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Tuesday, December 8, 1998 Published at 19:42 GMT


Health

Diet pills dished out with few questions asked

Most GPs do not prescribe diet pills

Many women see diet pills as the easy answer to a weight problem. GPs do not approve of them, but private clinics have moved into this lucrative market, to the dismay of many in the medical profession. Susan Donald, of BBC Television's Frontline Scotland, investigates.

For people desperate to lose weight there's always one major problem - how to eat less.

Diet pills seem the easy solution, a quick fix, pop a pill and keep the hunger pangs at bay.

But you are unlikely to be prescribed them by your family doctor.

Diet pills have fallen out of favour with the Health Service which now believes a permanent change in lifestyle is vital for effective weight loss.

However, private slimming clinics are happy to prescribe the pills - at a price.

Teresa Lambie is a typical patient. She started going to see a private doctor three years ago after the birth of her first child.

She had already taken a three-month course of pills prescribed by her GP. Then, when he thought she was thin enough and refused to give her any more, Teresa turned to a private clinic.

"I was told it was fourteen pills for £10. I'd take one supply then I'd give the doctor £20 and get 28 pills," she said.

"Then over a period of time I had seen that other people were getting more. So then I would go in and ask her for £50 worth, £60 worth.

"Sometimes when I went down to get the pills off her I could actually feel the sweat in my body just running down me, and I actually thought at the time 'she's not going to give them to me today, not if she really looks into my eyes, she's not going to give me them today'. But never once did she say no."

Obesity problem

Scotland has a major problem with obesity that contributes to high rates of coronary heart disease.

Seventeen per cent of women and more than 14% of men are clinically obese.

Obesity is linked to social deprivation. A weekly diet of fish suppers and alcohol simply pile on the pounds.


[ image: Professor Michael Lean: Diet pills are a last resort]
Professor Michael Lean: Diet pills are a last resort
Professor Michael Lean, of the Human Nutrition Department, University of Glasgow, said: "The only way people can lose weight is to eat less calories than they need."

He said there was a place for recommending medication, but only as a last resort.

A patient should first try to follow a structured programme of lifestyle and dietary change.

"If they are failing to control a weight problem and you can predict they're heading into worse and worse medical problems, then there is a place for an effective, safe drug to be used," he said.

The drug phentermine is the most commonly prescribed diet aid, sold as duromine or ionamine.

Carefully monitored

It works by suppressing the appetite so you just don't feel hungry. According to the doctors' bible, the British National Formulary, it should only be used in very specific circumstances and even then patients should be carefully monitored.

The BNF said it should only be used to treat medium to seriously obese people.

Even then the person should have been dieting for three months before and been unable to lose a realistic amount of weight. It should only be prescribed for three months or less. It should not be given to people who have heart problems, epilepsy, an unstable personality, a history of psychiatric illness or drug or alcohol abuse.


[ image: Dr Chris Freeman: Drug should only be used rarely]
Dr Chris Freeman: Drug should only be used rarely
Dr Chris Freeman, of the Cullen Centre for Eating Disorders, Edinburgh, said: "The guidelines are very clear that you can only give them to patients who are quite severely obese.

"You are only allowed to give them for 12 weeks at a time, and you are warned about a large number of side-effects including possible dependence. Now if you're giving them just for 12 weeks the amount of weight loss overall is going to cause major problems because you put it back on when you stop them."

Guidelines issued to doctors by SIGN, the Scottish Intercollegiate Network in 1997 go even further - they say there is no drug on the market that should be used to manage obesity. And the General Medical Council (GMC) says that the prescription of such drugs should be "exceptional".

But at one private clinic, a Frontline Scotland volunteer was offered phentermine without being asked about her diet or exercise regime.

Patients are asked if they want their GP told about the diet pills they're getting from the doctor, but many do not.

This is causing concern among GPs in the area. If they don't know a patient is taking the drug, they do not know not to prescribe certain other drugs which react badly with phentermine.

Dr Freeman said: "This is a powerful drug. It shouldn't be given without the GP knowing about it. Most specialists work by seeing a patient, assessing them, writing to their GP and recommending a treatment. In the National Health Service in this country, the GP is the gatekeeper, he is the person who monitors all the treatment that the individual is having."

In the last 10 years, family doctors have largely turned their backs on phentermine. In the Glasgow area, prescriptions have fallen from 275 in the first quarter of 1993 to 45 in the first quarter of this year.

The GMC has been asked by Grampian Health Authority to investigate doctors working in a private slimming clinic.

Slim Chance, an investigation by Frontline Scotland is broadcast on 8 December at 20 30.



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