[aabajian]

Amphetamines were popularly used to suppress appetite in the mid-20th century, but addiction and abuse proved disastrous.

He glosses over amphetamines. They are highly effective at weight loss. So much so that ADHD patients have the stereotypical "Adderall skinniness" after 1-2 years of use. Addiction is a problem with stimulants, but psychiatrist routinely assess for addiction in the ADHD population. Why not prescribe Adderall for weight loss and similarly monitor those patients?

Which is better? A BMI of 40+ or a BMI of 25 and taking a daily stimulant?

The FDA agrees with the latter in at least one case. In 2015, the FDA approved the amphetamine lisdexamfetamine (brand name Vyvanse) for the treatment of binge-eating disorder.

[darekkay]

> Which is better? A BMI of 40+ or a BMI of 25 and taking a daily stimulant?

That's a false dilemma. You would have to be certain that "A BMI of 25 without taking a daily stimulant" cannot be achieved. Otherwise, that's the third option to consider.

[willsun]

Certainly abuse and addiction management has improved since the 1960s - but companies have struggled to get more stimulants to market because of other side effects as well (e.g. fenfluramine was quite effective, but withdrawn in the 1990s since it was found to cause heart valve disease / pulmonary hypertension). At this point, broader adoption of medications seems to be blocked by a combination of physicians choosing not to prescribe, payers unwilling to pay (e.g. $300/mo indefinitely), and patients who don't like the non-trivial side effects of existing options. Perhaps future drug discovery will alleviate these issues.

[batiudrami]

I have lost kilos post raves just from not being inclined to eat for days afterwards, but even just a dexie leaves me feeling scattered and non functional the day after. I assume you adjust to ongoing rather than occasional usage?

[azeirah]

I've been on a low dose of Ritalin for about half a year now, I experience very few side effects, but appetite inhibition is definitely a thing.

Even after half a year, it has barely changed at all. I usually don't really feel hungry until I'm at the point where I get a bit lightheaded because I haven't eaten for too long.

The most annoying part isn't even the inhibited hunger impulse, it's that even if I take that into account, and plan my meals accordingly, I don't really feel like eating much, and I'll eat like you would if you were daydreaming about a potential lover.

The most effective solution I've seen so far is to not chain the doses like it's usually advised, ie, one pill every four hours, but to plan your meals and your pill timings such that you'll eat when the medication is wearing off. It's annoying, because of course this half-hour to hour period after medication wears off is very annoying, but it's the better alternative, especially if you take into account that Ritalin has a more stable and gentle impact if you take it on a full stomach.

Taking Ritalin on an empty stomach is like drinking two double-espressos on an empty stomach after a bad night's sleep, right after you wake up. :c

[a_f]

I believe there is a significant risk of heart conditions arising from stimulant use.