug

The ads on TV for Meridia are certainly compelling. Those fat people are happy. Life is working. They have found the answer to their obesity. Meridia works!

It sounds wonderful. Even I was intrigued by the promise. Let's take a look at what Meridia is.

A recent study was reported in our friend the American Journal of Clinical Nutrition. This study assesses the extent to which Meridia raises body temperature to effect weight loss.

The premise behind obesity drug development is that obesity "develops from an imbalance between energy expenditure and energy intake." This is the same story we have always heard - if we eat more than we use, we get fat. The drugs are designed to get us to eat less and burn more.

The two mechanisms chosen in Meridia are to increase our sense of being full (satiety) by increasing serotonin levels and to increase our thermogenesis which elevates the burning of calories. Meridia acts as both a serotonin and noradrenergic reuptake inhibitor. It, like Prozac, increases the availability of serotonin, and like any stimulant (from speed to coffee) increases epinephrine, to stimulate your body to work faster.

The study published tested the effect of the drug on eleven normal weight men and found that in this group, it increased satiety and caused a "significant increase in energy expenditure." It also defined that increase as equivalent to the increase caused by one cup of coffee.

Essentially Meridia is designed to help you eat less and to warm up your metabolism. So, why not? What are the arguments against it?

We all want to take something, anything to make it easier to lose weight. Even I still feel this way. Can't I just "take" something? Change, particularly change about food is hard work. I would rather have a pill. I don't want to work for my change. ;-)

But the science of Meridia is looking at thermogenesis and satiety, not behavioral change and feelings. If you take a drug which is equivalent to taking a combination of Prozac and speed, you are setting yourself up for a rebound effect. You will really like the feeling it provides - I guarantee this. And if you stop taking it, you will be in trouble.

I suspect you already know my bias. I agree that we need to increase our satiety response so we stop eating when full. I agree we need to increase thermogenesis.

I believe the best way to warm up your body is to exercise. No side effects, no cost, no rebound and extensive health benefits. The least harmful way to increase satiety is to change your serotonin system through dietary change. Remember that a baked potato has a satiety index that is off the charts!

* Hansen, DL et al. Thermogenic effects of sibutramine in humans. Am. J. Clin. Nut., 1998:68:1180-6.

(c)Kathleen DesMaisons 2006. All rights reserved.