Obesity:

Medical Therapy of Obesity has so far (2005) been a disheartening failure. After years of chastising patients for their poor life styles, diet and exercise, I now acknowledge with a measure of guilt that concquerring obesity is far from being in the hands of Patients. Pfizer's upcoming Accomplia remains a distant dream. Fast weight loss usually is followed by rapid gain. Anabolic threshold pedalled by some personal trainers is an elusive concept. Staying below the Anabolic threshold, ( i.e. 60%-70% of maximal heart rate ) is purported to burn more fat. Skeptics say that because of the interchangebility of Fat and Carbohydrates, it matters little which calories you burn. On the other hand, I lost more weight painting my house for one week than daily greuling workouts at the healthclub for the same length of time. Laparoscopic Stomach Banding and Gastric Bypass have come around full circle due to low morbidity, ease of performance, and short recovery of the new procedures. Questions still remain as to long term outcome. In other words, if there is no successful algorithm to lose weight, why should we not expect patients to gradually regain their presurgical weights and stretch their stomach remnants. For this reason, I personally don't believe that Obesity Surgery is the optimal answer. The Optimal answer will be a drug, not because it usurps the patients' responsibility,( where there was none to begin with ), but because obesity is a metabolic anamoly, whose remedy yet eludes us. Of the currently FDA approved drugs for weight loss, none are satisfactory.