March 18, 2009
A 5-foot-9-inch man whose weight creeps up by 30 pounds to 205 may die three years earlier as a result, according to research that found even a moderate gain can drag down health.
The study, published in the U.K. medical journal The Lancet, found a person weighing 270 pounds at 5-foot-9 may lose a decade of life, with a death risk equal to that of a lifelong smoker. The report by British scientists reviewed past studies of almost 1 million people in Europe and North America and found carrying one-third more pounds than doctors deem ideal raises a person’s chance of dying early by 30 percent.
The World Health Organization expects obesity levels to swell 75 percent to 700 million people by 2015, an “epidemic” tied to rising diabetes and heart disease rates, the group’s Web site said. The problem has sparked a race for new fat-control treatments among Amylin Pharmaceuticals Inc., Arena Pharmaceuticals Inc. and Orexigen Therapeutics Inc., all based in San Diego.
“This is a reaffirmation of how fundamentally important it is for society to rally against” obesity, said David Katz, founder of Yale University’s Prevention Medicine Center in New Haven, Connecticut, in a telephone interview today. “The takeaway message is that obesity is lethal,” said Katz, who wasn’t involved in the study.
The Lancet study looked at the effect of increasing body- mass index, a common measure of body fat that compares a person’s weight and height. The ideal BMI is between 22.5 to 25, or about 154 pounds for a man or woman 5-foot-7-inches tall, the authors said in a statement.
Every one-third increase in a person’s score raises the chance of dying by a third, and the risks of stroke, diabetes and heart problems by more, the study said.
The main way extra pounds turn deadly is by causing heart attacks and strokes, the leading killers worldwide, along with increasing cancer risks, said researcher Richard Peto, from the Clinical Trial Service Unit at the University of Oxford in Oxford, England. Added weight may be responsible for a quarter of heart attacks and strokes in the U.K. and a third in the U.S., as well as 6 percent to 8 percent of cancer deaths, Peto said.
“This is the second most important cause of avoidable death in middle age,” Peto said in a telephone interview. “For people who are not smokers, this is the main thing.”
Keeping Weight Off
Keeping weight off in the first place may be the best solution, said Linda Antinoro, a dietician at Brigham & Women’s Hospital in Boston.
“The first piece of staying healthy is to recognize weight gain early on,” Antinoro said in a telephone interview. “Once gained, it’s a lot harder to lose, so you should minimize a gain pattern. If people see they’re up 5 pounds, they want to think about losing that then, not when they’re up 25.”
In the U.S., obesity rates doubled among adults between 1980 and 2000, according to the Centers for Disease Control and Prevention in Atlanta. The agency estimates 30 percent of the population is now obese, meaning their body-mass index is more than 30.
By that standard, the average American man, who stands 5- foot-9, according to the CDC, would weigh about 170 pounds if he had a healthy BMI. At 205 pounds, he’d be obese. Those in between are overweight, the agency says.
A 5-foot, 5-inch woman is considered overweight at 150 pounds and obese at 180 pounds, according to the body-mass index scale, The Lancet authors said.
The Lancet review, funded by the Medical Research Council, the British Heart Foundation and other groups, compiled data from 57 studies including 894,576 participants with an average age of 46 and a BMI of 25.
Efforts to develop obesity drugs have been plagued by setbacks. Paris-based Sanofi-Aventis SA yanked Acomplia from the market in Europe last year after it was rejected by the U.S. Food and Drug Administration over reports of increased psychiatric disorders. New York-based Pfizer Inc. and Merck & Co., of Whitehouse Station, New Jersey, halted development of similar drugs, spurring Pfizer to exit the market completely.
Amylin is working on a drug that combines pramlintide, the active ingredient in its diabetes drug Symlin, with leptin, a hormone tied to hunger. Arena’s lorcaserin is designed to stimulate a protein in the brain that makes people feel full. Results of pivotal studies from the final stage of development for both drugs are expected in the next few months. Orexigen is testing drugs named Contrave and Empatic, both of which repurpose existing drugs for weight loss.
New FDA standards for diabetes drugs suggest the agency is more willing to approve weight-loss treatments now, said Jonas Alsenas, an analyst with Leerink Swann & Co. in New York, in a telephone interview. The agency is accepting evidence of weight loss along with blood-sugar-lowering power in its reviews, he said.
“There’s more and more momentum in this area, assuming we have good and appropriate therapies,” Alsenas said.
In 2007, diet drugs generated about $330 million in U.S. sales, said Donny Wong, an analyst at Decision Resources, a Waltham, Massachusetts-based research firm. Most of that went for purchases of Meridia, made by Abbott Park, Illinois-based Abbott Laboratories and Swiss-based Roche Holding AG’s Xenical and Alli from London-based GlaxoSmithKline Plc, Wong said.
“There’s a tremendous need and desire for an effective and safe weight-loss drug out there, and the potential market is well into the billions,” Wong said in a telephone interview from London. Sales are tempered so far because the drugs have failed to reach the “holy grail” of double-digit weight loss that doctors and patients say in surveys they’re seeking, he said.
Other companies, led by New Brunswick, New Jersey-based Johnson & Johnson and Allergan Inc. of Irvine, California, are promoting gastric bands and other devices used in operations to shrink the stomach. An estimated 220,000 obese people had bariatric surgery in the U.S. last year, according to the American Society for Metabolic and Bariatric Surgery, in Gainesville, Florida. The procedures cost $17,000 to $25,000, the group says on its Web site.
Side-effects such as diarrhea and depression can make it hard for some patients to stay on obesity drugs and mean they’ll likely never replace diet and exercise as a solution, Brigham & Women’s Antinoro said.
“You can be on a zillion medicines and have a zillion surgeries, but you want to think about how you’re living your years,” she said. “Do you want to be constantly at the doctor’s office, or on medications, unable to do activities you enjoy? You want to think about quality of life, too.”
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