Diet Pills: Effective or Detrimental to Human Anatomy and Biological System?

NEGATIVE EFFECTS OF DIET PILLS

 

Part One

I have read about the story of a 362-pound pastor who was so humiliated when the flight attendant announced that she was bringing an extra seat belt to secure him. The pastor then decided to embark on the diet and basketball program. For the first four months of his personal weight-loss program, he avoided red meat and all fast and junk foods, stayed away from bread, and gave up his favorite munchies – potato chips.

 

He only ate boneless, skinless chicken and turkey meat, fish and fresh vegetable; learned to prepare his own low-fat, low-salt meals, taking over the family’s cooking chores from his delighted wife. To overcome late-night bringing, he ate oranges and grapes whenever he was hungry. Encouraged by his diet change, he embarked on an exercise program of swimming, aerobics and basketball. He joined a health club and started working out on a bicycle machine for an hour, and swam 5 or 6 laps every day for four months. This personal weight-loss program helped him lose 140 pounds.

 

The success story of the pastor motivated me to write something about weight-loss programs, focusing on diet pills. The story inspired me because of the fact that the pastor did not rely on diet pills which, nowadays, become a debate of health concerns. Thus this project, covering eight weeks, discusses the dangers of diet pills.

 

The title of my study is “Diet Pills: Effective or Detrimental to Human Anatomy and Biological System?” Obviously, I investigated the overall effect of diet pills to human system. I hypothesized that in general, diet pills are not detrimental to human anatomy and biological system. This was a result of my observation of some friends who do not experience negative side effects while taking diet pills. In this research, I attempted to answer the following questions: (1) How do diet pills affect the human anatomy and biological system? (2) How do people perceive themselves in terms of their appearance?; (3) Why do they turn to diet pills?

To carry out the overall aim I first assessed and evaluated the situation by observing some friends who are into diet pills. I underwent archival research to gather information about the positive and negative effects of diet pills. Then I did a review of related literature on the effects of diet pills. Afterwards, I identified main issues and problems, followed by the interview. I made sure that the information given by the interviewee would be confidential. Through this interview, I was able to gain first-hand information about the topic.

For this study, descriptive research method was utilized. In this method, it is possible that the study would be cheap and quick. The purpose of employing this method is to describe the nature of a situation, as it exists at the time of the study and to explore the cause/s of particular phenomena. I opted to use this kind of research considering the desire of the researcher to obtain first hand data from the respondents. Primary research data was obtained through this new research study. In-depth interview was conducted. On the other hand, the secondary research data was obtained from previous studies on the same topic. 

 

A lot of overweight people are getting more conscious about how they look. This is the result of the twisted thought that the seemingly anorexic supermodels and brainless beauty queens are the only beautiful creature in this planet. It is really important to watch one’s figures mainly for health concerns and not due to aesthetics concerns. 

 

Those who are considering to enroll in weight-loss programs, specifically those who are into diet pills will certainly relate with this study. Moreover, conducting this study provides personal benefits for me, especially that diet pills have no effect on me and that I am not able to follow any regime. Conducting this study then was a learning process for me.

 

Part Two

Although researching about the topic was a really tedious task, it was an adventure for me as well. Moreover, my eight weeks spent on reading everything about the topic makes me knowledgeable about the dangers of some weight-loss programs and diet pills.

 

For this research, I did library research and interview. For the first part, which was the library work, I gathered data, collated published studies from different local and foreign universities and articles from books and journals; and made a content analysis of the collected documentary and verbal material. Afterwards, I summarized all the information and made a conclusion based on the research question posited.

 

For the second part of the study, I interviewed a female human resources manager for whom I am working temporarily as a file clerk. In the interview, open-ended questions were used to obtain as much information as possible about how the interviewee feels about the research topic. Interviews took a maximum of approximately an hour. The interview process was spontaneous. We had fun recollecting our high school years when looks mattered over anything else. The interviewee shared that she tried taking diet pills but stopped after some unbearable side effects.

 

The questions being used during the interview have been based on the research questions for this project, they have been reviewed, refined and approved by the project supervisor. The researcher designed a semi-structured interview. Here, the researcher encouraged the interviewee to clarify vague statements and to further elaborate on brief comments. The interviewer did not share his/her own beliefs and opinions.

