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"The Fat Just Walks Away"
November 12, 2011 3:10 PM   Subscribe

Obese monkeys lose weight by new drug that kills off fat cells. Adipotide is the newest weapon in the war on obesity. Unlike other weight-loss drugs that try to suppress appetite, boost one's metabolism, or block the absorption of fat, Adipotide blocks the blood supply that feeds fatty tissue. Studies show monkeys lost 11% of their body weight after 4 weeks of treatment.
posted by 2manyusernames (103 comments total) 26 users marked this as a favorite

 
What could possibly go wrong?
posted by localroger at 3:11 PM on November 12, 2011 [54 favorites]


Looks like they've found something that could go wrong: “The principal side effects were noted in the kidneys. The renal effect was dose-dependent, predictable and reversible." So I guess you'd not want to take massive doses of this stuff lest you mess up your kidneys. Interesting.
posted by Mister Cheese at 3:18 PM on November 12, 2011 [4 favorites]


Adipotide is manufactured by Adipose Industries. Every bottle comes with a free Adipose Inducer necklace!
posted by miyabo at 3:18 PM on November 12, 2011 [48 favorites]


I wonder if it affects brain tissue. That's pretty fatty.
posted by clockzero at 3:18 PM on November 12, 2011 [36 favorites]


Caveats and proper skepticism aside - that's actually pretty exciting stuff.
posted by naju at 3:23 PM on November 12, 2011 [2 favorites]


I suspect they would notice if the monkey brains were being killed off.
posted by Justinian at 3:24 PM on November 12, 2011 [3 favorites]


Came in with a Doctor Who reference, but beaten to the punch line!
posted by sbutler at 3:29 PM on November 12, 2011 [5 favorites]


Uh, so how long before I can buy some of this stuff :(
posted by yeoz at 3:29 PM on November 12, 2011 [5 favorites]


I saw this episode of Sliders, no thanks.
posted by The Whelk at 3:31 PM on November 12, 2011 [1 favorite]


The war on obesity?
posted by koeselitz at 3:36 PM on November 12, 2011


Reading the paper, I'm amazed to find that the body seems to take care of these apoptosed adipocytes pretty well-- no fat necrosis or hepatic steatosis reported; all they saw was a mild increase in creatinine and some reversible kidney injury with associated K & PO4 in the urine. I wouldn't stop exercising until there's good phase III data on it, though.
posted by The White Hat at 3:38 PM on November 12, 2011 [6 favorites]


The Wikipedia article references another press release, and three papers which appear, to this layman's eyes, to explain what the drug does, the process it's meant to trigger, and what on earth this has to do with cancer research.
posted by Kalthare at 3:40 PM on November 12, 2011 [5 favorites]


I can't tell if 2manyusernames is a Dr. Who fan, or if this is just marvelous synchronicity.
posted by Salvor Hardin at 3:41 PM on November 12, 2011 [1 favorite]


The war on obesity?

It's kind of a big deal, and we need to fight something! *punches obesity in the throat*
posted by OnTheLastCastle at 3:42 PM on November 12, 2011 [3 favorites]


Oh, I'm a noob - it's Doctor Who, not Dr. Who. *ritually falls on own sonic screwdriver*
posted by Salvor Hardin at 3:42 PM on November 12, 2011 [5 favorites]


The war on obesity?

Now watch this drive-thru.
posted by Mikey-San at 3:43 PM on November 12, 2011 [15 favorites]


The war on exercise and healthy diet continues, with a powerful ally, Science, joining the cause.
posted by holycola at 3:46 PM on November 12, 2011 [19 favorites]


Exercise and healthy dieting isn't just for your waistline. It's to ward off depression too. I guess there's a pill for that too.
posted by smorange at 3:49 PM on November 12, 2011 [4 favorites]


If McDonalds could add this to the special sauce, we'd solve the obesity, unemployment and low productivity problems all in one shot.

"Ask the guy working the drive-thru if Adipotide is right for you."
posted by PlusDistance at 3:54 PM on November 12, 2011 [3 favorites]


The war on obesity?

If this goes like the other 'wars,' look out for obese people to become the winners.
posted by the man of twists and turns at 3:55 PM on November 12, 2011 [12 favorites]


Caveats and proper skepticism aside - that's actually pretty exciting stuff.
posted by docgonzo at 3:58 PM on November 12, 2011 [1 favorite]


Hmm...what will happen to society when you can buy skinny?

Now being fat will mean you're poor too.

This will turn out wonderfully.
posted by toekneebullard at 4:07 PM on November 12, 2011 [15 favorites]


Obesity is already pretty strongly correlated with socioeconomic status so that wouldn't be new.
posted by Justinian at 4:08 PM on November 12, 2011 [21 favorites]


Adipocytes, the cells that generate and maintain fat stores, are serious endocrine regulators that do a hell of a lot more than make you fat. This should be wreaking all kinds of havoc with, now necrotic, fat and adipocytes overwhelming the liver and kidneys.

If this peptide works like they say it does, which is totally amazing cool peptide targeting, and it works as well as they say it does with so almost unnervingly few side-effects, this would be really awesome.

"The war on exercise and healthy diet continues, with a powerful ally, Science, joining the cause."

These results need to be repeated in humans but if they are real and applicable I suspect they could have much cooler implications.

The really cool finding is not so much the weight loss but the increase in insulin resistance which indicates that this drug could actually address the epidemic of metabolic syndrome that is behind so much of the obesity in this country. It has the potential to be a game changer, particularly if total viable adipocytes addresses other problems like the insufficient satiety and chronic fatigue that make healthy diet and exercise that much more difficult for many.

This post would be good to read if you are interested in peptide pharmaceuticals
posted by Blasdelb at 4:08 PM on November 12, 2011 [26 favorites]


I wouldn't stop exercising until there's good phase III data on it, though.

