THE NEW DIET PILL; DOCTORS TURN TO FDA-APPROVED MERIDIA TO FILL GAP LEFT BY FEN-PHEN SCARE.

Byline: Carol Bidwell Daily News Staff Writer

You've got cottage cheese thighs and a willpower deficiency. The refrigerator calls your name so loudly you can hear it from your bedroom.

You try to resist the hot dogs at the ballpark, the hamburgers at the school carnival, the buttered popcorn at the movies, but you always seem to give in. And while the extra weight shows up almost immediately on the scale, it takes months - maybe even years - for it to disappear again.

So what's a dieter to do?

Just what we've always done: Pray for a new pill or potion or herb that will melt away fat while we scarf down our favorite foods.

Thirty years ago, we thought Regimen was the answer. Or maybe bananas and eggs. Eggs and grapefruit. Weight Watchers. Jenny Craig. The Calories Don't Count Diet. The Drinking Man's Diet. Ayds candy. Optifast. Over-the-counter appetite suppressants.

By 1995, more than 100,000 desperate dieters had even had their stomachs stapled or surgically bypassed altogether, according to Dr. Robert R. Baron, head of the University of California, San Francisco, Division of General Internal Medicine.

When the prescription fen-phen weight-loss ``cocktail'' hit the market a couple of years ago, we could see slim-fit jeans and bikinis in our future. But fen-phen was yanked off the market in September after a Florida study linked heart-valve problems with one of the fen-phen drugs. Frightened, some of us swore off diet pills forever; other, braver - or more desperate - dieters couldn't wait for another safer pill to become available.

``Patients would come to me with tears in their eyes and say, `I need it (fen-phen). It's the first time in my life I've had any hope. What do I do now?' '' said Dr. Robert Michals, who runs weight-loss clinics in Sherman Oaks and Glendale.

The new drug

Struggling dieters didn't have to wait long. Meridia, a new diet pill approved by the U.S. Food and Drug Administration, became available in late February. Is it the magic bullet?

Dayle Gloria, 42, of North Hollywood hopes so. She's fought her weight for half her life and says the extra 30 pounds she carries on her 5-foot-3-inch frame might as well be 500, as hard as each one is to drop permanently.

The department store saleswoman lost 40 pounds on fen-phen, then gained 37 back when the drug was taken off the market. She signed up for Meridia as soon as it was available, hoping that this pill, this time, would be the answer.

The new drug, plus vitamin supplements and behavior modification counseling, costs her $200 a month. But she figures she'll pay for it with what she saves by buying fewer groceries.

``I'm on a budget, but I'm so unhappy with my weight gain,'' Gloria said. ``Without something to help, I just can't stop eating. I used to pray every night, `God, give me anorexia.' ''

In the two weeks she's been taking Meridia, she's cut her food intake by half. ``(The drug) just tells you not to eat anymore.''

Meridia may be the answer for many dieters with large amounts of weight to lose, said Dr. David Heber, director of the UCLA Center for Human Nutrition and leader of one of the studies that convinced the FDA to approve the drug as a diet aid.

Meridia, according to Knoll Pharmaceutical Co., which produces it, is the first in a new class of drugs - called serotonin and norepinephrine reuptake inhibitors, or SNRIs - approved for treatment of obesity. It increases brain levels of both serotonin and norepinephrine, two chemicals that control appetite. As a result, the drug - prescribed in 5-, 10- or 15-milligram once-a-day doses - makes dieters feel fuller and may increase their metabolism.

No major side effects 

Unlike 1970s amphetamines and even fen-phen, which caused nervousness and sleeplessness in dieters, no major side effects have been noted in people taking Meridia, said Heber. The only downside is a mild rise in blood pressure, but by the time dieters have lost 10 pounds, the hypertension reverses itself.

The drug, however, is not recommended for people with a history of coronary artery disease, congestive heart failure, arrhythmias, stroke or seizures. And the behavior modification component is crucial to the patients' success, helping them keep the weight off after they stop taking the drug.

Beginning this week, 100 overweight patients enrolled in a new UCLA program will combine Meridia with low-fat eating, exercise and behavior modification that will not only help them lose weight but keep it off - something most diet plans lack.

