Appetite grows for obesity pills

THE number of NHS prescriptions for obesity drugs handed out in Scotland has soared fivefold in the past five years, with thousands of overweight patients given costly new treatments.

The latest official figures reveal almost 90,000 prescriptions for anti-obesity drugs were handed out by doctors last year at a cost of £4.1m to the NHS in Scotland. In 2001 there were just under 18,000 prescriptions costing £765,732.

Last night, health experts said the rise in cost was down to new slimming drugs which have become available on the NHS in recent years. But there are questions about whether drugs alone can combat obesity.

Scotland's weight problem has grown so serious that more than one in five adults is now classed as clinically obese, with a body mass index of over 30. For a 5ft 5in woman, this means weighing more than 13 stone - about 2.5 stone overweight.

While slimming pills such as herbal remedies and appetite suppressants have been available for decades, a new generation of anti-obesity drugs have now been developed to work in different ways on the body.

They include Xenical, which blocks the body's absorption of fat, and Reductil, which works by making dieters feel fuller quicker. Both are available on the NHS in Scotland and cost around £40 to £50 a month.

A typical 12-month course of Reductil for a patient would cost around £580, excluding the cost of doctors' consultations.

The drugs are only given out to patients with a body mass index of over 30, or slightly less if there are other health problems. They are only recommended as a last resort for patients who have tried to lose weight on conventional diets and failed.

Some also have significant side-effects, such as excess gas and incontinence or increased blood pressure and heart rate.

But experts voiced concerns about the rise in prescriptions and said people with eating disorders needed support to address their behaviour as well as medical help.

A spokeswoman for Toast, an obesity counselling service, said: "Obesity drugs can be useful as a part of a package, but on their own they are not enough because people need to be able to address their eating behaviour rather than just lose weight.

"Research suggests people can lose up to 10% of their body weight, but we have had people lose up to nine or 10 stone with these drugs, and others who have had uncomfortable side-effects.

"There is a danger that these drugs are given away to appease people. What they really need is support to make long-term changes and look at their eating behaviour."

Treating the consequences of obesity such as diabetes, heart disease and other illnesses costs the NHS in Scotland £170m a year, compared with those caused by smoking at around £184m a year.

Dr Andrew Walker, a senior lecturer in health economics at Glasgow University, said it was unclear whether the drugs were even proving cost-effective because it was uncertain whether the £4m spent last year on obesity drugs would result in less strain on the NHS from the consequences of obesity-related ill health.

He said: "The NHS is not good at saying whether something does what it is supposed to do. In terms of success, it would be up to the individual prescriber to judge. So we do not know what the honest answer is.

"I am certain that for some people these drugs play an important role in treating obesity. But they are designed for people who are very obese and they are fairly drastic.

"The main problem with the weight issue is that will power does not come in capsule form."

Laura Brown, from Glasgow, lost 11 stone after she was prescribed Xenical in 2000. When 23 stone, at the age of 27, she was one of the first Scots to take the drug. She was given it by her doctor after diets and exercise failed to shift her weight.

While on Xenical she kept her portions down because she quickly learned that every time she overate she would suffer the uncomfortable consequences of diarrhoea and flatulence.

But six years later she is back up to almost 22 stone because she could not keep the weight off when she stopped taking the medication.

Brown, now 33, said: "No drug is a miracle. I had to do a lot of the work myself. When I came off the medication, the weight came back gradually, then it spiralled.

"When I was on the drug, I was not eating much and there was no pleasure in my life because I couldn't eat. I couldn't go out because food was too tempting for me. It was all about going to the gym."

Last month, Scotland's obesity crisis was laid bare in two reports that showed official health targets are far from becoming reality.

Reports from the Food Standards Agency and an independent panel of experts found that targets laid down 10 years ago in the Scottish Diet Action Plan were "overwhelmingly" not being achieved.

Last night, a Scottish Executive spokesman said the drugs were only part of its efforts to tackle obesity.

He said: "Orlistat (Xenical) and Sibutramine (Reductil) should only be prescribed as part of an overall treatment plan for the management of obesity for people aged 18-65 years who have made serious attempts to lose weight by dieting, exercise or other changes in their behaviour."

DRUGS TO SHIFT THE POUNDS

XENICAL - around £40 for a month's supply. It blocks the action of the enzyme that digests fat, stopping almost one third of the fat consumed being absorbed, so leading to weight loss. Clinical trials showed that patients taking Xenical while on a low-fat diet lost twice as much as those on the diet alone. Patients can experience excess gas and frequent bowel movements. If a high-fat meal is eaten while on the pills it can lead to incontinence.

REDUCTIL - around £50 for a month's supply. It works by boosting levels of serotonin, making slimmers feel satisfied with less food. Side-effects can include increased blood pressure and heart rate, headaches, a dry mouth, constipation and sleeplessness.

ACOMPLIA - costs £55.20 for a month's supply. Developed by French company Sanofiaventis, it has been granted a licence in the UK but has not yet been approved for use in the NHS by the Scottish Medicines Consortium. It is the first to target the endocannabinoid system, which governs the body's appetite, making hunger pangs more manageable. Acomplia taps into the same brain circuits as cannabis but turns them off instead of switching them on. Sanofia-ventis claims people have lost about two stones over two years. Critics claim the drug may also alter takers' moods.