By Dr. Michael Colgan
The Fat Follies - Part 1
The fattest problem
The latest figures from the US Centers for Disease Control show that 7 out of 10 Americans are fat to the point of illness. Health Canada figures show that 5 out of every 10 Canadians are in the same condition. In October 2008, Health Canada reported that Canadians are fatter than had been reported because investigation of previous surveys shows that many people under-estimated their weight and over-estimated their height.
This massive overweight burden and its resulting diseases drive sufferers to desperation for anything to help them shed fat. In 2007, the US spent $26 billion on prescription drugs for weight gain and its complications, more than the cost of medications for any other illness, including cancer. That price is small, however, compared with the amount spent on popular diet plans, health clubs, boot camps, fat farms, liposuction, low-fat foods, and the bewildering array of non-prescription weight loss lotions, potions and pills. Then there are the gismos: crunch boards, abdominal machines, elliptical trainers, stair-climbers, treadmills and vibrating platforms. At spas, there are saunas, steam baths, seaweed body wraps, fierce pummeling by Amazon ladies wielding weird vibrating machines, and the latest fad: foam rubber clubs to beat the reluctant fat off.
It is simply not working. Despite all of this, since I first wrote The Battle of the Bulge 27 years ago, we have grown a lot fatter during the last decade. Since 1995, for example, the proportion of US children who are seriously overweight has doubled, from 8 to16 percent. The US Centers for Disease Control consider the present overweight epidemic to be by far the biggest health problem in America, a problem that is now dragging American health down towards the level of health in developing countries. US life expectancy increased by two years each decade from 1980 to 2000. Since then it has hardly increased, and the latest figures suggest it has been declining since 2005.
Unfortunately, despite the evidence, body fat is still considered mainly a cosmetic problem. One of the largest insurance companies will not pay for weight-loss drugs, even for those who are obese. The primary motivation to lose weight is still to look better. As with all look-better products, the market attracts every swindle in the book. In this series of articles, I will expose some of the worst offenders, show you the science of being overweight, and pinpoint exactly what you can do to lose fat and stay lean for life.
Fat is not a simple problem
Body fat is not simple. It is not just "calories in and calories out." It's not just "eat less and exercise more." Recent science has defined the mechanisms of fat control very well. They are an integral part of the same exquisite chemistry that runs everything else in your body. Multiple systems exert tight and continuous controls, right from the DNA code buried deep in the nuclei of your brain cells to the fatty liquid that oozes out of your feet every day. These controls are there to protect you from harm by preventing any rapid change. They neutralize almost anything you do that threatens the body's cells or organs, including its adipose cells (where fat is stored).
We know now that adipose cells are not simply deposit bags for fat. They are superb electro-chemical systems that emit and receive hormonal and neural signals every second. They know a lot better than you do what is going on in your metabolism. If you use drugs to up-regulate one or two controls that release fat from adipose cells and enable its use as energy, other controls will combat them immediately. The best we can do is to use a combination of strategies that affect most of the fat control systems lightly, so the alarm bells do not ring. We literally have to fool the chemistry of the body to allow us to make any permanent change in our level of body fat.
That is not the story you get in the marketplace. In advertising, every new fat loss product is a burgeoning "miracle" that melts fat away. The fanciest ploys are big budget productions with white-coated physicians of serious mien showcasing their trim and supple trophy bodies that, a few months before, reputedly resembled Porky the Pig. Every new product has to mount similar charades because it is competing with more than 200 other "miracles" in one of the most cutthroat markets in the world.
Because of novelty, each new product gains sales for a while. Often, however, the salespeople confuse novelty with efficacy. Their repetitive superlatives run sour as the customers see only their wallets grow slimmer. But there is always another new "miracle" out there just waiting for your online clicks to find it. One dear client of ours summed it up recently: "I have tried everything, but I’ve been losing the same 20 pounds repeatedly for the past decade. The fat comes back, the cost per pound to lose it again is rising out of sight, and all of the best-performing drugs are now banned."
Prescription drugs for fat loss
Where is weight loss science now? Totally reject the deluded fat loss advertising on TV, in other media, and in the raving reports of multi-level salespeople. As a medical scientist studying the problem for the last 34 years, I can tell you that I have never encountered any secret formulas, mysterious herbs, hidden knowledge, or magic potions that will remove body fat. The scientific research on fat loss is all published, known, and freely available to every biochemist.
Weight loss is a very lucrative field for pharmaceutical companies, offering over 200 million potential customers worldwide who can afford their costly patented wares. If there are effective fat loss drugs, pharmaceutical companies are the most likely to have the best chemists, best technology and greatest motivation to make them. But are they doing it?
Amphetamines
A few years ago, some drug combinations offset some of the major fat controls of thermogenesis, metabolism and appetite. Preparations containing the amphetamines dexedrine and methamphetamine were legally prescribed and used by many millions of people in the 1970s. These drugs disrupt fat control systems primarily by accelerating brain function out of control. They produce excitement, high energy and high activity for long periods, often to the point of aggression and violence. When they wear off, the users suffer depression from exhaustion of brain neurotransmitter systems and organs such as the adrenals.
