Helpless Heavyweights

Obesity is one of the most common medical complaints in the U.S. today. Depending on the choice of surveys, anywhere from one-tenth to one-quarter of the population is overweight to some extent, and millions of people unhappy about their girth and concerned about their health spend more than $400 million a year on reducing drugs and treatments. Physicians interested in the subject have even formed the American Society of Bariatrics (from the Greek baros, meaning weight) to study the problem collectively. The field has nowhere to go but up; medical science has so far failed miserably to help the heavyweights in any important way.

This was the admission of bariatricians and other physicians meeting in Washington last week. The average family doctor treats ten or more patients a month for overweight. A relatively small number have obvious metabolic disorders that can be checked. For most of the rest, the problem is simply excessive eating, and doctors have not found a way to control that for very long. A 250-lb. man who should weigh 165, say, would have to cut his caloric intake by more than half. By his eating standards, that would be close to starvation. It is easier to dry out drunks than to starve down heavy eaters.

Fad diets, the experts feel, have only temporary effect, and some can be medically unsafe. Drugs that dull the appetite, like amphetamines, help certain people for a while, and some doctors prescribe drugs in conjunction with diets. But no one considers pills a long-term answer because of side effects and the chance of addiction. Many extremely obese people eat heavily because of emotional problems. For these patients, psychotherapy can provide clues about the basic causes of the trouble and sometimes helps ease the anguish of kicking gluttony. The key element is usually motivation. Group sessions on the style of Alcoholics Anonymous benefit some people more than orthodox medical approaches do.

Regardless of method, the quest for permanent slimness is rarely rewarding. According to Dr. Alvan Feinstein of Yale medical school, the success rate of weight-loss programs is "terrible, much worse than in cancer." Out of every 100 obese patients, some doctors have found, only a dozen can be expected to lose significant amounts of weight in a yearlong treatment program. Of that happy dozen, ten can be expected to gain back their excess poundage during the following year.

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