Rimonabant: Miracle Drug for Obesity?
A recent article and editorial in the Journal of the American Medical Association (April 2, 2008) follows many recent studies on the drug rimonabant, available in many countries in Europe but not the US. This drug acts more or less as an anti-marijuana drug. Marijuana causes a state that in part is of euphoria, relaxation, a stimulation of the appetite, and a decrease in nausea. For the latter, some have claimed that it is useful in chemotherapy.
Rimonabant decreases appetite, weight, and may cause some nausea, depression and anxiety. For weight control, and therefore its effects on obesity and incidence of diabetes/metabolic syndrome and ultimately the chance of decreasing heart disease in our ever expanding population, rimonabant or a drug like it may have some uses.The drug has been well tested for the past two years on men who have a waist circumference of greater than 40 inches and women who have a waist circumference of greater than 35 inches. This drug however may not ever come to this country due to the possibility that depressive side effects may lead to increased suicide (not the way we want to decrease weight in our population, or suits in our courtrooms).
Unfortunately, doctors are left with few choices when suggesting weight reduction to overweight and obese patients. The current available drugs (orlistat and sibutramine) are actually very weak, and most have not been documented to keep weight off after one year. Less than 20% of patients taking these medications will achieve more than 10% weight reduction. Fat substitutes and blockers can be messy to take. Some low calorie snacks leave the patient with susceptibility to fatty diarrhea and “fecal staining.” This leaves many doctors frustrated by discussions of various diets to people that don’t want to be “deprived” of the foods that they have grown accustomed to eating.
So if the drug is not available why do I mention it? Perhaps to deal with the relationship between the brain, heart, obesity and risk of heart attack and stroke. Other recent research has noted “heavy marijuana use can boost blood levels of a particular protein [apolipoprotein C-III], perhaps raising a person's risk of a heart attack or stroke," (Molecular Psychiatry, May 13, 2008). ApoC-III is a protein that interacts with fats, delaying the breakdown of triglycerides, promoting formation of arterial plaque. Some antidepressant medications also can cause significant weight gain.
On the basis of the above research we can see that the stimulus to overeat is in the brain and can be manipulated with drugs. These drugs can increase the weight and appetite, or decrease it modestly (a weight loss of 10 to 12 lbs on the average, which is not much given that diets were also controlled by nutritionists). But we also have the ability to use our heads and control our diets, or accept frequently unnecessary gastric banding and bypass. Hopefully we can use the knowledge that control of the brain and its habits can be used both to avoid obesity and to treat it. Gastric banding and bypass grafting have problems associated with them that are life changing. Hopefully, through adherence to appropriate diets and medications to come we will be able to decrease the body weights of those who need it and reduce their chance of heart attack and stroke.
In the meantime most physicians will recommend the awful word “diet” to their patients and refer to one of thousands of books on the subject, as well as requesting the aid of one of the many nutritionists that have been trained seemingly just for this purpose.