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Genetics plays a big role in both the amount of fat we have -- and where we have it. "A lot of people, no matter how much they exercise and diet, are going to have those pads on their thighs," says Rox Anderson, MD, professor of dermatology at Harvard Medical School. Right now, the most effective option is liposuction. But it's invasive: The surgeon pokes holes in the skin, inserts a metal cannula and sucks out fat. Then there are risks of complications, infection and scarring."The holy grail of the next frontier is to be able to perform what liposuction does without breaking the skin, and to have no downtime," says Robert Weiss, MD, vice president of the American Society for Dermatologic Surgery. Dr. Anderson, a pioneer in medical laser technology, has created a laser that can kill fat cells without harming the skin. With the Free-Electron Laser, light goes through the skin into the fat layer, either killing or decreasing the amount of fat, which is then absorbed by the body. But this is early research; the laser has only been tested on animals. We still don't know how painful treatment would be, how long the effects would last, or potential side effects. Next, Dr. Anderson will begin studies to determine the laser's safety and effectiveness in humans, and how well it will treat conditions like cellulite.
More Novel Ideas
Another novel idea: using electricity to trick the stomach into thinking you're stuffed. Doctors at the Mayo Clinic in Rochester, Minnesota, are working with a company called EnteroMedics on the VBLOC (Vagal Blocking for Obesity Control). VBLOC is inserted laparoscopically and uses electricity to block the vagus nerve, which connects the brain and the stomach. It prevents the stomach from increasing in size when you eat (so you feel full quicker) and keeps it from emptying too quickly (so you feel full longer). The result? You get a bit nauseated when you overeat, and are satisfied with less food. The device turns on and off during the day, and shuts off for a period at night. The results of an international study of 30 people are due in a few months. So far, they look promising enough that a larger final-phase trial is planned for later this year.
It's still unclear how much you could lose with VBLOC, but "the minimum expectation would be to see reductions in excess body weight of at least 10 to 15 percent, similar to what you see with obesity drugs and surgical procedures," says William Sandborn, MD, a professor of medicine at the Mayo Clinic and one of the researchers working on the device.
Medtronic's Implantable Gastric Stimulator works in a different way. Rather than blocking the stomach, this device, also implanted via surgery, stimulates it. Electrical impulses make the stomach distend, leading to a feeling of fullness. The device has been tested on about 150 patients so far, but after a year it's failed to prove that it leads to serious weight loss.
Incision-less Surgery
The most effective tool for major weight reduction is surgery. But there are risks, even though it's done laparoscopically. "The next revolution, of incision-less, or endoluminal, surgery, may allow someone to leave the hospital the same day and go back to work in a few days," says Philip Schauer, MD, president of the American Society for Bariatric Surgery. With Natural Orifice Transluminal Endoscopic Surgery (NOTES), an endoscope is inserted through the mouth and threaded down to the stomach, where it staples or stitches the stomach to make it smaller. It would be done without any incisions or, possibly, even anesthesia.
"It's potentially a very effective, safe option," says Dr. Schauer. But it's at least three to five years from being tested on humans.
Rimonabant may be on its way, but the other breakthroughs are at least a few years away. "Expensive treatments can't be viewed as the ultimate solution," says Thomas A. Wadden, MD, past president of the Obesity Society. "We have to prevent more people from becoming obese." Change your shape by changing your lifestyle. Here's how:
Live the Basics
Open your eyes. The first step in adjusting any behavior is becoming more aware of the habit you want to change, says John Foreyt, PhD, director of nutrition research at Baylor College of Medicine. To do that, follow Foreyt's three-step program: Weigh in daily, record what you eat, and track your exercise.
All exercise counts. "Anything you do is good," says Kelly Brownell, PhD, director of the Rudd Center for Food Policy and Obesity at Yale University. "Is it good to walk down to the end of the driveway and back? If you were just sitting around watching Gilligan's Island, then yeah, it's good."
Slow down. "In our culture, you stagger up to the trough, wolf it down and stagger away," says Walter Willett, MD, professor of epidemiology and nutrition at Harvard School of Public Health. "Instead, think about what you're eating and enjoy it, bite by bite."
Treat yourself better. Would you give someone else what you feed yourself? Most people, says Dr. Oz, "if they look at it honestly, say, 'No, I'd never let anyone eat that crap. But I'm doing it, and too much of it.' "
Plan to fail. Most of us make rules when we go on a diet. And if we break a rule, the diet's off, says Brownell. Instead, know that you'll make mistakes and know how to pick yourself up.
Carry an "umbrella." "When the climate is foul, we take responsibility for defending ourselves against it," says Yale University obesity expert David Katz, MD. "We live in a foul nutritional climate. People go out in it every day hoping not to get fat. It's silly." So Katz never leaves home without bringing along whole-grain cereal, carrots, nuts, seeds, fruit and nonfat yogurt.
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