On World Obesity Day, expert outlines keys to prevention, treatment

Donna Ryan
Donna Ryan

The World Obesity Federation is marking its third annual World Obesity Day on Wednesday with a call to action, asking governments, health service providers, insurers and philanthropic organizations to prioritize investment in what is quickly becoming a global epidemic.

By 2025, the group projects that 2.7 billion adults will have overweight or obesity, and the annual global cost is estimated to reach $1.2 trillion.

“Investing in the prevention, management and treatment of obesity is a cost-effective action for governments and health services,” the organization states on its website. “Investment can help achieve the 2025 targets set by the World Health Organization to halt the rise in obesity and to achieve a 25% relative reduction in mortality from noncommunicable diseases.”

Endocrine Today spoke with Donna Ryan, MD, professor emerita and the interim executive director of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, about some of the underlying causes behind the growing obesity epidemic, new research on what drives risk, and the keys to keeping patients motivated to lose weight and keep it off.

A new report in The Lancet found that, worldwide, there has been a more than 10-fold increase in the number of children and adolescents with obesity since 1975. What has led to this dramatic rise?

Ryan: Developed countries are exporting their lifestyle to countries as they emerge to become more economically stable. So, the lifestyle we have — with ready access to energy-dense and highly palatable food and a lifestyle that requires very little physical activity for work and play — is being adopted around the world. Some people around the word are very susceptible to the metabolic consequences associated with weight gain. We know it just takes a little bit of weight gain for people with South Asian genetic background, for example, to be at greater risk for diabetes and other metabolic consequences. So, we’re very alarmed. Just as globalization has spread around the world, the big corporations are spreading the developed countries’ lifestyle all around the world.

Can you discuss some of the latest research that is helping us to better understand the causes behind obesity?

Ryan: The conventional wisdom is that it’s all about the environment. But I think we really need to be cognizant that there are other factors that drive obesity risk. Certain factors across the lifestyle, like menopause, like aging, like retained weight after pregnancy, drive risk. We have scientists who are very interested in sex differences and obesity risks, especially around those critical life points. We’re also really concerned about excess weight gain during gestation. That period of prenatal development is critical, and it seems to be one where nutritional programming occurs. Gestational diabetes really increases the risk of that offspring having diabetes as an adult. We’re interested in the microbiome, or changes in our diet and how those changes contribute to obesity. And of course, all the clues we have from bariatric surgery and its success. The biology that is behind what happens with those procedures gives us some real clues about what might be driving obesity risk. There are plenty of things to explore and discover in terms of drivers of obesity besides just eating too much and too little exercise. It’s exciting.

What do obesity medicine specialists need to know to better prevent obesity and to treat those with overweight and obesity?

Ryan: When a patient is overweight, or has obesity, I think to myself, “This person is demonstrating that she has genetic risk for developing obesity within this environment.” What other triggers could be driving this? What are the sleep habits of this patient? I want to know what medications they are taking and what they have taken in the past. I want to know what life events are associated with their weight history. Taking a weight history and getting patients to draw out when they gained and lost weight is very helpful, because it gives you insight into what the drivers may be, and you can help patients avoid them. Then, what is the patient doing in terms of lifestyle? Get a food diary and see what the patient is eating. The history of what patients have done is always good. Most of the time, it’s not a case of patients doing everything wrong. They’re not just drinking sugar-sweetened sodas and eating chocolate candy all the time. Most of the time, they are really struggling and they have a healthy diet.

Recognizing obesity as a chronic disease is important, and the most important thing is to keep that patient coming back. The last thing you want to do is preach to that patient or shame that person. We call it shared decision making. You want to come to behavioral goals with that patient that the patient buys into. There is the story of the tortoise and the hare, and this is a disease where the tortoise wins. You’re going to have multiple times where you can intervene with a patient. When a window of opportunity is open, you must walk through it. That’s the time to try to achieve maximal weight loss.

How can clinicians work with patients to sustain any weight loss?

Ryan: We know the secrets of long term weight-loss maintenance, and one is a lot of physical activity. We do it in the initial weight-loss phase, but it is critical to weight-loss maintenance. We introduce it early on because we want people to build those habits. The other thing is a regular dietary pattern. Even eating one meal replacement a day has been shown to help sustain weight loss. And, another big secret are these new medications that are approved for chronic use. If you work so hard to lose the weight, and if you stay on these medications, you’re going to keep it off.

The other thing to recognize is there are triggers for weight gain. We really want people to be weighing in every day. If your weight goes up, you initiate some changes. Don’t let it get out of hand.

In honor of World Obesity Day, t he A merican Heart Association released a statement calling for greater investment in public health policies that promote improved nutrition and increased physical activity. What further research — or action would you like to see?

Ryan: We must do something for children. This is the time where kids may grow into their weight. You may be able to overcome that metabolic adaptation because they are still growing. To me, it’s the opportune time and the most difficult time. I also want to see every primary care provider reimbursed for weight management. How can we expect our health professional work force to engage in this if they are expected to do it for free?

References:

NCD Risk Factor Collaboration. Lancet. 2017;doi:10.1016/s0140-6736(17)32129-3.

For more information on World Obesity Day, visit www.obesityday.worldobesity.org .

Disclosure: Ryan reports she has financial relationships with several pharmaceutical and device companies and weight counseling programs.

