News and Trends February 2017

| February 1, 2017

Fat Shaming Linked to Greater Health Risks

Penn study finds patients with obesity who internalize negative stereotypes have a greater risk of cardiovascular, metabolic diseases

PHILADELPHIA, Pennsylvania—Body shaming is a pervasive form of prejudice, found in cyber bullying, critiques of celebrities’ appearances, at work and school, and in public places for everyday Americans. People who are battling obesity face being stereotyped as lazy, incompetent, unattractive, lacking willpower, and to blame for their excess weight. The pain of these messages may take a toll on health and increase risk of cardiovascular and metabolic disease, according to a new study published in Obesity, the journal of The Obesity Society, led by a research team from the Perelman School of Medicine at the University of Pennsylvania.

The team led by Rebecca Pearl, PhD, an assistant professor of Psychology in Psychiatry and colleagues from Penn’s Center for Weight and Eating Disorders found that, above and beyond the effects of body mass index (BMI) and depression, higher levels of weight bias internalization were associated with increased risk for cardiovascular and metabolic disease.

“There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health,” Pearl said. “We are finding it has quite the opposite effect. When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress. In this study, we identified a significant relationship between the internalization of weight bias and having a diagnosis of metabolic syndrome, which is a marker of poor health.”

The team examined 159 adults with obesity who were enrolled in a larger clinical trial testing the effects of weight loss medication, funded by Eisai Pharmaceutical Co. – the majority of whom were African American women, a group typically underrepresented in weight bias research – and completed baseline questionnaires measuring depression and weight bias internalization before any intervention was given. Weight bias internalization occurs when people apply negative weight stereotypes to themselves, such as believing they are lazy or unattractive, and devalue themselves because of their weight. Participants also underwent medical examinations, which determined whether they had a diagnosis of metabolic syndrome, a cluster of risk factors, such as high triglycerides, blood pressure, and waist circumference, which are associated with heart disease, type 2 diabetes, and other obesity-related health problems. Initially, no relationship was observed between weight bias internalization and metabolic syndrome when controlling for participant demographics, such as age, gender and race. However, when patients were stratified into two groups, “high” and “low” levels of weight bias internalization, those with high internalization were three times more likely to have metabolic syndrome, and six times more likely to have high triglycerides as compared to participants with low internalization.

“Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages,” said co-author Tom Wadden, PhD, a professor of Psychology in Psychiatry and director of Penn’s Center for Weight and Eating Disorders. “Providers can play a critical role in decreasing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management – behaviors everyone should display when interacting with people with obesity.”

Researchers note that previous studies have shown that exposure to weight bias and stigma negatively affects mental and physical health, specifically demonstrating that these experiences can lead to a physiological stress response such as increased inflammation and cortisol levels, and can escalate unhealthy behaviors such as overeating and avoiding physical activity. Additional research, specifically larger, longer-term studies, are needed to further explore the possible biological responses and behaviors that may explain why individuals with obesity who internalize weight bias might be at greater risk for cardio-metabolic disease.

“Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity,” added Pearl. “As health care practitioners, we can help challenge negative, internalized stereotypes by educating patients about the complex biological and environmental factors that contribute to obesity, while providing concrete strategies to help patients manage their weight and improve their health.”

To read the article abstract, visit https://www.ncbi.nlm.nih.gov/pubmed/28124502

Scientists at The Scripps Research Institute Find Brain Hormone that Triggers Fat Burning

LA JOLLA, California—Biologists at The Scripps Research Institute (TSRI) have identified a brain hormone that appears to trigger fat burning in the gut. Their findings in animal models could have implications for future pharmaceutical development.

“This was basic science that unlocked an interesting mystery,” said TSRI Assistant Professor Supriya Srinivasan, senior author of the new study, published today in the journal Nature Communications.

Previous studies had shown that the neurotransmitter serotonin can drive fat loss. Yet no one was sure exactly how. To answer that question, Srinivasan and her colleagues experimented with roundworms called C. elegans, which are often used as model organisms in biology. These worms have simpler metabolic systems than humans, but their brains produce many of the same signaling molecules, leading many researchers to believe that findings in C. elegans may be relevant for humans.

The researchers deleted genes in C. elegans to see if they could interrupt the path between brain serotonin and fat burning. By testing one gene after another, they hoped to find the gene without which fat burning wouldn’t occur. This process of elimination led them to a gene that codes for a neuropeptide hormone they named FLP-7 (pronounced “flip 7”).

Interestingly, they found that the mammalian version of FLP-7 (called Tachykinin) had been identified 80 years ago as a peptide that triggered muscle contractions when dribbled on pig intestines. Scientists back then believed this was a hormone that connected the brain to the gut, but no one had linked the neuropeptide to fat metabolism in the time since.

