ASIA!

In 2004 the Hong Kong Association of Obesity made an interesting discovery: it found that the men in Hong Kong had been getting fatter since the early 1990s, while the women had been getting slimmer. Three years later it finally discovered why. It seems that Hong Kong women are addicted to popping pills to lose weight and some have carried it to a dangerous extent.

According to the Hong Kong Society of Hospital Pharmacists (HKSHP), many private doctors have been dispensing phentermine, a prescription-only pill, rather indiscriminately.

Phentermine is an appetite suppressant. It is chemically similar to amphetamine, a popular stimulant or "upper". Going by HKSHP’s findings, some 6,000 to 10,000 people in Hong Kong are taking phentermine every day. Nearly everyone gets their phentermine from doctors in private practice. In all, some 100 private doctors dispensed some 2.7 million pills last year, accounting for 99.7% of all the phentermine used in Hong Kong. This averaged 27,000 pills per doctor per year, or some 74 pills a day, assuming the doctors worked every day of the year.

This may sound like a lot. But there are reports to suggest HKSHP has erred on the side of caution. By some estimates more than 400 doctors are in the same game, though the pills they gave out may not be the real phentermine, despite what it may say on the label. In all more than 10 million real and fake phentermine pills could be dispensed a year in Hong Kong.

Phentermine is a generic drug. It can be produced by anyone. Many of the phentermine pills sold in Hong Kong are made in China, under dubious, if not non-existent, safety standards. China is believed also to be the main supplier of fake phentermine pills that are sold at a fraction of the price of the real pill.

Taking fake phentermine is obviously risky. But there are risks taking real phentermine as well. As an appetite suppressant, phentermine acts on the nervous system. It can cause high blood pressure, palpitations and insomnia, like its cousin amphetamine.

"We found out that family doctors are prescribing phentermine irrationally. It's moving in the direction of abuse," said William Chui Chun-ming, HKSHP's education director. He added that some people were hospitalised after taking the drug.

"Phentermine affects blood pressure and heart rate. If you have potential cardiovascular disease, it will worsen your condition. It can worsen your arrhythmia, and if your blood pressure increases, you can suffer from a stroke," he explained. Chui said phentermine is popular because its effect is visible. Taking the pill can lead to weight loss of one to two pounds (0.6 to 1.2 kg) within a week.

Another reason is that it is cheap, a major factor for price-conscious Hong Kongers. There is another appetite suppressant in the Hong Kong market, sibutramine, which is patented. This makes it more expensive. Compared to phentermine, sibutramine has fewer side effects, but phentermine is prescribed twice as often as sibutramine in Hong Kong.

In the US, a prescription is not enough for phentermine. Under Food and Drug Administration rules, phentermine can only be given to people who are obese, or with a Body Mass Index (BMI) of 30 and over. And it must be accompanied by exercise and proper diet control. In Hong Kong, a skinny girl can get the pills as long as she can pay a doctor to write her a prescription.

The Hong Kong Health Department, which virtually lost the esteem of the people through the way it handled SARS and the avian flu outbreaks, tries hard to talk its way out of being involved in this growing scandal. According to their spokesman, importers of phentermine as well as doctors and pharmacies are required to keep records of dispensing the pill for up to three years. In the past three years, the authority had successfully prosecuted eight parties for illegally selling phentermine and fined them, he said. He did not mention whether his department was going to do anything about phentermine abuse.

William Chui is carrying on a campaign against the pill. He says Hong Kongers should rely less on pills and lose their weight in the tried-and-tested way of exercise. Exercise is simply not the lifestyle of most of the 6.5 million living in the territory. And obesity has become a growing problem. A study by the Hong Kong University with the health department on 8,327 children born between April and May of 1997 (two months before the territory was handed back to China) found, at age seven, some 30% of them were already considered fat or obese.

The problem about Hong Kongers, said Gary Ko Tin-choi, vice president of the Association of Obesity, is that those who need to lose weight are not concerned about their obesity, while those who do not have a weight problem are driven by slimming advertisements to lose weight.

As a result, many have suffered eating disorders such as anorexia. Advertisements typically feature slim women who have become role models for Hong Kong females. Thin is so “in” that when actress Myolie Wu put on 20kg to do a comedy serial, she made headlines. No wonder the pushers of phentermine find a ripe market in Hong Kong.