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Food nutritionally sustains organic life. When we have an appetite for something, whether it’s a salad or a donut, our body is instinctively telling us that we’re desiring something essential to existence.

Which then begs the question: why are there products available that purposefully act to suppress a natural biological need that, by definition, is meant to sustain us?

Looking "big picture" at the multi-faceted problem that is obesity, there are no quick-fix solutions. Adopting a healthy lifestyle requires the thoughtful application of a number factors, including dedication and effort. However, there are a myriad of products that offer shortcut solutions to the complex topic of weight loss.

When considering any kind of aid towards the betterment of one’s well being—be it a dietary supplement, a new meal plan, or a product that claims to promote health and wellness—it is important to consider what it offers you and why you need it to accomplish your health goals.

Here we’ll review those considerations from the perspective of appetite suppressants and their use for weight management. In order to delve into this polarizing topic, we’ll have to look at the “big picture” problem which they’re meant to be solving before covering what they are, how they work, and ultimately whether or not they should play a role in one’s weight loss journey.

The Root of the Problem

The topic of obesity and losing weight is a complicated matter that is compounded by the presence of other health comorbidities, societal pressures, and socio-economic status.

Often, people are willing to try or do anything to lose weight and get back on track—even if it may not be the healthiest option.

Unfortunately, the promotion of quick fix products leads to the encouragement (intentional or not) of unhealthy habits for instant gratification and results that may lead to some negative consequences.

What the focus should really be turned to is the adoption of long-term nourishing lifestyle changes and a healthy relationship with food

Obesity

It is no secret, America (and much of the Western world) is dealing with an obesity epidemic.

Technically speaking, a simple way to determine if one is nearing obese levels is by measuring Body Mass Index (BMI)—a calculation relating a person’s body weight in kilograms (kg) divided by their height in meters (m) squared. Someone would be considered obese when their BMI equates to a value of 30 or above.Purnell2018 Under these parameters, a 5’8” (1.73 m) individual weighing 200lbs would have a BMI of 30.4 (roughly 30 pounds overweight), classifying them as obese.

Keep in mind, however, that BMI gives you a value based on how much you weight relative to your height. Given that muscle weighs more than body fat, it isn’t the most accurate way to determine obesity but it can give you an idea as to whether you may be at risk for being classified as overweight or obese.

Statistics from the Center for Disease Control (CDC) paint the pervasiveness of obesity with startling statistics:

  • Almost 40% (over 90 million) US adults were considered obese (2015-2016)Hales2017
  • Nearly 20% (over 13 million) children and adolescents aged 2-19 years were considered to be obeseHales2017
  • Obesity in the United States cost about $150 billion in 2008 with medical cost making the majority of that expenseFinkelstein2009
  • Medical expenses for obese individuals cost ~ $1,500 more than those considered to be at a normal weightFinkelstein2009
  • Obesity-related conditions (heart disease, stroke, type 2 diabetes and some cancers) are the leading causes of preventable, premature death

Unfortunately, a lot of these problems arise from our love affair with not only processed and high-carb foods, but also the portion size and quantity of our meals along with a lack of physical activity.

Quantity Over Quality

A 2003 study comparing French vs. American portion sizes found that American meals tended to be ~25% larger, soft drinks were ~50% larger, take-out meals were ~70% bigger, and even cartons of “healthy” foods, like yogurt, were 80% larger in America than they were in France.Rozin2003

The underlying issue highlighted by the study was that, as opposed to the French who make meals an experience, Americans would rather get the greatest value for their dollar when it comes to their food choices, regardless of tastes and / or experience.

Simply put: quantity, not quality, is champion in America.

With this kind of unhealthy perspective towards food and nutrition, the aforementioned statistics on obesity become less surprising, and instead more disheartening. When overeating leads to weight gain, this opens the doors for the formation of unhealthy habits as a result of external pressures to quickly rectify the situation.

