my take on the recent article in the lancet (treating obesity seriously)

OBESITY AND WEIGHT LOSS
ONE OF THE OLDEST AND MOST PRESTIGIOUS
MEDICAL JOURNALS ON THE PLANET WEIGHS IN

Obesity Cure

“Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation. These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption……   Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely  From the February issue of The Lancet (Treating Obesity Seriously: When Recommendations for Lifestyle Change Confront Biological Adaptations)
This depressing article essentially says that once you’re Obese, you’re screwed.  Depending on whose definition you use (HERE is the government’s), OBESITY is usually defined as being 50% or more over your ideal weight, while “Morbid Obesity” is what happens when a person is 100 lbs overweight). 

The chief “biological adaptations” that the authors speak of in this paper include a vicious cycle of ADDICTION TO HIGHLY PALATABLE FOOD, overeating, and increasing your body’s ability to store fat by increasing both the size and number of fat cells.  But here is where the rubber meets the road in this study.  The authors go on to say that, “Evidence suggests that these biological adaptations often persist indefinitely, even when a person re-attains a healthy BMI via behaviorally induced weight loss….  few individuals ever truly recover from obesity…  and are biologically very different from individuals of the same age, sex, and bodyweight who never had obesity.”  In other words, according to these authors you can lose all the weight in the world, and your body never really gets over it.  According to a recent interview in the LA Times, lead author Dr. Christoper Ochner added some perspective to just how serious this problem is for the nearly 100 million Americans who are Obese by saying that, “The depressing fact is that the average adult with sustained obesity has less than a 1% chance of reattaining and maintaining a healthy body weight without surgery.”  What are the author’s “EVIDENCE-BASED” solutions? 

  • DRUGS:  They list a wide range of drugs and biologics / metabolics that while they are not necessarily down on, neither do they give a ringing endorsement for any of them.  FYI, they do provide a link to the newest recommendations on OBESITY DRUGS.
  • NERVE BLOCK:  The Vagus Nerve (one of the twelve Cranial Nerves) innervates most of the Gut.  By using electric impulses — an “Obesity Pacemaker” — researchers have discovered they can block hunger signals.  But because 80% of the Immune System resides in the Gut (HERE), and we are learning more and more about the relationship between GUT HEALTH and weight (HERE is an example), who really knows what the long-term consequences of doing this are?
  • LIFESTYLE MODIFICATIONS:  This is the old “eat less and exercise more” approach that they unequivocally tell us does not work (they do, however, specifically mention a “high protein” dietary approach).
  • BARIATRIC SURGERY:  This is the only one in the group they say, “shows long-term effectiveness.”  However, I’ve written about this approach HERE.

MY TAKE

What was my take on this paper?  For one, it tells me that what we are currently doing is a lesson in futility —- a model of abject failure.  How much money (public and private) is being thrown down the toilet looking for solutions that the authors have shown us are “temporary” at best?   Isn’t it amazing that in one breath they can essentially tell us that none of these treatments really work, and then in the next, reach their hand out to grab the money — and all in a “scholarly” journal?

For another, this paper the singular best news for Big Pharma since we learned that not only are Americans living longer than ever; but that the last years (decades) of their lives are lived with a multitude of Chronic Diseases (HERE).  Melissa Healy wrote in the LA Times just yesterday (Diet and Exercise Alone are no Cure for Obesity, Doctors Say) that, “These discouraging facts about the body’s response to weight loss are well known to obesity researchers: Drug developers wrestle with the fact that even when their treatments induce weight loss by one means, other mechanisms spring up to limit or reverse that weight loss. So why would an influential foursome of clinicians see the value in recapitulating these ideas in a respected medical journal?”  Why?  For the very reason that the Pharmaceutical Industry exists in the first place — to make money.  Who did the four authors of this paper have financial ties to?  Let’s look.

  • ACCERA:  Accera is a Pharmaceutical Company that according to their website provides, “solutions to deliver improved personalized healthcare for medical conditions, such as diabetes, obesity, cardiovascular disorders….
  • PROBAR:  This tie was said to be “non-fincancial”.  PROBAR LLC of Salt Lake City is a company who makes nutritional bars as meal replacements, post-workout recovery, etc (their Frosted Peanut Butter Bar is currently on FDA recall).  Maybe they kept everyone from getting hungry while they worked?
  • NUTRISYSTEM:  Although extremely popular with the general public via a huge marketing budget, this approach has been proven not work long term.
  • WEIGHT WATCHERS:  Dito.
  • NOVO NORDISK:  Pharmaceutical Giant Novo Nordisk came up with the injectable Obesity drug liraglutide (Saxenda), which is actually a more potent formulation of THIS DRUG that Paula Deen was pushing for DIABETES back in 2012.  Natalie Grover said this back in a December 23 article for Reuters News Service. “Novo believes Saxenda has blockbuster potential, although doctors doubt it will be a game changer. ‘None of the available drugs and none … on the horizon are sufficiently powerful to eradicate obesity,’ Lee Kaplan, chair of the clinical committee of the Obesity Society, told Reuters in October.
  • VIVUS:  They make the anti-obesity drug Qsymia (a daily pill).
  • TAKEDA:  Takeda Pharmaceuticals is marketing Contrave for Orexigen (see below).
  • OREXIGEN PHARMACEUTICALS:  Orexigen makes Contrave.  According to Arlene Weintraub of FiercePharma, “….good-news, bad-news day for Orexigen, which won FDA approval for its obesity drug Contrave. The good: The green light, three years after the agency demanded additional safety testing. The bad: The FDA slapped Contrave with the dreaded ‘black box’ warning on side effects.
  • SHIRE PHARMACEUTICAL:  Shire makes the drug Vyvanse, which is directed specifically at those with “Binge Eating Disorders”.
  • BOEHRINGER INGELHEIM:  This monster company is deep into the development of medications for cardiometabolic problems, diabetes, and obesity.  BI makes a “glucagon-like peptide-1 (GLP-1) agonist” that they market not only for Diabetes, but for Obesity as well (The Lancet authors mention this class of drug specifically in their paper).  Interesting how all of these companies seem to be moving from Diabetes Drugs to Obesity Drugs.  Maybe it’s because they are hoping to bail before everyone finds out the DIABETES DRUGS DON’T WORK AS ADVERTISED.
  • GUILFORD PRESS:  Guilford publishes large numbers of journals, books, handbooks, etc on Obesity, eating disorders, and similar topics.

If you want to get down to brass tacks on what it takes to lose wight and keep it off, GO HERE.  No; it isn’t easy.  But with the proper approach it’s not nearly as hopeless as the authors would lead us to believe.  However, you’ll have to change your mindset and realize that you will need to make some permanent lifestyle changes as opposed to another temporary diet or exercise program.  And what about the next generation (HERE)?  Do not fool yourself.  You had better be teaching your children to make the proper lifestyle choices when they are young, or one day soon they’ll be sitting exactly where you are now wondering what they are going to do about their weight and their health.  If you are one of those people who cannot seem to lose weight no matter what you do, don’t do another thing without READING THIS first.

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