The drug, rimonabant, works by blocking the circuits in the brain that control the urge to eat and smoke.
Obesity and smoking have become two of the world's biggest killers, and are being targeted for action in the UK.
The makers, French firm Sanofi-Synthelabo, hope to market the drug next year.
" We think this might be the ideal compound for
people who are overweight and smoke.
Dr Robert Anthenelli
In one trial the drug helped people to shed an average of 9kg (20lbs) in a year.
And in a second, it was found to double the chances of smokers successfully quitting - at least in the short term.
Dr Robert Anthenelli, of the University of Cincinnati, who directed the smoking study, said: "We think this might be the ideal compound for people who are overweight and smoke."
The drug works by blocking the endocannabinoid system in the brain which regulates hunger, and probably other urges, including craving for alcohol.
The drug marijuana makes people ravenous by stimulating this circuitry.
And it is thought that over-eating and smoking can also over stimulate this system, leading people to eat and smoke still more.
Rimonabant seems able to block the body's ability to receive these signals, allowing the system to return to normal.
The obesity arm of the research focused on 1,036 overweight volunteers, who were put on a restricted calorie diet, and given either rimonabant or dummy pills.
After a year, those who got the higher of two doses of rimonabant had trimmed 7.6 centimetres (three inches) from their waistlines. Nearly half of them took off 10% of their body weight.
By comparison, those on placebos lost just 2.25 kilograms (five pounds).
Rimonabant also seemed to cut levels of potentially harmful cholesterol, while boosting levels of "good" cholesterol.
People taking the drug reported that they simply felt less hungry.
Dr Jean-Pierre Despres, of Laval University in Quebec City, who led the obesity study, said: "The bottom line is we found a spectacular drop in waistlines and changes in many other risk factors that are beyond what you would ordinarily expect."
The smoking arm of the study showed 28% of smokers who took the drug shunned cigarettes for at least a month, compared to just 16% who were given dummy pills.
The people on rimonabant who quit gained little or no weight - and a third actually slimmed down.
Dr Ian Campbell, chairman of the UK National Obesity Forum, told BBC News Online that the drug "looked promising".
"It appears to have helped patients maintain significant weight loss over a 12 month period, but I look forward to even longer term results.
"However, I would stress that weight management remains a lifestyle issue. Medication must only ever be seen as an adjunct to support people who have made efforts to change their lifestyle first."
Dr Campbell said people who gave up smoking had a tendency to put on weight, and this put many people off even trying.
"A drug which could tackle both problems would represent a fantastic opportunity," he said.
Details of the trials were presented at a meeting of
the American College of Cardiology in New Orleans.
|29 February 2004
FOOD AS MEDICINE
Sheila Dillon investigates the money we could save ourselves and the NHS by replacing pills with a different diet.
Obesity alone (which shaves a decade off life expectancy and triples the risk of diabetes and heart disease) is estimated to cost the NHS two and a half billion pounds a year. Add coronary heart disease, cancer, stroke and iron deficiency and the burden to the tax payer of chronic diet-related illness is about £15 billion every year.
In this week’s Food Programme Sheila Dillon meets those taking action to reduce the burden on the NHS simply by looking more closely at the role food plays in the nation’s health.
Former GP Dr Brian McDonogh who now runs a private practice in Crawley, West Sussex (The Eagle Clinic)
Professor Sue Fairweather-Tait, Head of the Nutrition Division of the Institute of Food Research in Norwich.
GP Dr Julia Davis and colleagues from the Bromley-by-Bow Healthy Living Centre.
Patrick Holford from the Institute of Optimum Nutrition.
Professor Andre Tylee from the Institute of Psychiatry.
Teodoro Bottiglieri, professor of pharmacology at Baylor University Medical Centre in Dallas, Texas.
Khush Mark cancer specialist working for a private practice in London.
Dr Siobhan Quinn, NHS registrar in psychiatry.
Professor Pekka Puska, Director General of Finland’s National Public Health Institute.
Melanie Johnson, Government Minister responsible for public health.
