Slim Hopes?

At a Westside school, mothers laugh knowingly when their watch alarms beep in unison at the morning PTA meetings. “Fen-phen time,” they chorus.

At Los Angeles doctors’ offices, even patients who usually push for natural remedies are increasingly asking, “What about fen-phen?”

And at an upscale Orange County hair salon, Cindy finds herself explaining to clients how fen-phen helped her lose 23 pounds in three months.

If someone you know has slimmed down recently after years of trying, chances are--especially if they live in Los Angeles--they are on fen-phen, the weight loss program using the prescription appetite suppressants fenfluramine and phentermine.

Ever since the 1992 publication of a University of Rochester study, in which Dr. Michael Weintraub combined the two medications and achieved long-term success, doctors have been taking another look at diet pills. Fen-phen clinics have been springing up alongside university-based programs. One Southern California-based chain says it has treated more than 30,000 people. A UCLA-based program counts 750 graduates. Family practice physicians, gynecologists and other specialists, meanwhile, have incorporated fen-phen programs as profit-boosters.

Fen-phen is now hot, hot.

“It’s allowed me to take better control of my life, my exercise, my eating habits,” says Nathan Friedman, 35, a Glendale tax consultant who eats 1,000 calories a day and works out. In a year, his size 54 waist has shrunk to 34; his 6-foot-2-inch frame has dropped 152 pounds, down to 222.

Says Cindy, 23, the 5-foot-4-inch Orange County hairstylist who dropped from 159 pounds to 136: “This is the first thing that has ever worked.”

But Arlene Moody, 51, a West Los Angeles businesswoman who lost 31 pounds in seven months, says the program is not easy. “You have to work at it. They are not miracle drugs by any stretch of the imagination.”

Some doctors--including Weintraub--say the drugs are being overprescribed.

Lung specialists worry about an increased risk of primary pulmonary hypertension, a potentially deadly lung disorder, although they concede the risk to an individual patient is small. The most common side effect is dry mouth. Other possible side effects of fen-phen include depression, insomnia, fatigue, diarrhea, blood pressure increases, a feeling of “spaciness” and, in a small number of patients, short-term memory loss.

Still, some weight loss specialists are already offering dexfenfluramine (Redux), a newly approved diet drug--and cousin of fenfluramine--which might be more effective in some patients.

Careful selection of patients for a fen-phen program coupled with close monitoring are the keys to success, says Dr. Morton H. Maxwell, clinical professor of medicine and director of the University Obesity Center at the UCLA School of Medicine. The regimen has been offered at UCLA since 1993 and now draws 70 new patients every month.

The UCLA program, including a satellite clinic in Sherman Oaks, incorporates patient education, nutritional counseling and support groups. The first steps include a medical history and physical, followed by lab screenings and electrocardiograms. Patients see a doctor at least once a month; lab work and EKGs are repeated every eight weeks.

But figuring the best dose of fen-phen for each person can be tricky.

“Everybody metabolizes these differently, and we don’t know much about the receptors in everyone’s brains,” Maxwell says. The two drugs work together. “Phentermine works in the brain and releases noradrenaline,” Maxwell says. “It prevents its re-uptake, and you get a high level. When that happens, you get a lower appetite. It works in the hypothalamus, which is the appetite center.”

Similarly, fenfluramine raises serotonin levels, decreasing appetite and increasing feelings of fullness. (Increased serotonin generally improves mood, but doctors don’t know why some fenfluramine users get depressed.)

“We start at a tiny dose,” Maxwell says, “a dose you can’t even buy in the drug store--8 milligrams of phentermine and 20 of Pondimin [fenfluramine).” After a three- to six-week adjustment period, the correct dose is usually established, Maxwell says, and no tolerance develops.

But the correct dose is just part of the story.

Patients are encouraged to cut calories and fat--sometimes easier than dieters ever believed. “You’re so un-hungry,” Cindy says.

Drinking water, four to six glasses or more a day, gives a feeling of fullness and combats dry mouth. Alcohol use is discouraged, Maxwell says.

“We suggest exercising 30 minutes three times a week,” says Dr. Donald Jensen, founder and president of Manhattan Medical Weight Control. But, he adds: “I think most do not exercise.”

The weight loss goal should be slow and steady, says Maxwell: 1% of body weight per week. A 200-pound person, for instance, should aim for a two-pound weekly loss.

The UCLA program charges $285 a month and $50 per month while on maintenance, which is suggested for six months. At private clinics, a start-up fee of $65 or more and a weekly fee of $35 are common.

About 97% of patients lose some weight, estimates Jensen of Manhattan Medical, but he won’t have hard and fast numbers beyond that for six months.

At UCLA, of 115 patients analyzed so far for a year, 68% achieved success, Maxwell says, defining it as reaching a desirable goal weight. “Our patients lost 18% of body weight [on average] at the end of a year.”

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Not everyone, however, is singing fen-phen’s praises.

Weintraub, now a director of a Food and Drug Administration drug review office, complains that “the medications are being given to the wrong people,” saying that the regimen is meant only for those 30% or more over ideal body weight.

Yet, stories about women in search of fen-phen--with only 5 or 10 pounds to lose--are common. (Women make up 80% of fen-phen patients, doctors say.)

But Maxwell points out that even mild obesity can pose health risks.

The most serious concern is the fear of increased risk of primary pulmonary hypertension, or PPH, in which small arteries inside the lungs thicken and pressure rises, causing shortness of breath and exhaustion and sometimes necessitating a lung transplant. PPH is very uncommon, affecting about two people per million. In the United States, 250 to 500 people are found to have PPH each year.

But physicians say they don’t have enough information yet to pinpoint its incidence in fen-phen and dexfenfluramine users. A case-control study involving 1,000 PPH patients in four countries compared the relative risk of contracting the disease in patients who did and did not take dexfenfluramine, says Dr. Lewis Rubin, professor and head of pulmonary medicine at the University of Maryland School of Medicine in Baltimore and a leading authority on PPH who participated in the research.

“The relative risk among diet pill users was in excess of 20 times the risk” of those PPH patients not on the pills. The risk is still termed “small” by Rubin, who says PPH is not usually reversible.

Some patients believe the side effects aren’t worth the payoff of weight loss.

Michelle Sinnette, 22, learned her lesson after the fact. The Southern California massage therapist dropped 28 pounds while taking the diet pills but won’t use them again. “I had jittery hands, cold hands and feet, sweaty hands for no reason. I was moody and depressed. I had a fast heart rate and headaches.”

But a 50-year-old Los Angeles attorney in a high-profile, demanding job has stayed on fen-phen for more than a year despite side effects. “It lowers my anxiety level to the point that I’m not as productive. I don’t get my work out as promptly and I am not as mentally quick.”

But the attorney is not about to give up the fen-phen. After all, it is the only diet that has worked this well, this long.