Can the "holy grail" of weight loss medicine fight obesity?

A new study of 12,000 overweight patients shows that lorcaserin does not cause heart problems. But does that mean we should be taking it?

While climate change is the hidden known that many citizens have grown tired of hearing about, obesity faces a similar predicament. It has become so commonplace we rarely raise an eyebrow, even as it destroys us from within. Last year, research showed that more Americans are simply giving up the fight. 

Currently, nearly 70 percent of American adults are considered either overweight or obese. In Western Europe, the same number of adult men claim the same percentage, with 57 percent of adult women and a quarter of children classified as overweight. 

What to do? There’s good old-fashioned calorie restriction, but the sustainability of such an emotionally charged practice is always in question, especially considering the fact that once your body becomes accustomed to one weight the metabolic and physiological changes are challenging. As psychology professor David Benton puts it:

Losing weight is much easier than maintaining weight loss, yet for health reasons we need to retain the lower weight.

Which is a fact fad diet hucksters take advantage of. They exploit short-term loss by packaging it as a long-term solution. The easier to implement the better, hence the proliferation of green tea and açaí pills. So accustomed to popping a pill for any reason have we become that attempting any management solution without it seems impossible. Consider the opioid crisis: treat the symptoms instead of the cause.

Weight loss programs are of the same mindset. There is basically no intervention that does not require serious reconsideration of lifestyle habits for success, yet the focus is always on what allows you to shed pounds quickest. A pound a week has long been the healthiest target, but when people want to drop 20 or 30 pounds immediately, such humble ambitions seem ludicrous. And so a crop of “nutritional gurus” rush in to promise the impossible.

Sadly, we’re hardwired for the fantastic, however ludicrous it is over time. Which is why it’s almost refreshing to find a study with the most modest results from a pharmaceutical intervention: nine pounds lost over 40 months with no serious health implications.

Researchers have been looking into pharmacological solutions for weight loss for decades. The side effects of whatever has been packaged in pill form thus far have outweighed the benefits, most specifically pulmonary hypertension and heart-valve problems.

Since the selective serotonin 2C receptor agonist, lorcaserin, was approved by the FDA in 2012, it has been touted as a potential “holy grail” of weight loss intervention. So an extensive research team, led by Dr. Erin Bohula, a cardiovascular medicine and critical care specialist at Brigham and Women’s Hospital, put that to the test.

Twelve thousand overweight or obese patients, all of whom suffer from heart problems or display risk factors, were either given lorcaserin or a placebo. As noted, the lorcaserin group lost an average of nine pounds over 40 months. More importantly, however, that group showed no significant divergence in heart problems from the placebo group. Three earlier, small trials found similar results.

This fact caused Tom Fray, who works for Britain’s National Obesity Forum, to proclaim

I think there will be several holy grails, but this is a holy grail and one which has been certainly at the back of the mind of a lot of specialists for a long time.

That comment came with an important disclaimer, however:

But all of the other things apply—lifestyle change has got to be root and branch part of this.

When I sent this study to a friend who is working on a postdoc in clinical psychology focusing on obesity, remarking on the average weight loss, she replied, “which you could do with a bit more exercise.”

The same conclusion I came to reading this study. As mentioned, I appreciate the modest results. Yet is the pill even necessary? Currently, Belviq (lorcaserin) can be purchased for $220-$290 a month, so it’s not an inexpensive intervention. The side effects list is also exhaustive: attentional and memory problems; depression and suicidal thoughts; slower heartbeat; constipation; headaches; dizziness; even heart valve problems, despite this latest evidence. 

True, the fact that both cardiovascular problems and diabetes issues were not a factor after three years is a good sign. But if the goal is the slow and steady approach—lifestyle changes being incorporated into the weight-loss program—the pill hardly seems necessary.

Benton delivers sobering news about weight loss. It’s not a quick fix, nor does the long haul create a sexy headline. There is no “superfood” game-changer. Rather, it’s the tortoise in a media world dominated by the frenetic paces of hares—unglamorous, but sustainable.

