Obesity Epidemic, What Do We Really Know?

What if obesity has nothing to do with eating too much? Peter Attia, MD, President and co-Founder of the Nutrition Science Initiative, says we don’t know enough about the science of weight gain, and that clinicians — and society — should stop blaming the victims.

There is no getting around it, we are all fat (in general, not you specifically). I am on the heavier side. It is an undeniable truth, that there is an obesity epidemic, and it is a gold mine for companies looking to take advantage. cost-of-obesityDiet Fads, Books, Nutritionals, Drugs, we are shelling out billions on trying to loose weight. Just last month I paid $100 for a FitBit Flex, which tracks my movements throughout the day and syncs with my iPhone. Does it work? Sure I have lost 10 pounds , but I still don’t know if we grasp the science behind obesity.

Given that one-third of American adults are obese and another third merely overweight, an effective and safe diet pill would seem like the path to instant riches. Jack Lief, the chief executive of Arena Pharmaceuticals, said in 2009 that sales of obesity drugs could eclipse those of statins, the cholesterol-lowering pills like Pfizer’s Lipitor, which had peak annual sales of about $13 billion before falling to generic competition.

Yet no prescription drug for obesity has ever reached annual sales of even $1 billion, the lower boundary of what the pharmaceutical industry considers a blockbuster.

While it is estimated that more than two million people take weight-loss drugs, the vast majority using the old generic appetite-suppressor phentermine, that is still only a tiny fraction of the 70 million or more obese adults.

And patients typically give up on the drugs quickly. An analysis of prescription data by the Food and Drug Administration found that only one quarter of people kept using a drug for at least three months, and only 10 percent for at least 180 days.

Despite what looks like a favorable market size, companies focusing on anti-obesity drugs face a few challenges. These obstacles include lack of insurance reimbursement, modest weight loss, safety concerns, the troubled history of diet drugs, and a feeling on the part of many doctors and obese people themselves that excess weight is a lifestyle issue best addressed by more willpower, rather than a disease that requires medical treatment.

Diet pills have been plagued by safety issues that have marred the image of the class. Two drugs used as part of the popular fen-phen combination were taken off the market in 1997 for damaging heart valves. In 2010, Abbott’s Meridia was withdrawn after a study suggested it might raise the risk of heart attacks and strokes.

The last hurdle is starting to change at least a little. Last month, the American Medical Association, the nation’s largest group of doctors, declared obesity a disease. In April, the American Association of Clinical Endocrinologists included weight-loss drugs in its diabetes treatment guidelines.

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