THE OBESITY VACCINE

Rimonabant is one of dozens of drugs being studied. But medications that terget the stomach may also be helpful, says Dr Oz. "I think the best drugs will be those that work on the hormones in the gut. By the time you're working on the brain, it's a little bit late. The stimulus is already coming from the gut. The best way to influence hunger is to influence the gut's signal to the brain to eat," he says. "That way, you affect all the chemicals in the brain the way they're supposed to be affected."

To that end, researchers are looking at a hormone called ghrelin, scourge of yo-yo dieters. When you diet, your body goes into survival mode and ramps up ghrelin production, which may slow your metabolism, encourage eating and force your body to retain fat. A team of scientists at the Scripps Research Institute have found that keeping ghrelin from reaching the brain may prevent weight gain. When they injected rats with the so-called obesity vaccine, rats eat normally but gained less weight and had less body fat than rats that didn't get tha vaccine. Of course, the rats weren't on our high-fat, high-calorie diet.

The Thin Pill 2

Plus, you can't just take pill, lose the weight and stop. "You've got to take obesity medications for a long time, if not for life," says Dr Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis."You don't lower your blood pressure with medication and then say, 'Ok, now i'm going to stop.' If you lose weight and stop the treatment, it will bounce right back up again. That's been proved over and over again."

In any case, obesity drugs are reserved for people with a body mass index (BMI) of 30 and above, or a BMI of 27 or higher with diabetes, high blood pressure or another complication of obesity. They're not for the "gotta lose those last five kilos" dieter. And a review of studies found that rimonabant usually only leads to a five-kilogram weight loss a year on average.

The Thin Pill

Ask doctors what their biggest hope is for the near future and many will home in on rimonabant. Sanofi-Aventis, the pill's maker, is awaiting approval from the US Food and Drugs Administration, the drug is already available in Europe. Rimonabant stiffles hunger and cravings by tergeting the endocannabinoid system, which plays a role in regulating weight. Cannabinoid receptors throughout the body are tought to stimulate cravings; rimonabant blocks the receptors, knocking out cravings. It also lowers triglycerides and improves HDL - the good cholesterol.

Experts are exited about the drug, but agree it's not a cure-all. "You can eat your way through rimonabant - and all obesity treatments," says Dr Mehmet C. Oz, director of the Cardiovascular Intitute at Columbia University Medical Center in New York City and co-author of You: On a Diet. On the other hand, one study found that following a healthy diet and exercising regularly, in conjunction with obesity drugs, made them more effective.

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1 Billion Overweight Adults Globally

For the past 20 years, experts have searched for ways to reverse weight gain. The reasons we gain and lose are complicated, they've learned, and involve more than just diet and excersice.

Drugs can help, of course. Two are currently approved for long-term use: Reductile works in the brain to suppress appetite; Xenical blocks the absorbtion of fat - with unpleasant gastrointestinal side effects for some. And there's surgery, which is increasingly done laparoscopically but still has risks. we're all hoping, though, for a magic bullet. Biotech and pharma companies are spending millions to develop more powerful pills, gadgets and procedures to put an end to the condition that can trigger a host of serious diseases - obesity.

This quest isn't easy. "We're finding that many behaviours we don't think of as genetic often have a genetic basis," says Dr Susan Yanovski, an obesity expert at the Nasional Institute of Diabetes and Digestive and Kidney Diseases. "Some people get hungrier sooner than others; some fill up less quickly." Some binge; others are emotional eaters. And as more research is done, specific treatments may be discovered to deal with the various causes of obesity.

"The future is really bright for the development of better, safer and effective drugs," says Dr Yanovski. "We're going to have more choices to treat obesity. And they'll be more specific, so you can target the medication to the patient, as we do in the treatment of high blood pressure."

The Obesity

A debate is raging across the medical world to determine if obesity is actually a diseace or simply a matter of poor diet and lack of exercise. The simple answer is that it can be both. There are people with medical conditions such as hypothyroidism who cannot lose weight and need medical help to lead a healthy life. There are also people (like you) who should simply eat better and exercise more.

But what about people who suffer from medical conditions such as diabetes or heart disease caused by excess weight? Well, that's where the debate really hots up. Should we classify them as having "metabolic syndrome" - the latest term of obesity - and prescibe a pill, or should there be more emphasis on changing lifestyle options like eating right and exercising more?

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