It is hard to diet and harder still to keep weight off once it has been lost. Successful dieters claim a tight control over their food choices and portion sizes and often a commitment to consistent physical activity. But what if you suffer from a chronic condition that makes you hurt all over, disrupts your sleep, causes gastrointestinal upsets, blankets you with fatigue, puts your brain into a fog and causes you to use food to diminish your discomfort? Your doctor gives you drugs to lessen the symptoms but the drugs cause you to eat out of control and gain substantial amounts of weight. This is the picture of someone suffering from fibromyalgia. Fibromyalgia affects between 3 and 6 million people in the U.S. The number is imprecise because the diagnosis may be inexact. Fibromyalgia is termed a syndrome, not a disease, and its underlying cause is still not understood. However, people who suffer from this syndrome have had their lives disrupted and often find themselves unable to continue the lifestyle they had before developing the symptoms of this disorder.Recently, I met a former college classmate who had gained a considerable amount of weight. She was walking with a cane and looked as if she had not slept for months. She must have noticed my consternation at her appearance because she immediately told me that she had fibromyalgia. “I rarely sleep more than a few hours at a time because I am in so much pain. My muscles hurt, I am stiff and it is hard for me to feel comfortable. I had to stop working because some days I just couldn’t get my brain to work. It’s called ‘brain fog.’ And I cannot control my eating. I eat when I am tired, when I am in pain and when I am trying to stay awake. I am so heavy now, I can barely drag myself around.”Weight loss is desirable in someone with fibromyalgia because obesity puts an additional burden on already painful muscles. But how can someone follow conventional weight loss guidelines with this disorder? It is well known that people without this syndrome overeat when their sleep is disturbed and fibromyalgia patients may never have a good night’s sleep. We also know that people attempt to medicate themselves with food when they suffer from chronic pain, possibly because when they eat carbohydrates, serotonin is made. And serotonin may diminish the perception of pain. Someone with fibromyalgia endures daily pain and is more concerned about decreasing the hurt than with the calories consumed to bring about this effect. Following dietary guidelines to lose weight must be frustrating and ultimately futile. Complying with the other component of a weight-loss program, exercise, is just as impossible. The bone weary, muscle-heavy feeling of fibromyalgia fatigue makes it extremely hard to move about, let alone participate in aerobic activity or weight lifting. And, of course, it hurts to exercise.Various types of antidepressant medications that are known to relieve pain and improve sleep have been used to treat these symptoms. Some of them, such as Elavil, have caused significant weight gain, which, of course, exacerbates some of the fibromyalgia symptoms. Recently, the FDA approved three drugs for this syndrome: Cymbalta, Lyrica, and the most recent, Savella. All three are able to relieve pain and improve overall functioning. But Cymbalta and Lyrica do cause weight gain and thus may exacerbate the symptoms associated with carrying too much weight and make it even harder for the patient to try to stay on a diet. However, the most recently approved drug, Savella, did not cause weight gain. In fact, compared to patients on placebo, the drug was associated with a small weight loss. In addition, patients on the drug experienced less fatigue and “brain fog” than those on placebo. The drug increases the activity of two brain chemicals, the neurotransmitters norepinephrine and serotonin. Since the drug trials did not last longer than six months, no one knows yet the effect of longer treatment on these symptoms. But if this drug is able to diminish those symptoms that cause overeating, such as pain and sleep disruption, and increase energy so that physical activity does not seem impossible, then there is hope that weight loss will be able to follow.