28-32 High Street
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NOVEMBER 22 2005
I have warned for years that supplements of minerals are not always a good idea or even effective. The latest research confirms this for Calcium
By Graciela Flores
Tue Nov 22,11:36 AM ET
NEW YORK (Reuters Health) - Young girls who get extra calcium from food tend to gain more bone mass than those who get it from tablet supplements, but children who already receive adequate amounts of calcium in their diets do not benefit from any form of extra calcium, a research team in Finland reports.
"We conducted the study to learn how to maximize the children's peak bone mass during the rapid-growth period of puberty -- in which 60 percent of the adult bone mass accumulates -- and thus prevent osteoporosis in adulthood," Dr. Sulin Cheng from the University of Jyvskyl in Finland told Reuters Health.
For two years, Cheng and her colleagues followed a group of 195 healthy girls, ages 10 to 12, whose calcium intake was under the National Nutrition Council recommended levels (less than 900 mg a day.) They randomly assigned the children to receive 1000 mg calcium tablets, 1000 mg calcium plus 200 IU vitamin D tablets, low-fat cheese (1000 mg of calcium), or placebo tablets.
The researchers measured the effects of calcium supplementation on bone mass and body composition, and analyzed the data using traditional statistics as well as a new model that takes into account the rate of body growth.
"We found that the cheese group showed more beneficial effects in their bones than any of the other groups," said Cheng, "but when we took into account the individual growth speed, we found no beneficial effect with any of the interventions -- calcium alone, calcium plus vitamin D, or even cheese supplementation. This means that if you exceed certain levels of your dietary calcium intake, it doesn't matter how much you take; you won't get any benefits," explained Cheng.
In the Finish study, most subjects were already receiving adequate levels of calcium in their diets. Only one percent of the girls in the total screened population (more than 1000 girls) had a dietary calcium intake below 400 mg/day. "In Nordic countries, people already get enough calcium," added Cheng.
The authors believe that their study brings up a very important question for the entire medical community: how to avoid the unnecessary calcium supplementation in normally growing children. "I hope these results will make doctors and authorities think about this issue," said Cheng.
SOURCE: American Journal of Clinical Nutrition, November 2005.
By Nichola Groom Sun Feb 19, 2:45 PM ET
LOS ANGELES (Reuters) - New studies indicating a low-fat diet does not reduce the risk of cancer and calcium supplements do little to prevent broken bones are unlikely to change consumers' habits and may only add to confusion about the link between diet and health.
In the last year, researchers have released a series of medical studies that fly in the face of conventional wisdom, which holds that weight loss, nutritional supplements and diets low in fat and calories help fight disease and prolong life.
But three studies in the Journal of the American Medical Association published earlier this month showed that women who ate less fat and more fruits and vegetables did not reduce their risk of cancer or heart disease. And Wednesday's New Englans Journal of Medicine found that calcium and vitamin D supplements were unlikely to prevent broken bones in women as they age.
The research comes on the heels of statistics published last year that questioned the U.S. government's assertion that obesity causes nearly as many deaths as smoking.
The studies prompted headlines suggesting consumers would take the news as carte blanche to eat as they please, but experts said that was unlikely.
"Consumers are used to the fact that there are often multiple medical studies coming out that often have conflicting findings," said Michael Allenson, a principal at food industry consulting firm Technomic. "Until they see a greater consistency ... they are likely not to make a change."
Consistency, however, appears to be a long way off as theories about diet and health are constantly changing. In the last two decades, fats and carbohydrates have alternately been praised and demonized by health experts. Most recently, fear of carbohydrates like pasta and bread led to a boom in low-carb, high-protein diets in 2004 that quickly vanished.
The headline-grabbing studies against a background of diet trends like low-carb, low-sugar and low-fat forces consumers to sift through masses of conflicting as well as confusing information and ultimately draw their own conclusions.
"The public gets information in little, fragmented pieces through the news," said Dr. Walter Willett, a nutrition professor at Harvard University's School of Public Health. "If that's really all they are getting, it is extraordinarily difficult to make some sense out of what's there."
Adding to the confusion, according to some, is that while some consumers take their long-term health into consideration when eating, those concerns are typically outweighed by a preoccupation with saving time and money.
"The real problem with health is that there is no immediate payback," said Harry Balzer, vice president with The NPD Group, which tracks consumer eating trends. "If I have low-fat milk today, what do I get? Did it save me time, did it save me money? The feedback is going to get to you 40 years from now."