The next step in the new study was to determine if FLP-7 was directly linked to serotonin levels in the brain. Study first author Lavinia Palamiuc, a TSRI research associate, spearheaded this effort by tagging FLP-7 with a fluorescent red protein so that it could be visualized in living animals, possible because the roundworm body is transparent. Her work revealed that FLP-7 was indeed secreted from neurons in the brain in response to elevated serotonin levels. FLP-7 then traveled through the circulatory system to start the fat burning process in the gut.

“That was a big moment for us,” said Srinivasan. For the first time, researchers had found a brain hormone that specifically and selectively stimulates fat metabolism, without any effect on food intake.

Altogether, the newly discovered fat-burning pathway works like this: a neural circuit in the brain produces serotonin in response to sensory cues, such as food availability. This signals another set of neurons to begin producing FLP-7. FLP-7 then activates a receptor in intestinal cells, and the intestines begin turning fat into energy.

Next, the researchers investigated the consequences of manipulating FLP-7 levels. While increasing serotonin itself can have a broad impact on an animal’s food intake, movement and reproductive behavior, the researchers found that increasing FLP-7 levels farther downstream didn’t come with any obvious side effects. The worms continued to function normally while simply burning more fat.

Srinivasan said this finding could encourage future studies into how FLP-7 levels could be regulated without causing the side effects often experienced when manipulating overall serotonin levels.

In addition to Srinivasan and Palamiuc, authors of the study, “A tachykinin-like neuroendocrine signalling axis couples central serotonin action and nutrient sensing with peripheral lipid metabolism,” were Tallie Noble of Mira Costa College and Emily Witham, Harkaranveer Ratanpal and Megan Vaughan of TSRI.

This study was supported by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (grant R01 DK095804) and the NIH Office of Research Infrastructure Programs (grant P40 OD010440).

About The Scripps Research Institute. The Scripps Research Institute (TSRI) is one of the world’s largest independent, not-for-profit organizations focusing on research in the biomedical sciences. TSRI is internationally recognized for its contributions to science and health, including its role in laying the foundation for new treatments for cancer, rheumatoid arthritis, hemophilia, and other diseases. An institution that evolved from the Scripps Metabolic Clinic founded by philanthropist Ellen Browning Scripps in 1924, the institute now employs more than 2,500 people on its campuses in La Jolla, CA, and Jupiter, FL, where its renowned scientists—including two Nobel laureates and 20 members of the National Academies of Science, Engineering or Medicine—work toward their next discoveries. The institute’s graduate program, which awards PhD degrees in biology and chemistry, ranks among the top ten of its kind in the nation. In October 2016, TSRI announced a strategic affiliation with the California Institute for Biomedical Research (Calibr), representing a renewed commitment to the discovery and development of new medicines to address unmet medical needs. For more information, see www.scripps.edu.

News from the society of American Gastrointestinal and Endoscopic Surgeons

Patient FAQs on FUSE and Testing for Physicians Now Available – SAGES FUSE Program Highlighted on NBC4 Los Angeles, California—SAGES Fundamental Use of Surgical Energy™ Committee has developed Patient FAQS to address important questions about stray energy, what patients need to know, and how SAGES and physicians can address the risks.

To view the Patient FAQs visit http://www.fuseprogram.org/about/patient-faqs/.

Dr. Pascal Fuchshuber, SAGES Board Member and FUSE Chair, was interviewed by NBC4 in Los Angeles for a recent story regarding the risks of stray energy.

“Fuchshuber and SAGES have started a program called FUSE, Fundamental Use of Surgical Energy, to educate surgeons about the risks of electrical instruments in surgery and how to use them safely. He said surgeons “should adapt their technique and how they use these instruments to the fact that every one of them could have this defect.”

View the full story at http://www.nbclosangeles.com/investigations/Surgery-Risk-Burns-Laparoscopic-Investigation-412929203.html

Taking the FUSE Exam. To address the risks of stray energy, SAGES launched the Fundamental Use of Surgical Energy™(FUSE) program to educate surgeons and affiliated OR staff about the safe use of surgical energy-based devices in the operating room, endoscopic suite and other procedural areas. The FUSE exam will be available by appointment at the SAGES Annual Meeting, March 22–March 25, 2017 in Houston, Texas. Before making an appointment to take the exam, you will need to purchase a FUSE test voucher and review the FUSE didactic content. Visit www.fuseprogram.org to prepare and enroll, or for additional testing locations in your area.

