OBESITY DRUGS.

• Position: Use of drugs in treatment of obesity - Brief Article

Not a Quick Fix

Researchers understand more about the problem of obesity than at any other time in history, but the number of obese Americans continues to increase. Although the search for effective treatments has intensified, just a small number of obese people lose their excess weight and keep it off.

Once thought of as little more than "letting yourself go" obesity now is treated as an illness that has genetic, behavioral, environmental, and medical components. Researchers continue to learn about the balance between caloric intake and energy expenditure, but they admit that many aspects of obesity are poorly understood and that therapies often are unsuccessful in the long term.

Changes in lifestyle are the cornerstone of obesity therapy. Eating less and increasing physical activity usually help obese patients lose weight, and dropping as little as five to 10% of total body weight can improve a patient's medical outlook by lowering cholesterol and blood pressure and by ameliorating diabetes and other conditions exacerbated by obesity.

Maintaining lifestyle changes and keeping weight off for life is a difficult proposition. Researchers at Washington University School of Medicine in St. Louis (Mo.) say drug therapy can help improve long-term results for properly selected patients. However, Samuel Klein, professor of medicine and director of the Center for Human Nutrition, argues that drug therapy may be most useful for maintaining, rather than achieving, weight loss.

Many patients think of medication as a first treatment. Most have tried all kinds of diets, and most have lost weight, but when the diet ends, the weight tends to come back. Unlike some patients with other chronic diseases, most of those with obesity are very aware of their condition. "If you have hypertension, no one may know it except you and your physician," Klein says. "If you [are obese], everybody knows it, so there is additional social pressure to lose weight. This pressure drives many patients to look to drugs as a possible quick fix."

Patients at Washington University's Weight Management Center are not considered for drug therapy until after they have participated in the program for at least six weeks. By that time, many already have lost significant amounts of weight. "Most patients would like a pill to make their disease go...