Your Opinion
I believe you are confusing rimonabant with orlistat. I have not heard of any plans to take rimonabant OTC. In fact just recently the FDA refused to approve it for use in the United States. And the horrible picture of side effects you presented certainly does not apply to most people that choose to take orlistat and not at all to those that take rimonabant. And remember, if someone does have serious or distasteful side effects they can stop the medicine. No one is forcing them to take it.
But regardless of the medication, consider if your argument regarding obesity was made towards hypertension, high lipids, diabetes, cardiovascular disease or any other disease that can be modified, treated or prevented by lifestyle interventions. Your argument is that, as you are proposing for obesity, we should not treat them with proven effective medications because we know if they could make themselves change their diet and exercise patterns that most would not need to use the medicines.
The problem is that while diet, exercise and other lifestyle interventions are very effective no one has figured out how to actually efficiently change behavior in our large populations of obese patients. Presuming the interventions in the book you are trying to sell are effective (and I have no knowledge to either support or criticize your approach), how many people in your wildest dreams will you be able to impact? ½ Million, 1 Million, 5 Million? What about the 100 Million plus other people in the United States that need treatment for Obesity.
As a Preventive Medicine physician I ask why not take an inclusive approach? We all know that living a healthy lifestyle is the best approach to preventing disease and that changing to healthy lifestyle will solve many of the problems associated with a previously unhealthy lifestyle. Let us encourage and teach at every possible societal level these healthy lifestyle skills. But let’s not ignore those that need help now. Someone with a recent MI cannot afford to wait for their blood pressure to come down from lifestyle changes without risk further heart damage. If they have diabetes they must get their sugars under control quickly. If they are obese they must get their weight down as soon as possible. This usually requires medications but also requires learning a healthy lifestyle to maintain and support all of those changes.
To do otherwise is to simply say to an obese patient that because you have not been able to make significant enough lifestyle changes you will die sooner than the person that is doing both the lifestyle changes and taking the needed medications.