Q “I’ve been trying to lose weight, but it’s been really hard. Doctor, isn’t there a diet pill or something you can give me?” — F.S., Ayden

A It’s been several weeks since the holidays and New Year’s resolutions, and the difficulty of shedding a few pounds is setting in for some people. Alexandra Stang, a Brody medical student, was asked this question many times while she worked in Family Medicine. Here is what Alex has to say.

Many folks turn to their family doctor and ask for medicines to help weight loss. After all, the TV and Internet commercials make it look like there are wonder pills and potions that you can take and lose weight without doing any additional work. But popping a diet pill may not be the easy or perfect solution.

There are several prescription medications that can be used to assist an individual who is already obese and willing to make lifestyle changes. The medicines fall into two types: hunger reducers and medicines that allow fats to pass through your body without being completely absorbed.

Orlistat (Xenical as a prescription or Alli over-the-counter) belongs to the latter class of weight-loss drugs. It works by inhibiting the enzyme lipase from doing its work. As a result, less fat gets absorbed and more passes into stool. So your body gets the value of fewer calories than you consume. On Orlistat, people lose an average of 6 pounds over one year’s time. Some patients believe those 6 pounds are worth the cost and potential inconvenience.

Until you figure out how much dietary fat your gut can handle while taking this medicine, you might need to keep a change of underwear handy. Ask for an appointment with a registered dietitian who can give you a fat gram budget and teach you how to identify all the fat in your food. If you eat more fat than you should while taking the medicine you can possibly have oily discharge, as well as bloating and pale, foul-smelling, fatty stools.

To avoid problems, most people can eat fewer than 15 grams of fat in a meal. Without prescription insurance, a month’s worth of Orlistat (Xenical) costs a whopping $300. Xenical’s over-the-counter counterpart Alli, on the other hand, costs around $50 for a 60-pill starter kit. Alli contains the same active ingredient as Xenical at half the prescription strength, so expect less weight loss if you take it. Most patients who do well with this medication tell me it keeps them mindful about how much fat they are eating. So it really works like a training tool to learn to eat less fat.

The most often prescribed appetite suppressants include Phentermine (Apidex-P) and Sibutramine (Meridia). Unlike Orlistat, these medicines help people lose weight by decreasing the sensation of hunger. So these medicines only work if a person eats because of constant hunger rather than from habit or pleasure or mindlessness.

Phentermine and Sibutramine tend to produce an 8- to 10-pound weight loss when taken for 12 months, but they also have some drawbacks. Both of these medicines can cause nervousness, dry mouth, headache and insomnia. Neither Phentermine nor Sibutramine is recommended for patients with high blood pressure, since they both can increase blood pressure. Moreover, recent research has raised some concerns that patients taking Sibutramine might have a higher number of adverse cardiovascular events like heart attacks, stroke and death.

So what’s the magic bullet for weight loss? Unfortunately, there isn’t one. No medication is risk-free. Many products sold on the Web or TV don’t work any better than a sugar pill placebo. Unless you make changes in diet and exercise, once you stop taking the drug, you’re likely to regain the weight you lost. Medications like Orlistat, Sibutramine, and Phentermine may still be worth considering as a way to kick-start your weight loss, but only as part of an overall program that involves regular physical activity and healthy eating.

Professor Kathy Kolasa, a registered dietitian and Ph.D., works with the Family Medicine Center, Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu.