David Baxter PhD
Late Founder
Is Your Medicine Cabinet Making You Fat?
August 16, 2005
By MARY DUENWALD
Like many people with Type 2 diabetes, Sheila Israel struggles to lose - or at least not gain - weight. Extra pounds can worsen the insulin resistance that characterizes her illness.
So two years ago it was discouraging for Ms. Israel to learn from her new doctor that two of the drugs she had been taking to treat her problem were actually causing her to put on weight. One was a thiazolidinedione, also known as a TZD, which increases the body's sensitivity to insulin. The other was a sulfonylurea, which works by causing the pancreas to release more insulin. Over the course of five years, Ms. Israel, who is 58, had put on 70 pounds.
The physician, Dr. Louis J. Aronne, a weight specialist at Weill Medical College of Cornell University, gradually took Ms. Israel off both drugs and put her instead on metformin, sold as Glucophage, a diabetes medication not associated with weight gain.
Right away, Ms. Israel said, she noticed she was eating less. "I really wasn't as hungry at all," she said. "I got full very fast." Over the course of a year, Ms. Israel lost the 70 pounds, and she has kept it off for another year.
Dr. Aronne is one of many physicians paying increasing attention to the weight side effects of the drugs they prescribe.
Not only diabetes drugs but also certain psychiatric medications, some blood pressure treatments, corticosteroids (taken by people with severe allergies, asthma or arthritis) and even over-the-counter antihistamines can cause the patients who take them to gain weight.
People who gain weight during the time they are taking a new medication should consult their doctors about the possibility of switching drugs or taking other steps to resist further weight gain.
Until recently, many physicians considered a drug's weight side effect to be a necessary evil, said Dr. Michael D. Jensen, an endocrinologist at the Mayo Clinic in Rochester, Minn., or assumed that only weight gains of 100 pounds or more were worrisome. But drugs that lead people to put on just 10 or 20 pounds a year, if taken for many years, can add up to big problems over time.
"Gaining weight is a one-way trip for a lot of people," Dr. Aronne said. "It is often very difficult to reverse."
Zyprexa, Risperdal and other drugs for psychosis can cause particularly drastic weight gains.
"I have seen patients gain 100 pounds over the course of 9 to 12 months - people who started out a completely normal weight," Dr. Jensen said.
The drugs are prescribed for patients with illnesses like schizophrenia, bipolar disorder and severe depression that is resistant to other treatments. Growing concern about weight side effects from antipsychotics prompted a joint panel of American Psychiatric Association, the American Diabetes Association and other medical groups to issue a consensus statement last year urging doctors to monitor weight in patients who are taking them, and to consider switching medications for patients whose body weight increased by 5 percent or more.
If no alternative drugs are appropriate, Dr. Jensen sometimes suggests that the patient also be prescribed the anticonvulsant drug topiramate, sold as Topamax, which can also act as a mood stabilizer. Topiramate, which can have other side effects, has been associated with weight loss in some people. "There have been reports of people losing 10 percent of their body weight on topiramate," Dr. Jensen said.
Another option is to prescribe drugs specifically designed for weight loss, like Xenical, which blocks the digestion of some fat, and Meridia, which suppresses appetite. But these are often inadequate, Dr. Jensen said.
Antidepressants like Prozac and Paxil taken over months or years can also cause some people to gain a few extra pounds. "Some of them cause weight loss temporarily, but they all can lead to weight gain after a long period of time," Dr. Aronne said. "The problem is, we don't have good alternatives."
Drugs taken to control blood pressure, like beta blockers and calcium channel blockers, do not necessarily encourage weight gain, Dr. Jensen said, but they seem to make it harder for some patients to lose weight.
Antihistamines, which people usually take on their own to control allergic reactions or to help themselves get to sleep, can promote weight gain, too. This occurs only in a minority of people who take the drugs, said Dr. Linda B. Ford, director of the Asthma and Allergy Center in Omaha.
It is not known exactly how drugs cause weight gain. Antihistamines may increase hunger because histamine receptors are thought to play a role in appetite. The antipsychotics seem to increase appetite, too. "Patients don't complain of being ravenously hungry, but if you watch them, they're just eating a lot," Dr. Jensen said.
Recent research suggests that TZD's may work in part by keeping fat cells from releasing free fatty acids into the blood stream, where they can impair insulin function, said Dr. Mitchell Lazar, an endocrinologist who is the director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania. That would explain how the drugs can improve insulin function even as the patient gains fat. That means that TZD-induced weight gain may not necessarily worsen a patient's diabetes. But for some patients that may be little consolation.
