A big problem: weight is on the rise in the U.S., especially among children and teens. Find out why obesity is being called the epidemic of our time

Rocky’s Struggle with OBESITY

obesity2It’s 1:40 a.m. Rocky is talking softly to himself and his tape recorder. He’s thinking about his life and what a big difference it would make if he could lose weight.

“That would make everybody happy. Why can’t I just say ‘no, no’? See, right now I want to eat. Wow, I just thought about ice cream in the refrigerator that I saved yesterday. See, now I bet you five dollars I’m going to eat that ice cream eventually tonight. I’m going to try not to. I don’t want to eat. I’m not going to eat. I’m not. I’m not. I’m not going to eat.”

Samr “Rocky” Tayeh hit the airwaves late last year when a piece he produced for the award-winning “Radio Rookies” program was broadcast by public radio station WNYC in New York. In “My Struggle with Obesity,” the then 15-year-old Palestinian-American from Brooklyn described what it’s like to be 6 foot 1 and weigh 393 pounds.

He recorded his thoughts and conversations with his family for months. Then he distilled the results into a 12-minute story that was also broadcast nationally on National Public Radio’s “All Things Considered” program.

Rocky, a tenth grader at Edward R. Morrow High School in Brooklyn, doesn’t skirt the issue. “I’m the fattest kid in my house. I’m the fattest person on my block. I’m the fattest teenager I know.”

He wants to do something about his obesity.

imagesHis family tries to help. His dad says he loves him, heavy or not heavy. “I just worry about you because I’m not here forever. You have to lose all that heavy weight and love yourself. You’re a very handsome fella, very smart … and this is my only problem. I worry about you every day.”

His twin sister Samih (5 foot 9, skinny) teases him: “A turtle could chase you.” He duct-tapes a sheet of motivational thoughts to his shelf, but Samih thinks it’s a joke, and soon he does too. He puts on a tai-bo tape–but soon switches back to watching TV.

Rocky, a friendly guy with a great radio voice, had an overwhelming response to his piece from all around the country. The positive feedback increased his resolve. “Mentally,” he says, “I’m totally questioning everything now, like why do I eat, why don’t I. My family’s questioning. My twin sister is saying, ‘Come on. You did a story about it. Now let’s try to do something with it. Stop talking. Let’s get moving.'”

He doesn’t like what he calls “sad sympathy” about his obesity. He has some thoughts for anyone who, like him, is struggling with a weight problem. “Always strive for the best, and basically, you are what you are. Yeah, you have to lose weight. I’m not going to lie and say, ‘Oh, weight is good. Keep it on and be happy with it.’ You have to come to terms. You have to accept it. You have to start losing weight for you, not for anybody else, but for your health.”

Rocky’s problem with weight is similar to that of many Americans. It is a major health problem for U.S. kids, teens, and adults. In the last 40 years, health experts have clearly made the point that smoking is the leading preventable cause of death in the country. Today, the same experts are targeting another important health risk: obesity, or being extremely overweight.

It’s no coincidence that health pros sometimes compare the dangers of smoking and the dangers of being obese. The U.S. Centers for Disease Control and Prevention (CDC) ranks behaviors that put people at high risk for premature death, disability, or chronic (long-lasting) diseases. Risk number one is smoking and other forms of tobacco use. In second place is eating high-fat and low-fiber foods. Number three is not engaging in enough physical activity. Both second and third place factors have a lot to do with overweight and obesity.

The U.S. Department of Health and Human Services (HHS) says that nearly one-third of all adults in the United States are obese. The figure nearly doubled between 1980 and 2000. This fact gives obesity its status as an epidemic, which is defined as a quick and large increase in a disease or health condition within a population.

Much of the attention on obesity is focused on young Americans. The most recent national health statistics show that an estimated 15 percent of children and adolescents ages 6 to 19 are overweight. This amounts to almost 9 million young people. The percentage is three times higher than it was in 1980.

The figures have health experts concerned because they say that overweight adolescents are at increased risk of becoming overweight or obese adults. It has been estimated that one-half of overweight school-age children remain overweight as adults.

Health Risks Are Huge

Obesity increases a person’s risk for a number of serious diseases, including diabetes, heart disease, stroke, and some types of cancer.

For example, people who are overweight are more likely to have high blood pressure. They are also more likely to have high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance called the “bad” cholesterol). These are major risk factors for heart disease and stroke.

