June 29, 2006

Obesity Drug

Sick - or simply eating too much?(Filed: 30/06/2006)
Britain is reaching - apparently - a crisis point on obesity. A new pill promises to help by controlling appetite but should fat people really be turned into patients? Judith Woods weighs up the issues
The launch of a new weight loss pill has been hailed as a breakthrough by health campaigners wringing their hands over what can be done about Britain's "obesity crisis". The once-a-day pill, sold under the trade name Accomplia, controls appetite by blocking activity in the part of the brain that generates cravings.
As a nation we are steadily eating ourselves to death; 23 per cent of adults in Britain are obese
But when did being fat become a medical issue - and should it be regarded as an illness? Will the hoary old chestnuts "it's my glands" or "I have a slow metabolism" (both scientifically proven to be untrue) now be replaced with "I'm ill"? (Although perhaps not ill enough to eat less and exercise more.)
The self-avowed culprit is Professor Andrew Prentice, professor of International Nutrition at the London School of Hygiene and Tropical Medicine, and co-author of a provocative paper published in 1995 in the British Medical Journal, called Obesity in Britain: Gluttony or Sloth?
"I have to hold my hands up," says Prof Prentice now. "Around 15 years ago, when I was at the Association for the Study of Obesity, my colleagues and I consciously started to up the ante about obesity in the media, because it was a Cinderella area and nobody was taking any interest in it. I think it was the right thing to do, but now I do have concerns, and I confess that it's a tortuous issue.
"On the one hand,'' he continues, ''we need to medicalise obesity to give people a wake-up call; they should be made aware of the health consequences of being overweight. But on the other hand, we don't want to go too far and we certainly don't want to play into the hands of the lobby that would say this can be treated only by drugs."
By all accounts, as a nation we are steadily eating ourselves to death; 23 per cent of adults in Britain are obese, up from seven per cent in 1980. An additional 42 per cent of men and 32 per cent of women are now overweight. More depressing still, the Health Survey of England showed that nearly half of teenage girls and more than a third of teenage boys are overweight or obese.
Obesity is measured by calculating the Body Mass Index (BMI) where a person's weight is divided in kilos by his or her height in metres. A BMI of 20 to 25 is considered normal, 25 to 30 overweight and over 30 obese.
The medical implications for the overweight and obese are severe; a woman with a BMI of 28 will be 18 times more likely to develop type 2 diabetes, compared to a slim woman. Type 2 diabetes is a progressive disease, with complications that can result in amputation and blindness. Obesity-linked fatal diseases include heart disease, high blood pressure, stroke and some cancers.
Type 2 diabetes and obesity-related conditions are costing the NHS £1 billion a year, and rising. One maverick commentator has suggested the rather Swiftian notion of a fat tax, related to people's girth, to counteract the health resources they will consume proportionate to their size.
A nonsensical idea, but in the real world the previous laissez-faire attitude towards people deemed to be responsible for their own ill-health is also changing. Just as smokers may be denied live-saving operations until they give up cigarettes, so surgeons can turn away obese patients until they slim down. Last November, three Suffolk primary care trusts ruled that patients with a BMI over 30 would not get operations such as hip and knee replacements.
GPs have also been instructed to tell fat patients they should lose weight and to give them advice on how to achieve better fitness. A great many overweight people are likely to ask for a daily drug to control their weight.
"Medicalisation is necessary in cases of clear clinical obesity, which carries severe health consequences," says Dr Susan Jebb, head of nutrition and obesity research at the Medical Research Council in Cambridge.
"But there's a huge part of the wider obesity problem which isn't medical, which is about lifestyle and individual choice. There's a danger in medicalising obesity, particularly on the back of drug developments, in that it discourages people from taking individual action, and puts them into patient mode."
There have, of course, always been fat people. In developing world cultures where food is scarce and it's easy to be thin, plumpness is an index of wealth and status. Conversely, in western cultures where food is cheap, plentiful and calorie-rich, it is easy to be fat, and so slimness is regarded as the paradigm of beauty.
Notwithstanding the current "thinspiration" debates surrounding Victoria Beckham and her elevation to a role model for anorexics, as a society we value slimness. Women in particular congratulate each other on losing weight, which is regarded as a praiseworthy achievement - which begs the question, why are so many of us obese?
"Obesity is a classic gene-environment interaction," says Dr Jebb. "People have varying degrees of genetic susceptibility to obesity, and if you are in an environment where food is available all day long, people with this susceptibility are going to find it very hard not to overeat.
"Of course eating is a voluntary behaviour, but it's not such a free choice as it might seem. There are lots of complicated factors involved, which is why tackling obesity is a complex issue."
The so-called obesity gene GAD2 has been shown to be more common in a particular form in obese people than the non-obese. External factors include depression, stress and social and economic deprivation, which are often linked to obesity levels.
Most fatally, our consumption of high-energy processed food, which is laden with fat and sugar, has gone hand in hand with a reduction in our levels of physical activity. These, ultimately, are what trigger obesity.
A typical obese man or woman has enough energy stored away to survive 140 days without eating another burger. The obvious, and to some degree easy targets to blame for overeating are the companies that manufacture processed convenience food and the fast-food chains.
The banning of food advertising on children's programmes will help to reduce childhood obesity. But interestingly, a study carried out in 1997 revealed that the British actually consume 20 per cent fewer calories than in the Seventies. Yet still we pile on the pounds.
In our desk-bound culture, where children are driven to school and playing fields are sold off to developers, reducing opportunities for them to exercise, a huge proportion of the population is sedentary.
Professor Prentice, who, incidentally, cited sloth, rather than gluttony as the prime suspect in obesity levels, says that inactivity is a crucial contributor to obesity.
"When it comes down to it, I don't care how fat anyone is as long as it's not making them unhealthy. It's when I see the medical misery caused by obesity, that I start to care," he says. "I care about the person and I care about myself as a taxpayer."
Two years ago, the Government stated that it would halt the year-on-year increase in childhood obesity by 2010. There is little sign that this target will be met. A child with one obese parent has a 40 per cent likelihood of being obese, which doubles if both parents are obese.
Slim celebrities are routinely scapegoated for contributing to anorexia. Who is to blame for making us fat?
An area that must surely demand research is why obesity is on the rise, despite the social stigma traditionally attached to it. It is well-documented that overweight people are less successful in job interviews, for example.
Could it be that there are so now so many obese people in the country that being merely clinically overweight no longer carries a stigma? If so, that could have very grave repercussions.
"In the past, the main motive for weight loss was fashion and vanity," says Prof Prentice. "Thank goodness for vanity. I dread to think how fat we would be otherwise."