"I've been overweight my entire life," Ms. Israel said. "The last thing I needed was to gain more."
August 16, 2005
By MARY DUENWALD
Like many people with Type 2 diabetes, Sheila Israel struggles to lose - or at least not gain - weight. Extra pounds can worsen the insulin resistance that characterizes her illness.
So two years ago it was discouraging for Ms. Israel to learn from her new doctor that two of the drugs she had been taking to treat her problem were actually causing her to put on weight. One was a thiazolidinedione, also known as a TZD, which increases the body's sensitivity to insulin. The other was a sulfonylurea, which works by causing the pancreas to release more insulin. Over the course of five years, Ms. Israel, who is 58, had put on 70 pounds.
The physician, Dr. Louis J. Aronne, a weight specialist at Weill Medical College of Cornell University, gradually took Ms. Israel off both drugs and put her instead on metformin, sold as Glucophage, a diabetes medication not associated with weight gain.
Right away, Ms. Israel said, she noticed she was eating less. "I really wasn't as hungry at all," she said. "I got full very fast." Over the course of a year, Ms. Israel lost the 70 pounds, and she has kept it off for another year.
Dr. Aronne is one of many physicians paying increasing attention to the weight side effects of the drugs they prescribe.
Not only diabetes drugs but also certain psychiatric medications, some blood pressure treatments, corticosteroids (taken by people with severe allergies, asthma or arthritis) and even over-the-counter antihistamines can cause the patients who take them to gain weight.
People who gain weight during the time they are taking a new medication should consult their doctors about the possibility of switching drugs or taking other steps to resist further weight gain.
Until recently, many physicians considered a drug's weight side effect to be a necessary evil, said Dr. Michael D. Jensen, an endocrinologist at the Mayo Clinic in Rochester, Minn., or assumed that only weight gains of 100 pounds or more were worrisome. But drugs that lead people to put on just 10 or 20 pounds a year, if taken for many years, can add up to big problems over time.
"Gaining weight is a one-way trip for a lot of people," Dr. Aronne said. "It is often very difficult to reverse."
Zyprexa, Risperdal and other drugs for psychosis can cause particularly drastic weight gains.
"I have seen patients gain 100 pounds over the course of 9 to 12 months - people who started out a completely normal weight," Dr. Jensen said.
The drugs are prescribed for patients with illnesses like schizophrenia, bipolar disorder and severe depression that is resistant to other treatments. Growing concern about weight side effects from antipsychotics prompted a joint panel of American Psychiatric Association, the American Diabetes Association and other medical groups to issue a consensus statement last year urging doctors to monitor weight in patients who are taking them, and to consider switching medications for patients whose body weight increased by 5 percent or more.
If no alternative drugs are appropriate, Dr. Jensen sometimes suggests that the patient also be prescribed the anticonvulsant drug topiramate, sold as Topamax, which can also act as a mood stabilizer. Topiramate, which can have other side effects, has been associated with weight loss in some people. "There have been reports of people losing 10 percent of their body weight on topiramate," Dr. Jensen said.
Another option is to prescribe drugs specifically designed for weight loss, like Xenical, which blocks the digestion of some fat, and Meridia, which suppresses appetite. But these are often inadequate, Dr. Jensen said.
Antidepressants like Prozac and Paxil taken over months or years can also cause some people to gain a few extra pounds. "Some of them cause weight loss temporarily, but they all can lead to weight gain after a long period of time," Dr. Aronne said. "The problem is, we don't have good alternatives."
Drugs taken to control blood pressure, like beta blockers and calcium channel blockers, do not necessarily encourage weight gain, Dr. Jensen said, but they seem to make it harder for some patients to lose weight.
Antihistamines, which people usually take on their own to control allergic reactions or to help themselves get to sleep, can promote weight gain, too. This occurs only in a minority of people who take the drugs, said Dr. Linda B. Ford, director of the Asthma and Allergy Center in Omaha.
It is not known exactly how drugs cause weight gain. Antihistamines may increase hunger because histamine receptors are thought to play a role in appetite. The antipsychotics seem to increase appetite, too. "Patients don't complain of being ravenously hungry, but if you watch them, they're just eating a lot," Dr. Jensen said.
Recent research suggests that TZD's may work in part by keeping fat cells from releasing free fatty acids into the blood stream, where they can impair insulin function, said Dr. Mitchell Lazar, an endocrinologist who is the director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania. That would explain how the drugs can improve insulin function even as the patient gains fat. That means that TZD-induced weight gain may not necessarily worsen a patient's diabetes. But for some patients that may be little consolation.
"I've been overweight my entire life," Ms. Israel said. "The last thing I needed was to gain more."
