This patient was unable to tolerate one of the pharmacotherapeutic options for obesity treatment because of its common sympathomimetic cardiovascular side effects. Unfortunately, many of the medications for obesity have undergone intense scrutiny because of potential cardiovascular and other side effects and have come up short when evaluated for health risk versus benefit. Phentermine was approved for weight loss by the Food and Drug Administration (FDA) in 1959 for short-term (12 weeks) treatment of obesity; long-term studies are unavailable.7 It was combined with fenfluramine in a popular combination termed “phen-fen” until concerns about valvulopathy prompted the FDA to withdraw fenfluramine from the market in 1997. Another agent for obesity, sibutramine, approved in 1997 for long-term use, was withdrawn from the market recently after a study of subjects with preexisting cardiovascular disease, type 2 diabetes mellitus, or both showed increased risk of nonfatal myocardial infarction and stroke with treatment for a mean duration of 3.4 years.8
