Mary Linnen wanted to lose weight for her wedding. She never made it down the aisle.

Though deep in planning her 1996 wedding, Mary Linnen held off on one crucial detail: the dress.

The 29-year-old wanted to lose some weight first — nine kilograms, or so.

Her doctor had prescribed her 'fen-phen', a popular combination of the diet drugs fenfluramine and phentermine. 

These medications were approved and prescribed separately in the US in the 1980s, but in 1992 a University of Rochester report indicated they were more effective and had fewer side effects when taken together. Despite the combination not being formally approved, doctors prescribed the hyped, fat-melting, 'miracle' cocktail to millions of people in the 1990s. 

For Mary, it proved fatal.

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After just 23 days taking fen-phen, the Massachusetts woman became ill with what was ultimately diagnosed as primary pulmonary hypertension — a condition that makes it difficult for the heart to pump blood through the lungs. 

Though she stopped the medication, her symptoms escalated. She died in February 1997, gasping for breath.

"Instead of walking down the aisle before a bride," her mother told AP at the time, "I walked behind a casket."

Later that year, a Mayo Clinic report linked fen-phen to 24 cases of heart-valve damage, of which PPH can be a consequence. Dozens more cases were subsequently reported America's drug regulator, and fenfluramine (the 'fen' part) was removed from the market.

The case sparked a class action lawsuit against Wyeth, the drug's manufacturer the States. It involved more than 175,000 claims and led the company to set aside US$21 billion for payouts.

In the years since, a number of other weight-loss drugs have been pulled from the shelves. But others have overcome the stricter hurdles necessary to make it to market.

Weight-loss medication today.

Weight loss medications are commonly prescribed in Australia as a useful aid in the short-term management of obesity — a condition that affects one in three adults.

Four are approved for this purpose: Saxenda, Xenical, Duromine and Contrave.

They work either by limiting fat absorption or suppressing appetite, and each have varying potential side effects, including gastrointestinal problems, heart palpitations, insomnia and headaches.

Doctors prescribe these medications for people with a body-mass index over 30 (the threshold for obesity), or people with a BMI of 27–30 who have weight-related conditions such as pre-diabetes, type 2 diabetes, high blood pressure, high cholesterol or sleep apnoea.

They aren't miracle drugs, nor are they a replacement for diet and exercise. Rather, they're prescribed as an extra tool for those who haven't achieved results via traditional methods alone. 

The results are moderate. Over 12 months, these medications lead to an average weight loss of 4-6 per cent above behavioural intervention alone.

And the cost can be prohibitive. None of the four approved medications are subsidised by the Pharmaceutical Benefits Scheme, meaning the patient must foot the entire cost, which ranges between roughly $100 and $400 per month.

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Because of this, a number of people turn to over-the-counter supplements and herbal medicines that are marketed as weight-loss aids, but there is no reliable evidence that they are effective. 

Others source weight-loss pills online from overseas retailers. But the Therapeutic Goods Administration strongly warns Australians against purchasing weight-loss products from international suppliers, as they can contain harmful or banned ingredients:

"Analysis of seized products by the TGA Laboratories has found products that contain contaminants such as heavy metals or undisclosed pharmaceutical substances, including: Sibutramine and Phenolphthalein."

Both of those substances were withdrawn from the market in the 1990s after being linked to increased risk of heart attack and cancer, respectively.

Like all chronic conditions, obesity requires a long-term management using a variety of treatments. As endocrinologist Associate Professor Katherine Tonks previously told Mamamia, a tailored approach is best.

"We can go through strategies for weight loss, check for hormonal contributors to weight gain, and check for the metabolic complications that can occur when your weight is higher. We can also prescribe medications that can assist with weight management, and discuss surgical weight loss options as well."

The above is general information only and should not be substituted for professional, personalised medical advice. If you’re concerned about your health, or wish to discuss weight loss, please consult your GP or a medical professional. 

Feature image: Getty/Mamamia.