MAY 29, 2014 10:30 AM PDT

Why are we unable to lose weight and keep it off? All about the connection between the gut and the brain

  • Professor of Medicine and Pediatrics, Boston University School of Medicine Director, Center for Nutrition and Weight Management, Boston Medical Center
      Caroline Apovian is Professor of Medicine and Pediatrics, in the Section of Endocrinology, Diabetes, and Nutrition at Boston University School of Medicine, USA. She is also Director of the Center for Nutrition and Weight Management at Boston Medical Center, USA. Dr. Apovian is a nationally and internationally recognized authority on nutrition and has been in the field of obesity and nutrition since 1990. Her current research interests are in: weight loss and its effects on endothelial cell function, adipose cell metabolism and inflammation, research in the bariatric surgery population, and novel pharmacotherapeutic antiobesity agents. She is also an expert in the technique for subcutaneous adipose tissue biopsies, and has been performing these biopsies on research subjects for over 10 years. She was on the expert panel for updating the 2013 AHA/ACC/TOS Clinical Guidelines for the Management of Overweight and Obesity in Adults. Dr. Apovian was a recipient of the Physician Nutrition Specialist Award given by the American Society of Clinical Nutrition. This was for her work on developing and providing nutrition education, to medical students and physicians in training at Boston University School of Medicine. She has published over 200 articles, chapters, and reviews on the topics of: obesity, nutrition, and the relationship between adipose tissue and risk of developing cardiovascular disease. Dr. Apovian has recently published a new book entitled the The Overnight Diet and has also written a popular book for patients called The ALLI Diet Plan. Dr. Apovian has been a member of The Obesity Society since 1992, and has served on the Clinical Committee as well as Secretary/Treasurer and the Executive Committee from 2005 to 2008.  She has been a faculty speaker and has presented papers at several of the Society's Annual Scientific Meeting and until recently she served as Associate Editor for the Society's journal, Obesity.  


    Obesity is a disease. It was once not considered to be a disease and to be a matter of will power and gluttony. It was also the case that we once thought that fat tissue had no metabolic function other than to be inert and store fat. We now know that adipose tissue is an endocrine organ that secretes adipokines that regulate metabolism and energy balance. There are several kinds of adipose tissue: white brown and beige. We used to think that brown fat was not present in adult humans, only in animals and human babies to generate heat. We now know that brown fat exists in the adult human and that white fat can undergo browning to become beige fat and burn more calories. We used to think that people who lost weight and regained it back and more had psychological disorders that made them eat. The overwhelming reason for weight regain is the body readjusting the energy regulation system and adjusting hormone levels so that a person feels preoccupied with food until they regain the weight. Other adjustments are made to resting metabolic rate so that it decreases to facilitate regain of weight. There is also some evidence to suggest that it may be our food supply that is creating this increase in the prevalence of obesity by interacting with pathways to appetite and satiety in the brain, thereby altering the signals to appetite and satiety. Foods high in fat cause obesity in animal models also cause inflammation in the hypothalamic area that controls food intake. These animals no longer regulate body fat and gain weight and eventually defend a high body set point weight. Human physiology may go through this same mechanism to defend a higher body weight in this toxic food environment.
    How can we combat this new disease? Drugs devices and surgery and new methods in the pipeline are considered.

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