Conventional wisdom says that staying thin is simply a matter of willpower and sweat. But science suggests that the key to being in shape is a bit more complicated. Even if you eat right and stay active, obesity may be an inevitable part of your life -- especially if you were unlucky enough to have inherited a genetic predisposition for the condition. Call it the "beer-belly gene."
But whether you're chubby because you have bad hand-me-down DNA, a time-consuming job that doesn't allow you the luxury of working out, or simply because you can't stand the thought of life without fudge, your fortunes -- and your waistline -- could soon be a-changing. Yes, exercise and diet are still very important in the war on weight, but within a few years it could be a handful of pills or quick voluntary surgery that will be doing the heavy lifting.
Although doctors have been looking for a miracle weight-loss pill for decades, the quest picked up serious steam about 10 years ago, when a scientist at New York City's Rockefeller University discovered leptin, a hormone that controls the body's storage of fat. Combine that knowledge with more recent findings on how metabolism works and how fat cells get their nutrients, and it's no longer a matter of if a fat-fighting pill can be developed, but simply a matter of when it will be ready for devouring.
Experts, however, remain divided on just how effective any pill could be. "I hate to be pessimistic," sighs Manfred Kroger, Ph.D., professor emeritus of food science at Penn State, "but I've been a nutritionist for a long time, and I've seen a lot of different weight-loss treatments come and go. The bottom line with all the ones that sort of worked in the past is that they also encouraged the people who were using them to eat less and work out more. If we can do that, we don't need a pill."
Still, there are many in the nutrition world who would welcome other options besides the tried and true "calories in, calories out" formula.
"Not every method of weight loss works with every person," says Kathleen Zelman, R.D., director of nutrition for WebMD.com's Weight Loss Clinic. "The more tools we have for weight loss -- whether they're drugs, medical treatments, or educational programs -- the better off we're all going to be, and I do think there are some options on the horizon that hold great promise."
Regardless of whether they really want to change the planet or are just cashing in on a trend, international drug and medical-technology companies are scrambling to get their weight-loss products on the market as quickly as possible, and are pouring millions of dollars into research and development in the process.
And the early prognosis for their efforts is very good, with some medications already appearing to be more effective than anything currently in your neighborhood pharmacy. Existing weight-loss drugs, such as Xenical, for example, only help most people shed an average of 10 pounds -- not nearly enough to help an obese man once again see his feet. The next generation of drugs and medical treatments promises to put those numbers to shame. Here's a preview of five up-and-coming fat fighters we think hold the most promise for helping America slim down.
The skinny: Paris-based Sanofi-Synthelabo is developing a potentially wicked one-two punch in the fight against flab. Unlike most weight-loss drugs under development (which tend to target either the brain or the gut), rimonabant performs its magic in both areas, helping to eliminate hunger and promote feelings of fullness at the same time. According to Jean-Pierre Despres, Ph.D., of Laval University in Quebec, the drug works by blocking cells in the brain that, when stimulated by signals from the stomach, cause you to feel sensations of hunger.
In its most recent human trial, researchers found that overweight men and women who took rimonabant for a year dropped nearly 20 pounds. Subjects ate less because they felt full sooner. They were also able to lower their triglyceride levels by 15% and raise levels of HDL, the so-called "good" cholesterol, by 22%, two changes that help seriously reduce a person's risk of heart disease. Better still, the drugs seem custom designed for overweight men, since most of the weight that patients lost came from around their middle.
That's an important distinction and benefit, because unlike women, who generally accumulate fat in their thighs and hips, obese men store the majority of their dangerous and most deadly fat in the belly.
Time to market: About two years, should the clinical trials currently underway prove successful.