THE SKINNY: Available in Europe since mid-2006 as Acomplia, rimonabant is currently under review by the FDA for prescription use here under the name Zimulti. It works on the brain's endocannabinoid system a system that plays a crucial role in regulating food intake and energy expenditure. The drug helps shut off appetite by reducing levels of insulin, a hormone that promotes fat storage, explains Louis Aronne, M.D., director of the Comprehensive Weight Control Program at the New YorkPresbyterian Hospital/Weill Cornell Medical Center in New York City. Diabetics who took rimonabant for six months lost two-and-a-half times more weight (15 pounds versus 6 pounds) than those taking a placebo, according to a study sponsored by Sanofi Aventis, the drug's manufacturer. Rimonabant was also found to significantly lower blood sugar, raise HDL ("good") cholesterol, and lower triglycerides (harmful fats in the blood linked to heart disease).
THE RISKS: People who took rimonabant were slightly more likely to suffer anxiety and depression. "Since this drug works by inhibiting the pleasure center of the brain, it may trigger or exacerbate these conditions," explains George Blackburn, M.D., director of the Center for the Study of Nutrition Medicine at the Beth Israel Deaconness Medical Center in Boston. Some experts question whether rimonabant is safe for people with even mild depression. "I would be comfortable with prescribing Zimulti to patients as long as I'm monitoring them for any mood changes," says endocrinologist and obesity specialist Scott Isaacs, M.D., author of The Leptin Boost Diet.
IS THIS PILL FOR YOU? Clinically obese people with low levels of HDL cholesterol and high levels of triglycerides, who also have no history of anxiety or depression, are the best candidates for this drug, says Apovian.