Diet & fitness

LONDON, England (AP) -- Three diet drugs recommended for long-term use result in minimal weight loss and carry some serious side effects, a review of research found.

Patients on the drugs, men and women weighing about 220 pounds, lost less than 11 pounds on average.

Though most users of the drugs remained overweight, experts said the drugs could help curb the dangers of obesity by reducing rates of heart disease, diabetes and other health problems.

In a paper published Friday in the British Medical Journal, researchers in Canada and Brazil analyzed existing data on three popular weight-loss drugs: orlistat, or Xenical; sibutramine, known as Meridia in the United States and Reductil in Europe; and rimonabant, or Accomplia.

Scientists found that patients on the drugs -- men and women between 45 and 50 years old who weighed about 220 pounds and had a body mass index of about 35 -- lost less than 11 pounds on average. The study participants used the drugs for periods of between one and four years.

"Drugs are not the magic cure and are not for everybody," said Dr. Raj Padwal, an assistant professor at the University of Alberta in Canada, one of the paper's authors. "But in specific patients, they have great benefits."

Padwal and colleagues considered 16 trials that tested orlistat, which involved 10,631 people. Orlistat, which works by preventing fat digestion, helped people lose about 6.6 pounds on average. But it also reduced diabetes and improved their cholesterol levels and blood pressure. Up to 30 percent of patients had unpleasant digestive and intestinal side effects, such as incontinence.

Of the 10 trials on sibutramine, which involved 2,623 people, study participants lost about 9 pounds on average and had improved cholesterol levels. In up to 20 percent of patients, sibutramine caused side effects including raised blood pressure and pulse rates, insomnia and nausea.

And in the four rimonabant studies involving 6,365 people, scientists found that users lost on average about 11 pounds. Rimonabant also improved their blood pressure and cholesterol levels. The risk of mood disorders increased in 6 percent of patients.

Both sibutramine and rimonabant work by interrupting nerve signals in the brain.

Another study published Friday in The Lancet also showed rimonabant raised the risk of psychiatric problems such as depression and anxiety.

A report from the Food and Drug Administration in June found that 26 percent of people on rimonabant -- versus 14 percent of those given a placebo -- developed symptoms that included depression, anxiety and, in severe cases, suicidal tendencies. The FDA refused to authorize the drug.

Modest help is worthwhile

Rimonabant has been approved by the European Drug Agency, and is available in countries including Austria, Denmark, Germany, Greece and the United Kingdom.

Sibutramine and orlistat are licensed for sale in the U.S. and Europe. Another version of orlistat known as Alli is sold over the counter in the U.S., and its maker, GlaxoSmithKline PLC, is seeking approval for sales in Europe.

Some experts say that the few pounds the drugs help people to shed are worth it. "Modest weight loss brings surprisingly big health gains," said Susan Jebb, head of nutrition and health at Britain's Medical Research Council. Jebb was not tied to either study.

"We are not just fighting obesity, but the things that come along with it," Jebb said. Losing as little as 5 pounds can help reduce the risk of heart disease and diabetes.

But other experts worry that easy access to diet drugs give people a false sense of security.

"Selling anti-obesity drugs over the counter will perpetuate the myth that obesity can be fixed simply by popping a pill," wrote Dr. Gareth Williams, dean and professor of medicine at the University of Bristol, in an editorial in the British Medical Journal.

Padwal said the biggest caveat about the drugs is that their long-term effects are unknown. In 2005, global sales of the drugs were estimated at $1.2 billion.

Faced with an increasing global obesity epidemic -- the World Health Organization estimates that 3 billion adults will be overweight or obese by 2015 -- many experts think the drugs could be used more widely.

"Diet and lifestyle interventions on their own have been stunningly poor," Jebb said. "We've got to be realistic," she said. "Even though the weight losses from the drugs are modest, they're better than most other things we've got."

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ATLANTA, Georgia (CNN) -- College senior Lisa Hamlett is looking forward to going home to Crossville, Tennessee, on Wednesday, but she hasn't always been so enthusiastic about spending Thanksgiving vacation with her parents.

Lisa Hamlett found that returning home for the holidays after tasting college freedom was stressful.

A blowup over a broken curfew during her first year at Emory University in Atlanta, Georgia, is still fresh in her mind. "I'm used to being out on my own," says Hamlett, now 21, "I'm not a child."

Hamlett's mother, Betty, 60, has her own take on the freshman-year clash. "It was so tense it was unbelievable." She describes being caught in the middle as she tried to run interference between her feuding daughter and husband. "I felt resentful and I kept my feelings to myself."

Family tension is often a surprising development for students and their parents who reunite during the holidays.

"Thanksgiving is the worst time," says Marjorie Savage, director of the parent program at the University of Minnesota in Minneapolis. "It's a shock for kids because they haven't been on anyone's schedule. They often come home with an attitude."