Also people with more body fat can have higher levels of substances in the bloodstream that cause tissue inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk. Inflammation can also be a risk factor for other problems. One is sleep apnea, a condition in which a person stops breathing for short periods during the night. Another is osteoarthritis, a painful joint disorder.

Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. In fact, some scientists believe that fat cells may make hormones that affect cell growth and lead to cancer.

All of these are diseases that normally affect adults. Health professionals, however, report that growing numbers of overweight children and teens who are overweight have risk factors for these diseases. New research shows that an increased number of children are already developing type 2 diabetes, which generally begins in adulthood.

Being overweight at any age puts increased stress on weight-bearing joints and can create respiratory (breathing) problems. In addition, being overweight often comes with a stigma that causes social and emotional problems. It takes a toll on self-esteem.

Body Image

Tailor Series - Measuring

Body image and self-esteem are major concerns for most teens. Many think they are overweight when, in fact, their weight is normal. This is especially true in adolescence, when body shape changes as boys and girls grow.

“Teens are already very concerned about body size,” says Joanne Ikeda, a lecturer at the University of California at Berkeley and an expert on childhood obesity. “Many are in fact preoccupied and very dissatisfied with their bodies no matter what size they are–whether they happen to be thin or ‘medium.'”

Another factor to consider is heredity. The genes you inherit from your parents account for about 75 to 80 percent of your body fat. The remaining 20 to 25 percent comes from what scientists call “environmental influences.” These influences relate to your personal eating habits, fitness, and physical activity.

Lifestyle Makes a Difference

“Teens should be concerned about obesity if, in fact, the cause of their being overweight is an unhealthy lifestyle,” says Ikeda. She feels lifestyle is the key to good health, not a person’s size or shape. The risks associated with overweight and obesity are not so much a matter of body size but the degree of physical fitness.

“When you go to the doctor’s office, he or she doesn’t only weigh you to assess your health,” Ikeda points out. Taking blood pressure, blood tests, and other evaluations are necessary to tell the doctor about your general health and fitness. One important indicator of that is your “metabolic fitness,” which is related to blood pressure, blood cholesterol, and blood sugar. (Metabolism is a series of chemical reactions in the body that convert calories to energy.) People who have good metabolic fitness burn calories effectively–both when they are physically active and at rest.

Those who are at increased risk for health problems are people who are both overweight and metabolically unfit. “But,” cautions Ikeda, “large children who have healthy lifestyles are probably just meant to be–are genetically programmed to be–large, and there is very little if anything they can do about changing their body size and shape.

“We will always have size diversity in our society,” she says, “but the most important thing is for people of those different sizes and shapes to maintain healthy lifestyles.”

Set Goals

set-goal

So, what can you do? For one thing, think behavior, not dieting. “Weight is not a behavior,” adds Ikeda. “Having a goal of weighing 10 pounds less is sort of ludicrous, because even that you can’t accomplish without setting behavioral goals.”

Amazingly, those goals can be quite simple. Instead of going on a diet (see sidebar above), check out the U.S. Dietary Guidelines (www.health.gov/dietaryguidelines). The 2000 guidelines emphasize balance, moderation, and variety in food choices, with a special emphasis on grain products, vegetables, and fruits. Watch for the brand-new 2005 guidelines one year from now.

To get moving, start with a plan–and think variety here too. It’s recommended you fit in 60 minutes of fitness-promoting activities five days a week. A 30-minute gym class usually takes care of half of that. Other activities can be entirely of your design and should be a combination of things you really like doing. Most activities you can do on your own, or with a friend–be it swimming, biking, jogging or fast walking, or jumping rope, spinning indoor–or playing sports like tennis, baseball, or soccer. Even little bursts of activity count, such as carrying things up and down stairs, dancing to a favorite song, or helping with chores.

Seek Support

For all this, it’s a good idea to have an adult in your corner. Your mom or dad can help you design, build, and carry out a good eating and exercise plan. For any questions about your weight, ask your doctor.

When you get down to it, though, it’s your call. Ikeda, who works with many young people, says she finds that teens are interested in taking more responsibility for themselves, at a time when they can see a future of independence. “You are making your food choices,” she tells teens. “There’s no one watching over you to make sure you’re well nourished except yourself. It’s time to take responsibility for caring for your body.”

