Last month, I had the privilege of attending Harvard’s annual course.  While it’s impossible for me to summarize all of the material presented at a course such as this, I wanted to bring you a quick list of highlights:

1)       Genomics and Pharmacogenetics in the Physiology and Treatment of Obesity

As scientists have unraveled the human genome, it is becoming clear that the scientific basis of obesity involves not only our environment, but many different parts of our genetic code.  Scientists are researching how different genetic causes can be identified, and how they may respond to different types of treatment.  Perhaps with more research, we will be able to determine an individual’s genetic makeup, and tailor specific treatments to that individual, such as special types of dietary therapy, or specific types of pharmaceutical interventions.

2)       Medication Update

There are several clinical trials underway using various combinations of and new medications.  An enormous amount of money and research is currently being conducted to find new treatment approaches.  While none have come to market yet, there continues to be much interest in:

Endocannabinoid receptor antagonists (they block the receptor that is stimulated by marijuana) Rimonabant, Taranabant, and others.  These have been approved in several other countries, but continue to be studied for safety here in the US.  They can be helpful not only with weight loss, but with metabolic syndrome and smoking cessation.

Combinations:  Topomax and Phentermine (this drug is being called Qnexa), Buproprion and Naltrexone (Contrave), and others.  I have spoken with several patients involved in these clinical trials and many report these approaches to be highly successful.  Other combinations including Amylin, Symlin, Leptin, with Phentermine or Sibutrimine (Meridia) are being studied as well.

In addition to looking at new medications and combinations, many medications that we commonly use to treat a variety of conditions can cause significant problems with weight gain.  Often, there are better alternatives.  Classes of medications to watch out for include Corticosteroids (such as prednisone), old antihistamines (like periactin, benadryl), Insulin, Many anti-depressants (SSRI’s like Paxil, Tri-Cyclic Antidepressants like Elavil / Amitryptilene), many anti-psychotics (such as Zyprexa), and many Anti-Convulsants (used in the management of seizure disorders), and Mood Stabilizers (like Lithium, Depakote, Tegretol).   Sometimes medications can be substituted for those that cause weight gain and can help a patient with weight management.

3)       Behavioral Strategies

There were several discussions on the benefits of nutritional counseling for long-term weight control.  Clearly this is helpful for weight loss, but so many people have trouble maintaining a weight loss.  Long-term accountability does appear to be an excellent tool for long-term success.  Data was presented from DPP (Diabetes Prevention Program) emphasizing that Lifestyle Intervention for patients at risk for Diabetes resulted in 58% reduction in risk for diabetes.  Look AHEAD is an ongoing trial with 5145 type 2 diabetics enrolled in a lifestyle modification program involving 6 months of weekly meetings, followed by long-term supervision.  Early data is already showing significant improvements in diabetes control and sustained weight loss.  It has certainly been our experience at CNC that our programs are extremely effective in obtaining good control of Diabetes, and often weight loss enables us to use fewer medications.

Other lecturers discussed methods to prevent regain.  Specifically, every-other week accountability for many can be very helpful, continued physical activity (200 plus minutes per week), long-term medications when needed, and perhaps long-term partial meal replacement.  These presenters went on to recommend weighing weekly while losing, but weighing daily for maintenance.

One excellent lecture was on NEAT:  Non-Exercise Activity Thermogenesis.  The premise of this lecture is that exercise only accounts for a small percentage of the calories we burn on a daily basis.  How many hours can you actually spend at the gym during the course of a week?  However, as we get heavier and heavier, there is a tendency to also become more sedentary during all of our daily activities.  NEAT is the energy burned from these normal daily activities.  For example, people who fidget all day tend to be skinnier than their non-fidgeting counterparts.  Dr. James Levine has been studying this component of our energy expenditure, and presented compelling data that if we can be less sedentary (move more) during the day, this is helpful for both obesity treatment and prevention.  The problem is that so many of us work sedentary jobs.  He has started a company developing all sorts of contraptions to help people be more active at work.  One famous example is the walking workstation, where there is a treadmill platform and higher desk integrated in to the work station for people, so they can walk at a slow pace rather than sit at the desk all day.  What a way to get your 10,000 steps daily!  What can you do during your work day to be less sedentary?  He argues that NEAT can vary over 2000 calories / day between individuals.

Other behavioral recommendations:

Focus on achievable / sustainable weight loss

One size does NOT fit all

Try not to set unachievable goals

Understand your biological limits

Focus on non-weight outcomes (improved quality of life, longevity, health, etc)

4)       Herbal therapies and CAM (Complimentary and Alternative Medicine) in the treatment of obesity

This topic is quite easy to summarize:  there are no herbal therapies or dietary supplements that have been proven safe and effective in the treatment of obesity.  While herbal therapies and CAM do play an important role for many people in their health and wellness and even in the treatment of certain diseases, to date, there has yet to be any good evidence on the use of these therapies for weight loss.  Further, many popular alternatives have been shown to cause harm and have been withdrawn from the market (such as ephedra/caffeine combinations).  However, it is important to include physical, emotional, mental, and spiritual aspects of a healthcare plan.  For example, stress, insomnia, and depression management can play an important role in the treatment of obesity.

5)       Physiological Adaptations to Weight Loss

This is a fascinating topic.  Why it is hard to lose weight and maintain weight loss?  There is a lot of thought now regarding our bodies establishing a “set point” for weight.  Trying to move too far from this set point can set in motion a variety of responses designed to return the body to its starting point.  There is thought that this theory can explain why maintaining weight loss can be so difficult, and a lot of research looking at how to move this “set point.”  George Blackburn, one of the leading minds in the field of Obesity and the lead organizer of the conference, has published a book, "Breaking through your set point" discussing these theories at greater length, and is next up on my reading list - watch for a brief book report from me on this one in the coming months.