It was like being on meth. That’s how Brittany describes the sudden surge of energy that had her crushing it at work and deep-cleaning her house, euphorically scrubbing down walls and scooping up cat litter.
But that wasn’t even the best part. The best part, according to Brittany, was the 35 pounds that “just melted right off” her 5'3", 165-pound frame. It took less than three months to shed the weight, and she never even had to step foot in the gym. Instead, she ate whenever she was hungry—it’s just that she was never hungry. At meals, she could usually stomach three or four bites before feeling full. Otherwise, she mainly subsisted on grapes and Diet Dr. Pepper.
Brittany, who lives in California, wasn’t on a low-carb diet or trendy mindfulness plan. Instead, she’d started taking diet pills: phentermine, to be exact, a prescription stimulant and appetite suppressant that she’d heard would help her drop a few sizes effortlessly. “My family doctor gave me a three-month prescription,” she says. “I was a little nervous about the side effects—I had read that it wasn’t great for your heart—but my excitement to lose weight trumped all those anxieties.”
When she first started popping the mint-size meds, Brittany noticed that her heart would race on and off for hours and she’d feel weirdly antsy. This made her uncomfortable—until, just weeks later, she put on a pair of shorts. “I had always been so insecure about my legs,” she says. Now, she thought she looked good. And well, that made her heart race too.
Before the rise of body positivity and the anti-dieting movement, there was just dieting. In the ’90s, when waifish Kate Moss ruled the runways, thin was in, and the tic-tac-clack of weight-loss pills rattling around in women’s purses was practically a status symbol. Everyone was particularly obsessed with a combo drug called fenfluramine-phentermine (more popularly known as fen-phen). Marketed as a weight-loss miracle, the drug helped users lose an average of 30 pounds in just a few months. It became a total sensation in the media, attracting such a cult-like following that in 1996, its year of peak use, 18 million prescriptions were written for it. But despite its catchy nickname and miraculous fat-evaporating abilities, the too-good-to-be-true pill did indeed prove to be too good to be true.
Fen-phen was shown to cause heart valve problems in up to one-third of people who used it, in addition to a potentially fatal lung condition called primary pulmonary hypertension (PPH). By 1997, the FDA had banned fenfluramine, one of the two drugs contained in the combo, and yanked fen-phen from the market. But not before thousands of people suffered serious side effects and even died, including Mary Linnen, 30, of Massachusetts, who was dead from PPH just 10 months after taking fen-phen to lose weight for her wedding. Tens of thousands of legal claims were filed against the makers and distributors of fenfluramine, with pharma company Wyeth ultimately setting aside $21 billion for payouts.
The fen-phen scandal was sufficiently shocking that it scared many women off of weight-loss drugs entirely, in addition to causing doctors to become skittish about handing out prescriptions. The FDA didn’t approve any new diet drugs for a decade. Instead, women begrudgingly returned to exercise and fad eating plans like the South Beach Diet (2003). Eventually, a burgeoning “wellness” mega-trend replaced calorie-counting with a Goop-ish regimen of Spin class, green juice, and “self-care.” Nowadays, women meditate and preach body positivity and supposedly eat “clean” to gain strength and mental clarity, not a six-pack.
Oh, and they still take diet pills too.
Phentermine, as it turns out, never went off the market. It has been low-key available on its own ever since fen-phen was pulled. And young women are taking it—even if they’re out here on Insta extolling the powers of Peloton. The most recent FDA study, from 2016, found that more than 25 million prescriptions for phentermine were dispensed between 2008 and 2011 (65 percent of those were to women between the ages of 17 and 44). And the number of prescriptions doubled between 2007 and 2017, according to the health care data company Iqvia. “Women are taking phentermine,” says Alicia Mundy, author of Dispensing With the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle Over Fen-Phen. “They just don’t want to talk about it because it’s not a shiny new thing like the keto plan or intermittent fasting.”
Taken solo, the phen half of fen-phen doesn’t melt pounds quite as miraculously as the infamous super-drug, but it’s still an effective appetite suppressant, helping users lose weight without having to lift a dumbbell. Doctors believe it works by targeting the hypothalamus (the part of the brain responsible for satiety) and boosting neurotransmitters that help minimize hunger and cravings.