``With Meridia, dieters will feel more in control of their eating,'' Heber said. ``It's part of the answer, but it's not the whole answer. You'll still have to diet and exercise. People really need to be ready to change.

``But today, when you combine medications and behavior modification, you can help people lose weight very successfully.''

Michals, who's been prescribing Meridia for 300 patients for as long as five weeks, said their weight loss has been steady and painless.

The only major side effect is the financial bite the drug regimen takes out of their wallet. Not that anyone who's ever been on a diet should be surprised. The never-ending search for a weight-loss solution is a pricey proposition.

Last year, Americans spent more than $30 billion on weight-loss plans, diet pills, potions and books, Baron estimated.

And although Americans overall are more health-conscious than ever, with sales of low-fat foods and health club memberships at an all-time high, more than 30 percent of us are overweight, up from 25 percent in 1949 and 20 percent in 1933.

Another way to diet

Houry Zakarian, 21, of Glendale, an assistant manager for a paging company, is one of the 30 percent. She's been trying to lose weight since she was 13 and family members began to comment on her growing girth. On her last diet, she lost 40 pounds. But soon her clothes began to get tighter; by the time she stepped back on the scale, she'd regained the 40 pounds she'd lost, plus 40 more.

Six weeks ago, tipping the scales at 256 pounds, she had despaired of ever losing weight again. But since then, using a combination of the herbal supplement St. John's wort and fentermine, the nondangerous half of the fen-phen cocktail, she's dropped 19 pounds. And she's looking forward to September, when she's scheduled to attend a family wedding. By then, she figures she'll have lost 60 to 80 pounds.

So far, it's been easy to lose, Zakarian said, but if the regimen she's on stops working, she'll do whatever it takes to take off more pounds. Even if that means taking Meridia.

``I've tried so many things, I'm not frightened of anything anymore,'' she said. ``I'll take whatever the doctor recommends.''

Of course, if we listened to our doctors, we'd all be slim and trim. We know that being obese - more than 20 percent over what medical experts say is your ideal weight - puts us at risk for diabetes, heart disease, hypertension and some forms of cancer.

To someone who's never fought excess poundage, losing weight seems so simple. Just eat less, exercise more.

Still, we hang the laundry on the otherwise unused exercise bike and continue to chow down on the foods we know we shouldn't eat. Why? Why?

Can you spell C-R-A-V-I-N-G-S?

Regaining control

``Have you ever gotten up at 3 a.m. and driven to the grocery store because you wanted ice cream and, somehow, felt perverted?'' Michals asks rhetorically.

He battled his own diet demons - and lost 50 pounds himself on fen-phen two years ago.

``I love bread, and I'd wake up and smell it baking even though there was none in the house. That's what makes us eat out of control,'' he said. ``You can lose weight on your own, but it's agony. Meridia makes it easier; it allows you to distance yourself from food so you're in control again.''

That's just what Gloria needs.

``Food becomes very comforting,'' she said. ``You look at the commercials on TV, and everything is food, food, food. And that ice cream at 11 o'clock sounds so good, so I'll eat it. Not eating is not an option. I'll eat it and I'll cry, and I'll eat and I'll cry.''

Controlling those cravings is one of the keys to weight loss, Heber said. And new medical breakthroughs are about that and more - controlling appetite, controlling how much fat is in our foods, controlling metabolism, even controlling what may be a ``fat gene,'' an unwanted inheritance from our ancestors that predisposes us to get and stay fat, no matter how hard we try to diet.

Until now, an estimated 95 percent of dieters - even the ones who reach their goal weight - regain their lost poundage, plus additional pounds, health experts say.

But Gloria and Zakarian - and many more like them - are determined that this will be their last diet ever.

What makes it different this time, Zakarian said, is that before, she always lost weight so her ever-critical family wouldn't nag her.

``Now, this is for me,'' Zakarian said. ``It's not for anybody else. It's my turn. I want to look good. And I'm going to do it - for the last time.''

