Selling Dreams and Drugs

THE waiting room at the office of Dr. Stanley Title on West 57th Street in Manhattan is full of women, all of them seeking a cure for fat.

It is a man's job in life to make money, but "a woman has to look good," said Dr. Title, explaining why the women flock to his office, where the walls are decorated with framed articles from newspapers and magazines that quote him as a leading weight-loss expert.

Skip to next paragraph Richard Patterson for The New York Times

Dr. Caroline Cederquist is a specialist in the field of medical weight loss.

A Guide to Weight-Loss Drugs Forum: Fitness and Nutrition

Joyce Dopkeen/ The New York Times

Dr. Jonathan Schwartz is a specialist in the field of medical weight loss.

In The Daily Star, the British tabloid, he warned that Mel Gibson's diet of raw beef could contain parasites. He told The Courier-Mail of Brisbane, Australia, in 1998 that a super-thin Courteney Cox appeared to have taken her dieting too far.

Yet, for all the sane advice Dr. Title dispenses to others, he was censured last year by the State of New York for ordering too many tests and treatments for his own patients.

Dr. Title, 69, who calls the sanction the only blemish on a 45-year career, is one of an estimated 2,500 doctors practicing medical weight loss in the United States. As obesity becomes an increasingly intractable national problem and more people seek medical solutions, diet doctors represent a growing segment of the country's billion diet market, according to Marketdata Enterprises, a market research firm in Tampa, Fla.

Virtually ignored by medical schools and residency programs, medical weight loss has no specific entry requirements and no recognized certification board. But the field, which recently gained a delegate seat at American Medical Association meetings, does seem to have more than its share of complaints leveled at doctors who sell products to their patients, whether special food, liquid diets, unproven therapies or potentially dangerous and habit-forming weight-loss drugs.

Like many diet specialists, Dr. Title supplies drugs directly to his patients rather than giving them prescriptions to be filled at the pharmacy.

Erika Coble of Brooklyn, who is 5 feet 6 inches tall, weighed 170 pounds when she started seeing Dr. Title in June. She had lost 14 pounds by her August weigh-in. And she says she is continuing to lose weight on a regimen of diet, exercise and the pills - one yellow, the other purple - that Dr. Title provides her for 0 a month, an amount that includes his fee. Ms. Coble says she has no idea what the pills contain; she has never asked.

Dr. Title, in an interview, said the purple pills were vitamins and yellow ones were phendimetrazine. Sold elsewhere under brand names that include Adipost and Bontril, it is an amphetaminelike drug that suppresses the appetite but has been found to raise blood pressure in some cases. The Food and Drug Administration, which considers it potentially habit forming, has approved phendimetrazine for only short-term use. Dr. Title says the medications, despite the stigma, generally are safe.

Because insurance plans typically do not cover nonsurgical treatments, patients generally pay cash to their diet doctors.

"The problem is that some of them are in the entrepreneurial, cash-up-front storefront obesity clinic, as opposed to practicing real evidence-based medicine," said Dr. Neal Kohatsu, an epidemiologist at the University of Iowa who has studied physician disciplinary records.

A recurring complaint about diet doctors is that they are too liberal in dispensing drugs. In Tennessee last month a diet doctor was ordered to perform community service after state regulators said he had signed blank prescriptions and sold drugs without a pharmacy license. Authorities in Washington State cited inappropriate use of amphetaminelike drugs when they took away the prescribing rights of an obstetrician-turned-diet doctor in Seattle last March.

No doubt there are many dedicated and qualified doctors specializing in weight loss. And those doctors fill a void left by internists who are frequently ill at ease discussing obesity with patients and who have little idea how to treat it, said Morgan Downey, who runs the American Obesity Association, a national patient advocacy organization.

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