Their blatant overuse caused heart problems and deaths, and also showed potential for addiction. Consequently, most amphetamine preparations were banned by 1980 except for special medical conditions. They are still used widely by military personnel to keep soldiers "awake and alert in battle," and also illegally in the form of crystal meth. Although temporarily effective for weight loss, they were never sensible drugs to use because they disrupt bodily systems rather than working with the body to tip the use of energy sources away from sugar and towards body fat.
In the eighties and nineties, two other amphetamine related drugs, phentermine-fenfluramine and dexfenfluramine, became favourites, heavily prescribed for weight loss. They were reasonably effective in an amphetamine related way, but toxic as hell. I wrote widely of their dangers for the heart in 1994. By September 1997, at the FDA's request, the manufacturers voluntarily withdrew them from the market after research showed that they were the likely cause of heart valve problems that led to some deaths.
Today, Arena Pharmaceuticals has developed a similar drug, lorcaserin hydrochloride, which it claims has no adverse effects on the heart. Phase 1 and Phase 2 trials reported no effect on heart valves. Lorcaserin works on the brain’s level of appetite stimulation, but does not affect most of the fat loss control systems in the human body. Nevertheless, it is in the last of its clinical trials and will soon be heading to the FDA for approval. Given that approval, lorcaserin will become a multi-billion dollar fat loss "miracle" drug.
How big a miracle? Obese men and women given 10 milligrams of lorcaserin twice daily for three months lost an average of 7.9 pounds. The control group given a placebo lost 0.7 pounds. Based on the current cost of prescription weight-loss drugs, when lorcaserin is launched it will cost about $1,200 for a three-month supply. That works out to a cost of $167 per pound of fat. And users will not be covered by medical insurance. There has to be a better and cheaper way to lose fat.
In 1997, the FDA approved another related but weaker compound sibutramine (Meridia) which is still one of the most prescribed today. It is even cruder than lorcaserin and does not get equivalent results. In addition, while sibutramine does increase the levels of certain brain chemicals that help reduce appetite, it also increases blood pressure and heart rate. Common side effects include insomnia, headache, dry mouth and constipation. Other even cruder weight loss prescription drugs that are still around include amphetamine-like stimulants phendimetrazine tartrate (Bontril), low level methamphetamines (Desoxyn and Ionamin) and phentermine (Adipex-P). These drugs are prescribed to obese people, but only for use from three to four weeks. They do not cause much weight loss beyond that period, and they have significant potential for addiction. For a strong-minded person with money to burn, and with a physician who takes firm control of the prescription pad, these may be useful to start a weight-loss programme. Beyond that, I have seen huge weight rebounds in those who used them too long and then had to quit.
Cannabinoid receptor inhibitors
New drugs appeared recently to combat marijuana addiction. Specific receptors in the brain that respond to cannabis (cannabinoid receptors) cause a common side effect of cannabis use, popularly called "the munchies," in which the users eat as if ravenous. Two drugs that turn off the cannabinoid receptors, called taranabant and rimonabant, were found to also turn off the munchies. Rimonabant (Accomplia) was approved as a weight loss drug in the UK in July 2006.
Unfortunately, the cannabinoid receptors are inextricably intertwined with receptors that turn on when people are happy. As makers of several anti-depressants have found out to their cost, you shouldn't mess with happiness receptors. Reports of severe depression and suicidal tendencies in patients prescribed rimonabant have enabled it to be jerked from the market after only two years. In October 2008, the European Medicines Agency released a press statement concluding that the benefits of Acomplia no longer outweigh its risks and recommended that it be withdrawn, and manufacturer Sanofi-Aventis withdrew the drug. At the same time, Merck stopped development of its drug taranabant, after data in a late-stage clinical study found "unacceptable side effects."
Fat blockers
There is only one other form of anti-obesity drug. Approved by the FDA in 1999, orlistat (Xenical) was the first in a new class of drugs known as lipase inhibitors. Lipase is the enzyme that breaks down dietary fat for use by the body. Orlistat interferes with lipase function, decreasing dietary fat absorption by about 30 percent. Because the undigested fats are not absorbed, fewer calories are available to the body, meaning less weight gain. So orlistat does not help anyone lose body fat, it only helps them not gain more. It would be a lot better to learn to refrain from eating the excess fat in the first place. There's another catch, too. The unabsorbed fat has to go somewhere. It sits in the lower gut and ferments, and therefore orlistat produces intestinal discomfort, cramping, diarrhea, flatulence, and, worst of all, sudden unstoppable leakage of oily stool.
That's it. The best chemists in the world have failed miserably to produce any pill that will reliably cause loss of body fat without side effects and without addiction. In the next few articles in future issues of VISTA, I aim to show you how you can use current science better than it is being used now to become and remain lean for life.
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Dr. Michael Colgan
Dr. Michael Colgan, president of the Colgan Institute in San Diego and best-selling author on sports nutrition, also lectures and writes extensively on aging and is a member of the American Academy of Anti-Aging Medicine.
