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People’s Pharmacy: No silver bullet for weight loss

Hope springs eternal, and in the spring it is frequently focused on losing weight. Plenty of us realize, as we contemplate donning shorts or even bathing suits, that winter has not been kind to us. We may be looking for a way to drop those extra pounds.

Losing weight is difficult, whether it’s 15 pounds or 50. That’s why weight-loss drugs are appealing, even if the Food and Drug Administration says they are really only for obese people.

The FDA approved lorcaserin (Belviq) in 2012, and it became available in 2013. You may be seeing ads for it now. They suggest that the pill will take away your appetite so that you can stick with a sensible diet and exercise program. The manufacturer acknowledges that “the precise way Belviq produces feelings of satisfaction is not fully understood.”

The big question is efficacy: How well does it work? According to Consumer Reports, it can lead to weight loss of about 3 to 4 percent of body weight in a year. Now, that might be quite a few pounds for someone who meets the criteria for Belviq, with a body-mass index, or BMI, of at least 30. BMI is a way of determining obesity based on weight and height.

A woman who is 5-feet-6 and weighs 185 pounds has a BMI of 29.9. That means that she is overweight, but isn’t considered obese and wouldn’t qualify for a Belviq prescription unless she had other health problems.

How well does Belviq work? In two studies, subjects started at an average weight of 220 pounds. At the end of a year of treatment, those on Belviq weighed 7.25 pounds less than those who had taken a placebo. During the second year, many of these subjects gained back some of the weight they had lost.

What are the downsides of Belviq? Despite relatively modest benefit, there are side effects associated with this weight-loss drug.

Most worrisome, though rare, is serotonin syndrome. Belviq can trigger this condition, especially when people also take other medications such as cough remedies with dextromethorphan (DM), antidepressants, migraine medicines or even an herbal preparation such as St. John’s wort.

Symptoms of serotonin syndrome include anxiety, agitation, nausea, vomiting, hallucinations, uncontrollable muscle twitching, changes in blood pressure and heart rate, fever and loss of consciousness. It can be life-threatening.

Other side effects of Belviq include headache, nausea, dizziness, fatigue, dry mouth and constipation. An unusually high rate of upper-respiratory-tract infections was reported during the clinical trials. People with diabetes also were more likely to experience low blood sugar while taking Belviq.

According to the experts at Consumer Reports, it would be safer to lose weight the old-fashioned way with diet and exercise.

Our recommendations include keeping a detailed food diary. Conscientious use of this technique has been shown to help people lose weight.

There also is data suggesting that people can benefit by avoiding refined carbohydrates, such as products made with white flour and sugar. Concentrating on low-starch vegetables, fruits, healthy fats and lean protein also can be helpful.

Our book “The People’s Pharmacy Quick and Handy Home Remedies” describes three scientifically proven diets that can be useful (