The overwhelming message is that the price of freedom from obesity is eternal vigilance. When the initial attention associated with dieting dissipates, basic biology ensures that weight is regained. For the weight-conscious, actively counting calories can be successful, but losing weight and keeping it off can only work if one’s calorie intake becomes an issue high on the agenda.


Stay in touch with Derek on Facebook and Twitter.

Related Articles

How does alcohol affect your brain?

Explore how alcohol affects your brain, from the first sip at the bar to life-long drinking habits.

(Photo by Angie Garrett/Wikimedia Commons)
Mind & Brain
  • Alcohol is the world's most popular drug and has been a part of human culture for at least 9,000 years.
  • Alcohol's effects on the brain range from temporarily limiting mental activity to sustained brain damage, depending on levels consumed and frequency of use.
  • Understanding how alcohol affects your brain can help you determine what drinking habits are best for you.
Keep reading Show less

Scientists sequence the genome of this threatened species

If you want to know what makes a Canadian lynx a Canadian lynx a team of DNA sequencers has figured that out.

Surprising Science
  • A team at UMass Amherst recently sequenced the genome of the Canadian lynx.
  • It's part of a project intending to sequence the genome of every vertebrate in the world.
  • Conservationists interested in the Canadian lynx have a new tool to work with.

If you want to know what makes a Canadian lynx a Canadian lynx, I can now—as of this month—point you directly to the DNA of a Canadian lynx, and say, "That's what makes a lynx a lynx." The genome was sequenced by a team at UMass Amherst, and it's one of 15 animals whose genomes have been sequenced by the Vertebrate Genomes Project, whose stated goal is to sequence the genome of all 66,000 vertebrate species in the world.

Sequencing the genome of a particular species of an animal is important in terms of preserving genetic diversity. Future generations don't necessarily have to worry about our memory of the Canadian Lynx warping the way hearsay warped perception a long time ago.

elephant by Guillaume le Clerc

Artwork: Guillaume le Clerc / Wikimedia Commons

13th-century fantastical depiction of an elephant.

It is easy to see how one can look at 66,000 genomic sequences stored away as being the analogous equivalent of the Svalbard Global Seed Vault. It is a potential tool for future conservationists.

But what are the practicalities of sequencing the genome of a lynx beyond engaging with broad bioethical questions? As the animal's habitat shrinks and Earth warms, the Canadian lynx is demonstrating less genetic diversity. Cross-breeding with bobcats in some portions of the lynx's habitat also represents a challenge to the lynx's genetic makeup. The two themselves are also linked: warming climates could drive Canadian lynxes to cross-breed with bobcats.

John Organ, chief of the U.S. Geological Survey's Cooperative Fish and Wildlife units, said to MassLive that the results of the sequencing "can help us look at land conservation strategies to help maintain lynx on the landscape."

What does DNA have to do with land conservation strategies? Consider the fact that the food found in a landscape, the toxins found in a landscape, or the exposure to drugs can have an impact on genetic activity. That potential change can be transmitted down the generative line. If you know exactly how a lynx's DNA is impacted by something, then the environment they occupy can be fine-tuned to meet the needs of the lynx and any other creature that happens to inhabit that particular portion of the earth.

Given that the Trump administration is considering withdrawing protection for the Canadian lynx, a move that caught scientists by surprise, it is worth having as much information on hand as possible for those who have an interest in preserving the health of this creature—all the way down to the building blocks of a lynx's life.

Why cauliflower is perfect for the keto diet

The exploding popularity of the keto diet puts a less used veggie into the spotlight.

Purple cauliflower. (Photo: Shutterstock)
Surprising Science
  • The cauliflower is a vegetable of choice if you're on the keto diet.
  • The plant is low in carbs and can replace potatoes, rice and pasta.
  • It can be eaten both raw and cooked for different benefits.
Keep reading Show less