Savage believes the Thanksgiving holiday comes at a point in the school year when students are feeling extreme pressure, having just finished midterm exams and facing finals. "They've been away on their own and it's the first time they've come home. They want their parents to see they're independent," says Savage.

The quest for independence under their parents' roof can lead to tension when students ask for the keys to the family car or make plans with friends and don't bother telling Mom and Dad.

Betty Hamlett admits her expectations of her time together with Lisa didn't match reality. "She was aloof. I asked her about it and she said she didn't like having to answer to us for everything."

Psychiatrist Charles Raison with the Emory School of Medicine suggests another part of the problem lies with Americans' expectations about staging a traditional family gathering. "Everything is under the microscope at the holidays," says Raison. "It's this perfect image we have that we fail to live up to that causes so much angst and unhappiness."

In the Hamletts' case, the tension led to a change in the family dynamic. Lisa says she doesn't get home very often these days, and when she does she tries to find middle ground with her parents. "It's not good when everybody is butting heads. I try to make it a compromise rather than a battle of wills."

She tells parents not to wait until the turkey is being carved to talk to their college-age teens about expectations at home regarding curfew and family traditions. "Do it beforehand on the phone or via e-mail and let them know if there are family dinners they need to mark on their calendar."

She also warns parents not to assume the student will be the same, and she admonishes students to give their parents a little notice if something big has changed. For instance, she says, "Don't let your mother know that you've become a vegetarian on Thanksgiving Day."

Family members will also want to know ahead of time if the student's appearance has changed. Tell them about "any new body piecings, tattoos or unusual hairstyles," she says.

Conversely, parents should be upfront about any changes at home, especially if the child's room has been converted into a sewing or workout room.

Savage tells parents to brace themselves. "They have this image that things will be exactly what it used to be." And usually it isn't.

Betty Hamlett concedes she learned the hard way. She has some advice for other parents: "Try to be as relaxed as you can. Don't try to pin your kid into a corner with requests or they will rebel."

She also tries to keep an open mind when she does see Lisa. "She's not the same kid I sent away to school. I had to grow a lot.

Grandparents Care for Siblings Orphaned by Violence

“I know I can work, but I am old,” Mr. Mayorga said, pausing as if admitting a weakness. At 65, he already has one full-time job in a kitchen prepping meals for a chef. “People probably think I can’t do what I can do, but I can do any level of work.”

Mr. Mayorga needs the extra work because after raising their own family, he and his wife, Maria, are taking care of their grandchildren, Ashley, 9, and Joshua, 7. The Mayorgas have been raising them since 2001, when their daughter Linzay was killed by her husband, who then killed himself.

Speaking of the crime still brings Maria Mayorga to tears as she sits in the kitchen of the family’s three-bedroom apartment, which is part of an old house in Port Chester, N.Y. The children share one bedroom, and the third is occupied by the Mayorgas’ daughter Patricia, 43, who is mentally retarded. A small yard behind the house is crammed with toys and is home to a turtle and a duck.

“My daughter was good mother; she was a good woman,” Mrs. Mayorga said, wiping her eyes with a tissue. A photo of Linzay rested on a nearby shelf. The two grandchildren played in the small backyard.

After the deaths, the Mayorgas navigated the maze of the state courts to take custody of their grandchildren. Mrs. Mayorga, who speaks little English, was shuttled from one office to another. She recalls a helpful court officer pointing her away from one courthouse, saying, “This is the court for the living; you need the court for the dead.”

The Mayorgas have raised the children since then, even though it is often difficult to maintain the household on Mr. Mayorga’s pay of $10.85 per hour.

“Nobody is going to take away these kids,” Mrs. Mayorga said.

Mr. Mayorga arrived in the United States in 1983. A tailor in his native Ecuador, he left when he could no longer find work. Now a United States citizen, he remembers his illegal crossing into the country as an ordeal, crammed into the back of a tractor-trailer for hours, unable to sit and often barely able to breathe.

He arrived in New York City knowing no one and unable to speak English. (Even now Mr. Mayorga is not comfortable in English; interviews with him and his wife were conducted with the help of an interpreter.) Within three days, Mr. Mayorga had a job at a clothing factory in Manhattan’s garment district.

He started as a porter, but an impromptu display of tailoring on a pair of pants won him a promotion. Mr. Mayorga spent years as a tailor at the factory, earning $14 an hour; but in the early 1990s the factory closed. Garment district jobs had become scarce, he said, forcing him to look for other work.

Mr. Mayorga now works six days a week in a restaurant, but the money often does not stretch far enough. Catholic Charities of the Archdiocese of New York, one of the organizations that receive support from The New York Times Neediest Cases Fund, has helped the Mayorgas with money toward the rent and sometimes for food.