Rebecca Scritchfield, RDN, a registered dietician nutritionist who runs a body-positive anti-dieting nutrition group in Washington, D.C., says there’s a real stigma around admitting you want to lose weight nowadays, let alone that you’re doing it with diet pills. This has driven phen users underground, to a network of online health and fitness message boards where they can anonymously share doctor recommendations and compare doses with their “phrend friends.”
Are you on the butterfly-shaped pill or the white-and-blue speckled oblong one?
My doctor told me she would never take it herself and made me sign a consent form, but I’m losing weight like crazy.
Really works. I have to remember to eat.
Stacey*, from Southern California, got on phen last summer, after she’d compulsively overshared on social media in a bout of tiredness and unhappiness. My bod is a mushy mess. Help! Publicly, she received comments like, “Love your body!” “Don’t worry about the number!” “As long as you’re healthy, that’s all that matters!” But she got multiple DMs telling her about a local weight-loss clinic that prescribed phentermine, a drug that could supposedly make her skinny fast.
By then, Stacey had already tried Weight Watchers, now WW, which always left her feeling “hungry and tortured,” as well as boutique fitness studios, but her schedule made it hard to find the time. And anyway: $40 classes where everyone wears $100 yoga pants? With wannabe fitness influencers doing crunches next to her?
She got the pills.
Not six months later, she was down 60 pounds and wearing her skinny jeans. “I did nothing and the weight just…went away,” Stacey says, in wonder and amazement. “It was crazy.” Most people in her life still think the results happened because—wellness! She had her mother-in-law believing she’d cut out soda and swapped bread for lettuce wraps. Amid all the attention and compliments, Stacey couldn’t bear to come clean: “It seemed embarrassing to me that all the effort I’d put in at the gym and with my diet wasn’t cutting it,” she says, “and that I couldn’t lose weight the way that everyone else was.”
It was five months after Stacey swallowed her first phen that she passed out. She was at a bar with friends, one of whom caught her in his arms. She came to quickly—and immediately suspected the pills.
By then, there had been other strange things happening to her, including clumps of hair falling out in the shower (hair loss is not a direct side effect of phen but can result from nutrient deficiency) and a hip that had become weirdly numb. The symptoms were so pronounced that for months, she’d been joking with a close friend that her diet pills would kill her.
Now, the joke seemed anything but funny. Stacey started questioning whether the satisfaction of wearing her skinny jeans was really worth the risk. She decided, reluctantly, that it was not. “I emailed my doctor the next day and said, ‘I’m getting off this stuff,’” she recalls. “‘I don’t want to die from taking diet pills.’”
The new embrace of weight-loss pills by a generation that doesn’t remember fen-phen poses dangers, according to some doctors. Phentermine may seem like an easier fix than eating “clean” and working out, but the amphetamine-like drug—which, far from being a shiny new therapy, was first approved by the FDA in 1959—has serious known side effects. These include heart palpitations, high blood pressure, and PPH, not to mention sleeplessness, nervousness, and constipation. That the risks aren’t as pronounced as they were with phen-fen doesn’t mean they should be ignored.
“Phen isn’t just speeding up your metabolism, it’s speeding up every part of your system—your breathing, your heart rate,” says Donna Ryan, MD, a professor emerita at Louisiana State University’s Pennington Biomedical Research Center and president of the World Obesity Foundation. “And that can lead to problematic side effects.”
The drug is FDA-approved only for people considered obese by the CDC (e.g., with a body mass index of 30 or higher) or who are overweight (BMI of 27+) but with additional health reasons for needing it (pre-diabetes, for example). In other words, it’s for people facing a true health crisis, not just a bachelorette party in Miami. “There’s too much potential risk to ever use phentermine for aesthetic purposes,” says Dr. Ryan. “Only when you’re treating for a health benefit can we tolerate a little risk.”
Even then, the FDA recommends that anyone taking phen should first undergo a series of tests, including cardiac screenings, to determine if their heart is healthy enough to handle it. Once on the drug, patients should be closely monitored on a weekly basis by a doctor for high blood pressure and other adverse effects. And they’re supposed to take the meds for 8 to 12 weeks max, alongside a nutrition program—not indefinitely.
The problem is that many more women want to take phentermine than should technically be on it—and doctors are giving it to them, says Melina Jampolis, MD, an internist and recent past president of the National Board of Physician Nutrition Specialists. Brittany’s physician prescribed it to her despite the fact that she didn’t medically need it. “A lot of doc-in-the-box clinics”—sometimes called weight-loss clinics—“will provide it to anyone who will pay money,” says Dr. Jampolis. (The pills usually run $10 to $20 a month, earning them the nickname “cheap speed”; some insurance plans will cover phen.)
