Losing Weight More Complex Than Taking One Kind of Diet Pill by Gina Shaw Letís face it: Americaís fat. With our national weight ballooning dailyóaccording to the National Institutes of Health, fewer than half of the adults in the United States currently have a healthy weight, and nearly a third of us are obeseóthe diet dilemma has gone beyond just how to look good in a swimsuit. With our ever-increasing weight, weíre at an ever-increasing risk for a host of medical problems: diabetes, hypertension, high cholesterol, cardiac problems and increases in cancer deaths. To the rescue comes a deluge of diet drugs? According to the Washington Post, some 180 drugs aimed at slimming down our super-size society are now in the pipeline, being tested by more than 70 pharmaceutical companies. At first, this may sound a bit ominous. Remember Orioles pitcher Steve Bechler, who collapsed and died during spring training in February 2003, at least in part because of the ephedra supplement he was taking to lose weight? A host of health problems, and deaths, have been associated with many popular diet pills, such as fenfluramine and phentermine (fen-phen), now the subject of many class action lawsuits. So do we really want to push for more weight loss in a pill? Donít panic (or rejoice) just yet, said Dr. Arthur Frank, medical director of the George Washington University Weight Management Program. First of all, 180 new diet drugs arenít going to hit the market any time soon. ìSo many of these drugs are in such early stages of research that they wonít be in clinical trials for years,î he said. ìIf one of every 10 of them makes it to a clinical trial, that would be wonderful, and if we get two or three drugs out of the whole bunch, weíll be lucky.î At the same time that obesity in America has reached epidemic proportions, Frank said, science has begun to understand just exactly why we eat too much. ìIíd like to think that we have at least a fuzzy idea of the things that cause people to eatóthe start or stop signals, if you will, the sense of satiety,î he said. ìItís very hard to change eating by will. We think of it as merely a matter of choice, but itís not. Itís so intensively regulated by the brain.î Just as with the diseases that it sometimes can contribute to, such as diabetes and heart disease, serious clinical obesity may need to be controlled with multiple medications. ìOne medication, one drug isnít going to be sufficient for a lot of these cases,î said Frank (who is obviously not referring to those of us who just want to take off those stubborn 10 pounds before the office holiday party). ìIf youíre using just one drug, the body has too many ways of compensating for one intervention. So you may need to hit it in different ways at the same time.î Scientists looking to solve the obesity problem with medication face the same challenge that goes with drugs developed for other diseases and disorders: side effects. ìAll medications, even aspirin, have a certain amount of risk associated with them,î Frank pointed out. Drug developersóand eventually, doctors who prescribe the drugs and patients who take themówill have to balance those risks with the health hazards posed by being seriously overweight. ìThe magnitude of the problem has to justify the magnitude of the risk,î Frank said. At the moment, there are only two weight-loss drugs approved by the Food and Drug Administration: Meridia, which suppresses appetite, and Xenical, which inhibits the enzyme that metabolizes fat. Citing reports of serious cardiovascular and other complications, the advocacy group Public Citizen has been petitioning the FDAóso far unsuccessfullyófor a ban on Meridia since 2002. Among the drugs now being studied as possible weight-loss prescriptions are some already FDA-approved as antidepressants (Wellbutrin) and seizure-control medications (Topamax). Furthest along in the pipeline of new drugs is rimonabant, which appears to target the area of the brain that triggers the phenomenon we call ìthe munchies.î The drug is now in phase III clinical trials, the last and crucial step before applying to the FDA for approval. But most people, when seeking weight-loss help in a capsule, still seek out nonprescription supplementsósomething Frank thinks is dangerous. ìThe stuff you get over the counter is trash. If Cortislim were really going to solve the problem, they wouldnít have to advertise it,î he said, referring to the omnipresent cable ads that lament people who think theyíve lost fat, ìwhen all youíve lost is meaningless weight.î Unregulated by the FDA, weight-loss supplements can contain virtually anything, Frank warned. ìYou can put any label on it and sell it to anybody,î he said. ìWith these products, there have been no systematic studies, you donít know if the dosage is the same from product to product, and thereís no way of ensuring that itís what it is represented to be. For all you know, someoneís grinding up cigar butts in his garage.î Gina Shaw is the medical writer for The Washington Diplomat.