Medication-dispensing weight loss clinics

The use of phentermine and fenfluramine, commonly known as phen-fen, for weight loss increased dramatically in the mid-1990s. Phen-fen usage brought about an impressive increase in the number of medication-dispensing weight loss clinics.

These clinics, which made phen-fen available as well as dispensed it, were usually physician-supervised. Themajority of the medications were dispensed from the clinic itself, although a patient could be given a prescription to obtain medications at a pharmacy. Despite a rather dramatic fall in phentermine usage at the end of 1997, phentermine and other weight loss medications are still sold through these
clinics.

An Internet search of medical weight loss clinics identifies at least a dozen in any major city. A vast majority of these programs advertise the use of weight loss medications, nutritional supplements, and diet programs. A majority of the Web pages of these medical clinics that this author visited feature testimonials, including what appear to be before and after pictures, of patients who have participated in the program, as well as pictures of women with supermodel-like figures, often emphasizing the abdominal region with a tape measure around the waist.

Typical weight loss medications advertised by medication-dispensing clinics include phentermine; Bontril (phendimetrazine, Carnrick Laboratories Inc., Cedar Knolls, New Jersey, U.S.); Tenuate (diethylpropion hydrochloride, Sanofi-Aventis, Bridgewater, New Jersey, U.S.); Meridia (sibutramine hydrochloride monohydrate, Abbott Laboratories, North Chicago, Illinois, U.S.); and Xenical (orlistat, Roche, Basel, Switzerland). Phentermine, the most commonly prescribed medication in these types of clinics, is inexpensive, and has been available for nearly 50 years. Many discount drug stores sell phentermine for $18 per month’s supply. Medication-dispensing weight loss clinics often buy phentermine in bulk and sell the medication directly to the patient. Phendimetrazine and diethylpropion hydrochloride are also dispensed in this manner. Sibutramine and orlistat are less commonly used because both are still under patent as well as are more expensive than other available weight loss medications. Subsequently, patients are often given a prescription for sibutramine and orlistat, as opposed to the clinic dispensing them.

The majority of medication-dispensing weight loss clinics also use supplements, such as vitamins (including B vitamin injections) and “fat metabolizers.” Some clinics’ Web sites use comments such as “scientifically proven” or “proven results” to describe the supplements or diet plan.

In the past, the Federal Trade Commission (FTC) has tried to alert consumers to deceptive advertising. In the early 1990s, for example, a chain of weight loss clinics operating in California, Nevada, Texas, Georgia, and Virginia and featuring a supplement known as growth hormone releasers came under FTC investigation. The FTC charged that the clinics misled consumers by falsely advertising that through the clinics’ “medically safe” program consumers can adjust their metabolism and lose up to 1.5 lb/day without exercise or strict dieting.  Most medication-dispensing clinics do not practice deceptive advertising, although some claims can be difficult to believe.

The types of patients who present to these clinics vary, but patients are usually female and suffer from simple obesity. Because these sites are run by physicians, patients who have comorbidities can enter these programs, although patients with complicated medical histories or multiple comorbid problems typically do not participate in these programs for fear that the medications or supplements will exacerbate existing medical problems.

The range of weight loss treatments is extensive; in addition to medications and nutritional supplements, diets and meal replacements are also offered. Some medication-dispensing clinics offer other therapies, such as body wraps, mesotherapy, and injections of human choriongo-nadoptric hormone (hCG).

Little has been published regarding these weight loss clinics. In one peer-reviewed article, patients participating in a commercial medication-dispensing weight loss clinic were seen by a nurse between two and five times per week and were followed for 12 months. For patients who completed the program, weight loss at the end of 12 months was 10% to 11%; the dropout rate, however, was between 55% and 85% at 12 months. The study followed patients who were given a prescription for a weight loss medication, however, which is not the norm for that particular clinic; as verified by the study’s author, the majority of patients seen in that clinic receive phentermine. In the study author’s experience, the one-year weight loss was similar or slightly better to weight loss with phentermine.