Don't buy diet pills, slimming coffee, slimming candy or enzyme plums (酵素梅, plums said to be soaked in enzymes) that promise fast weight loss

Cost

Free. If anything, you save the money you would have spent on these products. The hard part is accepting that there is no such thing as losing several pounds in a week.

What you get

The SCOUT trial enrolled 9,804 people. All were 55 or older, overweight or obese, and had cardiovascular disease or type 2 diabetes. They were assigned by lottery to a drug group and a no-drug group, treated for an average of 3.4 years. The main outcome counted a set of bad events fixed in advance: nonfatal heart attack, nonfatal stroke, cardiac arrest with resuscitation, and cardiovascular death. The rate of these events was 11.4% vs 10.0%. HR 1.16 (95% CI 1.03–1.31, P=0.02), so those on the drug had about 16% higher chance of an event. The true value likely lies between 3% and 31% higher. Nonfatal heart attack was 4.1% vs 3.2%, HR 1.28 (1.04–1.57), about 30% higher. Nonfatal stroke was 2.6% vs 1.9%, HR 1.36 (1.04–1.77), about 36% higher. Cardiovascular death and all-cause death did not rise; all-cause means deaths from every cause added together. After the lottery, the sibutramine group lost on average 1.7 kg more. Based on a safety assessment, the former State Food and Drug Administration (原国家食品药品监督管理局) held that “the risk of weight-loss treatment outweighs the benefit,” and in October 2010 notified that production, sale and use of sibutramine preparations and the raw drug be stopped. Both sibutramine and phenolphthalein are banned as additives in food, including health foods.

Notes

SCOUT enrolled people who already had heart disease or diabetes. This trial did not prove that healthy young people would have the same problem if they took it. But precisely because it can't be told who is at high risk, the regulator simply pulled it from the market. Another ingredient often secretly added is phenolphthalein, originally a laxative, which if taken for a long time in large amounts can upset the body's electrolytes and trigger an abnormal heart rhythm. How to judge: a proper weight-loss drug is a prescription drug, and its approval number can be looked up at pharmacies and hospitals. Something sold as “coffee,” “candy,” “plums” or a “meal replacement” and promising several pounds off in a week should, by definition, have no drug effect; if it does have an effect, something has been added. The original text of Guo Shi Yao Jian Ban [2010] No. 432 (国食药监办〔2010〕432 号) is on the National Medical Products Administration (国家药监局) website, which kept returning a 412 error from this machine, so a provincial regulator's page that repeats it is cited instead. The two phrases “the risk outweighs the benefit” and “stop production, sale and use in October 2010” can be checked word for word there.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. James WPT et al. (2010). Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. NEJM. https://doi.org/10.1056/NEJMoa1003114
2. 天津市市场监督管理委员会. 警惕部分食品中违法添加「盐酸西布曲明」和「酚酞」. https://scjg.tj.gov.cn/tjsscjdglwyh_52651/hdpt/cjwtyxfts/202007/t20200720_2972549.html

Translated from the Chinese original. Original book, section 28, tip 4. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer