A drug which blocks the urge to eat can help dieters shed pounds and inches, a study suggests. Belgian researchers writing in the Lancet said people taking rimonabant lost an average of 8.6 kilograms (18.9 pounds) in a year.

They also lost an average of 8.5 centimetres (over three inches) from their waists.

UK experts commented that rimonabant might help people lose weight - but could not replace eating healthily.

In the UK, it is estimated that one in five men and a quarter of women are obese.

Hunger

The researchers from Antwerp University Hospital studied 1,507 people from Europe and the US who were obese or overweight.

This drug doesn’t offer an easier way of losing weight but it appears to help you do it more successfully Dr David Haslam, National Obesity Forum

They were either assigned to take 5mg or 20mg of rimonabant or a dummy pill each day.

All those taking part in the study were also advised to cut 600 calories from their daily intake.

Nine hundred and twenty people completed the year-long study.

Just over 39% of those who took the higher dose of rimonabant lost more than 10% of their bodyweight.

People on the higher dose of the drug lost an average of five kilograms (11 pounds) more than those taking the dummy pill.

They also cut their waist measurement by an average of seven centimetres (just under three inches) more than those on the dummy pill.

Carrying weight around the abdomen has been shown to put people at high risk of heart disease and diabetes.

A separate study by Karolinska Institute researchers in Sweden, published in the British Medical Journal on Friday, showed people with a waist measurement of more than a metre, equivalent to 39.4 inches, were at highest risk.

The Dutch team taking the higher dose of rimonabant showed improvements in cardiovascular risk factors such as cholesterol levels, insulin resistance and metabolic syndrome, a condition which can increase the risk of heart disease.

However, they also showed the highest level of side effects such as nausea, dizziness and diarrhoea.

Rimonabant works by blocking the endocannabinoid system in the brain which regulates hunger.

‘Encouraging’

Dr Luc Van Gaal, who carried out the study, said: “Treatment with rimonabant over one year led to sustained, clinically meaningful weight loss, reduction in waist circumference and associated improvements in several cardiovascular and metabolic risk factors.”

UK experts said the drug was effective - but only in conjunction with dieting.

Dr David Haslam of the National Obesity Forum, said: “This drug appears to be very successful.

“This drug doesn’t offer an easier way of losing weight. But it appears to help you do it more successfully.”

Nilami Sritharan, a nutritionist with the Medical Research Council, said: “These are very encouraging results. But it’s important to remember drugs such as these are only an adjunct to improving your diet and lifestyle.”

Professor Steve Bloom, an obesity specialist at Imperial College and Hammersmith Hospitals, said: “This drug is a helpful addition. But one would need more clinical studies to make sure it is safe.”

A pill that helps you lose weight and quit smoking? That was amazing enough to capture headlines last week. But scientists say the experimental drug might be even more versatile, providing a new tool to help people stop abusing drugs and alcohol, too.It’s called rimonabant, or Acomplia, and last week researchers reported it could help people not only lose weight but keep it off for two years.

That burnished the drug’s reputation after two studies in March, which suggested it could fight both obesity and smoking, two of humanity’s biggest killers.

The French pharmaceutical firm Sanofi-Aventis plans to seek federal approval for rimonabant next year.But the drug’s benefits may go beyond just smokers and obese people, researchers say.

“I think it’s going to have a big impact on the treatment of addiction,” said Dr. Charles O’Brien, an addiction expert at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center.

Animal studies suggest rimonabant can block the effects of marijuana and fight relapse in alcohol and cocaine abuse, he said. Once it is approved for treating obesity or smoking, “we’ll be free to study it in these other areas and I’ll try to get my hands on it as quickly as possible,” O’Brien said.

He’s not alone in his enthusiasm.

Halting the brain’s reward system
The National Institute on Alcohol Abuse and Alcoholism is interested in seeing whether rimonabant can help treat heavy drinkers, said Dr. George Kunos of the institute. No human test results for rimonabant in alcohol abuse have yet been published, he said.

But researchers at the National Institute on Drug Abuse reported in 2001 that a single dose of the drug could block the effects of smoked marijuana in people, not just animals. That suggests the drug could be useful in treating marijuana dependence, said Marilyn Huestis, principal investigator of the study. The institute is now pursuing follow-up research, said Huestis, acting chief for chemistry and drug metabolism research at NIDA.

