CAN MEDICINE END OBESITY?

In recent weeks, the weight loss drug sibutramine (Meridia) has been pulled from the market due to an increased risk of heart attacks. The U.S. Food and Drug Administration (FDA) also failed to approve lorcaserin (Lorqess), because of a possible cancer connection, as well as phentermine/topiramate (Qnexa), because of possible health risks, including birth defects and heart problems. This has left some declaring that science should stop looking to medications to help with the battle of the bulge.

I strongly disagree. While I do support possibly dangerous medications being taken off the table, I by no means think we should completely abandon the search for a possible pharmaceutical solution to the obesity epidemic.

Consider, for example, if science had given up on searching for safer and more effective treatments for cancer after the first few tries. Or if the search for a solution to diabetes had been declared an impossible task.

In a similar way, I think the future still holds immense promise for the development of new medications that could help those who struggle with their weight. It’s important to remember that like cancer or diabetes, obesity is a medical condition a disease. So while diet and exercise will always play a key role in weight management, for some they alone are not a solution. In these cases, looking to science for additional help just makes sense.

Obesity occurs for many complex reasons we are only beginning to understand. One of these seems to be simple genetics. Some people just seem to gain weight more readily and hang onto fat stores better than others. In fact, in the not-so-distant past when famine and food scarcity were common facts of life, having the ability to gain weight and hang onto it was actually a genetic advantage.

But in 2010, that’s no longer the case. The same genes that were once a benefit are now, in the face of an easily accessible food supply and a sedentary lifestyle, a negative. People are dying today from too much food, not too little. Oh, the difference a few hundred years can make!

For others, gaining weight is not so easy, also for equally complex reasons we are just beginning to understand. For example, naturally thin people often have larger stores of a type of fat called brown fat. This fat seems to fuel metabolism. Imagine if science could somehow help those with a natural tendency toward weight gain to increase their brown fat stores, for example. Weight problems could become a thing of the past.

While we are a long way from there yet, it only makes sense for us to continue to look for ways to manage these genetic pathways and fight a disease that is affecting almost one in every three American adults. We physicians need as many tools as we can possibly have in our tool chest.

So while it is unfortunate that we’ve had a bad run lately when it comes to weight loss medications, I feel it would be irresponsible and even foolish for us to throw up our hands as a medical community and stop searching for solutions to a serious health problem so many are facing.

We can and we must continue to look for answers. And I believe they will come. In the meantime it’s time to let go of shame and blame and to treat obesity like the medical condition it is. By doing so we will be taking an important first step toward ending the obesity epidemic.