STAR-LEDGER - February 1997

Annie Abrams always thought she was too fat.

In high school, she wore a matronly dress -- not a slinky gown -- to her prom. She wanted to disguise her weight.

In college, when she didn't get asked out as much as she wanted, she thought it was because she wasn't thin enough.

When she went to work, she stayed behind a desk, rather than go out to meet the public, for the same reason.

The 34-year-old Clark resident recalls how miserable she was. "I wouldn't go to places where bathing suits or shorts were worn I didn't want to eat in front of people."

Annie Abrams, now a manager at a training company, newly married and trimmed down through a regimen of diet, drugs and exercise, was 40 pounds overweight at her heaviest.

But was Abrams obese?

There is no undisputed standard. determining just how fat is fat, and what should be done about it, will shape the fortunes of companies, bureaucracies and millions of people.

Funding for the study of obesity and its cure produces as much argument as the definition of "too fat" does. Critics say that pharmaceutical companies are unfairly influencing the public's perception of fat by financing research and by underwriting nonprofit organizations dedicated to wiping out obesity. Even the National Institutes of Health task force on obesity has been questioned because of the relationships between its members and the drug industry.

Americans are being frightened unnecessarily about obesity, critics of the diet industry say, because the pharmaceutical industry wants to make as much money as possible.

Drug makers counter that hiring leading researchers is only logical and that the practice is common in most areas of research; why shouldn't they make sure the best minds at work on a subject advise them?

By the year 2000, sales of diet pills are projected to reach $1.7 billion, up from $243 million in 1996. By then. diet pills will account for 30 percent of the projected $5.6 billion diet industry, according to Medical Data International, a research company.

The weight-loss industry, including health clubs, is worth $40 billion overall. "Obesity is a wealthy business. Companies have a vested interest in telling America that it's overweight. That's a big market," says David Levitsky, a Cornell University professor of nutrition and psychology. He is a critic of Redux, the first diet pill to gain federal approval in 23 years.

Richard Atkinson, a University of Wisconsin professor who heads a nonprofit organization called the American Obesity Association, said there is nothing wrong with his group taking funding from pharmaceutical companies.

"Obviously, we'll take money from anyone who'll give it to us. But our endorsement is not for sale," he said.

Atkinson has proposed -- so far, unsuccessfully -- that physicians expand their notion of obesity in a way that would designate half the nation as too fat. Current scientific thinking puts about one-third of the nation in the obese category.

The American Obesity Association gets funding from a number of pharmaceutical companies that are developing diet pills -- American Home Products, Knoll pharmaceuticals and Hoffmann-La Roche. Atkinson has said that most of the organization's funding comes from the drug industry. Neither the association nor the drug companies would provide exact numbers.

Similarly, an organization called Shape Up, America! -- founded by former Surgeon General C. Everett Koop -- has gotten $100,000 from American Home Products' Wyeth-Ayerst division, according to Barbara Moore, the group's president. She said Hoffmann-La Roche may contribute $1 million as a three-year sponsor. Hoffmann-La Roche officials declined to comment. Shape Up, America! also gets funding from Jenny Craig, a weight-loss company, and Slim-Fast Foods.

Eight of the nine members of the National Institutes of Health task force on prevention and treatment of obesity have ties to the weight-loss industry, either as consultants to pharmaceutical companies, recipients of research money from them, or advisers to for-profit groups such as Weight Watchers.

The concern grew last summer about the ties between those who sell diet pills and those who define what is too fat and what should be done about it. Two leading obesity researchers, Joanne Manson of Harvard Medical School and Gerald Faich of the University of Pennsylvania, wrote an editorial in the New England Journal of Medicine downplaying a critical report on Redux without disclosing that they each had been consultants to the companies that make and sell Redux.

"The argument goes that you can't find anyone knowledgeable who doesn't work for a company -- which isn't true," said Sidney Wolfe, director of Public Citizen Health Research Group. "There are a lot of qualified people out there."

Unfortunately, noted Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, "it's hard to study obesity without clinking your toe against someone who (runs) a weight-loss clinic or promotes a certain drug."

Barbara Rolls, a nutrition professor at Pennsylvania State University and a member of the National Institutes of Health obesity panel, said: "Anybody who is a top scientist these days is working with companies." She added that she doesn't believe such relationships cloud judgments.

Representatives of the pharmaceutical industry are equally adamant that there is not a problem. "These accusations are terribly unfounded," said Marc Dietch, medical director at Wyeth-Ayerst Labs. Carter Eckert, president of Knoll Pharmaceuticals, bluntly addressed the sharpest criticism: "We're not in this to sell pills," he said, "We're in this to treat a long-term disease."

His company has been told by the Food and Drug Administration that its Meridia diet pill is likely to get approval soon if it can offer more proof of its effectiveness. In September, a subordinate FDA panel would not recommend approval.

Two months ago, the National Institutes of Health obesity panel published a paper in the Journal of the American Medical Association detailing the use of drugs In treating obesity. The task force warned against using drugs as a quick fix but said they could be useful for keeping weight off once a patient reduced.

"Because obesity is a disorder that cannot be expected to remit without continued treatment, short-term treatment of obesity Is not warranted. Treatment with medications will likely need to be continued for years, and perhaps for the lifetime of the patient, to sustain weight loss and improve health," the panel wrote.

Because of the panel members' relationship to drug companies, the paper was criticized. "Why should drug companies, which have money to make, issue guidelines? They have a bias," said Joanne Ikeda, a nutrition professor at the University of California at Berkeley.

Task force member Xavier Pi-Sunyer, who runs the Obesity Research Center at St. Luke's-Roosevelt Hospital Center in Manhattan, has been a paid speaker at a seminar sponsored by Wyeth-Ayerst. He would not say how much he received.

Drug companies "have no influence over what I say. ... I'm not accepting payment directly. It comes through a company that runs continuing education," Pi-Sunyer said. "Maybe that's a bad thing. But if you did away with this, you would wipe out 80 percent of the education programs. That's how much of medical education is funded in the United States."

Caplan of the Center for Bioethics at Penn says there's an answer. "The ethics involved are to disclose it, disclose it and disclose it."