Rimonabant’s versatility traces back to its effects on the brain’s reward system, circuitry that tells you to keep on doing something. Basically, it appears to help break the connection between an activity like smoking and the rewarding feeling it causes in the brain.

The body has its own marijuana-like substances called endocannabinoids, and they activate certain brain cells that in turn can lead to stimulation of the brain’s reward system. Pleasurable things like drinking alcohol are thought to activate a feeling of reward by acting through the endocannabinoid system.

“We think that the (endocannabinoid) system is overactivated by chronic smoking, or perhaps even excessive overeating,” said Dr. Robert Anthenelli of the University of Cincinnati College of Medicine and the Cincinnati Veterans Affairs Medical Center. He’s on the advisory board of Sanofi-Aventis.

Rimonabant blocks the effect of the natural endocannabinoids by keeping them from latching onto the brain cells they normally stimulate, he said. In smokers, for example, that seems to restore the natural balance of the brain reward circuitry, he said.

What makes us fat? A generation ago, the answer was simple — eating more than we needed to.

That may still be true, but researchers investigating the genetics behind appetite, metabolism and weight gain have learned that putting on pounds is much more complicated than a simple equation of calories. They’re finding certain genes allow some people to pig out and not gain weight, while others put on pounds after a slight overindulgence. Other research has shed light on genes that may play a role in how much we crave food.

But can these findings lead to surefire treatments to tackle this country’s growing weight problem? A consensus among scientists is surprisingly optimistic.

“I truly believe that the discovery of obesity susceptibility genes will identify new molecules and pathways that will lead to effective new medications and other interventions,” said Dr. Alan Shuldiner, head of endocrinology, diabetes and nutrition research at the University of Maryland’s School of Medicine. Shuldiner adds, however, “I do not think this will occur in the near future.”

Still, Andrew Greenberg, director of obesity and metabolism studies at Tufts University, pointed out that obesity research has accelerated in recent years, and that’s bound to help scientists find cures sooner.

“The Internet has changed science,” he said. “It has changed the pace at which we learn about each other’s research and then build on it. Advances are happening faster than ever before.”

An Anti-Obesity Wonder Drug?

In fact, the introduction of new treatments has already begun. In the coming year, the French pharmaceutical giant Sanofi-Aventis plans to release what many believe could be one of the first truly effective anti-obesity drugs. Preliminary data from large trials have suggested that weight loss is much greater than with any current drugs on the market.

The drug, rimonabant, targets receptors of cannabinoid 1, which stimulates appetite and other cravings (including nicotine) in the brain. By blocking cannabinoid 1’s receptors, rimonabant helps people beat their cravings and lose weight.

Shuldiner said so far the trials for rimonabant have been “very impressive. “I believe it will be a very useful agent for weight loss. But not the end-all.”

While a drug like rimonabant is designed to help any person beat cravings and lose weight, part of finding “end-all” treatments may lie in figuring out how people’s genetics vary and tailoring drugs to match.

A recent study in Spain has offered insight into one such variation. The research, published in the Journal of Clinical Endocrinology & Metabolism, examined the role of a gene that may lie behind a phenomenon that so many find frustrating — you cut back calories but still don’t lose weight at the same pace as your thinner friends. Jose Ordovas, director of nutrition and genomics research at Tufts University, said those frustrated dieters may share a variation in a gene called perilipin.

Targeting a Fat Guardian

Perilipin, he explained, creates a protein that settles around fat droplets and protects the fat from being destroyed.

“That may sound funny these days,” Ordovas said. “But in old times, fat was difficult to hold on to, so this protein protected it.”

Some versions of the perilipin gene (originally identified by Greenberg and colleagues) make this fat bodyguard stronger, while other mutations make it weaker.

“This means we have identified one of probably many genetic variations that help us distinguish between those who will and won’t respond to diet,” said Ordovas. “Some people think that patients don’t lose weight because they don’t follow the recommendations. But in some cases, their bodies may just be more thrifty with the fat.”

Figuring out how people’s genes react differently when it comes to weight loss might also help prevent dangerous side effects to obesity-fighting drugs as they emerge on the market.

Many may remember the controversy over phen-fen, a once popular obesity-fighting combination of drugs that was recalled in 1997 after some studies and reports showed it caused heart problems in some patients. By tailoring drugs to people with specific genomes, drug manufacturers may be able to avoid such fallouts in the future.