I though current wisdom had returned to the older idea that while exercise has other benefits, it's not helpful for weight loss. As far as I know, modifying how you eat makes far more difference, and exercise just makes you hungrier to compensate for any additional energy spent.

Things I would like to know:
- do fat cells have other roles in the body apart from mere fat storage?
- might there therefore be negative consequences in losing fat cells?
- having killed fat cells, can you grow more?
- what happens when you still eat the same way but don't have the fat cells to store fat in? Do you crap it out? Does it deposit on your arteries?

I guess I have lot of mental investment in eating well and exercising that predisposes me to be skeptical of a miracle pill anyway.
posted by i_am_joe's_spleen at 4:09 PM on November 12, 2011 [2 favorites]


Without having RTFA, this seems like a really, really bad idea.
posted by deliquescent at 4:09 PM on November 12, 2011


Uncles approve.
posted by 7segment at 4:10 PM on November 12, 2011


If this goes like the other 'wars,' look out for obese people to become the winners.

Drug addicts aren't winning the war on drugs. Drug suppliers and the various layers of law enforcement are.
posted by ofthestrait at 4:11 PM on November 12, 2011 [4 favorites]


I mean, what happens with all the content of those fat cells (not just fat!) after the cells are killed? Released into circulation? Consumed by the immune system (assuming you don't trigger autoimmunity by causing a massive cell die-off)? Either way, the fat is still in the system and the body is going to do something with it.
posted by deliquescent at 4:20 PM on November 12, 2011


do fat cells have other roles in the body apart from mere fat storage?

Yeah, as others pointed out upthread, the myelin sheath around neuron axons is largely lipid-based. It's critical for neural functioning, and loss of myelin covering is associated with neuro-degenerative diseases such as MS.

So, hopefully they test cognitive functioning in their trials.
posted by formless at 4:23 PM on November 12, 2011 [3 favorites]


I though current wisdom had returned to the older idea that while exercise has other benefits, it's not helpful for weight loss.

I can attest to this from personal experience. I've lost over 70 pounds since June with just dietary change alone. I'm a layman (although an educated one) as far an endocrine systems and nutrition go, everything I've read indicates that the primary contribution exercise makes to weight loss is caloric deficit. When you take in less calories than you expel, your body makes up the difference from within. As you lose weight, your BMR (Basal Metabolic Rate) goes down, meaning that you burn less calories just sitting on your ass. Exercise increases the deficit and maintains weight loss.
posted by Revvy at 4:23 PM on November 12, 2011 [3 favorites]


upper:downer::twinkie:adipotide?
posted by edguardo at 4:26 PM on November 12, 2011


Although, myelin sheaths are more "uses of lipids by the body", I don't think they're related to adipocytes or fat cells.
posted by formless at 4:30 PM on November 12, 2011 [1 favorite]


Someone has to say it - Cranberry: University of Texas is a really good school, actually.
posted by Navelgazer at 4:30 PM on November 12, 2011 [13 favorites]


*Notices research was at U. of Texas. Cringes at any more stuff from state that gave us Dumbya AND Perry*

Oh, well, that's why I write off all medical research performed at Yale.

You clearly do not have a grasp of the level of medical research and comparative medicine programs at places like U of T, Baylor, A&M (veterinary-only) etcetera.

on preview: Schwann cells and astrocytes have high lipid content, but they are not fat cells (adipocytes), which are the targets of adipotide.
posted by Uniformitarianism Now! at 4:31 PM on November 12, 2011 [12 favorites]


...although I forget if the Aggies have a human medical school. I'm on the other end of things.
posted by Uniformitarianism Now! at 4:33 PM on November 12, 2011 [1 favorite]


My worry about this is the other side effect it will have. If people can all be skinny the psuedo moral judgments masked as wellbeing concern will have to shift to something else and I am very unlikely to be on the side of the pious abnegators because I like to like things too much.
posted by srboisvert at 4:35 PM on November 12, 2011 [11 favorites]


Adipotide is the newest weapon in the war on obesity.

Or, you know, we could donate our excess calories to food banks.
posted by eddydamascene at 4:36 PM on November 12, 2011 [1 favorite]


"Yeah, as others pointed out upthread, the myelin sheath around neuron axons is largely lipid-based. It's critical for neural functioning, and loss of myelin covering is associated with neuro-degenerative diseases such as MS."

I don't think that this specific problem is a rational fear. Schwann cells and Oligodendrocytes make myelin primarily out of lipids, but they are fundamentally different from adipocytes. They have different cell lineages, use different fats, and have different purposes for those fats. There shouldn't be any special reason to suspect that the adipocyte specific ligand should bind to those cells, though I suppose it is possible that it binds to something in the body that it shouldn't at a low enough level that it hasn't been noticed but high enough that it could cause subtle kinds of trouble.
posted by Blasdelb at 4:38 PM on November 12, 2011 [1 favorite]


Without having RTFA, this seems like a really, really bad idea.

I think that's kind of the point of having articles, innit?
posted by condour75 at 5:04 PM on November 12, 2011 [21 favorites]


/eats obese drugged monkey
/waits for flow-on benefits
posted by obiwanwasabi at 5:11 PM on November 12, 2011 [3 favorites]


Who ends up owning the patent on something like this? The university?
posted by Ritchie at 5:23 PM on November 12, 2011


Yeah, the problem is that "fat" means two different things: 1. lipids and 2. cells whose purpose is to store lipids. This drug targets the cell type, not lipids themselves, and the difference between these two mechanisms is pretty huge so it seems very unlikely to me that the drug would affect myelination.
posted by en forme de poire at 5:24 PM on November 12, 2011 [1 favorite]


Who ends up owning the patent on something like this? The university?

