Fat is a pharmacist issue

A new drug to combat obesity is now available on the NHS, but can a packet of pills really be a long-term solution to being seriously overweight?

The idea of introducing chemicals to your brain in order to tell yourself you aren't hungry seems like science out of control. But a new slimming drug, sibutramine – marketed in the UK as Reductil – has just come on the market that does just that, and doesn't use amphetamine-like drugs to suppress appetite. And, most importantly, it's now available on the NHS.

The idea of introducing chemicals to your brain in order to tell yourself you aren't hungry seems like science out of control. But a new slimming drug, sibutramine – marketed in the UK as Reductil – has just come on the market that does just that, and doesn't use amphetamine-like drugs to suppress appetite. And, most importantly, it's now available on the NHS.

Is this a recognition that obesity is a problem big enough to merit action? Recent statistics suggest that it is. Currently, around 20 per cent of the population in England and Wales are obese. The NHS spends £50m per year on treating it, yet, by 2030, as many as 50 per cent of people may suffer from it.

The approval, on Wednesday, of sibutramine by the National Institute for Clinical Excellence (NICE) means that within three years, the NHS will spend a further £19.2m on obesity. With this move, Britain is following the lead of the United States. In 1997, the Food and Drug Administration (FDA) approved the use of sibutramine, manufactured by Knoll – who also manufacture the UK version – under the name Merida. Sibutramine suppresses hunger by inhibiting the neurotransmitters norepinephrine and serotonin, and promotes significant weight loss within short periods of time. NICE is quick to underline its approval with certain caveats. It insists that it must be used in conjunction with a healthy diet and exercise, and that only patients who have already made "serious attempts" to lose weight can be treated. In other words, sibutramine is being pushed as a "contribution", not a quick fix, and only those who have a body mass index (BMI) of 27.0kg/m2 or above and who suffer from other significant diseases can apply for treatment.

The last clause is an interesting one. Obesity is now recognised not simply as a problem with aesthetic or emotional consequences, but as having serious ramifications for the development of potentially fatal disease. It is not a coincidence, for instance, that 80 per cent of those who suffer from type 2 diabetes are obese.

Simon O'Neill, head of Care Developments Diabetes UK, underlines that it is obesity that causes diabetes, not vice versa: being overweight impairs insulin levels, which in turn control the amount of glucose. When this is affected, diabetes occurs.

"One million people have type 2 diabetes in this country," says O'Neill, "and a further one million have it but don't know. Worldwide, it's an epidemic."

And weight is a major cause. As a result, Diabetes UK welcomes the decision by NICE, although as an independent body they cannot specifically endorse Reductil itself. O'Neill points out that losing weight can be extremely difficult for some, and that "if there are drugs to help, at least that gives options".

But having more choices is not in itself the solution. Dr Julian Barth, at Leeds General Infirmary, approves of Reductil's introduction to the NHS, but adds a note of caution. "At the moment, society as a whole is a very obesity-stimulating environment. As a society, we are now inactive: we don't really exercise any more, and the combination of this and the easy availability of high-fat convenience foods is a problem."

So, is taking a pill a valid option, or does it store up more problems for the future? Dr Barth believes that drugs are often essential. "I can give many case histories of people with arthritis who are told to lose weight before they can have an operation, but can't lose weight because they are unable to exercise," he says.

For these patients, and those for whom the traditional advice of "eat less and exercise" is not motivating enough, Reductil is a godsend. Barth lists some negative effects of obesity – arthritis, diabetes, high blood- pressure, time off work due to disability – and sees the drug as providing a good "external cue" to weight loss, which can be the cure of disease, as much as weight was the cause.

The side effects of sibutramine seem relatively small: some sources cite headaches and constipation, while the biggest concern is a slight rise in blood pressure. But are there hidden costs to this wonder cure? NICE has set out guidelines that seem, on the surface, to hold safeguards for the health of individuals. People are only allowed to continue with the treatment after four weeks if they have lost 2kg – in other words, that they work with the drug as opposed to seeing it as a magic tool. Barth points out, however, that in its guidelines, NICE hasn't addressed the long term. "You don't," he says, "stop treating people with asthma after an initial treatment. It is a lifelong disease. And obesity is the same."

Obesity can be combatted, but it seems that without a sustained weight loss, those who suffer from the condition will not be allowed to continue with the programme, and so the vicious circle continues. The path to solving the obesity problem is a long one yet.