I.M.120 Helping you to BE YOUR BEST SELF

Imagine that there was an epidemic sweeping the nation affecting greater than half the population. Imagine that people were dying, the epidemic was linked to cancer, heart disease, diabetes, depression, sudden-death, and an increase in human misery in general. Now imagine Doctors, hospitals, Pharmaceutical companies, and the government were doing nothing about it. Or worse yet, were blaming the victims of the epidemic for it's cause. This is not the beginning of a science-fiction movie. Welcome to the great obesity epidemic of the 21st-century.

How did we get to this place? 

To gain understanding, first we must deal with a pervasive cultural bias, the belief that fat people are simply not as good as the rest of us. Somehow they lack discipline, are more lazy and slothful and that is the cause of their obesity. In countless cases taken from histories of people with medically significant weight, they shared with me the manner in which their previous physicians  had addressed the problem. "Just eat less, and exercise more" they were told by their doctor. As if that revelation had eluded them all along. Giving such obvious advice to a person battling obesity is insulting to their intelligence. Furthermore, it reinforces the victimization psychology that drives our individual and collective acceptance of biases against heavy people.  If you're suffering with obesity and you believe there's absolutely no medical cause for it, then by process of elimination, the cause must be you.

Confronted with ignorance and indifference from their doctor, people have turned to the commercial arena seeking help. Despite billions of dollars spent, countless books being written regarding the latest diet, and innumerable visits to the gym with a personal trainer, the rate of obesity continues to climb upward. After 20+ years of banging our head against the same "diet and exercise wall" with no discernible broad-based benefit, maybe it's time to seek other solutions.

The American Medical Association recently declared obesity to be a medical condition. This is eminently logical and should help to direct us toward a better treatment pathway. For those who doubt the validity of this position, consider a more widely accepted metabolic disorder. Diabetes is a condition analogous to obesity. It is a metabolic disorder that requires a combination of lifestyle, nutritional and ultimately, pharmacologic therapy to achieve the best outcome. Where is the “insulin” to treat obesity? Why are there so few drugs to treat such a wide spread condition? I believe much of the blame for the lack of progress remains embedded in our bias against giving heavy people any kind of a “crutch.” There is a large segment of the medical and scientific community that share the cultural bias. Add to the inherent suspicion of drug therapy for obesity the “Fen/Phen” debacle and you have the start of the “dark-ages” for obesity treatment. 

In the 1990s, dexfenfluramine-one half of the "Fen/Phen" combination-was found to cause a rare heart valve disorder in a minority of patients. Although this combination was enormously effective, rather than allowing it to remain on the market with precautions and further study, it was immediately pulled off the market. The subsequent lawsuits and financial calamity have  put a chill on the research for new options.

In 1993 one of the leaders in obesity medicine, George Bray stated that there is "unjustified distrust in the potential of drug treatment for obesity." Recently, two new drugs have come to the market for the treatment of obesity. Qsymia and Belviq have both been greeted by indifference in the conventional medical community and failure to pay by insurance companies.

Imagine that. In the face of an epidemic, despite over half the population suffering with this metabolic disorder, new medications enter the market and rather than being hailed as a step forward, they are looked at with suspicion and not supported. As if purposely to increase their profitability of failure, the FDA has burdened these drugs with  draconian regulations that make them  difficult for doctors to prescribe. With the deck stacked against innovative companies seeking to help patients, its no wonder there are so few willing to risk investing in obesity medications. if (when) these new drugs fail to turn a profit, the production pipeline is likely to dry up for years to come. 

When there is such an inexplicable failure to act in the face an epidemic, it is fair to ask, why?

Start with the food industry. Keeping you overfed and addicted to their salt sugar and chemical- ladened products is very profitable.

Next lineup the health insurance industry. They do not want to absorb the cost of treating obesity. It would make their premiums unaffordable and destroyed profit. Add in the conventional weight-loss industry. The last thing they want is effective treatment. Far better for them to keep you making circles on diets that fail.  Doctors, and medical schools, have contributed to the epidemic not only by their failure to act, but by prescribing drugs that stimulate fat growth (everything from antidepressants to drugs for diabetes), either ignorant or indifferent to the effects on patients long-term well being. Then there is the hospital medical complex. It turns out hospitals profit more from chronic illness than chronic wellness. Overweight and sick, but not quite dead is a good recipe for hospital profits. The only treatments they actively support are surgical procedures that bring money to the hospital. This odd collusion of financial self interest has led us to where we are in the moment. If Weight Watchers doesn't work, your next step is having part of your gut dissected in some type of gastric bypass surgery Nothing in between. Is this really the best we can do? It turns out there is some hope.

A small cohort of progressive physicians have pioneered creative treatment pathways that combine existing weight-loss drugs with "off label" use of other agents to modify hunger and impulse to eat that when combined with behavioral and nutritional guidance has led to weight reduction approaching that of surgery.

You would think such physicians would be widely celebrated. However, much like the patients they serve, and much like the pharmaceutical companies who have had the courage to bring new medications to market, They have run headlong into those pillars of conformity; fear, ignorance and established self interest.  These physicians  are frequently subjected to intrusive audits and are at increased risk of professional sanctions.

If you're reading this article and struggling with your weight, there is help out there, continue your search and don't give up hope. If you're reading this article and enjoy the genetic benefit of a lean physique, consider challenging the standard assumptions about  how and why people carry extra weight. Wise nutritional choices and an active lifestyle will always be necessary for healthy living. But maybe, just maybe, the more than 200 million americans who are overweight are suffering more from the wrong treatment than from character weakness.

To your best health,
Dr. Stephen Petteruti