Deann SHANNON hears the comments frequently at the Curves fitness center in Orange. Even as people work up a sweat on the exercise machines, the topic of conversation will turn to diet drugs.
"I hear people say they're going to buy this drug or that," said Shannon, the owner of three Curves gyms, which cater exclusively to women. "Some people don't like to exercise, and they would try anything. They're looking for a quick fix."
They're not the only ones. A drug that would make weight loss easier is one of the most prized, but elusive, goals in medicine. And numerous pharmaceutical companies are working on diet drugs that could reach the market during the next decade. One company, Sanofi-Aventis, recently applied to the Food and Drug Administration for approval of a drug called Acomplia, which, if approved, would become the first new prescription obesity drug in six years.
But one thing is becoming painfully clear to researchers and drug companies: Previous efforts to produce a blockbuster diet drug have fizzled, and there is still no miracle remedy in sight. Recent studies of Acomplia (also known as rimonabant, its generic name) show that the drug, while potentially helpful, will not benefit everyone nor will it produce substantial weight loss in most people.
Instead, Acomplia's role more likely would be as one of a number of diet drugs that not only aid weight loss but also address the medical consequences of obesity, such as diabetes and heart disease, say researchers. It's likely that a combination, or cocktail, of obesity drugs will ultimately prove most beneficial.
"What most patients are starting to realize is that they need a little help," said Dr. Ken Fujioka, director of the Nutrition and Metabolic Research Center at Scripps Clinic in Del Mar. "In our society, everything is set up against you when you're trying to lose weight. And one-third of Americans are heavy enough that they are running into medical problems related to their weight."
Two of three U.S. adults are classified as overweight or obese, according to federal figures, and drugs that help people lose weight could cut the rates of heart disease, diabetes, several types of cancer and gallbladder disease. A safe, effective pill to help people achieve a normal weight would increase life span, extend worker productivity and bring joy to many.
The last two prescription diet drugs to reach the market -- Meridia in 1997 and Xenical in 1999 -- were introduced with a lot of hype but have attracted only a modest following. Xenical blocks the absorption of some fat, but it causes diarrhea, bloating and gas in many people who take it. Meridia works by creating a sensation of fullness and curbing hunger, but it has been linked to increases in blood pressure and heart rate.
Doctors would love to have more options to help patients lose weight. There are only two prescription drugs to treat obesity, plus weight-loss surgery, contrasted with roughly 100 drugs to treat hypertension alone, said Dr. Louis Aronne, a professor of medicine at Cornell University's Weill Medical College in New York.
"There is a huge gap in our armamentarium," he said.
As recently as the 1980s, the only medications to help people lose weight were stimulants, which boost metabolism and suppress appetite. But stimulants are usually only effective for a short time, and they have been linked to side effects. The stimulant craze began to quiet in 1997, when the fen-phen drug combination was found to cause heart valve abnormalities, and more recently when the herbal stimulant ephedra was banned by the FDA last year due to safety concerns. (A ruling in April by a federal judge in Utah in favor of a dietary supplement company that had challenged the FDA ban has raised anew the question of whether the government's action will stand.)
Researchers today are focused on understanding how the body regulates weight and how fat is produced and stored in the body. It will likely take many years before scientists really understand the biology of obesity, they say. For now, most experiments are done on mice, not humans. The development of Acomplia, however, suggests that progress is being made.
Acomplia is the first of a new class of drugs that affect signals in the brain that influence appetite. The compound blocks the cannabinoid receptor 1, which helps control hunger; these same receptors are stimulated when people smoke marijuana and get the "munchies."
The overactivation of these receptors is thought to contribute to obesity and even nicotine and drug dependence. Preliminary studies on Acomplia for smoking cessation and alcohol and drug treatment are underway.
As an obesity treatment, Acomplia may be best suited for people who are not only overweight but also have metabolic syndrome. Metabolic syndrome is a collection of symptoms, including high blood pressure, high cholesterol, large waist circumference, obesity and insulin resistance, that can lead to diabetes and heart disease without treatment.