Luis Rustveld can offer help but no shortcuts for losing weight.
"There is no magic bullet," he says.
But the past decade has given people on the front lines - Rustveld is a dietitian and assistant professor at Baylor College of Medicine - as well as those afraid to step on the bathroom scale unprecedented insight into why losing weight, and keeping it off, has become one of the country's most complicated public health problems.
This summer alone, the Food and Drug Administration has approved two new weight-loss drugs, the first in more than a dozen years. The U.S. Preventive Services Task Force recommended doctors screen all patients for obesity and refer for treatment those who qualify, an acknowledgment of the health risks carried by the additional pounds.
Scientists understand the disease is not as simple as they once believed.
"In the past, it was that simple paradigm of calories in and calories out. Now it's not," said microbiologist Cynthia Chappell, a professor at the University of Texas Health Science Center at Houston. "You have to understand all of the factors that go into this epidemic of obesity."
But the additional knowledge hasn't slowed the rate at which Americans are packing on the pounds. Two-thirds of people in the United States are overweight or obese, with all of the health problems that brings: Type 2 diabetes, high blood pressure, high cholesterol, coronary artery disease, sleep apnea and more.
Breaking a streak
Calories still matter, and so far no drug can change that.
But the right drugs can jump-start a weight-loss program, and the FDA's approval this summer of two weight-loss pills breaks a cautious streak brought about in the late 1990s by evidence that the wildly popular "fen-phen" combination caused heart valve damage and primary pulmonary hypertension. Fenfluramine and phentermine were pulled from the market, although phentermine is one of two drugs used to create the just-approved Qsymia.
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Forget about 'magic bullet' for weight loss
