Thursday, 10 March, 2011
Every morning, Kay Brown engages in a ritual similar to a heroin addict’s, or a diabetic’s: she sticks herself with a syringe. Only hers contains hCG, a pregnancy hormone.
Ms. Brown, 35, is not taking hCG to help her bear a child. She believes that by combining the hormone injections with a 500-calorie-a-day diet, she will achieve a kind of weight-loss nirvana: losing fat in all the right places without feeling tired or hungry. “I had a friend who did it before her wedding,” Ms. Brown said. “She looks great.”
Women like Ms. Brown are streaming into doctors’ offices and weight-loss clinics all over the country, paying upward of $1,000 a month for a consultation, a supply of the hormone and the syringes needed to deliver it. More than 50 years after a doctor at a Roman clinic began promoting hCG as a dieting aid, it is as popular as ever, even though there is scant evidence that it makes any difference.
The regimen combines daily injections with a near-starvation diet, and patients, mostly women, are often enticed by promises that they can lose about a pound a day without feeling hungry. Perhaps even more seductively, they are frequently told that the hCG will prompt their bodies to carry away and metabolize fat that has been stored where they least want it — in their upper arms, bellies and thighs.
In response to inquiries stirred up by the diet’s popularity, the Food and Drug Administration warned in January that “homeopathic” forms of hCG, like lozenges and sprays, sold over the Internet and in some health food stores, are fraudulent and illegal if they claim weight-loss powers.
The injectable, prescription form of hCG, human chorionic gonadotropin, is approved as a treatment for infertility and other uses, and it is legal for doctors to prescribe it “off-label” for weight loss.
But the F.D.A. has also reiterated a warning, first issued in the mid-1970s, that is required on hCG packaging: It has not been shown to increase weight loss, to cause a more “attractive” distribution of fat or to “decrease hunger and discomfort” from low-calorie diets.
The F.D.A. recently received a report of a patient on the hCG diet who had a pulmonary embolism, said Christopher Kelly, a spokesman for the agency. He said the hormone carried risks of blood clots, depression, headaches and breast tenderness or enlargement.
Dr. Pieter Cohen, an assistant professor at Harvard medical school who researches weight-loss supplements, said that aside from the issue of side effects, the use of hCG as a diet tool was “manipulating people to give them the sense that they’re receiving something that’s powerful and potent and effective, and in fact they’re receiving something that’s nothing better than a placebo.”
But unlike other popular diet supplements, hCG, which is derived from the urine of pregnant women, has acquired an aura of respectability because the injections are available only by prescription.
Ms. Brown’s physician, Lionel Bissoon, a well-known society doctor with an office off Central Park West, charges $1,150 for his hCG program, which covers an examination, injection training, a month’s supply of the hormone and syringes, and blood work to monitor for possible trouble.
“From an anecdotal point of view,” Dr. Bissoon said, “physicians all around the country have seen people losing a tremendous amount of weight with this stuff, and you cannot afford to ignore that.”
Another New York doctor, Scott M. Blyer, offers the hCG diet as an adjunct to his cosmetic surgery practice, working with Jacqueline Fulop-Goodling, an orthodontist, out of her office in Midtown. Dr. Fulop-Goodling does not prescribe hCG, but she counsels patients. They charge $800 for a 40-day course of therapy, half-price for repeat rounds; they also require an EKG to make sure the patient has no heart trouble.
One of Dr. Blyer’s patients, a 30-year-old business consultant named May, who asked that her last name not be used because she was embarrassed to be considering the diet, described herself as an “emotional eater.” She is 5-foot-3 and 130 pounds, but said she hoped to shed 20 pounds in time to be a bridesmaid at an April wedding. “So I have just six weeks,” she said.
Dr. Blyer looked uneasy. “Your legs are thin, your face is thin,” he told her. “You’re a very attractive woman.” But he reassured her that she would lose weight where she wanted to, in her stomach. The hCG, Dr. Blyer said, “tricks your body into a state of pregnancy; it burns off fat so the fetus can get enough calories, but it protects muscle.”
May eventually decided that she did not need to lose much weight and did not go through with the diet.
Dr. Blyer’s explanation of how the hCG diet works resembles a theory first popularized in the 1950s by A. T. W. Simeons, a doctor in Rome who said he had used it on more than 500 patients, and published a paper about it in The Lancet, the British medical journal, in 1954.
In 1995, a Dutch study in The British Journal of Clinical Pharmacology tried to resolve the question of whether the hCG diet really worked by analyzing 14 randomized clinical trials of the diet. Only two, including one co-written by an advocate of the diet, found that people on hCG lost more weight, felt less hunger and had an improved body shape, compared with people on the same 500-calorie diet who received a placebo, like saline injections.
But several studies concluded that the ritual of the daily injection and the instant gratification of quick weight loss helped motivate people to stay on the diet.
However arcane the theory, some doctors say it is theoretically plausible that hCG would create a more toned body, because it can induce the production of male hormones and increase muscle mass.
“There’s a reason Manny Ramirez took it,” said Dr. Martin Keltz, director of the division of reproductive endocrinology and infertility at St. Lukes-Roosevelt Hospital Center in Manhattan. Mr. Ramirez, the baseball star, was suspended for 50 games in 2009 after evidence surfaced that he had used hCG, which is banned by Major League Baseball.
Dr. Keltz said he thought it was possible to redistribute fat with hCG, but, he added, “there are risks, like cardiovascular risks.”
“I would shy away from them,” he continued.
Then there are the nutritional concerns about a diet that some say mimics anorexia. “The average person is going to eat 1,800 to 3,000 calories,” said Kristen Smith, a bariatric surgery dietitian at Montefiore Medical Center.
“I don’t think it promotes healthy long-term eating habits,” she added.
Doctors who prescribe hCG for dieting say that experience is in their favor, even if the research is not. They point to women like Guldal Caba, a 53-year-old psychologist from Toledo, Ohio, who traveled to New York for treatment from Dr. Bissoon. “It was the fat that needed to go — you know behind my bra, that back fat, my belly,” Dr. Caba said.
Ms. Brown, a theater administrator who is 5-foot-8, said she was thrilled to lose six pounds in seven days, and hopeful about reaching her goal of losing 30, which would bring her close to her ideal weight of 135. She said she did not feel hungry and did not obsess about food as she had years ago, when suffering from anorexia.
“A lot of people have a lot of opinions,” Ms. Brown said, “but I don’t want to be a person who feels like my weight is not under my control.”
By ANEMONA HARTOCOLLIS
Published: March 7, 2011
The New York Times