REALITY CHECK

Does Dieting Work?

Not necessarily, according to a large three-year study of young people by Harvard’s Brigham and Women’s Hospital in Boston. The study, published in October 2003, found that frequent dieting appears to result in long-term weight gain.

The study began in 1996 with nearly 17,000 9- to 14-year-olds. At the beginning, 30 percent of the girls and 16 percent of the boys identified themselves as “dieting.” For three years, researchers followed up. They asked the girls and boys questions about dieting, weight change, and exercise and eating habits. In the end, the scientists found that dieters gained more weight than non-dieters. For example, a 14-year-old girl who dieted frequently gained about 2 pounds per year more than other 14-year-old girls who didn’t diet.

“Our study found that dieting was counterproductive,” said one researcher.

I Think I Can

You can take small, determined steps to reach a goal. Each of
the following activities, behaviors, and attitudes can help you
take steps away from being overweight. In fact, they can help
anyone lead a healthier lifestyle. First, decide whether you will
take the step. After two weeks, check if you have taken the
step and write down how you've done it.

Physical Activities                             I will    I have    How

[check] Participate more actively in PE           ()        ()
        class. (I don't have to be the
        best; I'll just try harder.)

[check] Do one physical activity or more          ()        ()
        on my own for at least five days
        a week (such as bike riding,
        walking, swimming, chores).
        Specify which:--

[check] Watch one half-hour less TV a day         ()        ()
        (or even more). These are some
        programs to skip:--

[check] Cut video game playing by 30              ()        ()
        minutes a day.

Eating Behavior

[check] Drink fewer sweetened sodas.              ()        ()

[check] Eat more fruits and vegetables.           ()        ()

[check] Eat less fast food.                       ()        ()

[check] Read food labels.                         ()        ()

[check] Eat less fat.                             ()        ()

[check] Eat breakfast.                            ()        ()

[check] Eat fewer unhealthy snacks                ()        ()
        (with lots of sugar and/or fat).

[check] Keep a food diary.                        ()        ()

Attitudes

[check] Set limits on unhealthy                   ()        ()
        activities/behaviors.

[check] Avoid using food as a reward.             ()        ()

[check] Avoid using food as a punishment.         ()        ()

[check] Avoid using food as a consolation.        ()        ()

[check] Talk with my parents about my goals.      ()        ()

[check] Talk with my doctor about any             ()        ()
        questions I have about my weight,
        shape, or size.

[check] Talk with a good friend about my          ()        ()
        goals.

OBJECTIVES

Students will be able to educate and advocate better nutrition and increased physical activity among their peers and in the community. Students will demonstrate an understanding of key concepts related to proper nutrition and maintenance of healthy body weight.

REVIEW/DISCUSS

* How are being overweight and obesity related to the problems of premature death, disability, and chronic disease? (High-fat, low-fiber diets and being sedentary are ranked second and third in terms of contributing to premature death, disability, and chronic disease. Both are related to being overweight and obesity.)

* Obesity is described as epidemic in our country. Whatdoes that mean? (That description refers to the fact that there has been a big increase within a short period of time of persons who are obese.)

* How prevalent is obesity in children and adolescents ages 6-19 years? (An estimated 15 percent of children and adolescents ages 6-19 years are overweight.)

* Identify several health risks associated with being obese. (Obesity is associated with an increased risk of diabetes, respiratory problems, hypertension, heart disease, stroke, some types of cancer, sleep apnea, and arthritis.)

* Beyond diseases associated with being obese, what other concerns might a young person have about being obese? (Because young people are so concerned with their body image and appearance, being obese may cause a person’s self-esteem to suffer.)

* What is meant by the expression “metabolic fitness?” (When someone has a good metabolic fitness, that means they are able to burn the calories they get from their foods effectively–both when they are physically active and when they are at rest.)

* What are some goals you could set that might help you to avoid being overweight or obese? (Answers will vary, but may include: You could set reasonable goals such as: increase your level of daily activity to 30 minutes of fitness-promoting activities per week; try new fitness activities until you find something you enjoy enough to carry through with over time; do some everyday things in a more energy-consuming way, such as using stairs rather than elevators.)

