- Obesity is a complex neurometabolic disease
and we need to treat it like we treat any other complex disease.
For years we've been implementing
lifestyle and behavior change in terms of treating obesity.
But what we know now is that often times patients can lose some degree of weight
but the difficulty is in maintaining that weight reduction
and the reason it's so difficult to maintain that weight reduction
is because our bodies are smart and they fight back.
They don't want us to maintain that weight reduction
and the therapies that we have found that actually work for that
are things like anti-obesity medications and surgery
and the reason for that is because those interventions
target disease, pathophysiology disease mechanisms.
Obesity is a disease whereby our body
tries to defend an elevated, defended fat mass set point.
So what do I mean by that?
Well,
our body has this concerted interest in carrying an appropriate amount of fuel.
It doesn't want to carry too little fuel or energy,
which it carries as fat,
and it doesn't want to carry too much energy or fuel.
It wants to carry just the right amount.
And we call that sweet spot the defended fat mass set point.
Our body evolved to carry an appropriate amount of fuel.
But what's happened in our current obesogenic environment
that's filled with highly palatable, delicious food, lack of sleep,
increased stress, lack of physical activity,
all these things on a population level
have driven up that defended fat mass set point
and if you think about this from an evolutionary perspective,
this makes sense.
We don't want to starve.
Centuries ago, there were times of famine.
There were times of food scarcity
and so it makes sense that this defended fat mass set point developed to really
make sure that we survived.
Now, how is this set point set
and how does our body regulate how much fat or how much energy we store?
There are these hormones in our body that are stimulated when we eat food.
We call them nutrient stimulated hormones
and what they do is that they inform our brain about our energy state
and this is akin to what our body does with many other functions
and so these hormones inform our brain about how much fat or how much energy we are carrying
and then our brain sets that defended fat mass set point.
Well, these new medications mimic these nutrient stimulated hormones.
So we call these new medications nutrient stimulated hormone based therapies.
So when we treat patients with these anti-obesity medications
and they're targeting receptors in the brain,
they reregulate or reset that defended fat mass set point
and a byproduct of that is that our patients lose weight.
We're at a watershed moment for the treatment of obesity
set in motion by these highly effective new therapies.
But there is not necessarily one right thing for everybody
and we don't think about it in these terms for other diseases,
nor should we think about it in these terms for obesity.
Our patients have so unfairly and tragically
faced stigma, bias, shame, blame for disease that is not their fault.
It's biology.
We need to have a reframing
of lifestyle changes of nutritious diet and physical activity.
Those are critical for health.
They're critical for obesity prevention.
But once we develop the neurometabolic disease of obesity,
once our patients develop this disease,
they need treatments that will target those disease mechanisms.