Doctors at clinics as well as those in private practice sometimes prescribe drugs off-label: In other words, they give a medication that's FDA approved to treat another disease—diabetes or epilepsy, for example—to overweight patients because the drug can cause weight loss. The approach is a gamble since these medications may have severe, even life-threatening side effects. According to the National Institutes of Health, off-label prescribing is an option only when patients face significant health risks because of their weight.
The clinics enter a gray area when they treat people who are basically healthy but would like to drop a few pounds. No prescription pill is approved for cosmetic weight loss, and meal-replacement diet plans are indicated only for people who are dangerously overweight. And some doctors, such as Kaplan, also offer nonsurgical cosmetic body sculpting, the kind Rose Katz had. Referred to as Lipodissolve, injection lipolysis, or mesotherapy, the treatment involves a series of shots into pockets of fat beneath the skin, using various agents including plant extracts, vitamins, enzymes, and a substance—phosphatidylcholine—that seems to kill fat cells.
The technique, developed decades ago and popular in Europe and South America, has only recently gained a big following in this country. Because doctors often use their own recipes, patients don't always know what they're getting, and some people experience considerable swelling and pain. While research suggests that the shots are relatively safe, there is still not enough data on long-term effects or on whether the shots actually work.
If you want to go down only a dress size or two, the research is resoundingly clear: The safest and most effective method is to cut calories and exercise more. A doctor-run clinic can provide guidance and regular check-ins—two other techniques that research has proven can help. But before any consumer signs up with a clinic, Dansinger advises her to visit more than one and ask the doctors these questions: What is your training? How long have you managed weight loss? What evidence do you have of your long-term success? What will I learn that will stick with me when I'm no longer a patient at your clinic? "Be wary of programs that have been around less than a year or two and don't have a track record," Dansinger says.
For those who qualify for drug treatment, ask all the above questions and then carefully consider the benefits and risks of any treatment the doctor proposes. If the doctor balks at answering your questions, doles out pills, shots, or shakes without a thorough checkup and regular follow-up, or pushes you to buy expensive vitamins and supplements the office happens to be selling, walk away. With the growth in medical weight loss, you're likely to find a more responsible doctor just up the road.
Fran Smith is a writer and editor living in Dobbs Ferry, New York.