Weight control is the cornerstone of therapy for both primary and secondary prevention of cardiovascular disease. Standard diets and exercise strategies have had limited efficacy because of low rates of long-term success in sustaining weight losses of 5% to 10% of initial body weight beyond 6 months. The use of appetite suppressants, which typically work on the hypothalamus, to decrease food intake can potentiate weight loss as long as treatment is sustained; however, weight is quickly regained on cessation of the agent. These drugs are also fraught with side effects such as blood pressure and pulse elevations, anxiety, and insomnia and thus can be extremely difficult to use, especially in patients with cardiovascular disease or risk factors. With a high BMI (class V obesity) and comorbidities such as hypertension, sleep apnea, and type 2 diabetes mellitus, the patient in this Clinician Update is certainly at increased cardiovascular risk. One of his prescribed medications, phentermine, acts primarily as a norepinephrine-releasing agent and centrally suppresses appetite in the hypothalamus. Because of its amphetamine-like actions, it also exerts peripheral effects of pulse and