ACTIVITIES

1. Have students prepare an event to increase awareness of the obesity problem and give tips on what people can do. Resources available to help them develop a plan include the Nutrition & Physical Activity segment of the CDC. This resource has information about marketing your message in a tool kit called Physical Activity: Ready. Set. It’s Everywhere You Go, which can be found at www.cdc.gov/nccdphp/dnpa/ physical/health_professionals/readyset_toolkit.htm

2. Invite a speaker to discuss proper nutrition and maintenance of healthy body weight. Good sources might include your state or community department of health, local health insurers, Team Nutrition (which can be located at http://www.fns.usda.gov/tn), a local culinary school, and so.

* TEACHER RESOURCES

Be sure to check out the CDC’s Nutrition & Physical Activity segment, which can be found at http://www.cdc. gov/nccdphp/dnpa/obesity/. There are many links from this site directing you to lay-person friendly resources.

News You Can Use

In support of the maintenance of healthy weight, the Food and Drug Administration (FDA) formed an Obesity Working Group to reexamine strategies that help consumers lead healthier lives through better nutrition. The FDA is now reviewing public comments on obesity issues. To find out more about this working group and the process the FDA has begun, go to www.fda.gov/oc/opacom/hottopics/ obesity.html.

THE QUICK FIX

Frustrated dieters have been quietly spreading the word about a controversial use of mood meds: effortless weight loss. Elizabeth Weil investigates the questionable trend.

weightloss1Everybody wants to look like the women on Justin Gelband‘s listlithe, luscious, toned, and tightand when prospective clients approach him, the New York-based trainer doesn’t just ask which shows and shoots they’re preparing for, he asks them if they’re clean. Gelband isn’t inquiring about cocaine. He’s not even asking about cigarettes or alcohol, though he cares about that, too. “It’s become a huge fad to use prescription drugs to lose weight,” he told me. “It’s even more everyday clients than it is the models.”

Some confess their pharmaceutical habits right away, telling Gelband they’re taking Adderall or Wellbutrin or any number of drugs that doctors prescribe off-label to help melt away pounds. Others are more coy. But partway through his workouts, which combine boxing, yoga, and Pilatesworkouts, incidentally, that have brought supermodels into pre-baby shape in less than three months without any medicinal edgeGelband always knows. “She fades because she’s not eating or because she’s taken something that gives her a short lift but then she can’t hold up the intensity of the workout,” he says. “It’s a big epidemic right now.”

In the Mad Men era, women chain-smoked and guzzled coffee to slide into their pencil skirts. Now they’re dipping into their medicine cabinets, maybe even the ones in their children‘s bathrooms. On the surface, this approach looks much cleaner, healthier: no ashtrays, no cancer, no stained teeth, just a discreet little pill that easily blends in with all the Yoga, Spinning (incase you need to buy a spin bike for workout at home, check out spin bike reviews here), and Gwyneth-inspired cleanses women do to maintain their figures.

For physicians, prescribing pills off-label for dieting is common and legal. Federal regulations allow doctors to prescribe almost every drug to patients for any reason at any time. (The rules are different for pharmaceutical companies; for them, promoting off-label drug use can be a felonyand a frequently prosecuted one, too.) As a result, women are heading to the pharmacy with hopes of shedding a dress size.

This gray market for thinness is hard to track, as much of the evidence for it exists in private, often coded conversations in doctors’ offices and shady Internet dealings. But culturally, the trend is predictable, perhaps even inevitable. Americans, as a group, have a convoluted and dysfunctional relationship with their weight. Our bookshelves sag with diet tomes, our gyms stay open 24 hours a day, and still the country is obese. We’re a fat country obsessed with skinnyand a quick fix.

Furthermore, the Food and Drug Administration is tied in knots over the question of whether obesity is a disease or a personal failing; thus it’s been largely unable to decide whether we should treat a weight problem with pharmaceuticals in the absence of other major health risks. The FDA has been slow to approve new weight-loss drugs in the wake of the fen-phen debacle. In 1996, fen-phen, a combination of two appetite suppressantsfenfluramine and phentermine, neither of which caused significant and lasting weight loss on its ownwas hailed as a miracle cure; doctors were writing 85,000 prescriptions a week. A year later, physicians started reporting untreatable heart-valve problems in patients who took fenfluramine. By September 1997, the fen-phen craze was over. Fenfluramine was removed from the market.

