Diet

Quixotic Qnexa and Other Non-Quintessential Queries

Obesity with a Q.

Posted March 5, 2012

I like the name of Qnexa. As it reminds me of all non-quintessential quixotic things out there or, in other and less fanciful words, things that have in common an ill described sense of being impractical, impulsive, extravagant, and maybe even foolish to some extent.

This is all great when it comes to chivalry and romantic pursuits, but kind of shady when it comes to solid medical practice.

Don't get me wrong. I am a doctor and my years of medical practice somehow wired me to get strangely excited about any new kid showing up on the medication block. Despite tremendous advances, our pharmacy is still rudimentary, and as a psychiatrist, facing limited options when it comes to treating mental illness, I am always looking for better interventions for my many treatment resistant patients.

But that does not mean that I dispense a fistful of medications to whoever asks for it. To give a prescription, I first need to ascertain the existence of a biological disturbance that can be corrected with a medical intervention. Otherwise, the risk of exposing a patient to "medical" toxicity (which comes as part of the package with any medication) is unwarranted.

When it comes to patients I need to discern what's the contribution of psychological, social, and biological contributors. And I follow the compass. If it turns toward psychosocial, well then I prescribe a psycho-social intervention.

If you agree with all these premises you will also agree that when psycho-social or cultural contributors are responsible for an epidemics of sorts, a biological intervention is not recommended and it is also potentially dangerous.

And that is my concern with Qnexa, the newest addition to our anti-obesity war chest.

Let me be clear: No one disputes that there is morbid obesity, a medical condition for which medical treatment is recommended. However the majority of obesity in this day and age is the product of a culture that's gone wild when it comes to dietary habits. And no pill will change that.

My Qnexic concern is the medicalization of psycho-social and maybe cultural obesity. I can envision patients stopping by the doctor's to get their Qnexa prescriptions in the morning, which they will then take with large Diet Cokes during their super sized Big Mac lunches.

Will their weights change? Not likely. But what it will change for sure is their exposure to a new chemical associated with clear toxicity in prior studies.