Emphasis on Unhealthy Quick-Fix Solutions

There is a lot of misinformation spread through the blogosphere regarding “quick fix solutions” weight loss solutions. No doubt you’ve heard about things like juice cleanses, weight loss pills, detox drinks, fat-burner “fit teas,” and appetite suppressants.

Unfortunately, many of these products are geared toward those who lack a proper insight into the complexities of nutrition and metabolism.

They are routinely touted by media personalities and “medical professionals” that have no nutritional background or qualifications. In recent years, there has been some backlash by those in the health field towards these people using their position of authority or influence to advocate unhealthy practices.

Worst of all: most of these products have little to no definitive scientific backing with regards to weight loss or controlled food intake.

For example, a 2015 review on detox diets found “no compelling evidence to support the use of detox diets for weight management or toxin elimination [a process that, for the record, is naturally carried out by the liver]."Klein2015 Furthermore, another 2017 review found that while juicing and detox dieting may result in an initial weight loss (due to a low caloric intake and a loss of water weight) these methods also tend to lead to a regaining of that weight when resuming a normal diet.Obert2017

This appears to confirm the old adage that goes, “if it seems too good to be true, it probably is.”

Are Appetite Suppressants a Viable Solution?

Appetite suppressants are just one of the latest “dietary aids” which promise to help you drop a substantial amount of weight quickly.

Before investigating this topic further, keep in mind the question posed at the beginning: can something that is meant to “suppress” a biological process essential to our survival be a healthy solution to losing weight?

What are Appetite Suppressants?

Appetite suppressants can be classified as products which act on the regulatory hormones that signal our metabolic desire or need to eat.

This product / method claims to “suppress” the individual’s urge to eat, resulting in a decrease in caloric intake and, ultimately, weight loss.

Most appetite suppressants work to reduce appetite by either blocking the absorption of certain nutrients or through stimulating specific neurological receptors or transmitters associated with appetite.

Appetite-Specific Hormones

The two most common hormones which these “suppressants” act on are called leptin and ghrelin.

Leptin is involved in the long-term mediation and regulation of energy. Its primary role is to send a response signal to our brain to let us know that we’re full; “suppressing” our consumption.Klok2007

Ghrelin, on the other hand, plays a more immediate role in signaling when we’re hungry and need nourishment.Klok2007

These two regulatory hormones have been often studied in terms of how they influence both weight gain and weight loss.

Possible abnormalities in the regulation of leptin and ghrelin signaling may be an underlying cause for the development and / or exacerbation of obesity.

For example, investigations on obese subjects found that the circulating levels of leptin tended to be increased, whereas the levels of ghrelin (often referred to as the ‘hunger hormone’) surprisingly decreased. As such, research now shows that obese individuals are often found to be leptin-resistant (meaning their bodies don’t respond to leptin the way they should) and are, therefore, more prone to over-eating and further weight gain.Zhou2013,Gruzdeva2019

However, the exact mechanism(s) for both leptin and ghrelin systems and how they contribute to the various facets of obesity remains unclear.

Natural Products Affecting Appetite

Appetite suppressants can be divided into two categories: “natural” or “prescriptive.”

The term “natural appetite suppressants” is a bit of a misnomer because they are not really suppressants at all. Rather, it refers to foods that have properties shown to promote weight loss.

These properties affect (rather than suppress) appetite by either increasing satiety (feelings of fullness) through the blocking of nutrient absorption, slowing of gastric emptying, or by affecting the activity of appetite-associated hormones.

A chief contributor to satiety are fiber-rich foods.

Soluble fibers—which dissolve easily in water—in particular have been shown to have an effect on delaying gastric emptying which can result in feelings of fullness longer.Lattimer2010 Plant components like fenugreek,Mathern2009 an herb common in Indian cuisine, and glucomannan,Zalewski2015 a component of cell walls derived from root veggies, are good food sources of soluble dietary fiber which can help in not only feelings of fullness but also delays gastric emptying, increasing satiety, and inhibiting nutrient absorption.

