Approved by the Board: October 18-19, 1999 Board meeting

Service Area: Medical

Subject: Obesity, Treatment of

From time to time the Board receives inquiries from physician licensees regarding the prescribing of medications in the treatment of obesity, a severe medical condition afflicting many South Carolinians. This brief communication is designed to address that issue.

The Board recognizes that obesity is a condition which affects millions of people in the U.S. and causes or exacerbates a variety of medical problems that contribute to a great deal of suffering. Further, there is a tremendous amount of research and product design devoted to this rapidly changing area of medical practice. Nonetheless, the Board believes that there are general and specific points that physicians should consider.

First, in determining the standard of practice for the treatment of obesity, the Board will continue to focus on the same concerns it has in other areas of practice. The Board's primary concern is the provision of safe, quality medical care including but not limited to the following: appropriate performance of an appropriate physical and psychological evaluation, appropriate laboratory testing, discussion of treatment risks and benefits with the patient. Follow-up care, monitored prescribing practices, and maintenance of proper medical records. In devising an appropriate treatment plan, the physician is encouraged to consult the medical literature regularly. In this regard, the Board recommends review of "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults", published by the NIH and available on the internet at http:/ /www.nhlbi.nih.gov/index.htm.

Second, the Board recognizes that pharmacotherapv is but one small area of the comprehensive treatment of the obese patient. However, the Board understands that controlled substances are subject to abuse by individuals who seek them for other than legitimate medical purposes. There is continued concern about the inappropriate prescribing of controlled substances in bariatric medicine, just as in other practice areas. Therefore, it is incumbent on the physician to be vigilant in the proper use of these medications. In that regard, physicians are reminded of the following excepts of current South Carolina Law:

The South Carolina Controlled Substances Act. Section 44‑53‑360(c) provides in part: A . . . No practitioner shall dispense any controlled substance outside of a bona fide physician‑patient relationship. No practitioner shall dispense any controlled substance for any use other than the uses approved by the Food and Drug Administration . . .@ (emphasis added). Most appetite suppressants have only received FDA indication as a short term adjunct in treatment of obesity.

Furthermore, the Medical Practice Act, Code 40‑47‑65, specifically prohibits the use of some Schedule II substances (namely amphetamine, methamphetamine, their salts and isomers), for the treatment of obesity.