YOU on a diet - Appendix A

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A Good Side to Bad Drugs? Very soon, more and more classes of drugs will be developed to help control appetite, and some of them have their

biochemical roots in the mechanisms of illegal drugs. One of the newest classes of weight-loss drugs-cannabinoid blockers, on of which is called rimonabant-are used to prevent cannabinoid receptors from making you hungry. Those receptors in your brain are the ones that are activated when someone smokes marijuana (cannabis is the scientific name for marijuana) and goes on to devour the top two shelves in the pantry (hence the marijuana munchies). How do they make you hungry? By blocking CCK and leptin, which encourages hedonistic eating. Drugs that block cannabinoid receptors are suspected to work because those blockers help reduce cravings. The cannabinoid recptors are also found in your liver, muscle, and belly fat and they affect how your body uses and stores food. Blocking these receptors results in less fat in the blood (triglycerides) , less risk of diabetes, and more of the healthy HDL cholesterol, dude.

YOU WHO Barbie It turns out that your waist divided by your height is as valuable as the BMI in predicting the risks of obesity to your health. Your waist height odds (WHO) should be less than 50 percent, but keep in mind that Barbie is 25 percent and Ken is 36 percent. The average for men is 58 percent and for women is 54 percent. Tale of the Scale This Body Mass Index (BMI) table lets you easily see what category you fall into. Just find your weight across the bottom and your height in the left column

to see where the lines cross. The most common way governments and doctors keep track of your fat is through tables like this BMI table. Drug Thugs You think you're doing something right: You're overweight, which causes high blood pressure, so you go on medication to bring your BP down. Or maybe you're depressed about being overweight, and you take an antidepressant to help deal with self-esteem issues. The irony of it all? Many of the drugs used to treat those issues have been shown to make you gain weight. Beta-blockers, one of the drugs most commonly used for hypertension, for instance, have been shown to cause weight gain and decrease metabolic rate by 10 percent. Several classes

of antidepressants have also been shown to increase body weight, as has insulin (used to help control diabetes, which can be caused by obesity). The lesson: Don't automatically assume that medications- even ones designed to help a specific problem- will help your weight-loss efforts. We recommend that you ask your doctor about weight side effects of drugs and try addressing weight issues with nutrition and activity levels first, before starting a prescription regimen that may leave you with an increase in the very thing you're trying to decrease. Get the Message? Neurons communicate with each other by sending and catching chemical signals. Serotonin, for instance, makes you feel good when you synapses are catching

it. When there aren't enough for your neurons to catch, that's when you feel depressed. Drugs that stimulate the feel-good aspect may help promote weight loss. The Future of Gut Drugs One of the most promising drugs therapies involves the injection of CCK or things that have a chemical structure similar to the Crucial Cravings-Killer peptide. (Remember, CCK causes your stomach to hold on to food for a long time and sends messages to the brain through the vagus nerve to say you're full.) The body produces specific enzymes in the small intestine to degrade CCK, but new developments show that you can stop that action. Ingesting or inhaling CCK that can access the bloodstream may help increase satiety

levels. FACTOID Many primary care doctors aren't specialist in weight control and often cannot devote adequate time to the issue. They have also been discouraged by talking with patients about weight loss and not felling that they've made a difference. Often, obese people have weight-related illnesses, like hypertension, diabetes, osteoarthritis, and sleep apnea, and one or more of these can go undetected. Knowing the straight dope on your health (and what extra weight has done to it) can be another kind of motivation. If you feel you're not getting anywhere with your primary doc and need further medical advise, see a weight specialist (called a bariatrician) . You can find board-certified specialists at the American Society of Bariatic Physicians website:

www.asbp.org. Amphetamines, while a type of appetite suppressant, aren't a good antiobesity drug, for the same reason cigarettes aren't. While the substances may help you lose weight, they're far riskier to your health because of their potential for abuse, dependency, and psychological dysfunction such as rage or panic. The supplement called Hoodia- originally used by African tribal leaders so they could go on long hikes without going hungry-seems to show some effectiveness by stimulating the hypothalamus to increase the energy source of the body (called ATP). One early study showed that people taking Hoodia ate 1,000 fewer calories per day than those not taking it. But there's one catch: There's been

more hoodia sold in the last year than has actually been produced in all of African history-meaning there are many companies claiming to have it in the bottles they're selling, when there's none in there. The herb Garcinia (at 300 milligrams) seems to work by the same mechanism, through changing ATP levels. One study showed that Garcinia decreased body weight by 5 percent in eight weeks. One of the newer weight-loss interventions involves OTC Zantac (an acid-relieving drug). It may work by activating CCK, so that you feel full. Some studies have shown that cimetidine, the prescription acid-relief form of Zantac (vanitidine) , in a dose of 400 milligrams three times a day, may yield a 5 percent decrease in waist size. YOU TIPS! Drugs: Just Say Maybe. Any of the drugs we discussed earlier in this appendix are practical jump starts to use when you've reached a plateau or need help getting over a hump. So when you start your diet, schedule an appointment with your doc when you're likely to hit the hump-about day thirty. If you fit the BMI or waist profile from earlier in the appendix, we suggest you and your doc thing about Wellbutrin. The drug is thought to work by helping emotional eaters decrease craving. The reason why it works: It helps us not think and obsess over food. It can program our bodies to get back into our natural position-that is, not substituting a six-pack of Hershey bars for a spouse who doesn't listen, a boss who doesn't understand, or a child who feels like rolling soup cans down aisle four. Very soon, more and more new classes of drugs will be developed to help curb cravings and appetites, and they're

worth exploring with your doctor. But these are short-term boosters to help you along your path. Try a Waist Management Cocktail. When many people quit smoking, one of the first things they'll do is complain about the weight they've gained after quitting. There's something to that. While cigarettes are bullets to your lungs, they do seem to help people control weight-possibly, in part, through the destruction of taste buds. But they also seem to help by increasing metabolic rate by up to 10 percent as well as helping to reduce appetite. Well, the chances of our offering up cigarettes as a waits-control method are roughly the same as the eight-track tape making a comeback. We don't want to rule out nicotine as one of those early-program jump starts you can use to

jump over a hurdle to increase you metabolism and reduce your appetite. Studies have shown that nicotine-in the form of patches and gum, not in the form of cigarettes- when combined with a modest dose of caffeine (as in two cups of coffee) can help reduce weight for those who use it. It's not a long-term solution but one that can help you adjust and automate. We've prescribed a 7-milligram nicotine patch to help some over a hurdle, combined with two cups of coffee (average cups, not the high-test espresso type-it would be only two-thirds of one of those babies). Of course we ensure that the patient doesn't have side effects triggered by the caffeine, such as migraine headaches, GERD, increased heartbeats, or anxiety. Caffeine will raise your metabolic rate just a tad to burn more calories. Combined the two if your weight-loss program stalls. They can act as that crutch to help you over the hump. This is one tip, like all

others in this appendix, that you should share with your doctor, to play it safe. Plus you need a prescription.