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Slim Hopes?

Fen-phen programs are all the rage. But the appetite suppressants have their side effects--fatigue, for one--and detractors.


At a Laguna Niguel hair salon, Cindy finds herself explaining to clients how fen-phen helped her lose 23 pounds in three months.

At a West Los Angeles school, mothers laugh knowingly when their watch alarms beep in unison at the morning PTA meetings. "Fen-phen time," they chorus.

At Southern California doctors' offices, even patients who usually push for natural remedies are increasingly asking, "What about fen-phen?"

If someone you know has slimmed down recently after years of trying, chances are--especially if they live in Southern California--they are on fen-phen, the weight loss program using the prescription appetite suppressants fenfluramine and phentermine.

Ever since the 1992 publication of a University of Rochester study, in which Dr. Michael Weintraub combined the two medications and achieved long-term success, doctors have been taking another look at diet pills.

Fen-phen clinics have been springing up alongside university-based programs. UCLA's program counts 750 fen-phen graduates. UC Irvine's weight management program does not promote fen-phen, yet a third of its patients are taking the two drugs, up from 10% only a year ago.

"It's going like wildfire," says Linda Gigliotti, a dietitian who manages the UCI program's health education. "People come in demanding it. They think it's the magic bullet, that this will make my problems go away."

No question: Fen-phen is now hot-hot.

Family practice physicians, gynecologists and other specialists have incorporated fen-phen programs as profit-boosters. One Southern California-based chain says it has treated more than 30,000 people.

Says Cindy, 23, the 5'4" Laguna Niguel hairstylist who dropped from 159 pounds to 136: "This is the first thing that has ever worked."

Says Emily, 55, a 5-foot-7 Laguna Beach nurse who shed 10 of her 179 pounds the first month: "It was a positive experience for me. I have nothing bad to say about."

Says Nathan Friedman, 35, a Glendale tax consultant who eats 1,000 calories a day and works out: "It's allowed me to take better control of my life, my exercise, my eating habits," In a year, his size-54 waist has shrunk to 34; his 6-foot-2 frame has dropped 152 pounds, down to 222.

But Arlene Moody, 51, a West Los Angeles businesswoman who lost 31 pounds in seven months, says the program is not easy. "You have to work at it. They are not miracle drugs by any stretch of the imagination."

Some doctors--including Weintraub--say the drugs are being overprescribed.

Lung specialists worry about an increased risk of primary pulmonary hypertension, a potentially deadly lung disorder, although they concede the risk to an individual patient is small. The most common side effect is dry mouth. Other possible side effects of fen-phen include depression, insomnia, fatigue, diarrhea, blood pressure increases, a feeling of "spaciness" and, in a small number of patients, short-term memory loss.

Still, some weight loss specialists are already offering dexfenfluramine (Redux), a newly approved diet drug--and cousin of fenfluramine--which might be more effective in some patients.

UCI's weight management program doctors consider fen-phen just one of their many available tools, says Gigliotti.

"It does decrease your appetite. If you just simply take the medication and eat less, yes, you'll lose weight, but you are not addressing maintenance of that weight loss. You need a lifestyle change, that's what it comes down to--an increase in physical activity and decrease in food intake. Success is a balance of calories in and calories out."

Careful selection of patients for a fen-phen program coupled with close monitoring are the keys to success, says Dr. Morton H. Maxwell, clinical professor of medicine and director of the University Obesity Center at the UCLA School of Medicine. The regimen, like UCI's, incorporates patient education, nutritional counseling and support groups. The first steps include a medical history and physical, followed by lab screenings and electrocardiograms. Patients see a doctor at least once a month; lab work and EKGs are repeated every eight weeks.

But figuring the best dose of fen-phen for each person can be tricky.

"Everybody metabolizes these differently, and we don't know much about the receptors in everyone's brains," Maxwell says. The two drugs work together. "Phentermine works in the brain and releases noradrenaline," Maxwell says. "It prevents its re-uptake, and you get a high level. When that happens, you get a lower appetite. It works in the hypothalamus, which is the appetite center."

Similarly, fenfluramine raises serotonin levels, decreasing appetite and increasing feelings of fullness. (Increased serotonin generally improves mood, but doctors don't know why some fenfluramine users get depressed.)

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