The men who made us thin. Part 2.

Jacques Peretti investigates the rise of the diet industry. In the second of four programmes, Peretti examines the relationship between exercise and weight loss and explores the history of diet pills. The fitness industry is worth nearly £4 billion per year in the UK, but does exercise really burn fat? Professor Terence Wilkin, expert on metabolism, believes not; his studies on children showed that bursts of intense exercise were compensated for by extended rest periods. Three quarters of the calories we burn are consumed by our resting metabolic rate; exercise alone is a relatively inefficient way to lose weight. So how were we sold the idea that exercise makes us thin? French-American nutritionist Jean Mayer’s observational studies of adolescent girls in the 1950s found that less active children were more likely to be overweight. Mayer concluded that exercise makes you thin; Wilkin suggests that in fact, being overweight makes you less active. Mayer became nutrition advisor to three US presidents; his influence was such that his theories entered public policy. The promise of slimming took exercise into the mainstream in the 1960s, setting the scene for a new breed of entrepreneur. Richard Simmons was one of the first to profit from the trend; Peretti visits one of his classes, concluding that his methods work by boosting self-esteem. The invention of the videocassette led to a new craze; celebrity-hosted exercise classes pioneered by the release of Jane Fonda’s Workout in 1982. Entrepreneur Stewart Karl persuaded Fonda to front the videos. His wife explains how she came up with the idea, which become a huge success. Footage of Princess Diana attending gyms heightened the fitness movement in 80s Britain. Fred Turok, chairman of the LA Fitness chain, describes how he transformed the brand from a male-oriented bodybuilding club to a hub for cardiovascular exercise popular with both sexes. He agrees that while those exercising intensively (for five or more days a week) lose weight, the majority put in fewer hours. Turok defends his industry on health grounds, while admitting that gyms are misleadingly marketed as tools for weight loss. Peretti looks at the food industry’s role in promoting exercise. Among the 2012 Olympic sponsors were food giants Cadbury’s, Coca-Cola and McDonalds. Yoni Freedhoff, non-surgical weight management specialist, claims that such sponsorship perpetuates the belief that exercise causes weight loss, negating the association between fast food and obesity. Derek Yach, former global health policy advisor for PepsiCo, believes the idea that exercise is a short cut to weight loss is endemic. He denies that food companies are promoting sports to subvert legislation. By the 1990s the spiralling costs of treating obesity-associated diseases led to weight loss becoming a public health priority. Peretti confronts the pharmaceutical industry over the rise of weight loss drugs, beginning with Gustav Ando, Director of the IHS Healthcare Group. Ando describes how government’s labelling of obesity as an epidemic prompted pharmaceutical companies into action. Peretti looks back at the use of amphetamines as slimming pills in the 50s and 60s, which, although disastrous for health, proved that there was an appetite for a safer version. A new class of drug, fenfluramines, were marketed in the 80s. Dr Stuart Rich opposed FDA approval following European reports of the drug’s link to a fatal lung condition, pulmonary hypertension. Despite mounting evidence, ‘Fen-Phen’ was approved for use in the US. After appearing on the Today Show to warn the public of the dangers, Rich was threatened by the drug’s manufacturers, Wyeth Pharmaceuticals. It later emerged that Wyeth knew of more linked cases of PH than it had declared to the FDA. Although liability has never been admitted, by 2006 the company had set aside $21 billion in compensation. The fall of fenfluramine created an opening for a successor. When GlaxoSmithKline discovered that its antidepressant Wellbutrin also caused weight loss, it tried to persuade doctors to prescribe the drug for this purpose as well as depression – a practice known as ‘off-labelling’. Physicians were bribed to promote the drug to other practitioners, in a process former GSK sales rep Blair Hamrick describes as inappropriate and illegal. Sir Stephen Bloom, Professor of Endocrinology at Imperial College London, understands the pressure to get weight loss drugs to market, and admits that some products are given licenses prematurely as a result. In 2006 a new drug, rimonabant, was approved in Europe despite known side effects. A patient describes the adverse symptoms she experienced. The drug was eventually withdrawn in a PR disaster for its manufacturer, Sanofi. The only weight loss drug still on the market is orlistat, which although safer, produces its own unpleasant side effects. Sarah McLean, Roche’s Medical Director defends the product, claiming that it is both clinically and cost effective. She admits, however, that obesity is a complex issue that cannot be resolved with drugs alone. Bloom and Wilkin agree that our evolutionary biology, coupled with the ready availability of food, is at the heart of the problem. But instead of changing our environment, Peretti concludes, we are developing profit-generating products that attempt to deal with the consequences.