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Anti-obesity drugs coming soon to a prescription pad near you
The Losing Game

Christine Barber | For The New Mexican
Posted: Tuesday, September 16, 2008
- 9/17/08
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Here's a question for you: If you wanted to lose weight, what would you be most willing to do?

A. Take an experimental drug

B. Undergo weight-loss surgery

C. Wire your jaws shut for a year

D. Leave family and friends for six months to attend a weight-loss retreat

This question was asked in an online survey posted on the Los Angeles Times Web site a few months back.

If I'd had to guess, I would have said that most people would choose to try an experimental drug — simply because it's easy and requires no real life change.

I think pharmaceutical companies are making the same bet, based on the zeal with which they are searching for the newest weight-loss pills. The makers of anti-obesity drugs are looking into lessening the pleasurable effects of food; tricking the body into thinking it's exercising; and fiddling with the brain's hunger triggers.

Even a dog knows that eating can be pleasurable. But what happens when our sometimes-crush on chocolate becomes a stalking-because-I-love-you-so-very-much obsession? We get fat.

Two anti-obesity drugs that have come out in recent years — Rimonabant and Taranabant — work on lessening the effect of that pleasure. And researchers found the drugs by taking a hit off some marijuana.

You know how smoking pot gives you the munchies? (At least, that's what I hear. It's not like I know about such illegal things first hand, officer.)

That's because the THC in marijuana binds to special receptors in your brain that are part of the food "pleasure experience," which I think is also the name of a strip club in Albuquerque.

One side effect of this process is that you get hungry. The new weight-loss drugs are actually cannabinoid receptor inverse agonists — meaning they physically block the pleasure centers that are associated with pot and food.

According to the research, people who take the drugs consume 20 percent fewer calories than those on placebos, while it increases resting metabolism by 5 percent. In one study of 500 people, even a small dose of Taranabant helped people lose weight. At the highest dose, study participants lost about a pound per week during the three-month study.

But these drugs, which were at first hailed as the new big-chiefs of weight loss, now are tied to higher rates of depression and suicide and are in the process of "further testing." One study found that 43 percent of the people on Rimonabant developed mental-health problems. Blocking the pleasure centers appears to make people unhappy.

Another drug in the mix is Lorcaserin, which is in the last of its clinical trials and will soon be heading to the FDA to gets its approval. Lorcaserin is the illegitimate stepchild of its evil Redux/Phen-Fen parents. But in this fairy tale, the makers hope the handsome Lorcaserin will redeem his mom and dad, who killed people back in the 1990s with heart-valve complications.

While both drugs focus on the same brain receptors, Lorcaserin is supposedly engineered differently and works on the brain's hunger response and metabolism. In one study of about 470 obese men and women, those taking Lorcaserin lost between four and eight pounds in three months with no other intervention (like a low-fat diet).

Another research group went in a completely different weight-loss direction.

Salk Institute for Biological Studies in La Jolla, Calif., studied mice trained in endurance marathons — yes, the image of that should make you laugh — as well as regular Joe Six-Pack mice.

The marathon mice, which could run up to 50 minutes on a treadmill, were fed a high-fat diet that would have caused ordinary mice to get a potbelly. The drug — given the sexy name GW1516 — permanently turns on the genes involved in metabolic pathways. It improved mouse performance by 77 percent and increased muscle fibers used in endurance sports by 38 percent.

But, not satisfied with their new breed of super mice, the team developed AICAR, a drug that constantly tells the cells to release more energy. In what came to be called the "couch potato pill" by the press, the researchers found that after only four weeks of taking the medication, untrained mice ran 44 percent longer than untrained mice that didn't get the drug.

I think all this research is pretty strong evidence that obese people are expecting — as well as hoping — for a quick weight-loss drug fix.

But the evidence might be misleading.

Embracing the idea of slow weight loss

Of the more than 500 people who answered the Los Angeles Times survey I mentioned at the beginning of this column, more then 50 percent said they would rather leave their family and friends for six months to attend a weight-loss retreat. Only 24 percent would try an experimental drug and 15 percent would choose gastric bypass. Not surprisingly, jaw wiring got the fewest votes at 6 percent.

I have to admit the results surprise me. Of all the choices, taking time to get healthy is actually the most sensible plan. A weight-loss retreat would give many people the best chance of long-term success. It would not be a quick fix. It would take time, effort and real change.

We might be a fast-food nation, but maybe we're starting to embrace the slow weight-loss notion.

Christine Barber is a pre-medical student at The University of New Mexico; she has been a journalist in New Mexico for 14 years. Contact her at tlg@sfnewmexican.com or via her blog at www.etastesantafe.com.


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