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This helped kids lose some weight. Ranging in age from 13 to 17, the teens started with an average weight of 228 pounds. After six months of behavior therapy, kids lost an average of seven pounds.

But if kids got Meridia as well as behavioral therapy, they lost twice as much weight. And over the next six months they kept most of this weight off. When kids started taking Meridia after six months of behavior therapy alone, they lost another three pounds. Meridia's manufacturer, Abbott Laboratories, provided the Meridia for the study.

"Forty percent of the kids on [Meridia] lost 10% or more of their weight. With behavior therapy alone, only 15% of kids lost 10% or more of their weight," Berkowitz says. "Ninety percent of health benefits come from the first 10% of weight loss. So 10% is a pretty realistic goal, and many of the health benefits are gained there."

Berkowitz concludes that adding drug therapy to behavior therapy makes a powerful combination. The reason? Obese children face toxic environments both inside and outside their bodies.

"Behavior therapy helps kids deal with this toxic outside environment. You get all this junk food coming at you, this television, this sedentary culture, and you teach families to manage that," he says. "The drug targets the kids' internal environment -- the biology of obesity."

Meridia is not by any means a totally safe drug. It's now approved only for adult use -- and many adults who take the drug have dangerous increases in blood pressure and pulse rate. Citing at least 32 patient deaths, the consumer group Public Citizen has called for a ban on Meridia. About 40% of the teens in the Berkowitz study had to have their Meridia dose reduced because of high blood pressure and/or high pulse rate. Doctors have to keep a close watch on patients taking the drug.

"When we did that -- closely monitor the kids -- we could keep blood pressure under control," Berkowitz says. "Their pulse rate did go up. But we saw a doubling in reductions in hunger compared to the placebo group. The drug is working the way we think it is working. ... My own belief is when you follow these guidelines, Meridia is a relatively safe medication. ... Although we had some adverse events, we could put most teens on the right dose and they were quite successful."

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