Why I am not excited about the new weight loss drugs

pills

There has been much talk this past week about the FDA approval of Contrave and Liraglutide as new anti-obesity drugs. Anti-obesity drugs were quite hyped some 10-15 years ago, but have since declined in use and interest. Instead bariatric surgery increasingly came to the limelight and got more and more attention, although this could possibly be waning now as there is increased awareness of quite serious adverse events such as alcoholism, suicide and weight regain. Hence, these new drugs can potentially be a way of injecting some new energy into obesity treatment.

The last time around drugs were “happening”, almost a decade ago now, they were not very successful either clinically or commercially, something the manufacturers blamed on stigma and shame. While this may hold some truth, it is also quite likely that more and more overweight people realized that their problems could not be “cured” by an external intervention in the form of a drug or quite radical gastrointestinal surgery, and were therefore understandably not very keen to try either of those methods. However, since treatment should always be tailored to the patient, and since everyone is unique, it is nevertheless obviously a good thing for the clinician to have a large tool box to go to as opposed to a small one.

But my take on any new and trending method (diet, exercise, drug or surgery) that does not get to the roots of the weight gain, is that they do not help much in finding a lasting solution, a cure if you like. Whilst some valuable lessons can be learnt from trying something new, it also means a delay in the road to finding a real cure, i.e. losing the weight more or less permanently. Moreover, they can also pile on the frustration and misery (not to mention adverse events and cost) for individuals that are already vulnerable. More or less the only way to find this lasting solution, as I see it, is to find out whatever caused the weight gain to start with, and try to reverse that.

My own research suggest that the majority of weight gain stems from psychological and emotional distress, usually established at a very young age as a result of the family/social environment. These factors then interact with the current junk food environment and stressed out lifestyles to cause overweight or obesity. Usually people are very unaware of how much negative thoughts and emotions they are carrying around all day, and how much this affects their body weight.

Unless we go back and help people understand this, and why they gained the weight to begin with, we are unlikely to make much progress, particularly when it comes to weight loss maintenance. That is, you might lose a few pounds when you take one of these new pills/diets/whatever, but you will very likely regain them all when you stop taking that same pill/diet/whatever. That is why I don’t see pills as even close to being a solution to obesity, and that is why I am not at all excited by these new weight loss drugs.

 

Erik Hemmingsson

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When will the obesity epidemic go away?

Today’s post is going to be another one of those interviews where I, er, interview myself. The topic is when we can expect the epidemic to be a thing of the past (easy theme, that…). Let’s get stuck in.

The Hobbit: An Unexpected Journey - Andy Serkis

 

Q: So, let’s jump straight in. When do you think obesity will be no more?

A: Don’t know. Could be a while. Depends.

Q: On what exactly?

A: On many things, such as how much longer we are going to allow the junk food industry to market and sell their garbage to children, families, etc, and things like when we wise up generally to issues like the importance of eating healthy and organic food free of pesticides, preservatives, steroids, antibiotics and lord knows what else, when we stress much less than we do today, when we create a more equal society, when we take care of our children much better, when we integrate physical activity into our everyday lifestyles, when we stop polluting the planet, when the whole world is at peace, when we place much greater emphasis on prevention as opposed to giving drugs or surgically operate on those with already quite severe illness, when we stop photoshopping already ridicuously slim models, when captain Haddock stops drinking whiskey, when…

Q: Alright, steady on, I get it. So, you think it might be a while then?

A: Possibly, but I am going to stick my neck out a little here and say that it could be much quicker than people think, say 2-3 decades, or possibly even less.

Q: To do all those things you mentioned? Surely not.

A: It obviously remains to be seen, but I would not be so pessimistic. We could actually be close to some kind of tipping point where enough people are getting utterly fed up with the whole mess – runaway mega food corporations that want to own everything (including the earth’s supply of water), pollution, out-of-kilter lifestyles, debt, dysfunctional health policies, inequality that went from bad to worse etc – that this current situation kickstarts a lot of energy to do things in a much better and more balanced way.