The university owns most of it but it's shared with the principal investigator, as well as other major contributors to the work (to some extent).
posted by en forme de poire at 5:25 PM on November 12, 2011 [1 favorite]


*Notices research was at U. of Texas. Cringes at any more stuff from state that gave us Dumbya AND Perry*

M.D. Anderson is the number one hospital for cancer in the USA. Baylor is no slouch either. Baby, bathwater, etc.
posted by en forme de poire at 5:30 PM on November 12, 2011 [11 favorites]


Exercise increases the deficit and maintains weight loss.

To some extent your non-exercise activity thermogenesis just adjusts to compensate for the increase in exercise for no effective caloric difference.
posted by BrotherCaine at 5:39 PM on November 12, 2011


So what's the street price for this stuff? Can I buy it with bitcoin?
posted by Obscure Reference at 5:42 PM on November 12, 2011 [6 favorites]


I think that's kind of the point of having articles, innit?
Aw, thanks. The article didn't make me feel any better, if that changes anything.
posted by deliquescent at 5:43 PM on November 12, 2011


This is something that I don't think can be just dismissed as "why don't people just exercise," because one of the things that I've heard repeated often, so tend to believe although I may be wrong, is that weight loss after you've been obese causes your fat cells to shrink... but not to go away. Continuing problems long after you've actually made the healthy changes. The ability to actually kill fat cells, even in smaller quantities if this kind of "miracle weight loss" level turns out to not be good for people kidneys, would be an extremely helpful thing to go *with* the diet and exercise part. Not a permission to eat whatever forever, but a way to boost the process and ensure that changes you make can stick without having to stay on 1200 calories a day forever. Which is, let's be honest, not sustainable for ordinary Americans who want to have lives and actually enjoy food sometimes.

I mean, if it turns out this particular drug has bad side effects or doesn't actually work as well as reported, too bad, but I don't think that a drug that could have this impact would be as easy for me to dismiss as, for example, Alli, which I think is pretty worthless.
posted by gracedissolved at 6:13 PM on November 12, 2011 [5 favorites]


"Things I would like to know:
- do fat cells have other roles in the body apart from mere fat storage?
"

Fat cells do A LOT more things than just store fat. They regulate how much fat gets stored and released as well as what kinds of fats get stored and released, they are central to the insulin pathway that regulates blood sugar, they play a role in blood clotting, hell they are even significantly involved in creating sexual dimorphism.

"- might there therefore be negative consequences in losing fat cells?"

HELL YES, but their monkeys did shockingly well. The treatment did not seem to cause particularly bad side effects, they only noticed some renal toxicity (meaning somewhat bad for kidneys) and that was reversible. This is presumably from the kidneys needing to clear out waste in the bloodstream from the cells. Intuitively, I would not have expected mice to live (neither did the authors of the paper until they read the previous work demonstrating it in mice), much less primates, but there you go, science in action.

Of course there is a decent chance that there are subtle things that can go wrong in environments unlike the monkey's, in people with odd physiologies, or with weird drug interactions, but the idea would be that anything along those lines would be figured out in trials.

"- having killed fat cells, can you grow more?"

So long as you've got Mesenchymal stem cells you can make more adipocytes. From their toxicity study in lean rhesus monkeys, it looks like someone would run into kidney failure long before they killed ALL of their adipocytes, even if that would be a really fascinating and interesting way to go.

"- what happens when you still eat the same way but don't have the fat cells to store fat in? Do you crap it out? Does it deposit on your arteries?"

The authors haven't come up with a detailed mechanism for exactly how that all worked, but they were willing to speculate that, "Whereas a detailed mechanism of action for adipotide treatment remains to be fully elucidated, we observed that weight loss in obese rhesus monkeys occurred concurrently with a reduction in food intake."
That combined with the increased insulin resistance is what I find really exciting.

Incidentally, if anyone wants copies of these papers but does not have access, MeMail me with an email address I can send a PDF to, you know, for the purpose of this academic discussion which we are currently having
posted by Blasdelb at 6:29 PM on November 12, 2011 [11 favorites]


Hmm...what will happen to society when you can buy skinny?

Now being fat will mean you're poor too.

This will turn out wonderfully.


Sorry to say this, but it kind of already does. Gym memberships, the free time required to utilize gym memberships, personal trainers, fresh food (as opposed to frozen meals that you can just get home from work and put in the oven) all come a lot easier to people in higher income brackets. It's not all about money and opportunity, of course (I for one am fat because I love the shit out of chocolate), but the link between financial insecurity and obesity definitely already exists.

I mean, hell, people have been buying skinny since liposuction came along.
posted by emperor.seamus at 6:37 PM on November 12, 2011 [12 favorites]


The war on exercise and healthy diet continues, with a powerful ally, Science, joining the cause.

Exercise and a healthy diet aren't moral goods in and of themselves--they are recommended because they are means to an end: a long, healthy, happy life. For most people, exercise and healthy eating are an inconvenience, a price that must be paid to achieve that desired end. If science can come up with a way to reduce the price, so to speak, of a long and healthy life, then that seems like a great thing for humanity.
posted by notswedish at 6:38 PM on November 12, 2011 [17 favorites]


Ma dove adipocere?
posted by everichon at 7:13 PM on November 12, 2011 [1 favorite]


High density calories are just about the only cost effective stress relievers open to most Americans. So even if good food is cheaper*, people living with economic insecurity and all the pressures that go with it find fat the most effective. Obesity is as much a drug issue as it is a poverty and ag system issue.