In addition, Allenson said, consumers usually go on diets so they can lose weight, not so they can prevent disease.
"That's not the only reason why people go on diets or eat low-fat foods," Allenson said. "A lot of people are looking to lose weight because they do feel better about themselves."
In the meantime, while researchers duke it out over the long-term benefits of diet and exercise, experts said consumers can rest assured that the conventional wisdom about maintaining a healthy weight and eating a balanced diet is more likely to help than hurt.
"What we know about diets hasn't changed. It still makes
sense to eat lots of fruits and vegetables, balance calories
from other foods, and keep calories under control," said Marion
Nestle, a nutrition professor at New York University. "That,
however, does not make front-page news."
"This insidious, creeping pandemic of obesity is now engulfing the entire world," Australia's Monash University professor Paul Zimmet, chair of the 10th International Congress on Obesity, said on the opening day of the conference.
The spread of the problem was "led by affluent western nations, whose physical activity and dietary habits are regrettably being adopted by developing nations," Zimmet told more than 2,000 delegates.
The world now has more fat people than hungry ones, according to World Health Organisation figures, with more than a billion overweight people compared to 800 million who are undernourished.
The congress on obesity is held every four years, with the last three staged in Toronto (1994), Paris (1998) and Sao Paulo (2002).
"The conference will treat obesity as the keystone of all health priorities because it is the single greatest contributor to chronic disease throughout the world," said University of Sydney professor Ian Caterson, the event co-chair.
"There are now more overweight people in the world than undernourished and we are seeing the double burden of the extremes of malnutrition -- undernutrition and overnutrition -- in many developing countries.
"We know this is not about gluttony -- it is the interaction of heredity and environment. We know that small changes can make a big difference in peoples weight and health."
Zimmet said the problem needed urgent solutions -- not just widespread changes to diet and exercise but the rethinking of national policies on urban and social planning, agriculture policy, education, transport and other areas.
He also warned in an opening address that the growth of obesity-related diabetes, or so-called "diabesity", was set to bankrupt health budgets all over the world.
Around 370 speakers and presenters at the six-day congress will discuss a range of issues, including scientific research on how the brain regulates energy and advances in the prevention and clinical management of obesity.
The conference is being attended by academics and health professionals from Australia, Japan, the United States, Britain, Canada, Sweden, Indonesia and New Zealand.
Researchers said such drugs would become more important in the future to combat the growing obesity crisis.
But the University of Alberta Hospital said in the Lancet that data on drugs already in use was limited particularly over cardiovascular outcomes.
They said there should be better testing of anti-obesity therapies.
The team analysed articles published over the last six years on three drugs - hunger suppressant sibutramine, orlistat, which restricts the absorption of fat, and rimonabant, a relatively new drug being targeted at people with diabetes.
| Doctors use these drugs
carefully, there are no wonder cures, but in the right circumstances
they can help
Jim Kennedy, of the Royal College of GPs
They said the long-term impact of the drugs was not clearly known with side effects including increased blood pressure and pulse rate for sibutramine and mood-related disorders for rimonabant reported.
The three drugs are used in the UK - where one in five adults are classed as obese - although they are restricted for clinically obese people or those at risk through conditions such as diabetes.
Doctors normally only prescribe them in tandem with exercise and dietary regimes and they are not often used for longer than a year.
But the researchers said as the obesity crisis escalates, as it is predicted to do, clinicians will have to increasingly rely on drug treatment programmes.
Lead researcher Raj Padwal said: "In light of successful weight-loss treatments and the public health implications of the obesity pandemic, the development of safe and effective drugs should be a priority."
But he said trails should show reductions in both weight loss and clinical outcomes "should be required either before these drugs are approved for widespread use or as a condition for on-going approval".
Dr Jim Kennedy, prescribing spokesman for the Royal College of GPs, said there was little known about the long-term impact of anti-obesity drugs.
But he added: "I think the use of drugs will be limited to certain situations.
"Obesity is a complex issue and there are many factors that need to be addressed, it is not just a question of handing out drugs.
"Doctors use these drugs carefully, there are no wonder cures, but in the right circumstances they can help.
"For example, if someone's diabetes is out of control or if they need to lose weight for an operation."