For more information on obesity or #YaleMedicine, visit: https://www.yalemedicine.org/departments/metabolic-health-and-weight-loss-program.
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. 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 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. 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. 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. 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.
0:00 – Obesity Is A Neurometabolic Disease
1:01 – Defended Fat Mass Set Point
2:13 – Nutrient Stimulated Hormones
2:58 – Anti-Obesity Medications
3:27 – Watershed Moment
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