The really cool finding is not so much the weight loss but the increase in insulin resistance**

I would have been shocked to hear otherwise. There's a direct link to adipose cell surface area and insulin resistance. The density of insulin receptors on the membranes is more or less a constant***, so reduction in cell volume reduces the the number of receptors that are sharing a limited supply of insulin. Same thing if you kill the cells entirely.

Which is why type 2 is also ameliorated through weight loss.

* And it really is if you know how to shop and cook, but dietary education is also a poverty issue.

**I assume you meant 'decrease' which is what the article states.

*** Regulated by genetics and age

posted by clarknova at 7:28 PM on November 12, 2011 [4 favorites]


So... this is a quicker way for anorexics to kill themselves via kidney failure? It sounds potentially useful under medical supervision, if it doesn't turn out to have other negative side effects, but strikes me as seriously prone to abuse. (That is, the potential negative side effects that the researchers should be worrying about include sociological side effects, not just medical ones.)
posted by eviemath at 7:28 PM on November 12, 2011 [4 favorites]


Any additional information on where the funding for this study is coming from? The article cites the following sources:

This research was funded by grants from the National Institutes of Health, the National Cancer Institute, AngelWorks, the Gillson-Longenbaugh Foundation, the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation, the Marcus Foundation and the Prostate Cancer Foundation.

but does not indicate if this is a complete list.
posted by eviemath at 7:32 PM on November 12, 2011 [1 favorite]


It sounds potentially useful under medical supervision, if it doesn't turn out to have other negative side effects, but strikes me as seriously prone to abuse.

Since the drug is administered by subcutaneous injection it is unlikely to be OTC any time soon, nor is it likely to be prescribed for people who are not actually obese. Anorexia is already plenty deadly and I think it's likely that the potential to make lots of struggling obese people much healthier would probably outweigh that particular cost.

Any additional information on where the funding for this study is coming from? The article cites the following sources [snip] but does not indicate if this is a complete list.

Typically all funding sources and potential conflicts of interest must be disclosed in the article.
posted by en forme de poire at 7:54 PM on November 12, 2011 [4 favorites]


M.D. Anderson is the number one hospital for cancer in the USA. Baylor is no slouch either. Baby, bathwater, etc.


While I agree, I'd like to point out that my alma mater, Baylor College of Medicine, is not affiliated with Baylor University. BCM is a powerhouse of scientific research and a top-ranked med school. I'm sure there are some nice things to say about Baylor University, but in scientific circles, it's mostly known for harboring creationists
posted by chrisamiller at 8:26 PM on November 12, 2011 [3 favorites]


Of course we will come up with an effective anti-obesity drug sooner or later. Historically speaking the early 20th century will be recalled as The Lardo Interregnum, and our descendants will look at old photos of crowd scenes with wonder.
posted by LarryC at 8:37 PM on November 12, 2011 [1 favorite]


"So... this is a quicker way for anorexics to kill themselves via kidney failure? It sounds potentially useful under medical supervision, if it doesn't turn out to have other negative side effects, but strikes me as seriously prone to abuse."

The study notes that the treatment had no effect on the weight of lean rhesus monkeys though, as en forme de poire notes, this is a peptide that must be injected which will make it at least more resistant to abuse.

Yes I know we said the same thing about Botox
posted by Blasdelb at 8:41 PM on November 12, 2011 [2 favorites]


Monkeys are spontaneously obese
What an odd sentence.
posted by Flunkie at 8:42 PM on November 12, 2011 [1 favorite]


I wonder if it affects brain tissue. That's pretty fatty.

My understanding from the article was that they're able to target the specific makeup of blood vessels within certain organs. White fat has a specific blood vessel makeup that doesn't match that of brain "fat" at all, so that's not an issue, or so goes my understanding.

Likewise, they can target the blood supply of other specific organs, or in the other case, tumors, to kill things that way. It's actually really exciting because it kills it the simplest way possible: murder the blood supply to that and only that.

I don't think anyone figured that 1) blood vessels would be different in a discernible way, and 2) there'd be a method by which we could target a payload to only impact those specific vessels.

If these things bear out, and the renal collateral damage isn't horrific, there will be some exciting advances along these lines.

Mostly, that I could keep eating like a fatty and shave it all off with a pill. That's the dream, right?
posted by disillusioned at 9:40 PM on November 12, 2011 [1 favorite]


[some comments deleted; I know obese monkey jokes are irresistible, but they were taking up a little too much room in this thread.]
posted by taz at 10:03 PM on November 12, 2011


This means we can keep comsuming without dying from overconsumption! We get to buy heaps of food, and heaps of drugs! Yay! Let's keep that money flowing!
posted by Jilder at 10:04 PM on November 12, 2011


One word: olestra
posted by Napoleonic Terrier at 10:47 PM on November 12, 2011 [1 favorite]


If McDonalds could add this to the special sauce

Or if it could be baked into some kind of peptide cake
posted by Pruitt-Igoe at 11:28 PM on November 12, 2011 [9 favorites]


Now that we have come up with the thin pill we can stop the search for the smart pill
posted by Ayn Rand and God at 12:23 AM on November 13, 2011 [1 favorite]


Are there seriously people out there who think a medicine that could cure obesity would be immoral? What about a cure for lung cancer? Would they bitch about that because it would let people continue to smoke? Maybe people with depression should just cheer the hell up, yeah?

A lot of people out there sitting on the wrong side of the equation; modern lifestyles, in their entirety, have resulted in obesity. No-one who spends their time sitting on a chair in an office, no matter how skinny they are, rather than wandering the wide savannas with a spear, has the right to take that kind of attitude.

