Weight Loss Drugs – A Long Line Of Losers Part 1 Fen-Phen and Belviq

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The history of weight-loss drugs is one of approving and prescribing dangerous drugs to fat people based on short-term data that shows a little bit of weight loss, and generating massive profit until the harm to fat people reaches a threshold that causes the drug to be pulled from the market. Bottom line: Pharmaceutical companies profit off the harm and suffering of fat people (who are almost never thinner or healthier - two different things - for having taken the drugs.)

This is a critical history to understand because until those in power are willing to admit this history, face up to it, and make changes, it will just keep repeating itself.

In part one we’ll look at two examples of this phenomenon that have already been pulled from the market. In part two we’ll look at some current drugs that look like they are on a path to fit this profile, and in part three we’ll look specifically at Wegovy and Tirzepatide which very much seem to be history repeating.

Fen-Phen

Fen-Phen is a perfect example of this. It was a combination of Fenfluramine and Phentermine, an appetite suppressant and an amphetamine-like medication. (The original version of fenfluramine was Pondimin, which was replaced with Redux – dexfenfluramine - to avoid a patent expiration and competition from generic options.)

It was introduced to the market in 1992 as an off-label prescription (not approved by the FDA) based on a four-year study of just 121 people. By 1994 the company was aware of 41 cases of valvular heart disease and pulmonary hypertension but they only reported 4 to the FDA. The drug combination became mainstream in 1995, garnering media attention (including fashion magazine covers.) In 1996 doctors wrote an estimated 18 million prescriptions for Fen Phen. In 1997 studies showed that about a third of patients had serious side effects including heart disease, valvular heart disease, primary pulmonary hypertension, and cardiac fibrosis and it was recalled. Eventually American Home Products, the pharmaceutical company responsible, paid billions in settlements but of course that doesn’t return the health and lives to the victims.

Belviq

Belviq initially failed to gain FDA approval, in part because of tumor risk shown in rat subjects.  In 2012 the FDA approved the drug after their Endocrinologic and Metabolic Drugs Advisory Committee claimed that “the potential benefits of lorcaserin outweigh the potential risks when used long-term in a population of overw*ight and ob*se individuals.” Note that while the committee says “when used long-term,” the study data they looked at was only between 52 and 104 weeks.

This is a subject that I’ll explore more in a future post, but I feel that the diet industry has invested significant time and resources into creating studies dubiously linking being higher-weight to health issues in order to tip the scales of these risk/benefit analyses toward their products.

The drug was approved only for those of a BMI greater than or equal to 30, or for patients with a BMI greater than or equal to 27 who had “at least one weight-related co-morbid condition.” As we know, being weight-related does NOT mean being caused by weight, nor does it mean that weight loss will cure the condition. Beyond that, this is another example of weight stigma in healthcare – when risk is predicated on size, those with higher BMIs are subjected to greater risk under the idea that people’s lives become more risk-able (and less valuable) at higher weights.

The side effects of the drug included decreased white and red blood cell count, slowed heartbeat, slowed thinking, heart valve issues, and increased risk of cancer. It was also a Federally controlled substance because of the possibility of drug dependence.

In terms of their research, about half the subjects dropped out with no follow-up. Those remaining lost 5-10% from their initial weight after one year. At two years, they had all gained back around 25% of the weight they had temporarily lost at which point they stopped following the patients and claimed “all people regained weight, but remained below their starting weight.” (From an ethical research perspective, I was taught that you are not supposed to mislead people by intimating that a variable which is on an obvious upward progression leveled off the day you, as a researcher, stopped tracking it.)

In February 2020 the FDA requested that Belviq be withdrawn from the market due to research that showed an increased cancer risk. The manufacturer said that they disagreed with the FDA, but pulled the drug. The FDA told people to stop taking it and doctors to stop prescribing it. Some of the lawsuits that came after have been settled, others are ongoing.

So, these are examples of weight-loss drugs that were approved on research that was short-term research and/or small, did harm to fat people, made massive profits for the companies that manufactured them until they were pulled from the market. In part 2 we’ll look at some current drugs that may be the next contenders for this destructive pattern.

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More research and resources:
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.