The Psychology of the Magic Pill

Imagine a miracle: You wake up one morning and calories don’t count. You could eat whatever you want and you won’t gain a single pound.  Blank check.  What would you do?  What would most people do?

A study about the latest emerging weight loss drug, called Adipotide was published this week (Barnhart et al 2011).  The researchers administered the drug via daily injection to monkeys who were overeaters and very sedentary.  The drug functions by killing the blood supply to fat cells which basically kills the fat cells.  The monkeys lost 11% of their weight in 1 month, that’s 22 lbs for a 200 lb man.  The researcher, Dr. Wadih Arap, was quoted on www.MSNBC.com  as saying “It’s incredibly exciting, a dream coming true in slow motion.”

Such a weight loss drug would essentially bring to life the miracle I mentioned above.  A dream come true, as the researcher said. We will eat what we want and trust that those fat cells will die before we are forced to loosen our belts.  Pure genius?

Let’s imagine that this drug makes its way through clinical trials with flying colors and eventually lands in the hands of every primary care physician in the country to dole out to the 1/3 of our population who are obese.  I ask you to consider the psychological and public health consequences of the wide availability of such a magic pill.  Many of us attempting to eat healthy and exercise in an effort to manage our waistlines could end up loosening up on that effort.   Let’s be honest, our waistline is often the barometer that tells us when we need to rein in our behavior.  People who take the drug may be especially disinclined to consume a healthy diet or exercise, because… why bother?  The pill is doing it for you.  Even people who are not on the drug might loosen the reins.  If people knew they could eventually take a drug to erase years of unhealthy habits, many would be disinclined to change those habits now.

Why do I think so?  I have patients who tell me they feel this way now, even in the absence of the magic pill.  The hope of a magic pill is enough for some to abort their exhausting efforts at healthy diet and exercise.  If an easy solution is coming soon to solve a problem that will otherwise require a lot of frustrating, exhausting effort, do you push forward or wait?

What are the consequences of a drug that gives us a physiological “cheat” and permission to loosen up the reins?  An unhealthy diet and sedentary lifestyle regardless of your size is associated with type 2 diabetes, heart disease, and cancer.  Eating a healthy, calorie-controlled diet and exercising regularly is important for more reasons than weight control.  The psychological impact of the presence of such a drug could possibly lead to fairly serious public health implications.  Science at the level of cells must be informed by the science of behavior, both individual and population.  Are we doing this?

The researchers of the drug reported that the monkeys did not increase their eating while on the drug, but I do not think that speaks to whether humans will or won’t.  Monkeys don’t live in a world with social norms about body size, chronic stress, 60-hour work weeks, fast food, and DVRs.  Monkeys don’t stare into the mirror longing to be just a little thinner.

When the monkeys went off the drug, they quickly gained all the weight back. The researchers suggested that the drug is meant to be taken short-term (i.e., just a few weeks) after which time patients will be encouraged to adopt healthy eating habits and exercise in order to maintain the weight loss and continue to lose weight.  Alas, we end where we started, with the task of behavior change.

The obesity epidemic, having emerged in the last 3 decades, has developed as a result of changes in our society and environment that have impacted our behavior in unhealthy ways.  If at the end of the day we need healthier behavior, our efforts are best placed on identifying and changing the societal and environmental factors that have made behaviorally controlling our weight so incredibly difficult.

Now THAT would be the dream come true.

 

Barnhart, K.F. et al.  A peptidomimetic targeting white fat causes weight loss and improved insulin resistance in obese monkeys.  Sci Transl 2011, 3(108), p. 108.

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2 Comments

  1. mbfgmike says:

    This scares me!! It scares me for all the reasons you listed, but there is more. Yes eating bad does more than make you gain weight, and I agree that people would eat worse because of the pill and become more unhealthy because of it. There would be a lot of skinny unhealthy people that unknowingly lowered their life expectancy. But what really scares me, is the side effects that are not known. I truly believe that 20 years after this drug is out, people will start having serious problems, it just doing something that is unnatural. In life you cant get something for nothing, there is ALWAYS a price. This is a Pandora’s box, IT NEEDS TO STAY CLOSED!!

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  2. Many ballerinas are bulimic. My mother was naturally thin and could eat massive amounts of fattening food without getting overweight. She taught ballet at Jouliards school of performing arts in NYC. As she got older she could still eat whatever she wanted and stay thin and look much younger than she was.

    At 46 years old she died of a stroke. I asked the doctor why she died so young. He said “she had the veins and arteries of an 80 year old woman! When she died I was 23 and my brother was 20 years old.

    Reply

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