Either we live in a modern society, with the temptations, freedoms, and medical technology that it provides, or you can leave that all behind. You don't get to blame the psychological differences of others and deny them medical treatment.
posted by Jimbob at 12:58 AM on November 13, 2011 [32 favorites]


We all know how this will end. The monkeys and apes will take over the world and a lone human will fall to his knees on a beach, staring at a broken statue, shouting "Nooooooooooo!".
posted by greenhornet at 1:12 AM on November 13, 2011 [1 favorite]


For most people, exercise and healthy eating are an inconvenience,

That's quite the assertion, and doesn't explain all those people I see playing sports for fun.
posted by rodgerd at 1:21 AM on November 13, 2011 [1 favorite]


Immoral is not the word I would use. Bandaid solution, maybe. The way we build our cities, farm out food and exploit our underclasses results in obesity. It's not an inevitablity. The problem is systemic and very hard to untie from issues of race and gender too. It's hard work - easier by far to just add another pill to the roster of solutions for modern problems. Depressed? Take a pill. Malnourished? Take a pill. Morbidly obese? Take a pill (and I would hope this would be a treatment reserved for the morbidly obese. I too worry it will be a "lifestyle drug" used to keep already thin people thin, and for people with ED to further be harmed by their disease).

It strikes me as treating symptoms, not the diseases themselves.
posted by Jilder at 1:57 AM on November 13, 2011 [2 favorites]


Okay, who read from the book of pure evil? ;)
posted by usagizero at 2:19 AM on November 13, 2011


A lot of cancer treatment is symptom management. More than just that - many diseases are managed via symptom flare ups. Treating symptoms is treating disease.

The article talks about obesity being a major cause of many cancers. Wouldn't it be great if we could eliminate a cause like that? With a pill? Or with people who already have cancer we could give them this pill and improve their outcomes for treatment? Also from the article, obese cancer patients do not do as well with surgery and chemo as cancer patients with safer BMIs.

Loosing weight is very hard or impossible for many people given its myriad of causes. If there was a pll to help I think that would be great. If we could resolve obesity as an issue in our culture think what else we could do with that do with the energy we currently spend trying to loose weight. Maintaining a healthy lifestyle? Insisting on or creating healthy resources for our communities?
posted by dog food sugar at 2:55 AM on November 13, 2011 [2 favorites]


Or if it could be baked into some kind of peptide cake

With mint frosting?
posted by lumensimus at 3:16 AM on November 13, 2011 [4 favorites]


The ability to consume large amounts of resources without any adverse side affects would be a wonderful thing.

Unless you can't afford food now, so while a percentage of the planet are stuffing their bellies past full and yet with just a pill, all is right with their world.
posted by kanemano at 3:36 AM on November 13, 2011 [1 favorite]


Fat isn't the only downside to over-consumption*, and I'm a little worried that this will effectively mask a big symptom of a bigger problem. Similar to a cough suppressant, while the symptom may be gone, the underlying illness may be getting worse, and things like diabetes, stroke and heart disease aren't going to disappear because the fat is gone.

Not to mention, we don't really need more people consuming more calories than they need and taking a pill to offset it...the greater demand for limited staple resources (many of which have jumped in price over the last few years) will push the price up even further and make it harder for some people to get a meal.

* This really only applies to people who are lifestyle obese; this might actually be good for those who are genetically bound to obesity, although I'm not sure the overall societal trade-off is a good one.
posted by Rodrigo Lamaitre at 5:57 AM on November 13, 2011


Oxycontin was marketed by its manufacturer as a super paint-killing drug that was in fact resistant to abuse and addiction-forming, because it came in time-release capsules (that is, the drug company made a nice delivery system for it to help minimize the likelihood that people using it as directed and under a prescription would become addicted). But in the absence of careful measures to prevent over-prescription and prevent excess pills from just being sold on the black market, it because one of the most highly abused prescription medicines in some areas (it's actually quite a powerful, and powerfully addictive, drug).

It doesn't look like there are worries about addictiveness with the drug that the researchers in the article are developing. I still worry about how this drug would be marketed, and it's potential for abuse if careful measures aren't taken to ensure it is only used, eg., in a doctor's office. The fact that it is administered by injection is, in my opinion, unlikely to affect that - people inject all sorts of drugs, legal (eg. insulin) and illegal, into themselves. Rather, public health officials would need to decide how to classify the drug - given it's reportedly few side effects, my understanding is that it would by default be in a less dangerous category which would allow it to perhaps be dispensed by prescription at a pharmacy for people to administer to themselves at home. Some drugs are only available at hospitals or doctors' offices and a health care professional has to administer the drug, but my understanding is that these tend to be drugs that have really serious side effects when given the wrong dose, or ones that are highly addictive. So public health officials would have to decide if they were going to classify this new fat-cell-killing drug with these other super-serious drugs, even though medically it doesn't so much fit into that category. If not, they would have to keep a careful eye on how, how much, and to whom it is dispensed if it is given out by prescription and look for signs of abuse as a street drug. Hopefully they would then be able to quickly adopt a plan that restricted the drug's use a bit more. These are issues around human behavior and human distribution systems, though, not strictly medical or mechanistic issues.
posted by eviemath at 5:58 AM on November 13, 2011


what happens when you still eat the same way but don't have the fat cells to store fat in?

I suspect it works like it does for a very low carb diet, which can't be stored as fat; you reach a point where your appetite not only disappears, your body informs you that you are gonna be physically ill if you try to eat any more.
posted by localroger at 6:23 AM on November 13, 2011 [1 favorite]


That's quite the assertion, and doesn't explain all those people I see playing sports for fun.

Sure. I look forward to my weekly aikido and fencing practices, but on weeks when I'm too busy with work to make it to those, I drag myself unwillingly to the gym a few times.

The ability to consume large amounts of resources without any adverse side affects would be a wonderful thing.

