human behavior

Obesity Drugs

Posted in Habits & Manners, Health & Medicine by humanb on December 2, 2009

On Saturday I attended a free public lecture on obesity in Sydney.

The lecture featured professors of pharmacology, nutrition and medicine from Australia’s top universities.

The standout speaker was undoubtedly Professor of Medicine, Dr. Joseph Proietto of the University of Melbourne. Dr. Proietto showed palpable frustration with those who blame the obese for their condition and flatly rejected the notion that obesity is self-inflicted.

Here’s what I learned from the lecture.

KEY MESSAGES

Obesity is epigenetic. There are hundreds of genes related to obesity, and any number of gene variations can make a person more inclined to gain weight. Two people with the same diet and exercise patterns will have vastly different body shapes and weights, if they inherited different gene variations.

Weight is Regulated. Your body and in particular, your brain, keep your weight under tight control. Your body has an exquisitely complicated system for managing hunger, satiety, and weight gain and loss.

Weight is Defended. Your body will fight tooth and nail to defend the weight it has. The obese who lose most of their excess weight only to regain it within a short time are a classic example of how the body defends its original weight.

Environment is Facilitative, Not Causative. Obesity is not caused by excessive eating and laziness. It’s caused by genes that predispose people to gain weight, interacting with an environment in which a person eats more than required and exercises less than needed, to maintain a healthy weight. The eating and exercise patterns of an obese person may be identical to or better than those of a genetically skinny person, but they will gain weight nonetheless, and the skinny person will never see the effects. This is because the primary cause of obesity is genes, genes, genes.

OTHER FACTS AND FIGURES

Who’s Overweight or Obese?  2/3 of Australian men, 1/2 of Australian women, and 1/4 of Australian children and adolescents are overweight or obese. In America, rates of obesity are higher for each population group.

Who’s Gaining the Most Weight?  In this order: 25-34 year olds; 35-44 year olds; 45-54 year olds. So it’s not the middle-aged, it’s the twenty-somethings. And women are gaining more weight than men.

Is the Problem New?  Yes. Rates of overweight and obesity have skyrocketed in only one generation. For example, in 1985, 1 in 10 Australian children were overweight or obese. In 2004, 1 in 4.

Why are We Gaining Weight Now?  Given that our genetic make-up has not changed, subtle changes in our eating, activity and environment are responsible for the rapid increase in obesity in just a generation. However, these changes have affected people differently depending upon their genetic make-up and predisposition for gaining weight.

How Has Our Eating Changed?  Portions have slowly increased to massive sizes since the 1980’s. In terms of specific foods, the biggest culprits have been sodas, chips and other snack foods – all completely unnecessary for nutrition.

Side note: Nutrition labels on the backs of food boxes are based on the recommended daily allowances for a 70 kg (154 lb) male. If you’re not a 154 lb man, that nutrition label does not apply to you.

How Have Our Activity Levels Changed?  There’s been a drastic drop in the rates and quantity of incidental physical activity, like walking and cycling for transport. Incidental activity, unlike purposeful exercise, is performed for practical purposes other than fitness. As levels of incidental exercise have decreased, levels of small screen recreation have increased. Small screen recreation includes television, video games and computer activity.

Increased time sitting: the number of minutes or hours sitting is a major risk factor for overweight and obesity, independent of the number of minutes exercising or moving. This suggests moving, always moving, is a valid way of reducing one’s risk, and that sitting for 12 hours a day then doing one hour of aerobics is not necessarily superior.

How Has Our Environment Changed?  This was not discussed much, but see my other post The overweight scapegoat for a discussion on exactly this.

Does it Matter Where You Carry Weight?  Yes. The greatest health risk involves abdominal or central obesity. Thus, the apple-shaped person who carries his weight in his stomach is at considerably greater risk of chronic disease than the pear-shaped person with large hips, thighs and buttocks.

Who is At Greater Risk of Becoming Obese?  People with a genetic predisposition to gain weight, if they’re exposed to a particular environment and adopt a pattern of eating and activity that promotes weight gain. Other groups include:

People who were born weighing ≤ 2.5 kg (5.5 lbs)

People whose mothers are overweight or obese

People whose mothers were overweight or obese during pregnancy

Women at menopause – they engage in less purposeless movement (fidgeting) and begin to shift excess weight from their lower body to their stomachs. The average women will see a 4 cm (1.5 in) increase in waist size during menopause.

How Do You Lose Weight? Rapid drops in weight from extreme exercise and diet activity are not sustainable. A healthful diet and regular exercise in the longterm can produce weight loss over time, but this is extremely difficult, particularly for the obese. While everyone has anecdotal evidence of successful weight loss through diet and exercise, medical studies have shown diet and exercise are largely ineffective in producing significant weight loss in the long-term. This makes obesity prevention critical.

However, some people are successful in losing weight and keeping it off. The National Weight Control Registry is a registry of people in America who have successfully lost weight in the long-term. So far the study has shown that among those who have successfully lost weight:

  • 78% eat breakfast every day
  • 75% weigh themselves at least once a week
  • 62% watch less than 10 hours of TV per week
  • 90% exercise on average 1 hour per day

Do Obesity Drugs Work?  Dr. Proietto believes the development of effective obesity drugs is “absolutely essential” to combatting the body’s overwhelming neuroendocrine response in opposition to weight loss. Drugs would be most useful in helping patients maintain weight loss, not achieve it.

FINAL THOUGHTS

Some skinny people with bad eating and exercise habits suck. They think they have better habits than obese people. They think they eat healthier and exercise more. They think they have more self-discipline and impulse control. They think they’re just plain better than obese people.

They don’t know anything.

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