AMERICA'S FIGHT WITH FAT

Dieting and weight have been national preoccupations since the turn of the century. Here are some high - and low - points in Americans' fight against excess poundage:

1903 - President William Howard Taft, at 355 pounds, gets stuck in the White House bathtub. He vows to reduce.

1907- Americans are introduced to the calorie and urged to keep count of how many they consume. ``Nobody loves a fat man,'' says actor Roscoe ``Fattie'' Arbuckle in ``The Round Up.'' Actress Lillian Russell, for years the nation's pinup girl at nearly 200 pounds, begins dieting and bicycling.

1910 - The first diet pills are prescribed; among other ingredients, they contain caffeine, arsenic and strychnine.

1911 - Doctors discover that the iodine they use to treat thyroid patients causes weight loss and prescribe it for overweight patients.

1914 - Overweight people are urged by various medical experts to consume quantities of lemon juice, vinegar, epsom salts or even soap as diet aids.

1923 - Insurance companies coin the term ``ideal weight,'' and begin to charge corpulent policyholders higher rates.

1920s - Cigarettes are promoted as a diet aid. ``Reach for a Lucky instead of a sweet,'' one popular brand urges. Bathroom scales become popular.

1933 - Dinitrophenol is marketed as Corpu-lean, Formula 39 and Slim. By 1936, it is taken off the market; a toxin used in dyes and explosives, it causes rashes, lost sense of taste, blinds some dieters, kills a few others.

1938 - Doctors begin prescribing benzadrine, used as an asthma medication since 1887, as a diet pill.

1942 - Amphetamines, handed out by the millions to World War II fighter pilots and combat troops to keep them alert, are found to suppress appetites. Doctors begin prescribing them for overweight civilians, adding barbiturates to fight nervousness and sleeplessness the diet pills cause.

1959 - Metrecal, the first diet drink in a can, is introduced. Regimen, a combination of benzocaine, ammonium chloride and phenylpropanolamine, is marketed. Costing 30 cents to make, a box sells for $5.

1960 - Overeaters Anonymous is formed, a weight-loss program using Alcoholics Anonymous' 12-step concept. It's followed in 1961 by Weight Watchers and in 1965 by Diet Workshops.

1969 - Cyclamates, used to sweeten soft drinks, are labeled cancer-causers and taken off the market.

1975 - The first ``lite'' beer is marketed.

1977 - Saccharine, used since the 1950s as a sweetener, is banned after it, too, is linked with cancer.

1979 - The FDA approves phenylpropanolamine as a safe, mildly effective appetite suppressant; it is marketed over the counter under a variety of brand names.

1981 - The FDA approves the use of Aspartame as a low-cal sweetener.

1980s - The market is deluged by a flood of low-cal and low-fat or fat-free foods, including sour cream, mayonnaise, cookies, crackers and deli meats.

1997 - The fen-phen ``cocktail,'' marketed as Redux and Pondamin, is withdrawn by the FDA after one of its ingredients is linked with heart-valve problems, and dieters who've relied on fen-phen begin to look for other aids to weight loss. Diet product companies step up their efforts to market over-the-counter appetite suppressants, ``natural'' diet aids under the guise of food supplements, metabolism boosters, fat blockers, fat-grabbing fiber supplements, protein shakes and packaged meals. Stomach-stapling and jaw wiring are still options.

1998 - Meridia, the newest diet drug, is prescribed by doctors; sucralose, a new no-calorie sweetener made from sugar itself, is approved by the FDA; and olestra, a low-calorie fat substitute that passes through the body without being digested, is being marketed as Olean in potato chips and other fried-food snacks.

- Carol Bidwell

CAPTION(S):

Drawing, Photo, Box

Drawing: (Cover--Color) WEIGHING IN

From amphetamines to fen-phen, how far will Americans go for instant thinness?

Bradford Mar/Daily News

Photo: Houry Zakarian, 21, under the care of Dr. Robert Michals, has lost 19 pounds in six weeks while taking a combination of St. John's wort and fentermine, the nondangerous half of fen-phen.

John McCoy/Daily News

Box: AMERICA'S FIGHT WITH FAT (See Text)