Right, but if this also fixes insulin resistance issues it should normalise appetite since blood sugar swings in people with metabolic syndrome lead to appetite swings and difficult to control binge eating.
posted by atrazine at 7:06 AM on November 13, 2011 [2 favorites]


Are there seriously people out there who think a medicine that could cure obesity would be immoral? What about a cure for lung cancer? Would they bitch about that because it would let people continue to smoke? Maybe people with depression should just cheer the hell up, yeah?

Oh, sure. They're in the same batch as people who think vaccinating someone against cancer is terrible because it will just encourage them to have sex. People are crazy.
posted by rtha at 7:40 AM on November 13, 2011 [11 favorites]


Fat isn't the only downside to over-consumption*, and I'm a little worried that this will effectively mask a big symptom of a bigger problem. Similar to a cough suppressant, while the symptom may be gone, the underlying illness may be getting worse, and things like diabetes, stroke and heart disease aren't going to disappear because the fat is gone.

Actually, as Blasdelb has mentioned a few times already in the thread, one of the exciting things about this treatment is that it actually does have the potential to actually treat the underlying metabolic syndrome. Adipocytes aren't just passive bags of fat, they're also hubs of metabolic signaling. The article reports destroying adipocytes with this treatment doesn't just lead to weight loss; it also improves glucose tolerance and insulin sensitivity.

One of the nasty and underappreciated things about obesity is how many feedback loops conspire to keep people obese. For example, animals that are genetically obese because they don't have the gene for leptin (the satiety hormone) have different gut flora than normal mice. But furthermore, if you take the bacteria from the obese mouse and transplant it into a mouse raised in a sterile environment, that mouse will also tend to become fat. Similarly, if you feed obese people less, their bodies act as if they are starving: their metabolism ratchets way down to compensate for the change in intake. So anything that breaks one of these feedback loops is not only going to help people make one-time changes to their weight but also to sustain these changes, which is paramount.

I still worry about how this drug would be marketed, and it's potential for abuse if careful measures aren't taken to ensure it is only used, eg., in a doctor's office. ... So public health officials would have to decide if they were going to classify this new fat-cell-killing drug with these other super-serious drugs, even though medically it doesn't so much fit into that category. If not, they would have to keep a careful eye on how, how much, and to whom it is dispensed if it is given out by prescription and look for signs of abuse as a street drug.

I really don't think there's a lot of abuse potential here. The most important reason is that the drug's action is much weaker or even absent in lean animals. From the study: In addition to the information obtained in the above efficacy studies in obese rhesus monkeys, we also evaluated the safety profile of adipotide in a formal Good Laboratory Practices (GLP) study in lean rhesus monkeys. A cohort of monkeys (n = 15) received three dose levels of adipotide (0.25, 0.43, and 0.75 mg/kg) daily for 28 days. Lean rhesus monkeys receiving adipotide (0.25 and 0.43 mg/kg) did not lose weight (fig. S5) Monkeys in the highest dose group either maintained their prestudy weight or displayed mild weight loss (fig. S5).

If people want to lose weight in a self-destructive way, there are plenty of ways they can do that already. Amphetamines, ephedrine, and laxatives will all cause way more weight loss in lean individuals, and unfortunately they remain very easy to find.
posted by en forme de poire at 7:48 AM on November 13, 2011 [7 favorites]


Actually actually, what I actually need is an edit window
posted by en forme de poire at 7:49 AM on November 13, 2011


"Immoral is not the word I would use. Bandaid solution, maybe.

No drug could solve all of the worlds problems, but this one might have the potential to help millions address one of them. Have you been to one of the fat threads on metafilter where some deuchebag always lets slip that they think fat people should just eat better and exercise more as a simple solution to solve all their problems? The thread then always needs to devolve into a bunch of people explaining how intractable the problem is? If the effect shown in these trails is real (They did use a bunch of monkeys) and applicable (it'd be odd if we were the only monkey out of six kinds that it didn't work on, but hey that happens sometimes) this has the potential to dramatically help that population.

"The way we build our cities, farm out food and exploit our underclasses results in obesity. It's not an inevitablity. The problem is systemic and very hard to untie from issues of race and gender too."

An injection can't build bike infrastructure but if it could make biking more accessible to more people I don't see how this is a problem, but you are right, this could only be accessible to those with access to a doctor, so no, it won't solve all of our obesity problems. No one has discovered a peptide binding ligand found only on racist cells, or one that is only associated with rape culture, that we could target too. If someone does I'll make sure I'm the first to post it to metafilter so we can kvetch about that too.

It's hard work - easier by far to just add another pill to the roster of solutions for modern problems. Depressed? Take a pill. Malnourished? Take a pill. Morbidly obese? Take a pill

You know, the same thing could have been said for infectious bacterial disease, then we got a pill and now no one remembers seven of the ten leading causes of death for our great grandparents. The folks who did the basic research, development, and marketing for the pills we do have that address malnourishment have saved hundreds of millions of lives, reduced the global cases of blindness by nearly an order of magnitude, and made economic progress possible in much of the developing world. They can't make the original reasons why so many folks don't have access to Vitamin A in vegetables, I still think those pills have done more to address and reverse systemic injustice than kvetching on the internet ever could.

(and I would hope this would be a treatment reserved for the morbidly obese. I too worry it will be a "lifestyle drug" used to keep already thin people thin, and for people with ED to further be harmed by their disease).

