AOA published a statement in August, indicating that we were concerned by the Mayo Clinic findings. But we cautioned against overreaction.

The story really took wing when Wyeth-Ayerst announced the recall of fenfluramine and a related drug, dexfenfluramine (Redux). We issued a second statement, endorsing the withdrawal because several researchers reported seeing similar problems. Our first priority was to ensure that persons with obesity were not incurring serious heart valve damage or other health effects.

Most reporters who phoned had a preconceived idea of the story. It went something like this: women wanting to lose weight for the sake of appearance were obtaining diet pills from unscrupulous doctors, who were not even seeing the patients. The doctors were in it for the money and were being encouraged by greedy pharmaceutical corporations.

The calls made clear that obesity is not even regarded as a disease, much less as the greatest neglected public health issue in the United States. Patients who needed treatment for the disease - including the thousands dying from it annually - were simply ignored by the media. The focus of the stories were "dieters," and the issue was a "diet pill," rather than a medication. The stories were not about a disorder but about a hobby (dieting). They featured not the sick but the vain.

Here were some of the frequently asked questions:

"Weren’t people using fen-phen for purely cosmetic weight loss?"

Although our culture is clearly obsessed with dieting, I responded, we don’t really know how many people took the medications for purely cosmetic reasons rather than for treatment of obesity. The number of estimated fen-phen users (six million) was much less than the number of Americans (58 million) who are clinically overweight. I also pointed out that appearances could be deceiving: a person whose weight seems normal might be on a maintenance plan, having already shed many pounds.

The perception of vanity and cosmetic use stemmed mainly from reports of unscrupulous doctors prescribing the drugs for persons whose weight did not warrant pharmaceutical treatment. l was sure that some, perhaps many, doctors were too quick to prescribe drugs. But despite anecdotes about undercover reporters going into a clinic and getting a prescription, the vast majority of physicians only prescribed weight-control drugs for sound medical reasons, if they prescribed them at all.

"Shouldn’t fat people just stop eating so much and get out and exercise? Aren’t they really failing to lose weight because they are lazy?"

I pointed out that diet and exercise sound easy but are extremely difficult in the real world. After all, the opportunities to eat are many, and the time needed for effective exercise is hard to find in our busy lives.

The stereotype of obese persons as lazy is grossly unfair to the many who struggle constantly to stay with a regimen. I myself was on a very low calorie diet for four months, took a score of classes and kept diet records. I still watch what I eat, shop carefully for food, and try to exercise an hour a day. It is not easy. Thc discipline and self-control required is enormous and not demanded of persons with other conditions.

"Aren’t greedy pharrnaceutical corporations to blame?"

lt seemed to me that Wyeth-Ayerst acted quickly and responsibly in withdrawing its products when the Mayo data came to light. In any event, drug companies will be answerable in the litigation that is bound to ensue. (AOA has received support from several companies, including Wyeth-Ayerst, but all of it in the form of unrestricted educational grants.)

"Why should there be any medication for obesity?"

This question implied that obese patients should be punished for their obesity, either by having to live with it or by having to take weight off the hard way. I asked whether methadone or "the patch" or an anti-alcoholism drug should be denied to persons with addiction to heroin, tobacco or drink just because they may and do relapse. I asked reporters if they had a problem with medication for HIV/AIDS patients - who might have avoided the disease if they abstained from sex. I also asked if a woman about to give birth would be "lazy" if she accepted an epidural to control the pain?

The history of medicine is one of transitions from no treatment to partially successful treatment to more advanced treatment, which can control for side effects. That was the case with depression, schizophrenia and Parkinson’s disease, to name a few. It will be true of obesity as well.

"Aren’t attempts to lose weight doomed to failure in the long run?"

Obesity is a serious, chronic medical condition that for the time being lacks a cure. In the meantime, I emphasized, it has to be managed, not only for health reasons but also for valid psychosocial reasons. Management is difficult, but some people do it successfully. As with other chronic diseases, a maintenance program sometimes falters, and the patient relapses.

But if this is "failure," so is a second or third heart attack in the cardiac patient. Do we regard attempts at heart thempy as futile? We are quick to fault obesity treatment but disregard the relapses that are common to other diseases.

For whatever reasons, in the public mind obesity is different than other morbid conditions. As a rule, the compassion that many people feel for patients with chronic diseases - including diseases aggravated by personal behavior - does not extend to persons with obesity

District of Columbia officials recently sought to broaden the definition of disability so that more injured policemen might be eligible for disability retirement. The congressman who oversees the budget for the district was quoted as responding, "Disability shouldn’t be something that happens when you are 300 pounds and can’t bend over to eat a doughout."