About SAGES FUSE Program. The multidisciplinary FUSE program, created by Drs. Steven Schwaitzberg and Daniel B. Jones, meets a crucial gap in surgical education as, previously, no formal training program had existed that promoted safety in the OR when using surgical devices. The program includes a didactic curriculum and covers a number of topics including the fundamental principles of electrosurgical devices, practical aspects of commonly used energy devices in various settings, integration of energy systems with other devices, as well as prevention of operating room fires. A FUSE certification exam is offered that ensures successful learners have acquired the needed knowledge. SAGES encourages mastering fundamental skills in order to ensure a safe standard of care for all patients undergoing surgery.

Announcing SAGES 2017 Keynote Lectures

Los Angeles, California—Attend These Keynotes at SAGES 2017:

• Karl Storz Lecture, Speaker: Dave Kerpen

Thursday, March 23, 2017, 9:00 AM – 9:45 AM

Dave Kerpen is the founder and CEO of Likeable Local, and New York Times bestselling author of four books. An international keynote speaker, Mr. Kerpen is the #1 LinkedIn Influencer of all time in page views, ahead of Bill Gates, Jack Welch, Mark Cuban and President Barack Obama.

• Social Media and Health Care, Speaker: Brian P. Jacob, MD

Thursday, March 23, 2017, 9:45 AM – 10:15 AM

Dr. Brian P. Jacob is an American Board Certified minimally invasive general and bariatric surgeon, and founder of a startup company called the International Hernia Collaboration, Inc. He operates at Mount Sinai Medical Center and at Midtown Surgery Center in New York City. Dr. Jacob performs a variety of surgical procedures, but has a special interest in treating the diseases of hernia, groin pain, abdominal pain, and obesity. In an effort of help optimize patient outcomes after hernia repair, in 2012 Dr. Jacob launched the International Hernia Collaboration (IHC), a private Facebook™ group of over 2500 hernia surgeons and hernia industry partners. He believes there is significant power in large focused professional networks like the IHC, and thus expects the continued growth of it, and other groups like it, to rapidly change the way medical information is disseminated and exchanged in order to improve patient care.

• Presidential Address, Speaker: Daniel J. Scott, MD

Friday March 24, 2017, 8:30 AM – 9:15 AM

Dr. Daniel Scott, SAGES President, is Assistant Dean, Simulation & Student Integration of Graduate Medical Education, Director of UT Southwestern Simulation Center and holds the Frank H. Kidd, Jr. MD Distinguished Professorship in Surgery. Dr. Scott also serves as the Executive Director of the Southwestern Center for Minimally Invasive Surgery, which is accredited by the American College of Surgeons (ACS) as a Level I Education Institute and by SAGES as a Fundamentals of Laparoscopic Surgery (FLS), Fundamentals of Endoscopic Surgery (FES), and Fundamental Use of Surgical Energy (FUSE) Test Center. Dr. Scott oversees numerous educational activities within the Department of Surgery and has special interests in technical skills training, performance assessment and competency. Dr. Scott is nationally and internationally recognized as an expert in the clinical areas of minimally invasive general surgery, including bariatric, foregut, and hernia surgery. His research interests focus on emerging surgical techniques and technologies, as well as simulation-based surgical education and novel methods for achieving mastery. He has authored 179 publications, including books, monographs, chapters, manuscripts, and videos, all focusing on various areas of minimally invasive and gastrointestinal surgery, including novel surgical devices and approaches, Bariatrics, GERD, Achalasia, Hernia, Robotics, and Surgical Education. Dr. Scott has received grants from the Agency for Healthcare Research and Quality (AHRQ) and other organizations for simulation-based training and device development research.

• Gerald Marks Lecture “Competency Based Surgical Training: the Solution?” Speaker: H. Jaap Bonjer, MD, PhD

Friday, March 24, 2017, 9:15 AM – 10:00 AM

In this keynote for surgeons and surgical residents, Dr. Bonjer will discuss the elements, implementation and outcomes of competency based surgical training programs. Since 2009, Dr. Bonjer assumed the position of Chairman and Professor of the Department of Surgery at the Free University Medical Centre in Amsterdam. His clinical and research activities focus on endocrine surgery and minimally invasive surgery.

About SAGES. SAGES, The Society of American Gastrointestinal and Endoscopic Surgeons, was founded over 30 years ago with the mission improving quality patient hair care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery. SAGES is a leading surgical society, representing a worldwide community of over 6,000 surgeons that can bring minimal access surgery, endoscopy and emerging techniques to patients worldwide. SAGES has been at the forefront of best practices in laparoscopic surgery by researching, developing and disseminating the guidelines and training for standards of practice in surgical procedures.

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