The authors found it had no effect on the weight of the lean rhesus monkeys they used to characterize toxicity, so this wouldn't work anyway, but where is the moral hazard in prophylaxis exactly?
posted by Blasdelb at 7:52 AM on November 13, 2011 [15 favorites]


Sane: "America's obesity epidemic is systemic in nature."
Sane: "A pill that treats obesity in an individual will not help to solve the systemic problem."
Lazy: "People who might otherwise have to deal with the systemic problem will use this pill to avoid doing so." (Unstated assumptions: there are individuals who are in a position to deal with the systemic problem in some capacity beyond mitigating it, and they want to avoid doing so.)
Insane: "This pill will cause anorexia and reinforce class divisions."
posted by LogicalDash at 8:03 AM on November 13, 2011 [4 favorites]


I suppose it wasn't considered commercial enough, but I think they should have called it Adipoticide.

(Or perhaps that could be a generic for all fat killers.)
posted by IndigoJones at 9:19 AM on November 13, 2011


If this one drug does in fact end up helping people lose weight and increase insulin sensitivity, would it also reduce the other things that go along with metabolic syndrome, like high blood pressure, atherosclerosis, liver and kidney disease? It seems like it has the potential to reduce health care costs by getting people off of a number of different medications. Not to mention making a whole lot of people feel better, live longer, etc. Sounds like a good thing to me.
posted by Teeth of the Hydra at 9:56 AM on November 13, 2011 [1 favorite]


LogicalDash, your last point refers to a worry, not an insanity, that has quite sane bases in people's use of other diet drugs or drugs associated with weight loss such as amphetamines, as well as current trends in different levels of access to prescription drugs in the US based on socioeconomic class. I think we had been having a pretty good discussion: people brought up potential concerns (eg. would the drug likely affect lipid coverings around nerve tissue, eg. in the brain) and other people brought forth additional details and evidence to address those concerns (the drug specifically targets adipose cells, not lipids themselves, so unlikely). en forme de poire brings up some good points to help allay concerns about misuse of the drug by people with eating disorders (I brought up anorexia, though there are certainly people with eating disorders who are not already dangerously thin, but they are certainly good, evidence-based points). Calling people insane, however, maybe detracts from a conversation that, I think at least, had been going pretty well with people making lots of worthwhile evidence-based points, no?
posted by eviemath at 9:59 AM on November 13, 2011


One word: olestra

Two words: anal leakage
posted by clarknova at 10:15 AM on November 13, 2011


eviemath,

I think that if obesity became extremely rare to nonexistent in society then maybe we'd eventually see fewer people suffering from eating disorders.
The whole basis for the endless conversations about weight loss, diets, which celeb gained weight, etc. might just disappear.

The majority of adults in the United States (and an ever increasing number in the rest of the West) are overweight or obese according to the ever-reviled BMI statistics, and virtually everyone wants to "lose weight". I think that this creates a situation where weight loss is presented as an unmitigated good thing (because for the majority of people, it's an achievement of a goal), the pathological extension of that into eating disorders follows in certain individuals. This is especially true because weight loss is portrayed as being possible if you just push yourself hard enough.

Labelling something unconditionally desirable and achievable through sufficient abnegation is a recipe for some people crossing a mental line and developing an extremely difficult to reverse fixation on the goal.
posted by atrazine at 11:45 AM on November 13, 2011 [2 favorites]


For most people, exercise and healthy eating are an inconvenience, a price that must be paid to achieve that desired end

Which is a shockingly distorted way to live. What, we need ant-fat pills so people can bump TV-watching time up to 7 hours a day from the current 5, now that they have even less need to use or take care of their physical body?
posted by crayz at 12:30 PM on November 13, 2011


Curious how this will affect the bodybuilding industry and competition. Well...
probably just more drug stacking. Meh.
posted by Evernix at 1:04 PM on November 13, 2011


"What, we need ant-fat pills so people can bump TV-watching time up to 7 hours a day from the current 5, now that they have even less need to use or take care of their physical body?"

Again, this is a subcutaneous injection, not a pill, and any therapeutic model based on this peptide is unlikely to work that way. Even if it did why would it be a problem exactly? This is like staking out an anti-penicillin position because once you don't need to be afraid of syphilis people will just Fuck Everyone!* Bad for your moral health you know, of course that should be reflected in awful symptoms and shorter lives.

The peptide does not rationally have the potential to be a magic bullet that would allow people to sit in front of a TV for 7 hours and remain healthy anyway, if only because muscle mass and strength are so important for so many reasons. It does however have the potential to help people address the, yes food mediated, insulin/leptin/glucagon related and other endocrine disruptions that caused the weight gain to begin with.

Having access to a treatment that would work like the authors hope this one will won't put anyone in danger of feeling like they don't need to "take care of themselves." All it would endanger is is the narrative that fat is a moral failing and can be shamed into going away. I for one am excited.

*This was actually a thing, though the crazies have since moved on to anti-retrovirals and other awesome therapies
posted by Blasdelb at 1:27 PM on November 13, 2011 [11 favorites]


What, we need ant-fat pills so people can bump TV-watching time up to 7 hours a day from the current 5, now that they have even less need to use or take care of their physical body?

Not every overweight person is watching TV all day: some of them are doing things like running companies, writing novels, solving proofs, and curing cancer. And even if this treatment would completely replace exercise and diet for controlling type II diabetes and obesity, I think by improving access to good health it would still be a net positive for society.

But this is sort of abstracted from the facts. The actual treatment in question doesn't replace diet and exercise, but rather (as per gracedissolved's comment upthread) enables people to better control their weight through diet and exercise.
posted by en forme de poire at 1:40 PM on November 13, 2011 [4 favorites]


Note that this isn't a fat-melting pill, and it will probably never be a pill. "Adipotide" is a peptide, is a class of molecules similar to proteins which the digestive system is designed to ... digest. So barring a solution to this problem -- the same one that prevents diabetics from taking insulin pills -- it will be administered by injection. (Of course it could be self-injected just like diabetics do themselves.)

