Frequently Asked Questions

General Questions
The Prescription Medication Options
The OPTIFAST® Program

General Questions

How much weight should I expect to lose?

     2-5 lbs per week is a safe figure. Obviously it can vary depending on each person’s situation. Very heavy people tend to lose more early on. Remember that if you gained 50 lbs over many years, it’s not realistic to think you can lose all of it in a month. Steady, moderate weekly losses are safer and more likely to stay off in the long run.

Which one of the programs should I go on?

     If you have some preference of program type because, for example, one of your friends or someone you know had good luck with it, we will generally prescribe it for you if there’s no medical reason not to. If you have no preference, our doctors will prescribe the approach he or she thinks is best suited to you.

What’s the first step?

     On your initial office visit as a patient, our medical staff will perform a complete history and physical examination with emphasis on issues that may contribute to your weight problem, complete blood tests including a thyroid test and blood sugar level, urinalysis, and an EKG if indicated. Once the best program for you is determined, the doctor and staff will give you all the specific information about that program that you need to get started.

Can I go to more than one Sunrise Health office for follow-up?

     Sure. It’s one of the advantages we offer. If your daily schedule takes you from place to place, just notify your “home office” where you expect to be, and they will forward a copy of your information to the other office.

Questions about our prescription medication programs

What medications are available?

     We use a number of classes of FDA-approved medications. Phentermine and various of its relatives are appetite suppressants and appear to work by altering levels of a brain chemical called norepinephrine. Meridia® is thought to decrease both appetite and food cravings by altering a different brain chemical called serotonin in the brain’s appetite control centers. Xenical® has no effect on appetite. It is not absorbed into the body in significant amounts but instead works directly in the intestine to prevent about 30% of the fat in the food you've just eaten from being absorbed into your body.

     We also use several unusual medications not generally available elsewhere for weight control. This relies on results of research findings from experimental drug trials conducted at UCSF Medical School for which we've helped recruit research subjects.

What side effects can I expect from the medications?

     Any medication might have side effects. Generally, these are not severe. The most common side effect of appetite suppressants we see is dry mouth. Nervousness, insomnia, drowsiness, and constipation or diarrhea may occur but usually improve or disappear within a few days or weeks. The most common side effects of Xenical® is gas and/or diarrhea.

Are there any dangerous side effects of the medications?

     It’s best to assume that all medications might have some dangerous side effects. Medications approved for marketing in the U.S. are expected to be safe for the vast majority of people if used appropriately. In real life, all drug testing is performed on relatively small groups of people for only a few years at most. If a very rare danger exists, it may not make itself known until large numbers of patients have taken the drug for an extended period.

     Rare possible dangers of appetite suppressants include rapid or irregular heartbeats, marked elevation of blood pressure, or psychotic episodes. Safety in pregnancy has not been established for any appetite suppressant . In our many years of experience with traditional appetite suppressants, we have never seen a patient develop a life-threatening or persistent side effect.

     The manufacturer of Meridia® warns of an additional range of possible risks including primary pulmonary hypertension (PPH), worsening of glaucoma, seizures, and mental function. Many of these concerns are strictly theoretical and have not, so far as we know, been observed in test groups.

Do these medications work on everyone?

     No. Being overweight is due to a variety of causes, and no one medication works on every possible cause. The vast majority of our patients placed on them will benefit from them, but there is no test currently available to predict which ones won’t. Trying them is the only way to know for sure.

Do all patients take the same drugs or doses?

     No. All eligible patients are started on small doses of any particular medication. About half require no adjustments and stay on the starting dose. The other half may be adjusted for hunger, lack of response, or presence of side effects.

Will I be on the medication for life?

     Some patients stay at their goal weight after stopping medication, particularly if they maintain good eating and exercising habits. Others may desire or require medications on a continuous or intermittent basis to keep their weight from “creeping.” Starting these medications doesn't mean you must take them forever. You can stop them whenever you want.

Are there interactions with these drugs and others I may be taking?

     A few. So-called MAO-inhibitor anti-depressants such as Parnate®, Nardil®, and others are of concern. New information on drug interactions is reported frequently. You should be sure we know all other medications you are on for this reason.

Will I be completely hunger-free?

     Most patients report far less appetite and fewer food cravings while using appetite suppressants, but some hunger often remains and the need for self-restraint still exists. Xenical® is not a meant to be an appetite suppressant, and its use is not expected to affect hunger or cravings.

Are there medical conditions that prevent the use of anti-obesity medication?

     Yes. Uncontrolled high blood pressure, glaucoma, symptomatic heart disease, and certain forms of depression. Xenical® probably should not be taken in the presence of various intestinal diseases including colitis and diverticulosis.

Why is it important to come in to the office weekly?

     All prescription medications are potentially dangerous. If there is a problem, it’s best to recognize and deal with it immediately. In addition, multiple studies have shown that the drugs rarely work outside of a comprehensive, monitored program. Coming for a visit on a weekly basis strongly influences the likelihood of success.