Mrs. Mayorga worries that as her husband ages, he will find it harder to work. Social Security would not be enough to provide for everyone.

Mr. Mayorga insists that he is able to work, provided he can find employment. He said his greatest hope was for his grandchildren’s education.

“I don’t want them to work like I did. I want them to be professionals so someday they will be sitting at a desk in an office,” Mr. Mayorga said. “I hope that I am going to have enough time left in my life to see that.”

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at a Cigar Show, an Air-Quality Scientis Under Deep, Smoo\ky cover

tobacco on air quality.

He crossed the border at Buffalo on Monday morning and on Tuesday crashed the giant cigar party and trade show sponsored by the publisher of Cigar Aficionado magazine at the Marriott Marquis in Times Square.

A nonsmoking vegetarian posing as a cigar lover, Mr. Kennedy was nervous. Canadians are, for the most part, known to be earnest, demure and very law-abiding.

“I think I’m being watched,” he said before the event, known as the Big Smoke, which drew hundreds of cigar lovers and peddlers into a ballroom on the hotel’s sixth floor. He said he strongly believed his room at the Marriott had been searched.

Mr. Kennedy, who holds a master’s degree in environmental science from the University of Waterloo in Ontario and is working on a doctorate in psychology there, soon found himself in the belly of decadence. The ballroom was swarming with stogies — Bolivar, Ashton, Don Tomas and a dozen other brands — whiskey, tequila and exotic dancers.

Mr. Kennedy, who has also researched the level of particulate matter produced by smoking tobacco on outdoor patios, and Kerri Ryan (Researcher 1), a friend from college who lives in New York, sneaked their devices in the door. (Mr. Kennedy’s professor used a discretionary fund to cover the costs of the event tickets — $400 each — and other expenses.)

A tiny white plastic tube protruding from each of their bags like a hidden microphone took in the air, which was then measured for particles by the device, known as a Sidepak. The device can log 516 minutes of air sampling before the battery runs out, and is a well-established method for detecting dust and smoke.

Mr. Kennedy measured the particles in the air on Monday to obtain a baseline before the cigar smokers descended. Then on Tuesday he tested the air inside the ballroom and in various places outside the cigar party — at the elevators, in guest rooms and in the lobby. To log enough data on the air, he would need to stand in one place for 5 or 10 minutes and look busy.

If Mr. Kennedy and Ms. Ryan were lurking in one place for too long, perhaps seeming suspicious to security guards, they would say loudly, “We’re waiting for Sally.”

It was easy for Mr. Kennedy to prove his thesis: that plumes of cigar smoke lead to high levels of particulate matter in the air.

Marriott Hotels announced in July that it was making all of its hotels 100 percent smoke-free, but it has made an exception for the Big Smoke.

Opponents of smoking working with Mr. Kennedy said the exception was a glaring violation of the hotel’s own policy.

“The event is really a flagrant contradiction to their commitment to their guests and employees,” said Louise Vetter, president of the American Lung Association of the City of New York and a spokeswoman for the New York City Coalition for a Smoke-Free City. “The dangers of secondhand smoke are indisputable, and in New York City it is law to protect workers from secondhand smoke. We applauded Marriott, but to have this event in New York City and to create an exception — there’s no exception for public health.”

Under the state law, smoking is banned in most indoor places, including the Marriott ballroom (though there is no legal ban on smoking in guest rooms). But the law allows an exception for tobacco promotional events “where the public is invited for the primary purpose of promoting and sampling tobacco products.”

Cigar bars that were open in the city before Dec. 31, 2002, and can prove that they generated at least 10 percent of their gross income from the sale of tobacco products are also exempt; they can extend their registration each year if they continue to meet those criteria and do not expand or change location.

Kathleen Duffy, a spokeswoman for Marriott Hotels, said the company was honoring a longstanding contract with the publisher of Cigar Aficionado, Marvin R. Shanken, and had been the host of the Big Smoke at the Marriott Marquis for at least 10 years.

“We are not going out and booking smoking events at any of our hotels,” she said. “We did announce we would be smoke-free, but with this client we had an obligation.”

She said “we tripled our efforts” to keep the smoke contained, banning smoking outside the ballroom and increasing the filtration in the room, so that the smoke was funneled outside the hotel through air vents.

Under Environmental Protection Agency guidelines, air with fewer than 15 micrograms per cubic meter is considered good quality; air with more than 251 micrograms per cubic meter is hazardous.

Mr. Kennedy’s preliminary findings showed that the average level of particulate matter in the hotel the day before the event was 8 micrograms per cubic meter, 40 micrograms where he was waiting to get in line for the event and 1,193 micrograms inside the ballroom.

About 10 p.m., after one last measurement — “Elevators, 9:44!” Mr. Kennedy said to his assistant — he was bloodshot and stinky, but he declared the experiment a success.