Losing weight is a frequent New Year’s resolution but for many people it involves more than pledging to skip snacks to drop an unwanted 15 pounds.

Nearly one-third of Louisianians and 37.5 percent of New Orleans residents are obese, which is generally defined as being 20 percent or more above the average weight for a particular age, height and bone structure.

Diet and exercise are the staples of most weight loss plans, but extra measures are often needed in obesity cases.

Dr. Vivian Fonseca, an endocrinologist and professor of medicine and pharmacology at Tulane University Health Sciences Center, leads a weight loss clinic that incorporates prescription medication with diet and other lifestyle changes.

Fonseca said many people embarking upon a weight loss program have unrealistic expectations. They should know there is no wonder drug that will melt the extra pounds without possible negative consequences.

There is no drug without side effects, Fonseca said. Aspirin has side effects.

Like any physician who prescribes medicine, Fonseca and other doctors who supervise weight loss clinics are bound by the rules of the Louisiana State Board of Medical Examiners. Its bylaws maintain that no physician shall dispense any medication except in the usual and ordinary course of his medical practice for a legitimate medical purpose.

Prescription medication for weight loss is intended for short- term use, said Fonseca.

Appetite suppressants help patients through the initial stages of the weight-loss regimen, said Fonseca. But manufacturers of the most popular prescription appetite suppressants advise against using them beyond 12 weeks. Phentermine, the most commonly prescribed appetite suppressant, can cause irritability, sleeplessness and blurred vision.

Cost is also a consideration. A survey of local independent and chain pharmacies revealed that a 30-day supply of Adipex, a brand of phentermine, sells for between $50 and $75.

Insurance coverage for prescription weight loss medication varies by state and insurance company, but there is an ongoing effort to convince insurance companies to cover weight loss programs.

The National Institutes of Health, an agency of the U.S. Department of Health and Human Services, is pushing for laws to mandate insurance coverage for bariatric surgery. This operation, which reduces the size of the stomach or intestines, costs around $25,000.

Virginia Moore, coordinator for the Louisiana Council for Obesity Prevention and Management, wants emphasis placed on preventive measures when it comes to weight loss. The Legislature created the council in 1998 to research Louisiana’s obesity problem. The state spends $1.4 billion a year to combat health problems with ties to obesity, according to council research.

Moore said insurance companies are more likely to pay for bariatric surgery than other approaches to weight loss because its results are more dramatic.

I’m not saying we shouldn’t pay for it because for some people it’s the only thing that’s going to help them lose weight, said Moore. But on the other hand, we really have to seriously look at paying for some of the other treatments because ... in the long run we really will be saving health care dollars.

Purveyors of weight loss programs that do not involve prescription medicine or surgery are also sensitive to the bottom line issues of their clients. Weight Watchers, based in Woodbury, N.Y., says the cost of weight loss programs is a tax-deductible medical expense.

The Internal Revenue Service ruled in April 2002 that medical expenses such as a fees from a doctor-ordered weight loss program can be deducted when they exceed 7.5 percent of adjusted gross income. Dana Fries, a public relations associate with Weight Watchers, said the company has mailed pamphlets to its customers and physicians detailing the deductions.

Weight Watchers does not operate with physician supervision and no state or federal laws regulate other weight loss businesses in the same category. The Federal Trade Commission cracks down on false claims in weight loss advertising but non-medical clinics are not subject to the same scrutiny as health care providers.

The Partnership for Healthy Weight Loss Management, a coalition of researchers, physicians and government and commercial interests, issued voluntary guidelines for providers of weight loss products or services. Members include Jenny Craig Inc. of Carlsbad, Calif., Slim Fast Foods Co. of West Palm Beach, Fla., Weight Watchers, the FTC and the NIH’s Division of Nutrition Research Coordination.

Cynthia Albert, head of operations for the Better Business Bureau of New Orleans, said her office has not recorded any complaints against local weight loss clinics. Kris Wartelle, spokeswoman for Attorney General Charles Foti Jr., said the state has not received any recent complaints either.

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