In addition to fenugreek and glucomannan, a number of plant-based products have been shown to have effects on the portions of the brain which control appetite.

For example, garcinia cambogia extract (a tropical fruit) has been shown to contain high levels of hydroxycitric acid (HCA) which has an effect on serotonin levels, a neurotransmitter known to control appetite as well as mood and sleep.Preuss2004,Onakpoya2011

The stimulant caffeine has long been proven to increase fat oxidation rates (“burn fat”) and assist with weight loss as a result of its thermogenic effect.Acheson1980,Acheson2004

Natural sources of high caffeine products include coffee beans,Schubert2017 yerba mate,Hussein2011 and green teaCabrera2006 (particularly green tea extracts, like matcha, which can be found as a supplement or powder) and have been shown to not only influences appetite-related hormones but also decrease rates of gastric emptying.

Prescription Products Affecting Appetite

“Prescribed appetite suppressant” is a term refers to a class of medications, sometimes called anorexiants, which chemically affect the brain to signal a feeling of perceived satiety. These medications can be either prescribed by a doctor or, in some cases, purchased over-the-counter.

The Food and Drug Administration (FDA) has approved a handful of these medications—most of which are marketed as a treatment for other ailments—that you can only get with a doctor's prescription.NIDDK2016

These include (but aren’t limited to):

  • Phentermine: a central nervous system (CNS) stimulant that on its own or taken in combination with Topiramate (a drug often prescribed for seizures and headaches) may make you feel less hungry and more full
  • Liraglutide: suppresses hunger by acting on a hormone in the gut, glucagon, to delay gastric emptying. Originally marketed as an injectable diabetes treatment
  • Lorcaserin: acts on receptors in the brain associated with serotonin. Has the effect of fullness after eating less food
  • Naltrexone: affects the reward areas in the brain – namely the hypothalamus (part of the brain responsible for regulating appetite)

While these drugs have the ability to produce feelings of satiety that leads to some weight loss, they are still medications and should not be abused.

The desire to continue seeing results may lead to over-prescription of these or other medications - especially medications with addictive components such as amphetamine, methamphetamine, and benzphetamine.Bray1993 Therefore, caution must be observed.

Side Effects

Remember what we said about something being too good to be true? These drugs— if chosen to be used—are meant as short term treatments which may aid in appetite control.

The efficacy of most of these medications tends to wear off after several weeks and even in the short term, bring about substantial risks.

Noted side effects include (but are not limited to):NIDDK2016

  • Drowsiness
  • Lightheadedness
  • Insomnia
  • Excessive thirst
  • Constipation
  • Sweating
  • Increased heart rate
  • Elevate blood pressure

It is also worth noting that one of the aforementioned prescriptions, Liraglutide, has also been shown to cause thyroid cancer in studies done on animals.Madsen2012 Therefore, it’s important to consider all possible risk factors.

While side effects generally tend to be mild in most cases, taking unnecessary risks when the alternative is to focus on optimizing one’s nutrition and increasing energy expenditure through a more active lifestyle may not be worth it.

As obesity is often associated with other comorbidities, such as type two diabetes and cardiovascular diseases, extra precautions need to be taken so as not to mix drugs that could affect or exacerbate underlying conditions.

Do Appetite Suppressants Actually Work?

So, do appetite suppressants actually work? When used on their own...not to the degree they’re promoted.

The FDA reports that using the medications listed above may result in around 5% body weight loss over the span of a year. But if we go back to our 5’8” 200lb example from earlier, that equates to only around 10lbs.

And while any weight loss is progress towards improved health, it’s also nothing to write home about. Most people, when starting a low carb diet, can lose anywhere from 2lbs - 10 lbs within the first few weeks just by strictly adhering to their diet plans.

Therefore, rather than relying on a quick-fix pill, true change towards a health requires the modification of a number of lifestyle choices.

What are Healthier Choices?

