Rimonabant – The Next Weight Loss Miracle Pill?
Repeat after me: There is no wonder drug
I’ll say it again … there is no miracle pill for weight loss. Not Meridia, not Orlistat, not the upcoming rimonabant. Certainly not Fen-Phen.
Not now. Not ever. Obesity is caused and complicated by so many different factors, it’s just not possible that one drug is the be-all-end-all solution. But no matter how many times responsible voices out of science and medicine say it, people seem unwilling to accept that there can be no wonder drug for obesity.
That doesn’t mean new treatments won’t keep coming out - - there’s powerful incentive for the pharmaceutical industry to keep looking trying.
Whenever a new treatment comes out that might help, it taps right into the desperation so many people feel about their weight. The hopeful excitement swells, rumors abound, and often the true hope gets lost in the hype.
And here we go again. Rimonabant is the newest entry in the weight drug derby. Developed by French pharmaceutical company Sanofi-Aventis, the new drug has not yet even made it to the market, but it’s already made its way into plot lines of TV shows and punch lines of late night comics. It’s chatted about on web sites, people are already asking their doctors for it.
And why not? It’s rapidly growing legend includes claims that it can help patients do it all: lose weight, quit smoking, grow taller, you name it. Oh, and it will boost your good cholesterol, too. Who wouldn’t want to take rimonabant?
These claims are not made by the researchers studying the drug’s effectiveness nor even an exuberant public relations department at Sanofi-Aventis. The spontaneous hype around rimonabant seems to be fueled largely by the hopes of desperate people praying once again for deliverance from their weight.
The real hope of rimonabant is that it seems to suppress appetite in a new way while also aiding smoking cessation, tying together two of the thorniest lifestyle habits people want to change.
While other weight loss medications on the market suppress appetite by acting as a stimulant (phentermine) or through an effect on neurotransmitters in the brain (Meridia), rimonabant is the first of a new class of drugs called Selective CB1 Blockers. It suppresses appetite by blunting CB1 receptors on endocannabinoids in the brain and elsewhere in the body. Associated with systems regulating the body’s intake of food, endocannabinoids are also involved in tobacco dependency.
If the word has a familiar ring to it, that’s because this brain chemical is the body’s own version of cannabis, the chemical in marijuana so famous for stimulating appetite. By neutralizing endocannabinoids, the drug effectively mutes one of the body’s mechanisms for communicating hunger messages. CB1 receptors are also found in body fat tissues, where they are associated with lipid and glucose metabolism.
So does it work? Well, in one study presented to the American College of Cardiologists, rimonabant helped overweight subjects lose an average of 20 pounds over a year, compared to only 5 pounds for subjects on a placebo. When used for smokers, rimonabant actually DOUBLED the number of those who kicked the habit.
But here’s the real kicker: the smokers who quit with rimonabant actually lost an average of one pound, while those on a placebo typically experienced the minor weight gain everyone fears.
In another study, by blocking CB1 receptors in fat tissues, rimonabant not only induced weight loss, but specifically reduced abdominal fat in overweight and obese people who had untreated dyslipidemia, and it also increased levels for good HDL-cholesterol, lowered triglycerides, and improved impaired glucose and insulin levels, all contributing risk factors for cardiovascular disease.
You can see why the hype took on such a fervor. What’s not to like in all that? But hold on. In more recent, larger studies, rimonabant hasn’t been any more miraculous than anything else for weight loss.
In one study, out of a couple thousand women whose average weight was 220 pounds, their average weight loss on rimonabant was only 14 pounds. Of course, that’s better than the participants who got the placebo and lost an average of just five pounds during the study.
And to be fair, mice on rimonabant ate less, lost up to 20 percent of their body weight, and lowered their blood glucose and lipids. So it may be just the thing, if you’re a fat mouse.
But if you’re a person with a weight problem, you can believe that this medication will not be a painless answer to your prayers. This is not to say that it won’t help. Medications for weight loss can be a tremendous aid. Many people come to me already so demoralized and frustrated by many fruitless efforts to shed their excess weight. The extra support offered by a helpful weight-loss medication is often all they need to see some positive change and get a little momentum going.
But that momentum will go nowhere if it’s not accompanied by a sincere effort to consciously make different eating and activity choices. If your weight problem is the result of entrenched habits, you have work to do that no pill can help. The stimuli to emotional eating need to be identified and confronted. The barriers to physical activity have to be overcome.
Even if every hopeful claim about rimonabant turned out to be true, it still couldn’t tackle the job on its own. It might be enough for chubby mice living in a controlled lab, but for real people in the real world, losing weight and getting healthy still takes a committed, comprehensive approach.
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