 

It has been hypothesized that women are generally particularly susceptible to the development and maintenance of disturbed eating behaviors Indeed, prevalence research supports that disturbed eating behaviors are common among these women. For example, large percentages of high school women indicate that they use several maladaptive weight control techniques such as fasting appetite suppressants and skipping meals to lose weight. This made me remember when I was younger. I was so much into dieting that there were days that I skipped meals to please people. Well, the truth is, I was delusional in hoping that I could be like Linda Evangelista of Cindy Crawford.   

 

During my archival work, I had found that a majority of college women report engaging in subclinical eating behaviors such as chronic dieting and binge eating, and a high percentage either occasionally or regularly use extreme measures to control their weight. These high prevalence rates of subclinical eating behaviors, combined with the information that .5% to 2% of young adult women have clinical eating disorders, have prompted many counselors and health care professionals to devote attention to the prevention and treatment of disordered eating behaviors among women.

 

Reading literatures on self-perception, I found that when women become dissatisfied with their inability to match the ideals presented in magazine photographs, stories, and advertisements, they begin to develop eating disordered cognitions which may eventually be acted upon in the form of anorexic and bulimic behaviors. Authors also reported statistically significant relationships between reading fashion magazines and “body dissatisfaction” as well as between reading health and fitness magazines and a “drive for thinness.” Moreover, adolescents who saw images of thin fashion models were more likely to report higher levels of body dissatisfaction immediately after exposure than those who saw non fashion images.

 

In addition to heightened body dissatisfaction, exposure to content and images depicting thinness may also lead to short-term reductions in self-esteem, distortions in body-size estimation, and more depressed mood. Recent research suggests that as many as two-thirds of all high school females are either on a diet or planning to start one. In fact, dieting has become so common that some researchers contend that what is now considered “normal” eating by many female adolescents may actually border on what has been traditionally considered to be pathogenic or eating-disordered.

Finally, in this study, I found that some diet pills provide life-threatening health risks. For example, a 2001 study published in the New England Journal of Medicine concluded the Ephedra could cause high blood pressure, heart problems, stroke, seizures and death. And the FDA has reports of 100 deaths among ephedra users. Yet manufacturers adamantly claim the reports do not prove the product is risky and ephedra-containing products remain on the market. In 1997, the prescription weight loss pills redux and fenfluramine were recalled by their manufacturers after the FDA recommended that anyone taking them stop and consult with their doctors. The FDA asked manufacturers to withdraw the drugs after reviewing the records of 291 patients and found 30 percent had abnormal heart-test results. Some 92 patients had problems with their aortic or mitral heartvalves, the data showed.

Most of the psychology books and journals were useful for my research. However, these are limited to the psychology of eating behaviors. Information of diet pills were briefly discussed on these materials. Nevertheless, they were still generally useful. The Internet was of little help. I could not find research articles on the negative impact of diet pills. As a result, I resorted to commercial domains.

 

Part Three

During the two years between 1996 and 1998, 2.5 percent of American adults used prescription diet pills, according to new figures released by the Centers for Disease Control and Prevention (CDC), based on the Behavioral Risk Factor Surveillance System. Four percent of all women and nearly 6 percent of women age 25 to 44 took the prescription diet pills. However, one-quarter of those who took the pills were not overweight; therefore, at least 1.2 million adults may have inappropriately used the pills, says the CDC (see Healthy Weight Journal, 2001).

Even diet pills that are prescribed by doctor may not be completely safe, either. By 1998, the use of prescription diet pills had dropped to 0.5 percent. The popular diet drugs fenfluramine and dexfenfluramine were withdrawn from the market in September 1997. Dexfenfluramine (Redux) had been approved by the US Food and Drug Administration in 1996; fenfluramine was approved earlier but not for the commonly used fenphen combination (Heavy Weight Journal, 2001). Although these drugs were effective in curbing the appetite, they were linked to heart valve disease as well as a condition called primary pulmonary hypertension (Dee, 2000). With this condition, there is an increased resistance to blood flow through the lungs. That puts strain on the heart and can lead to heart failure.