“Sometimes side effects only affect a minority of people,” said Ordovas. “In the future, we can identify drugs and supplements and target them to people with specific genetic profiles.”

The pace at which scientists identify new obesity-related genes has stepped up in the past few years as genetic research gains momentum. But Greenberg cautions that not every new discovery means new cures are on the way.

“We’ve come a long way in understanding obesity,” he said. “But every study has to be carefully replicated. And exercise and diet will always form the cornerstone of any obesity treatment.”

Acomplia (rimonabant) currently being sold in Europe has been seen by many patients struggling with obesity as a “miracle pill.”

Many studies have shown that this medication helps patients loose weight when compared to a placebo. Most of the weight reduction results from patients limiting the number of calories they consume on a daily basis. Acomplia helps to control appetite– something that for many patients involved in weight reduction programs is a major obstacle to success.

Even though the safety of the medication is being monitored, no major problems have yet been reported. There are some mild side effects that people should be aware of, including nausea, dizziness, anxiety and depression.

Many Europeans have accepted the efficacy of this medication. Sweden, for example, has approved reimbursement of the drug through their public service program.

How does it work? It controls the urge to eat. Many are calling this the “anti munchie effect.” Acomplia works in the central nervous system by affecting the cannabioids receptors in the brain. Yes, the same receptors that give people the urge to eat when exposed to marijuana.

The point of all the hype around accomplia is that it has been a long time since we have seen a medication so effective in controlling appetite. The FDA is considering approval of this drug in the U.S., but there is no clear indication as to when it will happen. In the mean time, other pharmaceutical companies are working on similar typed of drugs.

Why? Because the world is severely overweight and obesity is creating pockets of epidemic proportions of diabetes and heart disease.

Of course, a simple pill is not the answer to an unhealthy lifestyle. But hopefully, this “miracle drug” will be the miracle we all need to start focusing in eating right and exercising.

A drug which treats obesity by reducing the desire to eat has been launched in the UK. But NHS chiefs warned people not to expect it to become widely available straight away as the cost-effectiveness of the pill needed to be assessed.

Rimonabant is the first drug to target factors governing the body’s appetite, metabolism and energy use. Trials showed it can reduce weight by a tenth.

UK experts said it could not replace healthy food and regular exercise.

In the UK, it is estimated that one in five men and a quarter of women are obese.

Cost

But at a cost of over £55 for a month’s treatment, it could end up costing the NHS billions of pounds of money.

The drug still has to be assessed by NHS advisers the National Institute for Health and Clinical Excellence.

The review is not expected for another two years and NHS bosses warned the public not to expect its widespread use immediately.

Gill Morgan, chief executive of the NHS Confederation, said primary care trusts may be reluctant to prescribe the drug ahead of NICE guidance.

“PCTs receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities.”

And she added weight loss was “predominantly about diet and exercise”.

Preventative measures aren’t enough on their own Dr David Haslam, of the National Obesity Forum

The drug’s manufacturer, Sanofi Aventis, has argued the drug represents good value for money when set against the £7bn per year cost of tacking obesity.

Other anti-obesity drugs are already available, but rimonabant is the only one to target the endocannabinoid system, which governs the body’s appetite.

In a series of trials involving more than 6,000 patients in the US and Europe, a quarter lost more than 10% of their initial body weight after a year. About half lost more than 5%.

Side effects in some patients included nausea, dizziness and anxiety.

Significant improvements in measures of glucose control, cholesterol and triglyceride blood fats were also seen.

Smoking

Rimonabant, sold under the brand name Acomplia, is currently licensed for the treatment of obese patients, or overweight patients with associated risk factors such as type 2 diabetes or poor cholesterol and triglyceride readings.

But there are also trial data suggesting that the drug can help people give up smoking by overcoming their cravings.

However at present it is only being marketed to tackle obesity.

Dr David Haslam, clinical director of the National Obesity Forum, said the drug offered a real opportunity to get to grips with the obesity crisis.

“Preventative measures aren’t enough on their own. It brings into focus the priority that should be given to treatment as well as prevention.

“The launch of rimonabant is important news for patients who are overweight, with type 2 diabetes, or low HDL cholesterol or high triglycerides.”