If I'm sick, should I stop these medications?

     Yes. It's safer to do so. You are very unlikely to regain lost weight while ill, with or without these medications.

How long can I stay on these medications?

     No one knows for sure. The FDA has not approved any weight control medication for more than one year’s administration, but we and many other specialists in the field have had many patients who take medication either continuously or intermittently for many months or years without problems. A genetic tendency to gain weight is presumed to be a permanent part of one's physical and metabolic makeup and would require long-term therapy on that basis.

Are any of the medications amphetamines?

     No. Amphetamines have not been available by legal prescription for decades. Some of the medications we use are mild stimulants (comparable to, for example, caffeine) but none are amphetamines.

Can the medications interfere with sexual function?

     A small minority of patients on appetite suppressants may experience some degree of impotence or changes in libido. This should resolve quickly on discontinuing the drug. Xenical is not known to affect sexual function.

Can these drugs interfere with urination?

     This is listed as a rare side effect of appetite suppressants.

Can diabetics or those with controlled high blood pressure take these medications?

     Usually. Even relatively small initial weight losses while using the drugs can result in surprising improvements in diabetes and high blood pressure.

Is there a problem with anesthesia while taking these medications?

     It is generally wise to discontinue all non-essential medication for at least a week prior to surgery. Your surgeon and anesthesiologist should be informed immediately that you are taking these medications as theirs is the definitive word on whether you should or shouldn't discontinue medication.

Have the medications been approved for prescription in combinations by the FDA?

     All medications we use are individually approved by the FDA. The FDA has never specifically approved or disapproved medications prescribed together unless they are combined in one pill or liquid. For example, penicillin and cough medicine used together has never been FDA-approved or disapproved. The number of conceivable combinations of medications is just too enormous to test them all.

Questions more specific to our OPTIFAST® Program

Will it be hard to eliminate food and stick to this program?

     No, our experience is that it’s much easier than you might expect. There are many advantages to doing things this way. It allows you to stop making food choices, stop worrying about weighing food and figuring out calories, and stop a lot of grocery shopping. Pre-portioned servings, ready-to-drink products, bars, puddings, and soups make this program extremely convenient for you. They are surprisingly tasty and most of them are lactose free.

Can I expect any unusual health problems while on OPTIFAST®?

     Dieting (i.e., reducing calories) in any way at all can cause gallstones or gall bladder trouble. OPTIFAST® is not known to be more or less likely to cause the problem than any other diet regimen. Some people get light-headed when they diet and could possibly pass out and fall down. Other than that, if you are in normal health, OPTIFAST® is generally free of unusual risks. There is a reasonable number of daily calories in this program.

     All product combinations are nutritionally balanced and provide the government-recommended daily values of protein, carbs, fiber, vitamins and minerals. Many patients find they begin to feel healthier even before any significant weight loss.

     The Health Risk Management Division of Novartis Nutrition, the same company that makes Gerber Baby Food, has clinically tested all products and treatment procedures for safety and effectiveness. Each patient completes a clinic visit questionnaire and is seen by our medical staff weekly.

What if I have a special circumstance where I will need to eat regular food? How does that work?

     Regular food of comparable calorie count may be substituted if needed, but there is usually less trouble with hunger during the active weight loss phase if one just sticks with the OPTIFAST® products. The products are easily taken along to any place you have to go.

How do I maintain my weight after completing the program?

     Our ultimate treatment goal is to give you the skills and tools necessary not only to lose weight, but also to manage a healthier weight over time. We know that it isn't easy. We'll continue to support you after your weight loss to help reinforce positive eating habits and lifestyle behaviors. We'll help you right away if your weight starts to creep up again. We'll work with you to determine possible problem areas if things aren't going well. OPTIFAST® has a transition and maintenance phase with many different options and we also have options to offer that aren't part of OPTIFAST®.

Can I be on the OPTIFAST® if I have health problems?

     OPTIFAST patients usually show not only quick weight loss but also improved blood glucose levels, blood pressure and total cholesterol early in the course of treatment. Nevertheless, your health history and any medications you are taking will be reviewed before you are accepted for any of our programs. Our physicians will make individual determinations of the benefits and/or potential risks for you. Once underway, you will be medically monitored regularly to avoid potential problems.

I can get Slim-Fast at the store. How come OPTIFAST® is so expensive?

     Actually, in the past, the OPTIFAST® program was only available at university hospitals and later at local hospitals. Sunrise Health is the only OPTIFAST® provider in most of Northern California other than Stanford University Hospital and Peninsula General Hospital near San Francisco. The cost for the program at our clinics is much lower than the hospital- based programs. OPTIFAST® products are made exclusively from milk protein and are lactose-free, and are even Kosher. This product quality and Novartis’ ongoing research and medical updates, as well as our own expertise and 22+ years of experience provide you with the best and safest program you can get.