Concerned, the Food and Drug Administration collected information on 271 patients who had used these drugs and found that 32% had valve abnormalities (Harvard Heart Letter, 2000). Studies did show an increased risk of aortic regurgitation detectable by echocardiography among patients who had used one of the fenfluramines, particularly among those who had taken the drug longer than three months. However, the studies found that only one out of 1,000 patients who had used these drugs actually developed symptoms from their heart-valve problems.

Researchers found no differences in heart-related symptoms or physical examination findings among the three groups. They did find a higher rate of aortic valve leaking among those who used dexfenfluramine (9%) or phen-fen (14%), compared with the control group (4%) — however, severe leaking of the aortic valve was practically nonexistent in all three groups (0%, 0.2%, and 0.2%, respectively). Among the three groups, the rates of a leaky mitral valve were about the same.

The result of the study also showed that the rate of mild or greater aortic regurgitation was 1.4% for those who used the drugs for three months or less, but rose to 13% among those who used them for longer. Among people who used one of the fenfluramines for more than 18 months, the rate of aortic regurgitation reached 21%. Although the vast majority of these patients have not suffered from their leaking aortic valves, there is some possibility that, with time, the leaking will get worse and the patients will ultimately need surgery.

Sachdev et al. (2002) studied the effect of fenfluramine-derivative diet pills on cardiac valves. These pills were withdrawn from the market in 1997 because of an association with valvular regurgitation, but subsequent estimates of the prevalence of this condition have varied widely. Sachdev et al. (2002) concluded that their  data indicate that fenfluramine-associated valvular regurgitation is less common than initially reported, but still present in 1 of 8 patients treated for >90 days.

A variety of medications used to assist with weight loss have been implicated in the precipitation or induction of depressive symptoms and disorders. This is true of a large number of phenylethylamine agents possessing psychostimulant properties, non-phenylethylamine psychostimulants (e.g., caffeine) and the serotonergic agent, fenfluramine (Pattern, 2002). There is, as yet, no substantial evidence linking the more modern weight loss drugs, sibutramine and orlistat, to the aetiology of major depression. Nevertheless, when these drugs are used, major depression will continue to be an important clinical consideration because of the elevated frequency with which major depression occurs in obese patients, the contribution that major depression may make to poor outcomes in non-pharmacological weight loss treatment and because of the interplay between symptoms of depression and weight loss treatment.

Pattern (2001) evaluated epidemiological associations between self-reported diet pill consumption and major depressive episodes (MDEs), using data from a large-scale, cross-sectional survey of the Canadian population. The result of Pattern’s (2001) study shows that approximately 0.5% of the population reported the use of diet pills. Diet pill use was more common among women than among men. At the time of data collection (1996-1997), the most commonly used medication was fenfluramine (since withdrawn from the market because of cardiovascular toxicity). The use of these medications was strongly associated with MDE: the annual prevalence among persons reporting use was 17.1% (95%CI, 8.6 to 25.6), approximately 4 times the underlying population rate.

The association between valvular heart disease and diet pills was discovered several years ago in a small cohort of patients. Subsequent uncontrolled surveys and reports suggested a prevalence of cardiac abnormalities as high as 30%. (Weissman, 2001). These results led to widespread concern by millions of appetite suppressant users and the withdrawal of both fenfluramine and dexfenfluramine from the market. Through Weissman’s (2001) review of the literature, it becomes apparent that we have better defined the association between valvular heart disease and appetite suppressants; nonetheless, many questions and controversies remain. Most large scale, multicenter, controlled studies have shown that a prevalence of significant valve regurgitation is between 2 and 12% and that the likelihood of disease increases with increasing dose and/or duration of appetite suppressant use. 

 

Dieter and Vorperian (2000) presented the case of an otherwise healthy woman with a history of palpitations who survived sudden cardiac death from a ventricular arrhythmia. According to Dieter and Vorperian (2001), the patient’s only medications at the time of the event were alprazolan prn and over-the-counter diet pills. The authors explored the relation between ventricular arrhythmias and over-the-counter diet pills. Moreover, They discussed basic electrophysiologic principles as well as an overview for the work-up and long term management of sudden cardiac death.

