Getting Rid of Extra Pounds

Every morning Harley Lisherness, the head of a roofing materials company in Phoenix, looks out his bathroom window at Camelback Mountain and wonders if he’ll ever be able to climb it. Plenty of people make the trip. But Lisherness is carrying 370 pounds on his 6-foot-1 frame. He simply doesn’t have the energy to hike up the steep mountain trail. In the past, doctors considered weight problems like Lisherness’s a lifestyle choice— one that put him at greater risk for cancers, diabetes and heart disease. But Lisherness, 61, disagrees. “I’m completely convinced this is a disease,” he says. “This isn’t about willpower. No one would remain heavy if they could avoid it.”

Some prominent members of the medical community have begun to concur. They say that Lisherness, and 120 million overweight Americans like him, are suffering from a long-term and hard-to-treat illness. The rates of obesity in this country are staggering. More than 65 percent of Americans are overweight (with a Body Mass Index of 25 to 29) or obese (with a Body Mass Index of 30 or more). Rates of obesity-related diabetes are skyrocketing, too. In the past five years the number of Americans diagnosed with diabetes has increased 27 percent. And kids are not immune. Fifteen percent of children are seriously overweight, a rate that’s tripled since 1970. With obesity poised to become a worldwide health disaster, the race is on to find a way to bring it under control.

The search will be a difficult one. For years pharmaceutical companies have poured billions of research-and-development dollars into devising a pill to make fat people thin. The two drugs currently approved for long-term weight loss, Meridia, which works on brain chemistry to control the appetite, and Xenical, which prevents the body from absorbing fat, both have serious side effects ranging from increased heart rate to diarrhea. An epilepsy medication called topiramate has been effective in helping people lose weight, but it also causes cognitive impairment in many users. Scientists are unraveling the complicated interplay of hormones, peptides and genetics that are believed to control hunger and satiety, which in turn could lead to weight-loss remedies that are more narrowly targeted, says Samuel Klein, director ofthe Center for Human Nutrition at the Washington University School of Medicine in St. Louis. Researchers are also trying to determine just how excess pounds trigger cancer, heart disease and diabetes. “The hope is that we’ll be able to develop a medication that won’t necessarily affect body weight,” says Klein, but will keep that excess fat from making overweight people sick.

Without safe, effective solutions, the latest quick fix— bariatric surgery (sometimes known as stomach stapling)— is flourishing. Inspired by tabloid reports of spectacular celebrity slim-downs by weatherman Al Roker and singer Carnie Wilson, more than 100,000 drastically overweight people are expected to undergo bariatric surgery this year. The surgery is radical—a patient’s stomach capacity is reduced from a half gallon to a little over an ounce, and most can never eat a normal-size meal again. It is also dangerous. Although the American Society for Bariatric Surgery says ten percent of patients develop serious complications like blood clots and internal bleeding, new research suggests rates of complications may be much higher. A bariatric surgeon in Italy might have found a better way. He’s devised an implantable gastric stimulator, which delivers regular electrical shocks to the stomach lining. Scientists don’t yet understand how it works; electrical impulses may relax muscles simulating satiety or stimulate or suppress complicated hormonal connections between the stomach and the brain.

Changes in federal health-care policy may soon provide wider access to treatment. Last year the Internal Revenue Service declared obesity a disease (see related article) and made expenses related to treatment— exerclse programs, bariatric surgery and commercial weight-loss programs like Weight Watchers— tax deductible. And the agency that controls Medicare will soon decide whether to reclassify as well. If it does, it will be the first step toward allowing millions of overweight Americans to seek treatment.

Doctors say prevention, especially when it comes to kids, remains the country’s best hope for battling the epidemic. Spurred on by new recommendations by the World Health Organization, advocates are lobbying for new regulations limiting the kinds of food that can be advertised to children. The handful of obesity-related lawsuits this year were legally questionable but created a public-relations bonanza that sent fast-food restaurants and snack-food makers scrambling for the high road. At McDonald’s, salad sales have been brisk. Kraft has vowed to remove artery-clogging trans fats from snacks and limit marketing to children.

Obesity prevention comes too late for Harley Lisherness. These days he’s considering bariatric surgery. ” It’s just too depressing to regain the same weight over and over,” he says. The surgical risks and the long recovery will be a hurdle. But when he looks out the bathroom window, he knows he has other mountains to climb.

Article by Peg Tyre
Newsweek; 8 December, 2003