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Researchers today understand more about the problem of obesity than at any other time in history, but the number of obese Americans continues to increase. Although the search for effective treatments has intensified, only a small number of obese people lose their excess weight and keep it off.

Once thought of as little more than "letting yourself go," obesity now is treated as an illness that has genetic, behavioral, environmental and medical components. Researchers continue to learn about the balance between caloric intake and energy expenditure, but they admit that many aspects of obesity are poorly understood and that therapies often are unsuccessful in the long term.

Changes in lifestyle are the cornerstone of obesity therapy. Eating less and increasing physical activity usually help obese patients lose weight, and losing as little as 5 percent to 10 percent of total body weight can improve a patient's medical outlook by lowering cholesterol and blood pressure and by ameliorating diabetes and other conditions exacerbated by obesity.

Maintaining lifestyle changes and keeping weight off for life is a difficult proposition. But researchers at Washington University School of Medicine in St. Louis say drug therapy can help improve long-term results for properly selected patients. However, Samuel Klein, M.D., professor of medicine and director of the Center for Human Nutrition at Washington University's School of Medicine, argues in a June 1999 editorial in the American Journal of Clinical Nutrition that drug therapy may be most useful for maintaining rather than achieving weight loss.

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Many patients think of medication as a first treatment. Most have tried all kinds of diets, and most have lost weight. But when the diet ends, the weight tends to come back. And unlike some patients with other chronic diseases, those with obesity are very aware of their problem. "If you have hypertension, no one may know it excep
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Contact: Jim Dryden
dryden@medicine.wustl.edu
313-286-0110
Washington University in St. Louis
26-Jul-1999