THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, August 24, 1995 TAG: 9508230041
SECTION: FLAVOR PAGE: F1 EDITION: FINAL
SERIES: Fitness Quest
SOURCE: BY MARY FLACHSENHAAR, SPECIAL TO FLAVOR
LENGTH: Long : 180 lines
THERE'S GOOD news for chronic dieters: The latest research points to an imbalance in body chemistry or a genetic malfunction as the causes of obesity in some people.
The implication of such studies is that modern medicine will one day correct those conditions. What's more, that day may not be far off.
The bad news for those awaiting a miracle cure for obesity, is that none is on the horizon. And if the fail-proof diet pill ever does arrive, it may be the unappetizing day in the distant future when all food comes in pill form. So we'll all be skinny anyway.
Yet the coming of an obesity ``cure'' has been heralded in headlines for the last year or so, as research on appetite and metabolism has started to simmer. The results of studies on obesity are reported with increasing frequency in scientific journals, followed by newspaper, magazine and television summaries simplified for the consumer.
Often that consumer has been battling weight problems for a lifetime and is very hungry for hope.
A few weeks ago, the Amgen company - which has the rights to develop and sell products based upon the recently discovered obesity, or ob, gene - made a dramatic announcement. Its first laboratory studies indicated its ``ob protein'' reduced body weight and fat in normal mice as well as in mice with a defective ob gene.
In the week after the announcement, Amgen's office in Thousand Oaks, Calif., received more than 800 phone calls.
``Many were from people volunteering to be part of the clinical trials,'' said David Kaye, a spokesman for the company.
Eager for an easy cure, we will have to settle for an answer that is complicated although more optimistic than it used to be.
``What we're finding out is that obesity is like cancer, in that it may have many different causes,'' said Dr. Thomas Lauterio, an obesity researcher and associate professor of internal medicine at The Diabetes Institutes at Eastern Virginia Medical School in Norfolk.
Lauterio is investigating why half of the laboratory rats he feeds a high-fat diet gain weight while the others don't. The answer, he says, may lie in the animals' differing levels of the growth hormone.
Lauterio's work and that of many other obesity researchers strongly suggests that many overweight people do not simply lack willpower. This is a major shift in the thinking on obesity, with profound implications for future research and treatment, health experts say.
``The original philosophy was that obesity is a personal problem of people who have no self-control,'' said Dr. Donald Schumacher, medical director of the Center for Nutrition and Preventive Medicine in Charlotte, N.C. Last January, Schumacher served on an advisory committee to the Food and Drug Administration. Its goal: setting new guidelines for the development of weight-control drugs.
``The FDA was grappling with the question, `Is obesity a disease?' '' Schumacher said. ``The one thing they learned from that meeting was that not only is it a disease, it's a chronic disease. And not only is it a chronic disease, it's an epidemic disease.''
Those who study obesity already knew that - long before the FDA conferred its official agreement, Schumacher said.
Studies showed that some twins share the problem of being overweight, for example, although they were raised in different nutritional environments.
Schumacher cited another obesity study done in prisons: When participants were moved to a private dining room where they could eat what they wanted, all of them - the overweight and the skinny - gained weight. Back on a sparse diet, the naturally skinny prisoners lost weight but the overweight stayed heavy.
Pharmaceutical research
Now that the FDA agrees that chemistry and genetics might play a part in obesity, the pharmaceutical industry has the green light to conduct research on drugs that might block the tendency to gain. The new thinking goes that just as a diabetic needs insulin, some chronically overweight people may need long-term, maybe even lifelong, medication.
``We can expect tremendous advances in the next five years,'' Schumacher said.
But since obesity has many causes, no doubt many treatments will emerge.
The use of antidepressants is one treatment of obesity that has been studied closely in the last few years. In addition to its ability to dissolve some depression with few side effects, Prozac, the most widely prescribed antidepressant in the world, has been shown to have some usefulness in weight loss. The experts are quick to caution that Prozac is not the next wonder drug for dieters.
``Early on, there was some hope that Prozac might be the magic bullet in the treatment of obesity,'' said Dr. Marsha Marcus, a researcher in eating disorders and obesity at the University of Pittsburgh School of Medicine. ``It isn't, although for a given individual it might be useful.''
Lauterio, of EVMS, feels that Prozac may be a steppingstone to a more effective weight-loss medication.
