A little tired and bleary-eyed, the waitress said with a faint smile, "May I take your order?"  The six college students sitting at the table in front of her, all with bloodshot eyes, simultaneously burst out laughing.  After a few seconds the waitress said "I’ll come back in a few minutes."

Diagnosis?  Cannabis sativa with secondary hyperphagia.  In other words, the college kids were stoned and had the "munchies," a craving for food associated with marijuana use.

It must have occurred to someone long ago that if marijuana makes people hungry, maybe there is an "antimarijuana," a substance that opposes the appetite-stimulating effects of marijuana, causes weight loss and thus effectively treats obesity.

Hence, the drug rimonabant, a cannabinoid receptor blocker.  The cannabinoid receptor is a molecule in the brain which, when stimulated by the active ingredient in marijuana, THC, causes the typical effects of marijuana: euphoria (the "high"), antinausea effects, and appetite stimulation.  Rimonabant produces the opposite effects by blocking this receptor and is effective for weight loss.  In a recent study in the April 2 Journal of the American Medical Association, patients given rimonabant had a ten pound weight loss.

The problem is that rimonabant also causes high rates of nausea, depression, and anxiety. Rimonabant has been associated with a 2-fold increase in the risk of suicide.

Although rimonabant is available in Europe and Mexico, the US Food and Drug Administration’s Endocrine and Metabolic Drugs Advisory Committee unanimously recommended against approval of the drug in 2007.

There are a number of appetite suppressants available in the US, but these drugs at best produce modest weight loss.  The drugs must be taken continually to maintain this weight loss. Furthermore, many obese people need to lose far more than the 10 pounds seen in the rimonabant study cited above.  So the search for a safe and effective appetite suppressant continues.  The drug companies and the research community are hard at it, but as yet have had no success.

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