 

Phenylpropanolamine (PPA) is the major ingredient of many over-the-counter cold remedies and diet pills. According to Ryu and Lin (1995), the use or abuse of PPA may cause hemorrhagic stroke or cerebral vasculitis similar to the clinical and angiographic picture associated with amphetamine use or abuse. In their study, they reported a 32-year-old Taiwanese women who developed sudden onset of severe headache, nausea and vomiting on the seventh day of oral ingestion of 75 mg PPA per day. Cerebral angiograms showed multiple areas of alternating focal constriction and dilatation in the anterior and posterior cerebral arteries consistent with cerebral arteritis. Ryu and Lin (1995) warned medical practitioners of the potential hazards of over-the-counter drugs like PPA.

 

PPA is consumed by millions of persons annually and is sold in varying dosages and combinations for different ailments. Adolescents are an especially susceptible group influenced by its action as an anorexiant. In the early 80s, several cases had been reported of patients in whom intracerebral hemorrhage developed, with and without concomitant angiographic evidence of vasculitis, after taking PPA. In Forman et al. (1989), the 11th documented case of PPA-associated intracerebral hemorrhage with vasculitis is described. This was the first case in an adolescent following the ingestion of an overdose of diet-aid pills. Cases of intracerebral hemorrhage with vasculitis have also been described in users and abusers of amphetamine, methamphetamine, and ephedrine, all sympathomimetics with chemical structures similar to that of phenylpropanolamine. Forman et al.’s (1989) alerted pediatricians to the potential use by their patients of nonprescription medications containing phenylpropanolamine whenever unexplained acute cerebral symptoms were present.

According to Dee (2000), over-the-counter weight-loss drugs such as Acutrim and Dexatrim contain PPA. When combined with changes in eating habits and exercise, PPA can help people lose weight. However, the results are temporary and should only be used for the short term until new eating habits are established.

Kikta, Devereaux and Stroke (1985) described two patients with intracranial hemorrhage after ingestion of diet pills containing (PPA) in combination with caffeine. The first patient had bilateral simultaneous intracerebral hemorrhages, and the second had a subarachnoid hemorrhage. PPA is widely used most often without prescription and causes intracranial hemorrhage more often than has been realized. The mechanism may be induction of a transient hypertensive crisis.

 

Lewis (1992) reviewed twenty-six domestic reports of suspected adverse reactions from the guar gum-containing diet pill, Cal-Ban 3000 (filed with the FDA) were reviewed. There were 18 instances of esophageal obstruction, seven instances of small bowel obstruction, and one individual who was reported to have died after ingestion of Cal-Ban 3000, but for whom insufficient details were provided to assess causation. There were 14 women and 11 men for whom sufficient information was available. Preexisting esophageal or gastric disorders were present in 50% of those with esophageal obstruction, including peptic stricture, pyrosis, hiatal hernia, esophagitis, gastric stapling procedure, Schatzki ring, and muscular dystrophy. Fourteen of these 18 patients with esophageal obstruction were treated successfully by endoscopy, although the tenacious gel-like consistency of the material was often difficult to remove.

 

Two patients required rigid esophagoscopy when flexible endoscopy was unsuccessful. This resulted in the death of one patient who developed a pulmonary embolism after surgical repair of an intraoperative esophageal tear. For the seven patients with small bowel obstruction, no specific predisposing factors were mentioned. One individual required exploratory laparotomy, and inspissated tablets were found in the ileum. These cases, spontaneously reported to the FDA, are very similar to those reported in the literature. The water-holding capacity and gel-forming tendency of guar gum permits it to swell in size 10- to 20-fold, and may lead to luminal obstruction, especially when an anatomic predisposition exists.

 

Jones and Pillsbury (1990) stated that cellulose fiber diet pills have recently become a popular form of weight control. Jones and Pillsbury (1990) have seen two patients in whom ingestion of these pills had resulted in complete distal esophageal obstruction. Further studies revealed that each patient had a previously undiagnosed anatomical abnormality of the distal esophagus; in one case a Schatzki’s ring, and in the other a stricture probably secondary to chronic reflux. Jones and Pillsbury (1990) conclude that patients with known esophageal narrowing, or with a history of reflux and/or dysphagia, should use cellulose fiber diet pills only with extreme caution.

 

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