Hi, I’m Otto Puempel, D.O. (Board Certified in Family Practice)
My medical practice began in Arlington, Texas in 1963. As a physician from “the old school” I did everything including Internal Medicine, Obstetrics and Gynecology, Pediatrics, Geriatrics and minor surgery. My obese patients were treated for their weight problem with diet, exercise and diet pills; much the same as we do today. In 1987, after a ten year stint as Director of Medical Education at the Dallas Fort Worth Medical Center, I resigned to devote full time to the practice of Bariatric Medicine.
Obesity is a chronic, recurrent life-long disease that carries a fifty to one hundred percent chance of premature death if left untreated. Overweight And obesity in the USA have increased by more than seventy-five percent in the past three decades. Weight loss leads to improvement of sleep apnea, diabetes, arthritis pain, improvement of lipids and cardiovascular risk and an increased life expectancy. 1
The use of FDA approved medications in our treatment program makes us unique. I will review one of the medicines at this time, noting that most of these medicines are similar in history and chemistry.
Phentermine was approved by the FDA and brought on the market in 1958. I began using phentermine for my overweight patients when I started practicing medicine in 1963. Following two other FDA evaluations, one in 1976 and then again in 1996, phentermine was still found to be safe and effective.
Dr. Weintraub’s studies, under the direction of the National Institutes of Health, found phentermine to be safe and effective (these were three to three and a half year studies). A later report also cited the following recommendation from Weintraub & Bray as it relates to the pharmacotherapy (medication use) for obesity: “Since obesity is a chronic disorder, the short term use of drugs is not helpful. The health professional should include drugs only in the context of a long term treatment strategy.” 2
Obesity is now considered a chronic illness that produces life threatening complications.
At the present time there are ongoing clinical studies, several years in duration, which shows the safety and effectiveness of phentermine. Years of experience and additional research have shown this medication to be both effective and considerably safer than was previously recognized.
My experience over many years of practice has convinced me that the combination of diet, exercise and the use of phentermine (and/or the other FDA approved medications) for the treatment of obesity and related conditions is safe and effective.
The side effects of using phentermine are those that accompany the use of stimulants. It is comparable to coffee. Too much causes anxiety, headaches, insomnia, etc. These problems are minimized because of the prescription protocol used by our medical professionals. The “start low go slow” approach that is used when prescribing medicine for chronic conditions works well in treating obesity also. It is safe. It is effective.
Phentermine is classified as an anorectic agent. That is, it suppresses the appetite. It also has other effects that are beneficial. It helps control sweet and carbohydrate cravings. It lowers the “set point” so that you are satisfied with about one half your usual intake of food. It stimulates metabolism by causing thermogenesis. Also, because it is a stimulant, you have an increased activity level. All of these beneficial effects make phentermine an exceptional adjunct to diet and exercise in the treatment of overweight patients.
Chronic conditions require long-term therapy. We use FDA approved appetite suppressants long –term. By that I mean we use them for as long as it takes to get to a healthy weight. We use the medicine in weight maintenance programs as needed. A good outcome would be a five to ten percent weight loss. Most of our patients far exceed that expectation. The ultimate goal is weight loss and maintenance with the healthy lifestyle changes learned in our program.
1 The Bariatrician Fall 2008 – volume 23 #3
2 Weintraub and Bray GA. Drug Treatment of Obesity. Medical Clinics North America 1989; 73:273-249
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