January 25, 1996
Web posted at: 8:00 a.m. EST
From Correspondent Dan Rutz
ATLANTA, Georgia (CNN) -- Given the growing evidence that obesity greatly increases the risk of heart attack in middle age, some medical researchers are pointing to biological reasons for overweight patients' uncontrollable urge to eat. Consequently, some rather non-traditional methods to combat weight problems are now gaining acceptance, including drug therapy and stomach stapling.
Those little pills are "willpower" in a bottle, says Stephen Dyer, who has lost more than 60 pounds after spending seven months in a weight-loss program that used drugs as part of the regimen.
Psychologist Isaac Greenberg is part of a team of professional weight-loss experts at Deaconess hospital in Boston. He says that nearly all those who set out to lose excess weight are destined to regain it.
"If I were to exercise three times a week, drink more water and less soda pop and less fat food, I'd probably maintain my weight real well," says Kimberly Payne, who's part of Greenberg's program.
But, says Greenberg, it might be a lifelong struggle for Payne. He and other experts speak of a set point, a natural weight that's based more on heredity than lifestyle.
"While behavior is important and we stress it, I think you need to go and look at ...biological impact," Greenberg said. "And in that regard, willpower will take you so far. (But) you still need something that's going to take you the rest of the way."
At this clinic that something extra is a pair of drugs: phentermine and fenfluramine. There's a debate over the use of strong drugs to curb appetite, but here medicine is just part of the overall strategy.
"The main point is that medications are not magic," says Greenberg. "They won't make a person exercise more. They won't make a person choose lower-fat foods."
But the medicine apparently can help with one all-important exercise: the strength to say no to food.
Dyer says the drugs have helped him look forward to meals, and not obsess with food.
"The difference is that I don't need seconds to be satisfied," he says. "In this particular program, I find that as much as I have eaten is enough, and the word enough is new to me."
Years of dealing with weight swings sent Kathryn Graves to Deaconess for a more extreme solution to obesity: stomach stapling.
The surgery shortens the digestive tract, causing patients to feel full sooner, and since food passes through the tract faster, less of it can be stored as fat.
Dr. Armour Forse considers surgery only for those who can't keep weight off with drugs or other conservative measures, and whose health is in jeopardy because of obesity.
"The ideal candidate is a person who is morbidly obese," he says. "When we talk about morbid obesity, that's a person who's a hundred pounds over their ideal weight."
Graves has asthma, and her obesity was making it difficult for her to breathe. "I couldn't even walk down the street," she says.
Twenty years of experience with the operation shows 80 percent approach a normal body size -- and keep it. Doctors say the benefits of massive weight loss appear to offset any risk of the surgery encumbering normal digestion.
Today, Darren Johnson weighs 195 pounds. That compares to 310 pounds before he had his "stomach stapled." His surgery makes it hard for him to overeat or eat the wrong things because fatty foods can cause a stomach upset.
"It's taken away the ability to go after a huge dessert," Johnson says. "It's taken away the extra foods that people don't really need."
Research into the so-called fat gene may help explain why some people are naturally heavier than others, but few experts expect genetic engineering to provide an easy fix to obesity. But the research underscores the point that body shape is a product of both nurture and nature. And, some, by design, are destined to struggle more in order to weigh less.
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