Even doctors who prescribe the drug only to patients who really need it may not monitor these patients as closely as they should. Stacey’s doctor let her stay on phen for five months, which is a month longer than the 12 weeks stipulated by the FDA. Brittany’s doctor gave her a script without requiring her to come back for so much as a single checkup. “My doctor didn’t give me any tests and I wasn’t monitored at all,” she says. Her heart often felt fluttery while she was on it, like paper blowing in the breeze: “That did freak me out, but nothing else worked.”
Overprescribing is a common problem in modern medicine—and is not limited to diet pills (see: the opioid epidemic). “It’s easier to prescribe a pill than talk about changing habits, so that’s what a lot of doctors do,” says Ari Levy, MD, founder and CEO of Shift, an integrative health and wellness practice in Chicago. (Dr. Levy himself does not prescribe weight-loss medications, focusing instead on nutrition and exercise.)
And anyway, for some women, phen really is a lifesaver: LaNise was over 200 pounds with high cholesterol and sleep apnea when her doctor put her on it for a short period of weeks to jump-start her weight loss. She was monitored closely the whole time and now maintains her weight with nutrition and exercise. “I’m no longer at risk for diabetes,” she says.
But women who misuse the drug can be upping its potential danger. “People on phentermine should take the lowest dose possible, but many women will increase the dose to produce more weight loss,” says Dr. Ryan. “This is bad. Increasing the dosage does not produce more weight loss, but it produces more side effects.”
Phentermine can also be hard for some women to quit. The pounds pile right back on once you wean off, says Dr. Jampolis, unless you use the pill in combination with exercise and a healthy eating plan. And for those drawn in by the promise of effortlessly slipping into a size zero, the buzzy thrill of being on an upper can sometimes feel even harder to give up. “Part of phentermine’s popularity is that it’s a stimulant, and some people like that feeling,” Dr. Ryan says. It’s part of a class of drugs that has been shown to have potential for addiction.
Some women whose doctors cut them off turn to the black market to get their fix, ordering pills off the internet. A 2017 Atlanta Journal Constitution investigation alleged that a high-profile local weight-loss doctor had prescribed phentermine based on online requests from people she had never met in person—and charged them three times the normal cost. “You can easily order this stuff online,” says Julie Friedman, PhD, national senior director of the binge-eating treatment and recovery at the Chicago-based Eating Recovery Center. “I talk to women who do it all the time.”
One Miami pharmacist received a nine-year prison sentence after he wrote prescriptions for phentermine to anyone who answered an online questionnaire—and one of his “patients,” states away in Texas, died of an overdose.
To help curb overprescribing, physicians in Ohio are now forbidden from giving out any weight-loss drug in a manner contrary to the FDA label. Those who do risk losing their medical license and being charged with a felony. Tennessee does not allow doctors to prescribe phentermine (and other amphetamine-like substances) without prior approval from the state board of medical examiners.
“The problem is our culture—women still want to lose weight,” says Scritchfield. Despite all the focus on wellness and body positivity and the trendy self-care posts on social media, “there is still a lot of body hatred happening,” she says, “and popping a pill provides quick relief.” Adds Dr. Levy, “Society still places a disproportionate emphasis on unattainable images.”
And anyway, the tyranny of wellness culture has become its own impossible ideal. You can spend hundreds of dollars a month on Moon Juice smoothies and chakra-based dieting plans—or $20 on a bottle of pills that will definitely work. Which would you choose?
Stacey, while now mostly phen-free, admits to keeping a small stash of meds on hand to help stop her from indulging in cake and pizza at birthday parties.
As for Brittany, she and her husband moved, and she found herself states away from her phentermine-friendly doctor. Within months, she had gained all the weight back. When she went to a new physician and asked for a prescription, he refused and told her there were “better, old-fashioned ways” to lose a few pounds. That was a few years ago. She’s still trying.
*Name has been changed.
Leslie Goldman, MPH, is a freelance writer specializing in health, women's issues, and parenting. She is a regular contributor to Cosmopolitan, O, The Oprah Magazine, Women’s Health, Parents, and more. Follow her on Twitter @lesliegoldman.