  1. Ok am I being naive in thinking what is the difference between this new 'miracle' drug and other slimming products currently prescribed by medical practitioners? And what are the side effects with this drug? What are the long term effects on the heart and what happened to prevention is better than the cause. Isn't it time we re-addressed the messages we are given by society;
    " eat as much as you like" "supersize" etc and then we are being told do all this become obese and we will provide you with a little pill which will stop this for a while and help you lose weight. Isn't this an eating disorder in it's own right? Yes, I know Obesity is a serious issue as is bulimia nd anorexia but surely once again medication is the only way to treat this.

  2. Anonymous11:33 AM

    many a conspiracy theorist have said that this is a project that has been in the works for a while between the drug companiess and the food industries. First poison everyone with such things as trans fats then bring it to their attention and then at just the appropriate time have the scientific revelation that you may have the "cure for obesity" and sell it to them for disgustingly large amounts of money. Now what they wont tell you all these medications everl ast one of them in one way oranother is either one of the following a) a concotion similar to an amphetamine solution b) a concotion similar to a cold pill or an asthma medication or c) a synthetic fat causing your body to purge everything you eat directly into the large intestine creating some new age laxitve abuse anal leakage and very unattractive very expensive bulimia to the uninformed pleased weight dropping consumer [read about the chemical orlestat if u question this] or d) all of the above and society has the nerve to declare pro anorexia the social holocaust. No one is innoccent. Not the person who want take responsibility to lose weight responsibily nor the person who refuses to maintain it. Morally neither holds the upper hand. Im not sure if thats absolutely relevant but every oppurtunity I get to say that I MUST ..


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