Donna Ryan
Donna Ryan

The World Obesity Federation is marking its third annual World Obesity Day on Wednesday with a call to action, asking governments, health service providers, insurers and philanthropic organizations to prioritize investment in what is quickly becoming a global epidemic.

By 2025, the group projects that 2.7 billion adults will have overweight or obesity, and the annual global cost is estimated to reach $1.2 trillion.

“Investing in the prevention, management and treatment of obesity is a cost-effective action for governments and health services,” the organization states on its website. “Investment can help achieve the 2025 targets set by the World Health Organization to halt the rise in obesity and to achieve a 25% relative reduction in mortality from noncommunicable diseases.”

Endocrine Today spoke with Donna Ryan, MD, professor emerita and the interim executive director of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, about some of the underlying causes behind the growing obesity epidemic, new research on what drives risk, and the keys to keeping patients motivated to lose weight and keep it off.

A new report in The Lancet found that, worldwide, there has been a more than 10-fold increase in the number of children and adolescents with obesity since 1975. What has led to this dramatic rise?

Ryan: Developed countries are exporting their lifestyle to countries as they emerge to become more economically stable. So, the lifestyle we have — with ready access to energy-dense and highly palatable food and a lifestyle that requires very little physical activity for work and play — is being adopted around the world. Some people around the word are very susceptible to the metabolic consequences associated with weight gain. We know it just takes a little bit of weight gain for people with South Asian genetic background, for example, to be at greater risk for diabetes and other metabolic consequences. So, we’re very alarmed. Just as globalization has spread around the world, the big corporations are spreading the developed countries’ lifestyle all around the world.

Can you discuss some of the latest research that is helping us to better understand the causes behind obesity?

Ryan: The conventional wisdom is that it’s all about the environment. But I think we really need to be cognizant that there are other factors that drive obesity risk. Certain factors across the lifestyle, like menopause, like aging, like retained weight after pregnancy, drive risk. We have scientists who are very interested in sex differences and obesity risks, especially around those critical life points. We’re also really concerned about excess weight gain during gestation. That period of prenatal development is critical, and it seems to be one where nutritional programming occurs. Gestational diabetes really increases the risk of that offspring having diabetes as an adult. We’re interested in the microbiome, or changes in our diet and how those changes contribute to obesity. And of course, all the clues we have from bariatric surgery and its success. The biology that is behind what happens with those procedures gives us some real clues about what might be driving obesity risk. There are plenty of things to explore and discover in terms of drivers of obesity besides just eating too much and too little exercise. It’s exciting.

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What do obesity medicine specialists need to know to better prevent obesity and to treat those with overweight and obesity?

Ryan: When a patient is overweight, or has obesity, I think to myself, “This person is demonstrating that she has genetic risk for developing obesity within this environment.” What other triggers could be driving this? What are the sleep habits of this patient? I want to know what medications they are taking and what they have taken in the past. I want to know what life events are associated with their weight history. Taking a weight history and getting patients to draw out when they gained and lost weight is very helpful, because it gives you insight into what the drivers may be, and you can help patients avoid them. Then, what is the patient doing in terms of lifestyle? Get a food diary and see what the patient is eating. The history of what patients have done is always good. Most of the time, it’s not a case of patients doing everything wrong. They’re not just drinking sugar-sweetened sodas and eating chocolate candy all the time. Most of the time, they are really struggling and they have a healthy diet.

Recognizing obesity as a chronic disease is important, and the most important thing is to keep that patient coming back. The last thing you want to do is preach to that patient or shame that person. We call it shared decision making. You want to come to behavioral goals with that patient that the patient buys into. There is the story of the tortoise and the hare, and this is a disease where the tortoise wins. You’re going to have multiple times where you can intervene with a patient. When a window of opportunity is open, you must walk through it. That’s the time to try to achieve maximal weight loss.

How can clinicians work with patients to sustain any weight loss?

Ryan: We know the secrets of long term weight-loss maintenance, and one is a lot of physical activity. We do it in the initial weight-loss phase, but it is critical to weight-loss maintenance. We introduce it early on because we want people to build those habits. The other thing is a regular dietary pattern. Even eating one meal replacement a day has been shown to help sustain weight loss. And, another big secret are these new medications that are approved for chronic use. If you work so hard to lose the weight, and if you stay on these medications, you’re going to keep it off.

The other thing to recognize is there are triggers for weight gain. We really want people to be weighing in every day. If your weight goes up, you initiate some changes. Don’t let it get out of hand.

In honor of World Obesity Day, t he A merican Heart Association released a statement calling for greater investment in public health policies that promote improved nutrition and increased physical activity. What further research — or action would you like to see?

Ryan: We must do something for children. This is the time where kids may grow into their weight. You may be able to overcome that metabolic adaptation because they are still growing. To me, it’s the opportune time and the most difficult time. I also want to see every primary care provider reimbursed for weight management. How can we expect our health professional work force to engage in this if they are expected to do it for free?

References:

NCD Risk Factor Collaboration. Lancet. 2017;doi:10.1016/s0140-6736(17)32129-3.

For more information on World Obesity Day, visit www.obesityday.worldobesity.org .

Disclosure: Ryan reports she has financial relationships with several pharmaceutical and device companies and weight counseling programs.