I remember Fen-phen
Because I'm both fat and old, I am in a position to refresh your memory. You're welcome.
A note in advance: I’ve used general Google searches, Pub Med abstracts, and Wikipedia to refresh my memory and clear up a fuzzy detail or two as necessary, but all of this is common knowledge, and every search was generated from specific memories of information acquired over decades of being fat—and striving not to be. I’m sure there are far better histories of diet drugs out there, but this is mine.
I remember Fen-phen.
I also remember amphetamines of various legal and illicit types (benzedrine, dextroamphetamine, amphetamine), Ayds diet candy (which first contained benzocaine, which deadened the taste buds, and then phenylpropanolamine/PPA), and fiber pills (anecdote to follow), and Dexatrim (with first PPA and then ephedra).
I remember being at “riding camp” (quite the learning experience, though not concerning horses) and prolonged discussions, sitting on bunk beds, with more sophisticated campers about things like bennies and dexies and their benefits to weight loss (these were probably their mothers’ diet and pep pills, or simply illegal drugs, I suppose—this was 1984). I hope I don’t have to warn anyone of the dangers of the many varieties of amphetamine.
Ayds “reducing plan” chocolates were my Grandma Wittman’s choice throughout the 70s and early 80s. I remember distinctly that us grandkids were not allowed to ask for or eat “Grandma’s Candy,” though I remember doing both (chocolatey, a little grainy).
The AIDS epidemic was the end for Ayds—as well as the fact that in addition to the common side effects of dizziness, anxiety, and insomnia, the main ingredient PPA was causing hemorrhagic strokes (a current Google says the FDA is encouraging its discontinuance for all uses).
There was a fiber pill in the late 80s that was supposedly the secret of French women’s svelte figures (I can’t remember the exact name, there were several versions, and many are still around), which I tried with some success—until the long night I spent curled up on my sophomore dorm room floor, writhing and groaning with abdominal bloating and pain.
[Intuitively, fiber pills make sense, and no big-money drug companies are manipulating the market (though of course, the big-money weight loss industry is in play).
Just a few weeks ago on social media, I saw reference to fiber pills as “the poor man’s Ozempic,” which in this era of retro heroin chic will likely gain hold. Am I tempted to jump on this underdog wagon, despite a clear memory of agonizing pain in my guts? Well, yes.]
Dexatrim was popular for many years. I tried it in high school, but the act of buying it and hiding it (my mother would have had a fit) was too much to sustain. I don’t know if there is a historical or marketing overlap with dexedrine. I do know Dexatrim contained PPA (hemorrhagic strokes…) for a long time.
Then Dexatrim contained ephedra, an extract of ma huang. Ma huang has been used in Chinese medicine for ages, mostly as a tea. I used to drink ma huang tea when I had sinus problems; it was lovely and highly effective, though maybe not good for me, as I have high blood pressure. It had a moment many years ago when it became a popular supplement and pick-me-up, and could be purchased pretty much everywhere, especially in gas stations. Its dangers became most obvious when healthy young people looking for something stronger than caffeine started appearing in emergency rooms with dangerous hypertension and heart attacks. Pseudoephedrine is the manufactured form of ephedra, and it is the main ingredient in Sudafed. Sudafed is pretty much the only decongestant that actually works—but it can’t be taken by anyone with high blood pressure or heart issues, and is now only sold from behind the counter and in small amounts, with an ID, because it can be used to manufacture meth (methamphetamine).
Dexatrim is still around. In most formulas, it contains plenty of caffeine, under the moniker caffea rubusto (coffee). Other formulas contain DHEA, which is a hormone, and the effects on weight loss are dubious and the side effects are numerous and annoying (hair loss, anyone? facial hair in women? acne? insomnia?), if not dangerous, though no one seems to know to what extent.
And then came fen-phen, the early to mid-90s answer to if not out-right obesity, at least the best drug for being “not fat.” It was certainly The Answer for the average woman who wanted to be thin in the original days of heroin chic.
Fen-phen was wildly popular—one of those things people went to South America or Mexico for if they couldn’t get it at the right price from an accommodating doctor here. Of course, everyone wanted to “just be healthy,” to “live longer for my children” (both admirable goals)—and also to be super skinny if possible (just as, you know, a happy minor by-product, barely worth mentioning, really).
Then, it was killing people. Pulmonary hypertension, a horrible thing. Heart valve failures, another horrible thing.
That the danger was surprising is, well, surprising. Both components of fen-phen had been used, with hints and suggestions and evidence of serious side effects, for many (20?) years, and in combination for several years (about 1992 until about 1997).
A few issues, at first, were reported (like, reported in the media, it had gone that far) and openly poo-poo’d by anyone who might do anything about it; then these issues were revealed to be more prevalent, and still, any action was doubted and delayed; then, the issues were reported to have been widely under-reported; and eventually, the shit hit the fan, along with desperate patients/consumers and drug companies/dealers wailing in despair that they hadn’t gotten all of the health and longevity (money and thinness?) that could have been gained from fen-phen, despite the clear evidence that people were dying.
Yes, I remember fen-phen, blow by blow, as reported by Peter Jennings on World News Tonight. I was deeply invested, having been pudgy—>chunky—>fat—>obese—>morbidly obese all my life.
And now, in this era I’ve seen referred to as “the return of heroin chic,” we have Ozempic (Wegovy, Mounjaro, et al)—GLP-1 hormone mimetics (no, I don’t know what that means). Again, as in the earliest days of diet pills and the DHEA era of Dexatrim, these semaglutide products are hormones. I don’t claim to understand their actions, or if they are even hormones or proto-hormones or if they mimic hormones.
I do think they feel like more of the same. And so, I won’t try them, or even give in to being hopeful about them, for a while.
[And now I am caught in a bold-faced lie. I’ve thought about trying them for at least a year, I do think about them all the time, I will continue to be tempted and even hopeful for the foreseeable future. But I will forge on…]
For one, there are known side effects that no one denies. Nausea, gassiness and flatulence, and diarrhea are common. These side effects are said to be tolerable, and go away in time for most people. But my job involves four unrelieved hours at a time in a small room with teenage miscreants. The tolerance for gastrointestinal distress is exactly zero. Then there is fatigue. Would I rather be fat and naturally fatigued, or thin and artificially fatigued? I’m not sure. And then, a rare (but increasingly acknowledged) side effect is gastroparesis—a paralysis of the gastrointestinal system—which is sometimes irreversible.
I think I say no thank you, at least for now, until the risks are more clear. There’s more to know, which I would encourage anyone to explore.
There is so much more that I could say, indeed that I really have to say, at some point—about doctors, health care, my own health, my brother’s death, obesity, and so forth—that is all related and intertwined and so very complicated.
But for now, I just want to say that I remember fen-phen.
If you don’t remember it yourself, and the new diet drugs intrigue you, I hope I’ve spurred you to do some investigating, even if—especially if—you are desperate.
And if you think obese people should now, this moment, take the initiative to try the new drugs, because our lives are at stake—well, look up fen-phen yourself, and some of the history of modern diet drugs, and consider… Our lives are at stake.
If you are taking a semaglutide now, I don’t mean to stand in judgment. I may even admire you, for a courage I cannot muster, in the face of a problem I (and modern medicine) have been confounded by and suffer from terribly.
I’d even be curious how it’s going for you. I haven’t ruled it out for myself.
But I remember fen-phen. I don’t want it to be a case of Remember the Alamo.
Thoughtful. So many people who are not really obese have taken this drug, including my nephew and his wife. I feel like it is way overused. And I love what you say about faux concern over "health." ;-)