The Endocrine Society’s Scientific Statement Calling for More Research into Underlying Mechanisms of Weight Maintenance is Telling of the Chronic and Relapsing Nature of Obesity

| July 1, 2017

A Message From Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.


Dear Readers,

The Endocrine Society recently issued a scientific statement calling for more research aimed at understanding the underlying mechanisms that make it difficult for individuals to maintain long-term weight loss.[1] To summarize, the authors acknowledged that although research and billions of dollars are spent each year on obesity treatment, the health and economic burden of the disease in the United States has not improved. They assessed the current available literature and concluded that weight regain remains a large part of the problem, with effective options for long-term weight reduction lacking. They call for more research on obesity pathogenesis and list specific areas, such as energy homeostasis; genetic, developmental, and environmental forces; and biological markers and predictors for obesity’s associated comorbid conditions.

This statement is telling of the chronic and relapsing nature of this disease; we have decades of evidence and still do not fully understand all of the factors that contribute to the perfect obesity storm.I believe this is a very important area of study for a few reasons. For one, more research will uncover even more information, which will hopefully continue to drive the message to the public that obesity is complicated and requires serious treatment. Second, a better understanding of obesity will hopefully translate into developments in treatment pathways that will elicit more weight loss/maintenance success for our patients.

Weight recidivism is a common problem post-bariatric surgery that confounds patients and clinicians alike, and the complexity of the disease is likely influential in this phenomenon. More information on the factors that influence the body to defend weight or reach plateau may allow us to pinpoint exact factors during this stage and customize care. For instance, perhaps more research into the gut microbiota changes postoperatively will cause clinicians to become more proactive in monitoring this area during follow up and prescribe adjunct therapies that act on it.

The list of underlying factors that contribute to obesity is long and further research is likely to add to it. Just genetic influence alone is a vast area of research not only in obesity but in other diseases as well. Other areas mentioned in the Endocrine Society statement include genetic, developmental, and environmental forces. This brings to mind a great quote by obesity researcher George Bray, MD: the genetic background loads the gun, but the environment pulls the trigger.

Research into genetics has ushered in the age of personalized medicine. As we learn more about individual influences on health states, it becomes quite clear that we cannot treat obesity with a shotgun or one-size-fits-all approach. Michael W. Schwartz, MD, chair of the task force that authored the Society’s scientific statement hit the nail on the head when he said in a press release, “To effectively treat obesity, we need to better understand the mechanisms that cause this phenomenon, and to devise interventions that specifically address them. Our therapeutic focus has traditionally been on achieving weight reduction. Most patients can do this; what they have the most trouble with is keeping the weight off.”

I agree that weight maintenance is just as important as weight loss, and I believe these are two separate physiologic states that require, again, specific though perhaps different interventions. More research will hopefully tell us more about the post-weight loss stage of the journey, whether weight loss is being achieved through behavioral therapy, pharmacotherapy, surgery, or a combination of treatments. Early intervention when it comes to both states is likely needed, as is good follow up.

I’m encouraged by this statement and remain excited to learn what future research will reveal. There is always an opportunity to learn more, and the more we understand, the better equipped we will become to effectively treat our patients.

Sincerely,

Christopher Still, DO, FACN, FACP

References

  1. Schwartz MW, Seeley RJ, Zeltser LM, et al. Obesity pathogenesis: An Endocrine Society scientific statement. Endocr Rev. er.2017-00111.

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