A big, bad business
Medical firms struggle to profit from weight-loss treatments
OBESITY is an epidemic to some and an opportunity to others.
More than two-thirds of Americans are overweight.
Find a way to battle the bulge and a huge profit might be made.
On February 22nd one pharmaceutical firm, Vivus, took a small step towards this goal.
A committee advising America's Food and Drug Administration (FDA) recommended that it approve Vivus's diet drug, Qnexa.
However, the pill's long-awaited final approval may not come until April, if at all.
The announcement mostly served as a reminder of what a struggle it is to turn fat into gold.
Pharmaceutical and medical-device companies are quite good at treating the conditions that come with obesity.
However, they are dismal at helping consumers lose weight.
This is not for lack of trying. Take the curious case of the gastric band.
Bariatric surgery can lead to weight loss in the long term.
Hospitals can make money from all bariatric procedures, including gastric bypasses (in which the stomach is partitioned and the upper part connected directly to the small intestine), but the gastric band is a rare example of an opportunity for device-makers to profit from weight loss.
Allergan, best known for selling Botox, has tried to use its Lap-Band to tap the obesity market.
It is an inflatable loop which the surgeon fits near the top of the stomach, which helps the patient feel sated earlier.
Allergan has captured about 70% of the worldwide market for gastric bands and balloons, but sales are now shrinking.
The recession has sapped consumers' desire for expensive surgery.
Some patients have had bands removed because they slipped or proved ineffective.
Last year the FDA approved the Lap-Band's use in patients who are only slightly overweight, but insurers have refused to pay.
In January David Pyott, Allergan's chief executive, said he would scrap an effort to market the band for teenagers.
He is now trying to convince insurers of Lap-Band's merits, arguing that the $20,000 surgery is recouped in saved medical costs within four years.
There is some scepticism about his chances of success: "The fact that banding is not as good as bypass has been known by everybody except the PR firms for the band," says Lee Kaplan, director of the Weight Centre at Massachusetts General Hospital.
Drug companies have had even more trouble than device-makers.
It has been 13 years since the FDA approved a prescription diet pill.
That drug, Roche's Xenical, has notorious gastrointestinal side-effects.
The FDA rejected Vivus's Qnexa in 2010 over concerns for the safety of pregnant women and the quickening of patients' heart rates.
Vivus's new data apparently satisfied the FDA's advisory committee.
However, the agency may yet reject the drug.
Even if Qnexa is approved, it is unclear that patients will buy it.
Qnexa combines two treatments that are already on the market.
Both medicines are generic, which means that doctors may prescribe the existing drugs rather than Qnexa's more expensive version.
For now, it is more profitable to treat fat patients than to try to make them slim.