THE NEW MIRACLE DRUG?

THERE'S GREAT EXCITEMENT ABOUT REDUX, THE FIRST DIET PILL APPROVED BY THE FDA IN 23 YEARS. BUT IT'S HARDLY THE IDEAL WAY TO LOSE WEIGHT. HERE'S WHY

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What they can do, say the experts, is give obese patients a powerful head start on weight loss. Redux is revolutionary, explains author Levine, because "it overcomes the loss of confidence in one's own diet. The feeling that the drug gives you is the key." That's the attitude of Barbara Dorsett, the Red Lobster survivor: "I'm just so thankful they discovered this stuff," she says. "I felt so old and decrepit. It's like a new lease on life."

But Redux is revolutionary in a deeper sense as well: it represents a profound change in the way medical science looks at obesity. "There is an increasing consensus," says Dr. Michael Lowe, a weight- control expert at Philadelphia's Allegheny University of the Health Sciences, "that obesity is at least a chronic condition and maybe even a chronic disease that is in many ways indistinguishable from diabetes and hypertension."

Diabetes and hypertension are treated with medication that is essentially lifelong and, in the view that many physicians are coming to accept, this is the model that will be needed for obesity. At the same time, scientists are beginning to unravel the biological basis of overweight. Molecular biologists, for example, have identified five genes in mice that control food metabolism and that, if damaged, can lead to chubby rodents. In humans, physiologists are beginning to track the multiple hormones that conspire to keep fat people fat and thin people thin. And as Redux and fen/phen demonstrate, neurologists are beginning to sort out the brain chemistry involved in appetite.

All these lines of research are making it clear that attacking obesity as a physiological disorder is scientifically sound and that Redux--imperfect though it may be--is a step in the right direction. Says Yale psychologist Kelly Brownell: "We're at a historic moment in the treatment of obesity. The drugs themselves are less important than the fact that drugs for obesity are again on the scene." A new generation of antiobesity medicines is in the pipeline, under active development by drug companies, and yet another generation is sure to follow. As popular as Redux may be, both it and fen/phen represent just the first, crude attempts to attack obesity at its very source.

--Reported by William Dowell/New York, J. Madeleine Nash/Chicago, Ainissa Ramirez/Washington, Brian Reid/Atlanta and Jeffrey Ressner/Los Angeles

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