Obesity Society's annual meeting- New Orleans - LA Times Reporter

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How and why we gain weight



By Jeannine Stein, Los Angeles Times Staff Writer
October 29, 2007

Experts at a conference on obesity explore its possible causes, which
call for multi-pronged solutions.

Chewing gum, taking medication and laying off fast food won't by
themselves reduce America's waistlines -- obviously. But they may all
have a part to play.

As hundreds of medical, scientific and behavioral researchers gathered
at the Obesity Society's annual meeting in New Orleans last week to
present their work, they increased the collective understanding of how
appetite, metabolism, the environment and our genes may contribute to
the nation's increasing girth.


Research on weight gain and eating patterns

The smorgasbord of issues illustrates the many-pronged approach health
experts are taking in the fight against ever-expanding waistlines, says
Eric Ravussin, outgoing president of the Silver Spring, Md.-based
organization, which promotes research and education on obesity.
Researchers realize that numerous factors are to blame for Americans'
stubborn inability to shed their collective weight. "It goes from
genetics to behavior," he says. "There's a whole session on
gastrointestinal signals to the brain. [Researchers are] really trying
to put these things together."

Dine out and pay the price

One vital element is where and how often Americans are eating out. A
study by researchers at Temple University in Philadelphia reported that
Americans were less likely in 2006 than in 2004 to pay more for
healthful foods (40.7% versus 28.5%), knew less about healthful menu
items (18.5% versus 12.4%) and were more likely to regard healthful
foods as bland (21.4% versus 15.8%).

Gary Foster, the Obesity Society's new president and a coauthor of the
study, doesn't blame them for their reluctance to part with more money.
(Data on 12,000 Americans nationwide was collected by Aramark, a food
service and facility management company based in Philadelphia, which did
not fund the study.)

"I don't think that's an unreasonable position for consumers to be in,"
says Foster, director of the Center for Obesity Research and Education
at Temple University. "Why pay more for healthy foods? In the end, taste
and cost trump everything else, and convenience is in there, too."

Although there is a segment of the population that doesn't mind paying
extra for fruits, vegetables and more healthful offerings in
restaurants, he says, most won't bust their budget for them.

"The challenge," adds Foster, "is to make the foods tasty and
affordable. This is not about finger-pointing. But it does signal that
you have to be in the ballpark in terms of taste, convenience and cost,
or people won't be willing to do it."

Americans know they should eat at home more but radical changes in their
behavior are unlikely, he says. "People are going to continue to eat
out," he says. "The call should be to get people to eat healthier when
they're out. Why make it tougher?"

Married couples grow together

Another study found that the early years of marriage can be a catalyst
for weight gain. Of 1,200 people 18 to 28 in relationships, married
couples' average weight gain was 6 to 9 pounds more than that of their
single, dating peers.

"This is an understudied period," says Penny Gordon-Larsen, assistant
professor of nutrition in the school of public health at the University
of North Carolina at Chapel Hill and author of the study. Having studied
environmental influences on obesity, she wondered if living together or
just being in a romantic relationship was the important component of the
weight gain. "The shared household environment seemed to be the key."
Eating out more often and leading a busy lifestyle filled with work and
social obligations, she theorizes, might contribute to the problem.

"If the couples support each other in having a healthier house and
healthy activities," Larsen says, "there might be hope for reducing that
weight gain."

Weight Loss Drugs

Behaviorial changes alone are unlikely to help everyone lose weight,
however. For those whose pounds stubbornly remain, studies on two new
weight-loss drugs offer some hope. The compounds, still in clinical
trials, have shown promise in helping people lose weight and sustain
that weight loss for a year.

Both are from San Diego-based pharmaceutical company Orexigen and are
combinations of already available medications. Contrave (in phase III
trials) uses the antidepressant bupropion (brand name, Wellbutrin),
which can suppress appetite and increase calorie burn. It also contains
naltrexone, which is usually used to treat addiction to alcohol and
opiods but can also affect appetite and rev up the metabolism.

The second drug, Empatic (in phase II trials), also uses bupropion, but
in conjunction with zonisamide, an anti-seizure medication that has been
shown in other studies to be effective for weight loss.

In Contrave trials, different formulations of the drug resulted in a
mean weight loss ranging from 7.1% to 7.6%, compared with 1.1% for a
placebo after 24 weeks. The highest dose group in Empatic trials showed
a 10.3% weight loss, compared with 1.2% for the placebo group after 24
weeks. Approximately 3,000 men and women have taken part in the
randomized, placebo-controlled studies.

"With conventional weight-loss approaches using diet or drugs, you see a
common problem of a weight-loss plateau," says Dr. Gary Tollefson,
Orexigen's president and chief executive and coauthor of some of the
studies. "After about 12 to 18 weeks, people stop losing weight, and
that causes them to get frustrated."

Drug Targets - Cravings, Appetite

These new drugs, he adds, target the neural pathways responsible for
cravings and appetite surges. "For some people there is an
addictive-like component to some foods. I think these medications . . .
can help control some of those impulses in the brain. It's a tool --
there are no pharmaceutical cures for the problem, but this can help."

Gum may dull hunger

Something less drastic -- chewing gum -- might also help curb appetites
between meals, according to a study out of Scotland that had 60 people
(almost all women) chewing gum (mostly sugar-free) at various intervals
after eating lunch (the participants also served as their own control
group). About three hours after the meal, the subjects were offered
salty and sweet snacks. Chewing gym reduced calorie intake by about 25
calories on average. The study was funded by the Wrigley Science Institute.

"Clearly, chewing is very satisfying," enough to take a slight edge off
an appetite, says Marion Hetherington, professor of biopsychology at
Glasgow Caledonian University in Glasgow. Although the gum added no
calorie punch, "you're getting the pleasure of the intense flavors,"
which may act as an hunger suppressant. "It's a useful tool and one of
many."