slim-for-weightloss

Today, FDA-approved choices for dieters remain slim. Only one diet drug is available over the counter: Alli, a compound that prevents the body from metabolizing fat and has the unfortunate side effect of causing diarrhea in some users. A handful of meds are available by prescription. The oldest and one of the most common is phentermine, but the FDA authorizes its use only for twelve weeks (because there are no data on its long-term safety). Last summer, the FDA approved two new drugs: Belviq, known generically as lorcaserin, is also an appetite suppressant and works by activating a single serotonin receptor in the brain, making a person feel full. The second drug, Qsymia, is a combination of phentermine and an anti-seizure drug called Topamax; it seems not to have the negative side effects of fenfluramine, the problem component in fen-phen. All three are sanctioned only for patients with body-mass indexes over 27 (170 pounds for a woman who is five feet six inches tall) who have weight-related health problems or those with BMIs over 30. People seeking a medical edge to drop five or ten or even fifteen pounds have no “on-label” option.

This is not preventing relatively trim women from taking pills. AJ Johnson, a celebrity wellness coach in Los Angeles, sees a lot of use among her already svelte clients and blames what she calls “our multitasking lifestyle.” “We take a cocktail of medications just to get through the day,” she says. “We take something to burn fat, something else to sleep.” Just recently, Johnson herself went through a dark phase, using supplements and all sorts of pills to try to burn her already limited body fat. She wanted to look not just fitwhich, as a trainer, she already wasbut exceptional. “I live in Hollywood. It’s me on camera, not just my clients. I wanted to take my body to a whole new level.”

At first Johnson tried meeting friends for hikes instead of for drinks. But she didn’t see the results she wanted. So she started taking pills. The binge ended badly, of course. Johnson called her doctor, complaining of chest pains. He asked her to come in for an appointment and bring everything she was taking. “Here I was, thinking I’m Miss Clean, and I filled a Whole Foods shopping bag. I couldn’t believe I’d become that girl who takes six pills a day. I was so embarrassed. I’m supposed to know how this all works.” As Johnson can attest, even those focused on health and wellness can succumb to the overwhelming pressures to be thin. “You think you’re not included and then you’re sneaking your friend’s asthma inhaler because you heard it suppresses appetite.”

Jackie Keller, also a wellness coach in Los Angeles, notes a related phenomenon: high achievers overcome by their waistlines. “People who are engaged in their careers and involved in their lives are just at wit’s end when it comes to their bodies,” says Keller. “Weight loss can seem so overwhelming. People feel completely ill equipped to handle the problem.”

Enter the 10-mg. secret weapon. Off-label drug use for weight loss is not just a Los Angeles or New York practice. Trisha Danula, a 34-year-old who lives in Fairfax, Virginia, recently lost fifteen pounds the old-fashioned wayby following a strict diet and exercise planand stayed skinny for a while, then noticed the weight creeping back. A co-worker who’d recently lost and kept off more than 50 pounds suggested she see Michael Anchors, M.D., Ph.D., a bariatric physician in Gaithersburg, Maryland. At Danula’s first appointment, Anchors counseled the five-foot-four-inch firefighter about portion size and consuming minimal sugar. Then he wrote her two prescriptions: one for phentermine, the other for Prozac, even though she was neither obese nor depressed.

“Did the pills help?” I asked Danula when I phoned her one recent afternoon.

pillShe answered with a resounding yes: “They put you in a better mood, you’re not as hungry, and they give you lots of energy.” Danula did not experience the exercise fadeout that Gelband often sees; in fact, quite the opposite. “I ended up working out twice as long as I normally would,” she said. Today she is fifteen pounds lighter and continues to take her meds.

The majority of Anchors’s patients are significantly overweight, but he believes frustrated dieters deserve pharmaceutical help to lose even a single pound. As he said, “I have 20 years’ experience with these medications. I know they’re safe. Why not?”

Paul Rivas, M.D., who runs eight weight-loss clinics in Pennsylvania and Maryland, is also enthusiastic about pharmaceutical aids. “I treat hypertension with medication. I treat high cholesterol with medication,” he told me. “I treat obesity with medication. All the same.”

