Obesity From Different Perspectives

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Childhood Obesiy News quoted a paper written by researchers who studied the combined action of two different drugs as an anti-obesity medication. In writing about behavioral interventions, the drug developers limit the definition to dietary adjustments and increased exercise, which doesn’t work, because there are many other types of behavioral interventions.

It’s as if adherents of the energy-exchange school of thought, and of the more functional or holistic school of thought, somehow feel a need for their respective viewpoints to be mutually exclusive. It’s reminiscent of the endlessly ongoing tug of war in the social sciences between the proponents of nature and nurture.

Are people more a product of their heredity or their environment? Some say that every case differs. Some say that dualistic thinking leaves no space for anything else, especially the truth.

It is possible that, in obesity, everything counts. Caloric intake does make a difference, and exercise burns off calories. Also, a person might achieve life transformation through an obscure version of behavioral therapy that is scoffed at by experts.

Considering the proportions and implications of the obesity crisis humanity can’t afford to cavalierly dismiss any ideas. We are grasping at straws here.

The seriousness of the knowledge gap is confirmed by none other than Dr. Rebecca Puhl of the Rudd Center at Yale University. More specifically, Dr. Puhl is Director of Research & Weight Stigma Initiatives, and she says:

10% loss is typical outcome of the best behavioral and/or pharmacological treatments.

In other words, if a 300-pound person can lose 30 pounds, and keep it off for a year, that is considered a success. But the person still weighs 270 pounds! And that not-very-impressive measure of success is with “the best behavioral and/or pharmacological treatments.” With the best help available!

And while it may be true that both behavioral and pharmacological treatments have their place in the scheme of things, common sense dictates that drugs should always be a last resort. Quite possibly, any claims made about anti-obesity drugs should be taken with a large grain of salt.

The controversies

Back to the drug study (which in this case happens to be of a naltrexone/bupropion combination): Tunnel-visioned as they may be in some ways, the authors provide a solid foundation of background information on prior explorations of why weight loss is so difficult to sustain. It appears that the brains of obese people become rewired over time.

A lot of different things influence eating behavior, including “anticipation and reward, chemosensory perception, autonomic control of digestion, and memory.” The obese are at high risk for relapse because their brains generate abnormal neural responses.

The brain’s disordered responses to eating include delayed satiation, because the “enough is enough” signal is either not received or ignored. Normality is impaired, and connections are not made, or are misinterpreted. People who achieve a 10% weight loss are likely to feel as if they are getting even fewer calories than they actually are.

And they stay hungry. Parts of the brain that deal with reward become more active, and parts that are concerned with restraint shrink into the background.

The researchers say:

The availability of highly palatable food increases reward-based or hedonic feeding in humans and animals and individual differences in the neurophysiology of the reward system have been identified that may explain why certain individuals are at greater risk for weight gain.

In the obesity realm, almost every published study includes some version of the concept, “More research is needed.” Researchers say it in different ways, but they say it, and not simply as a device to assure their own continuing employment.

There is a lot that humans don’t know. Only a few years ago, almost nobody had heard of the microbiome, but it has received increasing attention lately. And just the other day, science discovered a new organ.

Your responses and feedback are welcome!

Source: “Naltrexone/bupropion for obesity: An investigational combination pharmacotherapy for weight loss,” ScienceDirect.com, June 2014
Source: “Clinical Implications of Obesity Stigma,” uconnruddcenter.org, 06/27/13
Photo credit: Paolo Gamba via Visualhunt/CC BY

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