Drugs and Obesity
Thin is in, in America. Not only fashion magazines, but also doctors proclaim the importance of a slim, healthy body. Yet despite the current obsession with the trim, taut and terrific body, Americans are putting on weight. In studies conducted in 1980, one quarter of Americans were found to be overweight. Fifteen years later, that number had risen to one third of the population.
In the past, doctors have always recommended a combination of diet and exercise to combat obesity. With the increase in the number of people who are overweight, however, this solution is increasingly being seen to be ineffective.
Given that diet and exercise often do not help produce weight loss, scientists are becoming convinced that, for many, obesity is a genetic disorder. In 1994 a research group at Rockefeller University discovered in experiments on mice what is now called the obesity, or "ob" gene. In turn this discovery led to the identification of a hormone, termed leptin, that signals to the brain the amount of fat stored in the body. When injected into the rodents, the hormone reduced appetite and increased the body's utilisation of calories, the energy produced by food which the body may convert to fat. With findings like these, a large number of medical experts are turning to a selection of drugs which appear to be safe and effective in reducing weight and maintaining lower weight levels.
Because they see obesity as an illness, these authorities claim that treatment should involve not only diet and exercise but drugs as well. What they have in mind is not just a short course of medication to produce small degrees of weight loss. They want to prescribe long-term, perhaps lifetime, drug therapies, just as they might for high blood pressure or diabetes. Obesity's victims, these doctors hope, will not only be able to lose weight, but will also keep that weight off forever.
Not everyone in the medical community is satisfied with the new therapies. Conservatives are seriously worried that the new drugs are, in fact, merely placebos ("medicines" that have no medical effect but may benefit the patient psychologically), or, worse, are actually detrimental to patients' health. Their concerns are understandable. A few decades ago amphetamines - nicknamed "uppers" or "speed" - were widely prescribed to control weight. Patients became slimmer, but suffered from tension and irritability, high pulse rates, and sleepless nights, side effects that may have outweighed the medical benefits of lower body weight. Conservatives also point out that risky as amphetamines were, they were generally prescribed only for temporary use. Advocates of new drug treatments leave open the possibility that the medications will be prescribed for a lifetime.
While there are at least 5 new diet drugs waiting approval by the us Drug and Food Administration, at the moment, the only diet medication that is normally used in the US is "fen-phen" , a combination of the drugs fenfluramine and phentermine. Fenfluramine boosts serotonin, which elevates mood, while phentermine mimics other substances in the brain. Together, the drugs suppress appetite and increase the rate of burning of calories. As its success becomes more widely known, demand for this medication is increasing. Prescriptions for fenfluramine in 1995 were expected to be four times what they were the previous year.
For several reasons, however, fen-phen is not the perfect diet medication. First, there is some debate over safety, although most fen-phen researchers say the drugs pose minor health risks compared with amphetamines. For most patients the short-term side effects are negligible; phentermine heightens alertness while persuading the body to burn more calories, and fenfluramine, thought to cut cravings for starches and sweets, can cause drowsiness. But some users experience a racing heartbeat and, although rarely, high blood pressure. While its effects are milder than those of amphetamines, the feeling of higher energy that fen-phen stirs can be habit-forming. Used alone, phentermine has enough kick to appeal to recreational drug users, who call it "bumblebee". Perhaps even more importantly for dieters, while the drug may cause initial weight loss, over a period of several years, subjects taking the drugs tended to regain some of the weight they had lost - although at a slower rate than those who did not take fen-phen.
Many conservative doctors, moreover, still remain reluctant to diagnose obesity as a disease. In a 19814 survey of 318 physicians, two thirds said their obese patients lacked self-control, and 39% described them as lazy. This traditional view holds that obesity results from a lack of discipline, correctable by diet and exercise. Since studies show that most dieters eat more than they say - or even think - they do, there is probably some truth in seeing a much simpler cause.
On the other hand, the traditional view is challenged by the discovery of the ob gene, which would seem to place significant weight loss outside the individual's control. Then there is the problem of the ever-increasing numbers of obese people, with the resulting increase in hypertension, and diabetes, leading to kidney failure and heart disease. All of these conditions require medication, if not costly equipment and surgery. If all of these effects of obesity must be treated with medication, why refuse medical treatment to help control body weight? Is not prevention better than a cure?