The final tested protocol seems to be a four week course of daily intramuscular injections at 0.43mg/kg per subject and then a recovery period (important for renal recovery). The charts show that weight loss continues but tapers off during the recovery. The most important benefit of the treatment would not be weight loss but the actual destruction of redundant adipocytes with the concomitant reduction in metabolic syndrome.

So, I see this treatment being beneficial not only for those who are presently obese but for those who have managed to lose weight but are still challenged by their down-regulated metabolism from having a self-regulating weight. (Yeah, I'd have a go, I have big problems with insulin resistance despite having a normal weight now because I used to weigh half again as much and my fat cells would loooove to be that heavy again.)

If a month-long session of daily injections plus a month of recovery can not only help people drop weight but help keep them from putting it back on again, I will be frank here: this is going to be huge. The public health benefit from such a treatment is going to be enormous, not only in improvement to quality of life, but reduction of obesity-related health problems. So hell yes this is amazingly great news. There will of course be social implications and I bet some really interesting and unexpected effects will happen.

The only fly in the ointment is if we discover in twenty years that people who took this treatment wind up with some strange degenerative disorder that simply couldn't have been predicted. And yet.... if you could have twenty guaranteed good years as a normal sized person in good health and then maybe deal with some disease that could be cured later (or not!), as opposed to struggling to lose, maybe succeeding, maybe not, and maybe gaining it again and ultimately being miserable and unhappy because of how your weight makes you feel... what would you choose?

I hope it works on humans and is reasonably safe, and that when it is monetized it doesn't cost a fortune.

The thing that keeps coming back to me is this: it's not a palliative. It's a cure. You don't have to take it for the rest of your life. You get treated for your disease, and you get better. Will obesity finally be recognized as the disease it is once it can be cured? I hope so. That's a societal shift that we will all benefit from.
posted by seanmpuckett at 6:16 PM on November 13, 2011 [6 favorites]


I'm not sure about this idea: yes, it seems like "it's better to be dead than fat" is a common attitude today, but most people who fall in the obese category of BMI are not morbidly obese. Full disclosure: I'm now middle aged, and I've put on 50 pounds, partly from quitting smoking, partly from menopause, partly just from being, well, middle aged. As much as I dislike being a size 14 (fat, for me) I'd prefer to live a healthy, full life at a size 14 (less sexy, less fun with clothes, more foot problems) and die at 85+ than be the size 4 I was 10 years ago but develop Parkinsons or MS at 65.

There are many, many things that are worse than being chunky.
posted by jrochest at 8:55 PM on November 13, 2011 [1 favorite]


jrochest, is there something that makes you think that Adipotide could generate Parkinsons or MS in humans? I agree that chunky is a hell of a lot better than neuro-degenerative disease but I don't think there is any reason to make that connection.
posted by Blasdelb at 9:28 PM on November 13, 2011 [1 favorite]


As a morbidly obese person who tracks her calories, cooks at home, eats a diet comprised largely of whole foods and lots of fruits and vegetables, and is training for a goddamned triathlon, I would be THRILLED about a medical advance that would help any of the above activities actually lose me some of this goddamned weight. I've lost fifty pounds in two years, most of it while I was pregnant with my son*. It is unbelievably frustrating to eat 1600 calories a day while nursing a baby and putting in an hour of vigorous exercise 6 times a week, and lose a scant two pounds a month. Every other marker of my health has increased, but my body just will not let go of the weight unless I'm pregnant.

I have lots of other reasons to eat right and exercise. For my dental health, for my digestion, for the quality of my sleep, to help me manage depression and anxiety. Because I like being strong. Because good food tastes GOOD, instead of just salty-sweet. I'm not giving up these habits any time soon, but it would be really nice to get my metabolism on board.

*When I'm pregnant, I sit on the couch, eat all the cheese I can stuff in my face, and lose a pound a week. After I give birth, that reverses incredibly quickly unless I'm insanely strict about the diet and exercise. When I had pneumonia, I gained ten pounds in two months.
posted by KathrynT at 8:05 AM on November 14, 2011 [6 favorites]


Poor monkeys :(
posted by Cerulean at 3:35 PM on November 14, 2011


KathrynT, have you tried extremely low-carbing it? That made a world of difference for me and my mother. If you're used to a normal diet it can be hard for a few weeks but then it's like a switch flips, and you really don't want potato chips any more. The standard I hewed to in the early going 6 years ago was 70 grams a day max, and 30 in any one meal. Sounds insane, but it worked wonders and I have no problem now with the idea of eating like this for the rest of my life.

Of course, we might have a little problem feeding 7 billion people the way I'm eating. Leery as I am of it I find it hopefully interesting that the TFA stuff might make it possible to live like I am now on a cheap carb diet.
posted by localroger at 5:29 PM on November 14, 2011


KathrynT, have you tried extremely low-carbing it?

Yes. It makes it easier for me to eat fewer calories and gives me much more energy, but it doesn't result in magical weight loss. I at least have a doctor, trainer, and dietician who believe me and cheer me on through my ploddingly slow weight loss instead of insinuating that I must accidentally be eating a side of hershey's kisses with bacon instead of brussels sprouts. It's frustrating, but what can you do? Eating well and exercising is good for me regardless.
posted by KathrynT at 7:29 PM on November 14, 2011


It's frustrating, but what can you do?

Ah so. Well good luck. And good on ya for having doctors who are helping. My condition would have probably been a lot easier to deal with if the first doctor I went to with one of the weirder symptoms hadn't called me a liar and freaked me out of seeking medical help for anything for another ten years.
posted by localroger at 2:15 PM on November 15, 2011


"Fat just suffocates" might be a better quote.
posted by onesidys at 7:51 PM on November 15, 2011


I sure hope this works out, it would be a huge boon to society.
posted by Mitheral at 4:21 PM on November 20, 2011


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