Today, approximately 40% of all women and 25% of all men in the U.S. are actively trying to lose weight. We are spending more than $33 billion each year on weight loss products and services, with few of us achieving any long-term success. The market is flooded with aids tempting to support our efforts, and even though statistically it is the better-educated that attempt to lose weight, it is hard to distinguish what among these enticements offers true hope, what represents false hope, and what is outright fraud. Let's look at some of these products, their claims, and the scientific data.

Most of us first try to lose weight on our own through diet and exercise. A variety of meal replacements, slimming formulas, food additives and fat substances are available to help us restrict calories. All too often, however, even with the best of intentions, these are not sufficient to help us achieve weight loss.

We then begin to consider over-the-counter (OTC) drugs and "aids" that claim to supress our appetite or increase our metabolism, or both. The truth of the matter is that the only FDA approved ingredient marketed today in OTC drugs is phenylpropanolamine (PPA). PPA, an appetite depressant, is pharmacologically related to amphetamines and ephedrine, with Dexatrim, Acutrim and Permathene being popular examples of products that contain PPA. However, PPA only works with diet and exercise. Other diet aids include vitamins, minerals and herbal products. These are all controversial. Although attempts are being made to regualate such products, standards for them are far below those for food and drugs. In fact, it is argued that the lack of regulation in this area allows sales of worthless and dangerous products. Beware! They are often not as effective or innocuous as represented. Remember, some of our most powerful drugs are derived from these "natural" products. The most popular of these products include:

• Chromium Products - Claims to increase HDL, lower blood lipids, decrease levels of glucose and insulin, and when combined with Picolinic acid to decrease body fat while increasing lean body mass. More research needs to be done to substantiate these claims.

• HCA Acid/Garcinia - Claims to prevent fat production. Through scientific studies that have been conducted on animals, most experts doubt whether such data can be extrapolated to humans, who receive a much smaller dosage.

• Ephedra (Ephedrine & Pseudoephedrine)/Ma-Hung - Claims to increase basal metabolism. This stimulant is highly controversial and could be dangerous.

Statistically, when we have exhausted OTC support, we turn to established weight loss programs, physicians, or best of all, a combination of both. Most weight loss programs are run by non-healthcare professionals and offer diets, prepackaged food and/or group support to help us lose weight. Many programs are medically supervised and claim to offer a comprehensive, individualized approach to dieting, which includes anti-obesity drugs, meal replacements, diet, exercise and group support. (You should find out who is supervising the program and for how many hours.) Anti-obesity drugs can also be obtained through individual physicians, however, when used alone, without diet, exercise, motivation and monitoring, the results are often less than expected and short-term.

Although current anti-obesity medications are not wonder drugs, scientific data shows that using Fenfluramine and Phentermine in combination can help people lose weight and maintain the weight loss. Dr. Weintraub at the University of Rochester found in patients needing to lose over 200 pounds that using these drugs along with exercise and diet enabled patients to lose 3 times the weight with 4 times the chance of keeping it off. Dr. Weintraub's data showed the drugs to be safe with few side effects. Studies at M.D. Weight Care, in collaboration with Dr. Foreyt at Baylor College of Medicine, have duplicated Dr. Weintraub's results on patients with less than 100 pounds to lose. The NIH and national bariatric societies now recognize that obesity is often a chronic disease due to physiologic and genetic factors, and suggested treatment protocols include the long term use of medications. It is true that when the medications are stopped, patients often regain weight and weight loss tends to peak after about 6 months. But, continued use of medications allows patients to maintain the weight they lost.

New hopes are on the horizon through new drugs and new programs which combine existing therapy modalities. M.D. Weight Care will be working closely with pharmaceutical companies to test Dexfenfluramine and Sibutramine, which are stronger versions of Fenfluramine and Phentermine. Olestra, a product scientifically proven to prevent production of fat, will be released soon. New programs directed towards adolescents at least 16 years of age and to those with over 50 pounds to lose will be offered soon at M.D. Weight Care. These programs will use existing knowledge in new ways to offer specialized care to these groups.

So, to summarize and advise about weight loss:

1) Use your money and time wisely. Don't expect cheap, instant results. Lifestyle changes take 6-9 months and are best made under the supervision of professionals.

2) Select a doctor, clinic or program that offers what you need to produce results: experts to provide a comprehensive program of diet, exercise, monitoring and individualized attention. Make sure that those taking care of you are qualified and competent. Ask for credentials of the professional staff and statistics of the program. Call the medical board of your professional (doctor, nurse, physician assistant) and ask if they have suspensions and actions against them.

3) Beware of programs offering short-term solutions, expensive meal plans, diets of less than 800 calories or unproven diet aids, especially when they are provided from on-site pharmacies.

4) Don't quit if you fail the first time! Research shows that people who have failed three times have more success than those who try the first time.