At the beginning of this article, we posed a question: “why would we want to suppress a biologically necessary function like appetite?”

The answer? We probably shouldn’t.

What we should be doing is shifting away from the term “suppressant” and emphasize the consumption of whole foods that are satiating.

This starts with being more attentive and controlled with our eating habits.

Mindful Eating

Certain diets, like a ketogenic diet, place an emphasis on eating delicious and nutritious foods while being mindful of macronutrient amounts.

Specifically, a ketogenic diet does NOT restrict energy consumption but rather adjust macronutrient amounts to limit carbohydrate intake ( <5% - 10% daily caloric consumption) and rather emphasize the consumption of healthy fat (70% - 80%) for use as metabolic fuel.

We mentioned earlier the benefits of incorporating fiber into the diet for satiation. However, not all foods, especially carbohydrates, are equally satiating.

Replacing carbs with good sources of protein and healthy fats has been shown to help control appetite by keeping you fuller, longer.Morell2017,Waldman2018 Good sources of satiating foods high in protein and / or good fats include meats, eggs, avocados, and high-protein or probiotic-rich yogurts.

The removal of carbohydrates from the diet may also result in dehydration (there’s is 2g - 3g of water chemically bound to 1g of glycogen, the storage form of carbohydrates). This is a metabolic side effect that is easily remedied by remembering to drinking enough water throughout the day. But did you know that drinking more water can have an effect on your appetite?

Studies have shown that drinking water prior to meals (~1.5 liters per day total) results in feelings of fullness, reduced appetite, and lower perceived hunger after eating which can lead to greater rates of fat loss.Vij2014,Corney2016

Fasting

A lot of recent scientific trials have been performed regarding the timing of food intake.Parr2018 Much of the focus has been on the optimal composition and timing of meals or whether having a period of no-eating at all (termed “intermittent fasting”) can help optimize metabolic processes that can help us lose weight.

The consumption of foods—namely carbohydrates—causes our body to release insulin, the hormone responsible for shuttling sugar, or glucose, from the blood into muscle and liver for energy. Excess sugar is stored in the body as fat.

The release of insulin, however, also turns off the metabolic machinery which we need to burn fat. Therefore, lowering levels of insulin may help promote the body to burn fat.

This can be accomplished by removing carbohydrates or going for a period of time (~16 hours - 36 hours) without consuming any calories.

By doing so, we give our body more time to metabolically shift towards utilizing stored fat for energy (in the form of fatty acid break down substrates known as ketones), effectively burning excess fat and helping you lose weight.

It should be noted that intermittent fasting is not meant to encourage weight loss by starvation. It is a thoughtful pause in consumption. Many who practice intermittent fasting consult their healthcare professionals before starting and undertake in measuring certain biomarkers to track its efficacy.

Exercise

It’s almost a moot point to emphasize how vital exercise is to not only lose weight, but also to maintain a healthy lifestyle.

As pointed out earlier, healthy weight loss plans should include not only considerations for quality and quantity of food, but also the incorporation of a routine plan for exercise.

Not only is exercise a great all-around tool for the prevention of a number of disease states,Han2017,Motl2015,Kirwan2017 but it is also a healthy means of controlling appetite.

Exercise has been shown to not only lower levels of ghrelin—effectively making you less hungry—but it can also lower levels of peptide tyrosine tyrosine (also known as peptide YY; PYY) and Glucagon-like peptide-1 (GLP-1), hormones associated with feelings of fullness and satiety.Schubert2014

Healthy Weight Loss Requires a Multi-Faceted Approach

As you can see, there is no quick fix pill that can easily solving the worldwide problem that is obesity.

Healthy weight loss requires the concerted and coordinated effort of watching what we eat, how much we eat, and incorporating healthy lifestyle choices like exercise.

Attempting to “suppress” the evolutionary adaptation of appetite involves taking unnecessary risks that could be detrimental to your health. Healthy and natural alternatives to regulate appetite, aiming for satiation rather than suppression, are recommended.

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