Tossing out the yo-yo: New drug may help keep weight off

Patient is an old hand at losing weight: he’s dropped at least 100 pounds, several times. Unfortunately, he’s also been a pro at gaining it back. Until recently, that is. Patient believes he’s found the way out of the yo-yo dieting that’s been the theme of much of his life. In July 2001, patient and his wife joined Weight Watchers® and faithfully kept with the program. Over a three-year period, patient lost 145 pounds, his wife lost 50. He really enjoys this lifestyle. He doesn’t think of it as a diet. Patient weight problems started as a teenager. During senior year of high school he dieted and stayed ‘fairly thin’ for a while, but his weight kept creeping up, five-to-10 pounds every year. When he married his wife in 1976, patient weighed about 200 pounds, but within six years he was up to 363 pounds. At that point, he underwent a stomach stapling procedure, which drastically cut his stomach capacity and caused him to lose about 100 pounds within a few months. But patient owned a delicatessen and he has a potato chip there and a piece of turkey here, and before he knew it, he was stretching his (stomach) pouch. The snacks added up and soon patient weighed more than 300 pounds. Once again he went on a diet and lost another 100 pounds. He kept it off for several years, but after he changed jobs in the early 1990, he "ballooned fast" to around 260 pounds. By 2001, his weight was "completely out of control in the 330 to 340 range. By then, patient and wife felt they were running out of options. His wife suggested Weight Watchers, which she’d tried while in college. The gamble worked.

Not only did patient lose weight slowly – about 50 pounds a year – but he developed the tools to keep it off. The key is portion control. He weighs and measures everything he eats. If he is eating a piece of chicken he doesn’t assume its four ounces, because nine times out of 10 it’s more. Wife and patient also learned to plan ahead. If they’re going out to dinner, they eat less early in the day. Being in it together is a real plus. They got rid of everything that was bad – like ice cream – so that one wasn’t eating it when the other couldn’t.

They met with a nutritionist who fine-tuned what they’d already learned. For instance, she suggested not eating carbohydrates during evening meals. Patient takes inspiration from weekly Weight Watchers meetings, and in three years has never missed one. That really helped. People were genuinely happy when he did well and they wanted him to succeed. Another change is working out. He took a while just to be able to, but now he exercise for about 45 minutes five days a week. One of the biggest differences this time around was patient’s overall attitude about weight loss, particularly when he hit plateaus. People tell you you’ll lose one-to-two pounds a week, but he had periods for three months where he didn’t lose a pound. It was so frustrating. It gets on the scale knowing he’d lost weight and not be down a pound. Then the day he’s least expect it, he’d find he lost weight. It completely screws up your mind and you have to be ready for it. Patient is more than ready to maintain his weight loss success. He has a lot of self-esteem and confidence now. He feels normal.

New evidence suggests that an experimental weight-loss drug helps people keep off the weight they initially lost for up to two years. In a study involving 3,045 people, subjects who took a daily 20 milligram dose of the drug rimonabant lost over 17 pounds on average within the first year of treatment, while maintaining their new weight throughout the second year. Subjects who switched to another pill after the first year gained nearly all of the weight back during the second year, a common result in most studies of weight-loss drugs. The findings were presented by the study’s primary investigator, chief of endocrinology at St. Luke’s Roosevelt Hospital Center in New York, at this year’s annual scientific meeting of the American Heart Association. The drug blocks receptors in the brain that control appetite and also has drawn attention for its apparent positive effects on waist size, cholesterol and blood sugar. The Food and Drug Administration may approve rimonabant by late 2005 or early 2006. While heart experts find these results encouraging, they stress that more information on the drug is needed, and that exercise and healthy diets are still crucial to losing weight.