Q: Are you suggesting some kind of overnight revolution, or something…

A: Not really, but I definitely see better things ahead, although the whole process could be likened to a massive ocean liner that needs to change course. It’s not going to happen overnight, but the intention to change – really change – can be a much quicker thing. Once the intention is there, then good things will start to happen in a more concrete way.

Q: Can you give an example?

A: OK. Basically much of our economy is founded on oil, and this is still so (which is pretty embarrassing), but people are obviously realizing that renewable energy is making so much more sense. So, we have the intention to change the old way of doing things to something infinitely better (the oil industry might not agree here though), but we need to get to grips with the new system, to get it on-line and working, if you like. Just like oil needs to go, so does junk food, stress, inequality, debt and sedentary lifestyles. There probably needs to be more awareness among the general population just how harmful those listed things are, but more and more people are waking up and want a change. Awareness is key, and it is growing, especially in social media, less so in mainstream media.

Q: Where do you see changes happening quickly, and where will it be more slow?

A: I think North America and Europe will struggle the most, simply because the environment is so obesogenic there, and will therefore take longer to change than Asia and Latin America, for example, where the epidemic is much less established. Both Europe and North America are mustering more and more powerful initiatives to counter the epidemic, however, so let’s hope that improvements in those regions do not take too long.

Q: Yawn, I am out of questions. Anything else? 

A: Next time I get to ask the questions.

 

Erik * 2

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New exciting frontiers in obesity research

microscopy

Some of you may be aware of that I used to do research on the role of behavior therapy and low calorie diets in the treatment of obesity, but that I realized some time ago that such treatment options did not provide any long-term solution to the treatment (or prevention) conundrum. Instead I decided to dig a little deeper and look into traumatic childhood experiences, which was very interesting, but to say that obesity is a result of childhood trauma would be a gross exaggeration and oversimplification.

Through a combination of listening more and more to patients as well as copious reading, I have come to focus my efforts on the early life (childhood) social environment. This also includes the time spent in the womb, and such factors as maternal distress and malnutrition, which has a huge effect on the baby.

The path to weight gain and subsequent obesity generally starts before the age of 5, so this is clearly the time we need to investigate more. What is becoming more and more clear is that any type of family dysfunction can very easily transfer to the child in the form of negative belief systems, negative emotions, stress, insecurity, low self-esteem, low self-worth, and so on. The real catalyst of family dysfunction is socioeconomic adversity, but obviously there are other factors as well, such as relationship discord, job insecurity, segregation, a lack of support and cohesion, disease, and food insecurity.

Let me stress that family dysfunction does not imply gross disturbances or failings, it can probably be quite subtle to have a negative effect, depending on factors like resilience and external support, perhaps from a significant other such as a grandmother or grandfather. More or less all families have some kind of dysfunction within them, it’s all shades of grey, perhaps not all the time but at least during critical periods. The effects is likely a balancing act between the amount, duration and type of adverse social exposure, combined with the above-mentioned protective factors.

What is clear is that as we grow older, we carry the effects of those early years with us, consciously or not. If someone is exposed to a lot of early life adversity, it will only be a matter of time before physical manifestations occur in the shape of increased stress, inflammation, as well as metabolic and endocrine perturbations. There is also likely to be behavioral disturbances, such as eating to suppress negative emotions. Eventually, this will lead to a disruption of homeostasis and weight gain.

This why I am very excited to dig deeper into this new field of research that focuses on the child’s social/family environment, and how those early years continue to influence us as adults many years later. The ACE study, which I wrote about recently, conclusively shows that adverse childhood abuseis the #1 cause of early mortality, numerous morbidities, addiction and functional limitations, so there can be no doubt about the very powerful effects that adverse childhood experiences has on us.

It really is time we took those early childhood years more seriously in the obesity field. Personally, I think there is a gold mine of information there, just waiting to be explored. Hopefully this will get us closer to the root causes of obesity, which should be of great benefit for eventually banishing the whole epidemic.