In some cases, Rivas, like Anchors, pairs phentermine with a second medication, a practice known as combo-pilling. “The two big things are compulsive eating, where people eat out of stress or boredom, and cravings,” according to Rivas. Neither, he believes, can be fixed with an appetite suppressant alone. Frequently the second drug is an antidepressantone of the SSRIs (Prozac, Effexor, Celexa), which, Rivas says, are “good at curbing sweet cravings,” or Wellbutrin or another dopamine drug, which are “better for salty things like chips.” These mood drugs have the ancillary benefit of helping to lift depression and anxiety, conditions that may have been contributing to the stress or boredom eating. Still, says Rivas, drugs like Prozac and Wellbutrin “don’t do a doggone thing for weight loss by themselves. You’ve got to mix ’em and match ’em. Then you can hit.”

But all drugs have side effects, and diet pills make medical sense only if the benefits more than compensate for the risks. Among the side effects for phentermine are heart palpitations, dizziness, headaches, and difficulty sleeping; for Wellbutrin, anxiety and seizures; for Prozac, drowsiness and loss of libido. Part of the FDA’s job is to weigh a drug’s potential harms against its therapeutic value and decide in what circumstances it will do the public good. Prescribing off-label circumvents this. “By definition, if it’s off-label, there isn’t enough evidence either for a doctor or a patient to accurately analyze the benefits versus the risks,” says Sidney Wolfe, M.D., director of Public Citizen’s Health Research Group. “Every one of these drugs has adverse side effects. No one has been able to find an appetite suppressant that doesn’t touch the heart.”

Adderall is arguably the riskiest pharmaceutical regularly used to trim down. The drug is an amphetamine and highly addictive. Its weight-loss properties are well knownin the 1960s a compound nearly identical to Adderall was sold under the brand name Obetrol as an FDA-approved “anorectic.” Obetrol was phased out because there was not enough evidence of its safety and efficacy as a diet pill (but now its on-label use is to treat attention-deficit/hyperactivity disorder, or ADHD). According to wellness coach Jackie Keller, some women buy it online from foreign pharmacies; others complain to their doctors about symptoms “that are thinly veiled disguises for other issues.” Pulitzer Prize-winning journalist Katherine Ellison, author of Buzz: A Year of Paying Attention, a book that explores treatment for ADHD, including her son’s and her own, has tracked Adderall usage in recent years and found what she calls “a bulge.” “There’s a huge increase in Adderall prescriptions among women in their mid-20s,” says Ellison. “It’s the fastest-growing segment.”

Tempting as it may sound, fast-talking oneself into an Adderall prescription is not a free ride to slim. Adderall’s side effects include insomnia, depression, and severe headaches. Worse, Adderall addiction can form in just a few weeks, and those hooked may experience hallucinations, delusional thinking, abnormal heart rhythms, and numbness in the hands and feet. Withdrawal can be both unpleasant and disheartening. Along with several weeks of fatigue, panic attacks, and paranoia, users often experience appetite surges, causing them to regain the weight they lost.

“Here I was, thinking I’m Miss Clean. I couldn’t believe I’d become that girl who takes six pills a day. I was so embarrassed”

Rachel Beller, a dietitian and founder of the Beller Nutritional Institute in Beverly Hills, sees a lot of clients who are trying to wean themselves from drugs used off-label for losing weight and views the whole adventure as a big mistake. “Most of my clients are women who looked pretty good to begin with,” says Beller. “Hollywood folks, actresses. They always say they want to lose seven pounds. Not five, not ten. Seven.” Often these women arrive motivated to hone their figures the tried-and-true way, through exercise and eating right. But then what Beller calls “lazy-mind syndrome” kicks in. “At some point, they’ll flop in a chair and say, ‘It was so much easier when I was taking the drugs!’ ” There’s also a lot of fear associated with stopping the medication. Says Beller, “They all think they’re going to balloon.”

food

For those trying to lose a significant amount of weight, some risk might well be worth it. Extra pounds can lead to high blood pressure, heart disease, and diabetes. What’s more, when a person has too much fat tissue, her metabolism is thrown off kilter, and lifestyle changes alone often can’t set it straight. As Anchors explains, “Obesity is not the result of hunger. Hunger is the result of obesity.” For this reason, in the obese, drugs can kick-start a positive-feedback loop, decreasing appetite and with it weight, allowing “the plane to get off the ground,” Anchors says.

But for those who are already trim, dabbling with drugs is bound to backfire. “If you haven’t changed your lifestyle, when you quit taking the drug you’re going to want 10,000 calories,” says wellness coach AJ Johnson. “You either do the work now or you do the work later. Much better to slow down, let shaping up take 60, not fifteen, days, and commit to the healthier way.”