January - time for weight loss resolutions.  The resolve I hear in patients this time of year will soon melt away as the year progresses.  Yet maybe we have a little reason to hope this year.

Given that I practice in both Internal Medicine and Pediatrics, I have dealt with the difficult problem of obesity with little success and much frustration.  When I started practice 12 years ago, it was still common for prescriptions of stimulants such as Adipex and Pondomin to be prescribed for weight loss.  I had numerous patients I treated with these medications (although never together, thankfully) and initially saw significant success.  Even after the Phen/Phen and Redux scares, the use of Adipex continued for some time.  I eventually concluded, however, that nearly 100% of those patients with successful weight loss on stimulants were back to their pre-morbid weights within a very short time.  I now only prescribe stimulants to help an anxious bride into a wedding dress or other life-threatening situations.

 In pediatrics, the situation is equally frustrating.  The incidence of very obese children continues to increase and my success with weight loss education, etc. remains very low.  Recent clinical studies have supported me on this - in-office counseling has little effect on weight loss in children.  The best advice I can give to my parents is to balance the diet as well as possible and limit TV (as that has the strongest association with obesity).  I recently had a mother leave my office disappointed when she asked me for solid advice on weight loss for her child and I was unable to come up with a good plan for her.

Even I am presently in Weight Watchers myself (but of course I will succeed this time).

The recent introduction of the new diabetes medications Byetta and Symlin have been the first real encouraging developments in the area of treating obesity from a practitioner’s perspective.  Use of these medications has not only resulted in better diabetic control, but also in sustained weight loss.  I have seen this borne out so far (with Byetta more than Symlin).  The drugs are polypeptides that counteract some of the insulin-resistance and subsequent appetite issues.  Even though they are injections, I have had no problem getting patients to use them.

 So this all gets me wondering, are we on the threshold of finally fixing the obesity epidemic through pharmacologic intervention?  Treating obesity makes good financial sense, as it would greatly cut down on hypertension, diabetes, heart disease, hyperlipidemia, sleep apnea (the list goes on....).  Wouldn't the drug company who invented the first good obesity drugs have the hottest drug in history?  Wouldn't it be "Viagra times 100?"  I initially felt that the motivation to develop this drug would be extremely high due to the incredibly windfall that would result.

But then the conspiracy-theorist in my head spoke up:  wouldn't this be a worst-case scenario for the drug companies?  Sales of Lipitor, Crestor, Diovan, Norvasc, Nexium, Actos, Avandia (again, the list goes on) would drop sharply.  Isn't it in the financial best interest of the pharmaceutical industry for there to be a heavy burden of disease?  Hmmmmm.

 I am not convinced that it is plausible that pharma could suppress obesity drugs, but it is an interesting thought.  They certainly have a mixed reputation in my book.  They do incredible good for society with their drugs that save lives and cure many diseases.  Yet they also have incredibly large profit margins, even when much of their research is federally funded. 

So what do you think?  Is it possible that the "magic bullet" - the obesity pill that could be used long-term safely - could be suppressed by pharma?  It sounds like a good subject for a John Grisham book...