 

Erik Hemmingsson

 

Polarity abounds and why it’s time for a new way of doing things

It appears to be a human condition to react very slowly, if at all, to adverse changes that happen very gradually (think the obesity epidemic). If bad things happen very quickly, then we have no problem mobilizing at all, such as what happened during the SARS outbreak just over a decade ago. Moreover, the factors that are feeding the obesity epidemic, such as processed junk food, stress, and socioeconomic adversity, have changed steadily but very gradually as well, making for one gigantic slippery slope that we have apparent problems reacting to.

It seems as if many things in society, including the drivers of the obesity epidemic, are now reaching some kind of peak polarity, i.e. you are either very poor or very rich, you either eat only nutritious organic food or only junk food, and you either exercise 7 times per week according to the latest hype, or you refuse to exercise at all. In terms of socioeconomics the middle class is disappearing fast, and the 1% seemingly flourishes at the expense of the rest of society.

Polarities abound in the present time, and this makes it very difficult to make any inroads into creating the conditions we need in order to produce successful obesity prevention and treatment programs. In short, it is very difficult to separate the fortunes of the individual from the rest of society, and society is not in a happy place right now.

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

change-since-1979-600

 

Politically, there is much current upheaval in the world, possibly with some kind of peak fear with war in the middle east, ebola outbreaks, water shortages, extreme weather, and an economy in tailspin – can it get any worse?

The good news is that more and more people are waking up to the fact that the current systems, i.e. politics, finance, food environment, lifestyles, etc, are obviously in need of major reform. Maybe we are even getting close to some kind of breaking point for the current dysfunctional way of doing things. I thick that we are, and when enough people wake up to this reality, that is when we can create the conditions we need for preventing obesity globally.

Do we, for example, want to keep eating junk food when it is abundantly clear that such food is very harmful to our health, do we want to keep the current financial system that only seems to work for the 1%, and do we want politicians that are heavily influenced by corporate interests. Or do we want something better? It’s not as utopian as many people think that it is.

 

Erik Hemmingsson

 

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We need to unite

connecting-to-your-followers

There are many things we need to do in order to banish the obesity epidemic, such as flushing the junk food and sugar industry down the toilet (please watch this trailer for the movie Fed Up), reform the economy so that we can create equal opportunities and prosperity for all as opposed to the current system that creates more wealth for the already wealthy 1% and more debt for the rest of us, reduce stress levels, reduce toxicity in our land, air and sea, and create a social environment where people feel happy, balanced and in harmony. This can obviously take a while, but I am convinced that by standing together and saying enough is enough to the things listed above, we can truly move mountains together.

Conversely, if we remain isolated and uninformed, we are sitting ducks for the mega corporations and others who would like nothing better than to keep the status quo. Many people are understandingly frustrated with the current situation and are expecting and waiting for a top-down solutions to our problems. But I have become less optimistic about the ability of governments and organizations to rectify these problematic situations, which have grown increasingly worse during the last 2-3 decades.

I have become more and more convinced that lasting and genuine change needs to come from the bottom up, from the people, the grassroots, the 99%, i.e. people like you and myself. For example, through this simple blog I have connected with so many people I would never have come into contact with before, demonstrating that it’s so easy to communicate these days. The ultimate aim of my work is to get rid of obesity, quite a grand ambition for sure, but it is certainly possible if enough people believe that it is.

Gandhi-Google-Doodle

In order to accomplish this goal, it is very important that we collaborate more, unite more. This is not exactly something academics are renowned for, myself excepted of course… (Yeah, right!). We have to get rid of our egos (should be fun) and do this together. I just started using a Twitter account to alert you to good things around the web, because there are very clear signs that many people are uniting and changing things together. And please send good things back to me and I will be very happy to pass them along. So let’s stay connected, and together we will achieve lasting change for the better.

Erik Hemmingsson

 

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