``I think that some people are trying to see how Prozac works in weight loss in order to design another drug more to that purpose,'' he said.
The FDA has approved Prozac for use in clinical depression and obsessive-compulsive disorder and has given its preliminary approval for its use in the treatment of bulimia, the eating disorder that involves bingeing and purging.
Prozac has not been approved as a weight-control drug, although its manufacturer, Eli Lilly and Co., sought approval for an obesity drug that is a higher dosage of Prozac's chemical compound, fluoxetine. The company withdrew that application late last year after the FDA increased the time required for studies on obesity drugs from six months to 24 months, a reflection of the new official thinking of obesity as a chronic and recurring disease. In a press release, Eli Lilly announced that ``the additional investment required to complete the 24-month studies is not in the best strategic interest of shareholders at this time.''
Dr. Hal Seim, of the Department of Family Practice at the University of Minnesota, said he thinks the drug's mixed reviews as a treatment for weight loss influenced the decision.
``Weight loss seems to be a side effect of Prozac only some of the time,'' said Seim, a member of the American Society of Bariatric Physicians, a group of about 600 doctors who treat obesity. Some studies show that patients who take Prozac for depression gain weight.
A common scenario is that a patient taking Prozac will lose weight initially but then regain it within a year, according to Dr. Michael Devlin.
``A lot depends on the context in which the pill is given,'' said Devlin, a research psychiatrist in eating disorders at the New York State Psychiatric Institute in New York City. ``The patient who just takes medication, with no improvements in diet and exercise, tends to regain the weight.''
Prozac suppresses appetite by elevating the level of serotonin, the brain chemical that transmits messages concerning satiety. Serotonin's influence on weight control was noted in the diet-drug trials performed by Dr. Michael Weintraub in the late '80s. His trials are considered the turning point in the treatment of obesity. At that time, Weintraub was a University of Rochester clinical pharmacologist.
Weintraub gave one group of people two types of diet pills and gave another group a placebo. All subjects were put on a healthful diet and exercise regimen. The pill-takers lost an average of 16 percent of their weight in eight months and kept most of it off for three years; the placebo group lost 5 percent.
The detail that intrigued researchers nationwide was that one of the diet drugs used in the study, Pondimin, raised serotonin levels.
An interesting footnote is that Weintraub, the first researcher to test the usefulness of long-term medication in obesity, is now the director of the FDA's Office of Over-the-Counter Drug Evaluation.
The new direction of diet-drug research is exciting for the 60 to 70 million American adults who are significantly overweight. But those who conduct and analyze the research prescribe a healthy dose of caution to go with the optimism.
``We still don't know Prozac's long-term safety and other effects,'' said John P. Galla, a professor of psychology at Widener University in Pennsylvania. Prozac was not authorized for use in this country until 1987.
Dr. Barry Levin's words of caution will strike a familiar note with chronic dieters:
``Losing weight is the easy part. Keeping it off is the hard part,'' said Levin, a professor of neuroscience at the New Jersey Medical School in Newark. In the past, he added, the recidivism rate among dieters has been 95 percent over a two- to five-year period.
Most researchers say emphatically that Prozac and many other drugs being studied for their usefulness in treating obesity may work for just a small percentage of the overweight population. We must be patient and open-minded.
One piece of data by the National Institute of Nursing Research illustrates the diversity of ongoing obesity experiments.
A five-year study concluded that women with greater self-confidence levels, called ``assureds,'' lost significantly more weight than ``disbelievers,'' the label for those in the same program who needed constant reinforcement about their ability to shed pounds.
The researchers likely will be in their labs dissecting obesity for a long time. Meanwhile, they agree that the best advice for those who await their updates is to eat less and exercise more. MEMO: Mary Flachsenhaar is a free-lance writer living in Norfolk.
The Virginian-Pilot's Fitness Quest is a six-month project to
inspire our readers to adopt a healthier lifestyle. Through the end of
the year, we are focusing on health, exercise and diet, as well as
reporting monthly in the Real Life section on four people's quest for
fitness. To learn more about Fitness Quest, call INFOLINE at 640-5555
and then press BFIT (2348).
ILLUSTRATION: Color staff photo by Mark Mitchell
The use of antidepressants, including widely prescribed Prozac, to
control obesity has been closely studied in the past few years.
KEYWORDS: PROZAC OBESITY by CNB