Sarah Rothman | FDA may hold the key to stopping obesity

What do you think when you see a fat person walking down the street?

I'm not talking about slightly overweight, I mean a really fat person - someone having trouble walking or taking up two seats on the bus.

Bear with me. I realize that the average Penn student may be unlikely to encounter such a person on the way to class, but move a little farther west and it wouldn't be so rare. Nineteen percent of West Philadelphia high-school students are either obese or very nearly obese, a recent study said.

At first glance, one could put the blame squarely on the obese themselves. Maybe they lack the willpower to stop eating or the persistence to exercise it away.

But perhaps these people were genetically predisposed to obesity. Perhaps they fall barely above the poverty line and cannot afford fresh low-calorie food or gym memberships. Perhaps they work a sedentary job (or two?) and have little time for recreational activities.

Luckily, good news may be around the corner.

Many pharmaceutical companies have obesity drugs coming down the pipeline soon and right now only one thing stands in their way: the Food and Drug Administration.

The FDA has a stringent series of guidelines that govern the regulation of what they call "weight control" drugs, making it difficult to bring them to the market. A big part of the problem is that FDA doesn't view obesity as a disease.

But being obese comes with a host of other medical issues such as high blood pressure that can lead to cardiovascular disease and even diabetes. People who are obese and display two (or more) of five symptoms - such as high blood pressure and high blood sugar - qualify for a diagnosis of metabolic syndrome.

If big pharma could get the FDA to define obesity as a disease instead of as a lifestyle choice, than HMOs might be more likely to cover prescriptions, and physicians would be more likely to prescribe. But isn't metabolic syndrome a disease?

The American Diabetes Association believes that the diagnosis of "metabolic syndrome" holds little clinical value. Richard Kahn, chief scientific and medical officer for the ADA, wrote in September 2005 that doctors should be treating all risk factors for cardiovascular disease regardless of whether a patient meets the criteria for metabolic syndrome. Further, the ADA was skeptical that the cluster of symptoms was any clearer of a risk for developing cardiovascular disease.

Mitchell Lazar is the director of Penn's Institute of Diabetes, Obesity and Metabolism. He defends the diagnosis for public-health reasons.

"It's a simple message, and if someone wants to break it down, they can figure out that it is a simplification. But there are many people who still need to get the message," he said.

But are pills really the best way to treat obesity? Or metabolic syndrome? What about exercise and healthy dieting?

Let's return to the fat person we saw earlier on the street. Why is it that there are so many obese people in West Philadelphia and not at Penn, for example? Certainly genetics is at play here. If the sociological proof does not convince you, I assure you the studies of identical twins will. But if it is genetic, then how can we be experiencing an obesity epidemic?

Arlen Price of Penn's Mahoney Institute of Neurological Sciences explains it best: "Genes determine our response to the environment." Societal changes have made it difficult for many to avoid obesity. For example, once we figured out how to process sugar cheaply, it became much more readily available. And jobs became less manual. And portion sizes increased. And the magnitude of these changes is too great for our society to turn back the clock to a healthier time.

Today in the United States, 85 percent of the about 84 million people with metabolic syndrome are also obese. Regardless of the clinical value of the diagnosis, there can be no doubt of the gravity of the symptoms.

It is time to stop arguing over definitions and start finding real solutions to the obesity epidemic.

Sarah Rothman is a fifth-year Bioengineering Ph.D. candidate and 2002 Engineering alumna from Fayetteville, N.Y. The Sounds of Science appears on Mondays. Her e-mail address is rothman@dailypennsylvanian.com.

Please note All comments are eligible for publication in The Daily Pennsylvanian.