Desperately Seeking a Flab-Fighting Formula

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Like more tradtiional approaches, the latest obestity treatments try to lower an elevated set point by decreasing a person's appetite. But they have added a new twist by also affecting the level of a chemical in the brain called serotonin. A shortage of this chemical has been linked to depression and other mental ills. Serotonin may curb the appetite by helping a person feel full and satisfied. And, it turns out, a growing body of research suggests that fatty foods can increase the amount of serotonin in the brain. So it appears that some people who are obese do not make enough serotonin and are in effect trying to treat their depression, or at least feel more satisfied, by overeating. That is why antidepressant drugs, like Prozac, seem to help people shed pounds. Unfortunately, the results are short-lived: patients lose weight at first, but after a year's treatment they have usually gained all of it back.

So far, the most successful medical regiments have addressed both mood and appetiete control. In a four-year study, Dr. Michael Weintraub, formerly of the University of Rochester and now at the FDA, found that a combination of the drug phentermine, which seems to speed metaboliusm, and fenfluramine, which may boost serotonin levels, improved an obese person's chances of losing weight. Of the 120 people in the study, those who took the drugs achieved an average 16% weight loss over eight months, compared with a 5% loss for those who had to depend on diet and exercise alone. By the end of the trail, nearly all participatnts had added back some of the lost weight, but those who were part of the drug-treatment group had regianed fewer poiunds. More research is needed to identify possible side effects.

Many doctors are beginning to view obesity as a chronic disease, much like high blood pressure or diabetes, that requreies lifelong therapy. The ailment can be controlled but not conquered, and treatment cannot stop even when the bathroom scale reports good results.