Episode 62 Understanding Obesity, New Concepts and Therapies

Obesity is a chronic disease and is associated with related conditions such as cardio vascular disease(heart attack and stroke),type 2 diabetes, and certain cancers. The current understanding of obesity demonstrates both biological and environmental factors like economics and infrastructure, psychosocial and developmental issues as important contributors as well as newer understanding of their role in influencing the hypothalamus.

New treatment strategies and medications demonstrate opportunities for success in management of obesity.

Guest:

Joshua Thaler, MD, PhD.

Associate Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition.

Dr. Thaler graduated with a major in Biochemistry from Harvard College (Magna Cum Laude with Highest Honors, and on the Dean’s List), then obtained an MD and a PhD in Biomedical Sciences from the University of California, San Diego and the Salk Institute (where he was a Chapman Scholar and a Lucille P. Markey Fellow). He short-tracked through the Internal Medicine residency program at UW and was an endocrinology/metabolism fellow, working in Dr. Michael Schwartz’s laboratory. He is currently an Associate Professor at the UW Diabetes Institute.

Research Interests

Dr. Thaler’s focus is the hypothalamic regulation of energy homeostasis and the alterations to this system during obesity pathogenesis. His primary project investigates hypothalamic inflammation and its relationship to high fat diet-induced weight gain with an emphasis on the role of glial cells (astrocytes and microglia) in modulating the neuronal regulation of energy homeostasis. In particular, his research aims to determine whether glial cells provide a repair response to diet-induced damage to critical hypothalamic neurons and whether interventions targeted at glia may therefore influence the course of obesity. A second study examines the role of inflammatory signaling in hypothalamic neurons and microglia in obesity-associated insulin resistance and diabetes. Additionally, Dr. Thaler’s research is examining the metabolic role of POMC neurons through modification of atypical protein kinase C signaling.

During This Episode We Discuss:

Obesity versus being overweight, what Body Mass Index (BMI) defines each condition.

Causes of obesity. New data on root causes

Health impact of obesity

The individualized approach to treating obesity

Investigations and Research into the role of the brain (Hypothalamus) in obesity and obesity management.

Successful strategies for managing obesity,including newer medications and Bariatric Surgery

Quotes (Tweetables):

The US obesity prevalence was 41.9% in 2017-March 2020

BMI 25-30 = overweight

BMI 30 or greater = Obesity

“Obesity by many estimates is at least 50% if not more based on inherited genes. That susceptibility is being acted on by the environment, You shouldn't take the fatalistic view I've got these genes and there is no hope”

Dr Josh Thaler

“The Heavier you are, the higher your energy expenditure. Thus we can’t say that in general, that people who are overweight have a slower metabolism”

Dr Josh Thaler

“How much weight needs to be lost in order to reverse either the disease that’s established or lower the risk of the one that hasn't come yet.. You don't have to go back to your original normal weight..What the data suggests is that even 5-10% weight loss from wherever your current weight,is sufficient to reverse a lot of things(associated diseases) that are associated with obesity”

Dr Josh Thaler

“The (newer injectable)weight loss medications do not cure (obesity), if you stop them, the weight will come back...there is no reason to believe it changed your biology in some way that's permanent”

Dr Josh Thaler

Recommended Resources:

CDC

https://www.cdc.gov/obesity/basics/index.html

Obesity Canada ( formerly called,The Canadian Obesity Network). Obesitycanada.ca.

The Obesity Society www.obesity.org.

Ania Jastreboff, MD, PhD

Kevin D.Hall, PhD Multiple You Tube videos and publications

Michael W. Schwartz, MD University of Washington