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by Sherry Baker If you've tried low-fat and high-fat diets, spurned carbohydrates, fallen out of The Zone and still find yourself overweight, you may think your chances of ever shedding extra pounds are slim to none. But here's good news: although there are no magic diets or instant fat melters (infomercial claims to the contrary), there are proven weight-loss techniques that work. And as medical science unravels the genetic and neurochemical links to obesity, more potential fat-busting therapies are on the horizon. Laurence Sperling, M.D., who directs Emory Heart Center's HeartWise Risk Reduction Program in Atlanta, Ga., calls obesity a lifestyle problem that can be remedied with lifelong behavioral changes tailored to individual lifestyles. For example, instead of ordering patients to drastically change their diets, Sperling looks at their typical daily meals and finds ways to reduce portions and replace empty calories with healthier choices. "A healthy diet should emphasize mono- and polyunsaturated fats from nuts, soy and fish," Sperling explains, "but basic carbohydrates should come from vegetables and fruits, not a lot of refined carbs." Regular physical activity is key to keeping weight off, Sperling adds. "Just a brisk walk will rev your metabolism and keep you burning more calories for hours afterwards." For extra help, Howard Eisenson, M.D., director of the Duke University Diet and Fitness Center in Durham, N.C., sometimes prescribes prescription medications -orlistat (sold as Xenical), which blocks about a third of dietary fat consumed, and sibutramine (Meridia), which suppresses appetite by increasing the neurotransmitters serotonin and norepinephrine. "When these medications work, they are moderately effective. But they have side effects and should only be used as adjunct therapy - not as a replacement for lifestyle changes," Eisenson says. "The pace of obesity research is increasing at a remarkable rate, and we can be optimistic we'll have better tools to help folks who are genetically predisposed to being overweight in the future." Currently undergoing clinical trials in the United States and Europe are a hormone dubbed PYY3-36 and the experimental drug Rimonabant that may block "I'm hungry" messages in the brain. Researchers are also studying leptin, a hormone believed to influence appetite and thermogenesis (fat burning). And scientists are pursuing the role neurotransmitters dopamine and serotonin and the stress hormones cortisol and adrenaline play in weight control, particularly in people genetically susceptible to obesity. For now, the most dramatic weight-loss treatment for the morbidly obese is bariatric, or weight loss, surgery. The "gold standard" is the gastric bypass which connects the stomach to a segment of the small intestine. Singer Carnie Wilson went from obese to svelte after her well-publicized gastric bypass. The newer LAP-BANDŽ procedure places an inflatable silicone band around the upper midsection of the stomach laparoscopically. There is no cutting or stapling of the stomach and no bypassing of portions of the stomach or intestines, which can affect absorption of nutrients. Weight loss results when the upper stomach "pouch" created by the band fills quickly with solid food and empties slowly. "Overeating and not chewing food thoroughly causes discomfort or vomiting, so it also forces people to make behavioral changes," says University of Louisville surgeon Jeff Allen, M.D., who has placed the LAP-BANDŽ in more than 100 patients since it was approved by the FDA in June, 2001. Designed to remain permanently in the body, the adjustable band may sound perfect for anyone ready to get off the diet bandwagon. But, like all bariatric surgery, it's reserved for the seriously obese. "Patients have to have a Body Mass Index (BMI) over 40, equivalent to about 100 pounds of excess weight, or a slightly lower BMI if they have significant weight related health problems like diabetes, " Allen notes.
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According to former U.S. surgeon general David Satcher, America has one big fat problem - and it's far more serious than simply not fitting into your hip-hugger jeans. Satcher recently warned that obesity is overtaking smoking as the No. 1 preventable cause of disease and death in the United States. In fact, 61 percent of American adults are either overweight or obese. Each year, 300,000 will die from health problems directly related to being overweight - including heart attacks, diabetes and certain cancers. 