Danielle Barron speaks to Professor Carel Le Roux about obesity as a chronic disease and why the social stigma needs to stop
“We need to change the narrative around obesity in our society and the blame culture needs to stop.” Professor Carel Le Roux is an international Obesity Expert, and UCD Research Professor and Head of Research at Medfit. He’s done the research to prove that dieting and exercise isn’t the whole story when it comes to weight loss, and wants to teach everyone that obesity is a disease of the mind – and not the mouth.
“The science that is evolving around it tells us that obesity is a complex and chronic brain disease. We now understand the parts of the brain that make you feel hungry, and that make you feel satisfied after eating food,” he explains to Self.
Le Roux explains that research has shown that every time you eat, your gut sends a signal to your brain to indicate how much food you have eaten. This signal uses satiety gut hormones, but people with fewer hormones need more food to feel satisfied. Going on a diet and eating less food reduces the level of satiety gut hormone levels even further, meaning you feel hungrier and even less satisfied. This could be why that January diet never took off for you – but it also shows that it’s not your fault.
“If that part of the brain isn’t working, you are constantly hungry and when you eat food you are never satisfied; what’s going to happen is people will just eat more food, and unsurprisingly that energy will be stored as weight and they will become overweight or obese. We now understand that obesity is as much of a disease as epilepsy was a hundred years ago, despite people at that time thinking it meant someone was possessed by demons.
” Unfortunately, these relatively new findings are in competition with longheld and deeply-engrained social stigmas when it comes to obesity. Obese and overweight people are often derided as being greedy or simply having a lack of willpower, admits Le Roux. “But that’s just not what the science is showing us.” In fact, research shows that willpower has very little to do with successful weight loss; “across all our treatments, we now know that motivation has zero impact on outcome, it is simply how you respond to that treatment.” He stresses the difference between motivation and compliance – a patient can be motivated but a treatment is only successful if it is adhered to.
That is why the professor established his website, itsnotyourfault.ie, in a bid to get this message across. He says he is passionate about making people with obesity aware of the true cause of their condition, as well as effective treatment options. The site also aims to promote the concept of obesity as a disease of the mind and not the body.
Le Roux believes one of the main problems is that people cannot differentiate between preventing a disease, and treating a disease. He uses the example of lung cancer – while not smoking can help to prevent this disease, once somebody has developed lung cancer, the treatment is not simply to stop smoking.
“I personally think we should spend more energy on prevention of obesity in people of normal weight, using lifestyle, good food choices, exercise etc. But once you have obesity, those treatments are ineffective. People need pharmacological help to treat their obesity.” In fact, theresearch shows that diet and exercise alone will only help 20 per cent of people achieve significant weight loss.
“If you have 2-3lb to lose, by all means eat less and move more, and try get it off that way. But if you have two or three stone to lose, then this will not work – we need to target the brain.”
Le Roux points out that while one in four people in Ireland are classified as obese, only one in 20 is obese and ill – that is, has another condition such as diabetes, sleep apnoea, or heart disease. These are the cohort that anti-obesity treatments should target.
“We cannot treat every obese person with very intensive treatment, we cannot afford to do that. But if we can treat the people who also have a disease that will get better if we make their obesity better, they are the ones we should target. We could put their diabetes into remission, or reduce their risk of heart attacks.
To do this, however, will require a minimum weight loss of 10 percent, which could be two or three stone – no mean feat. “Yet these people are told to go for a run or eat a little less food, and that in no way treats the underlying problem. We have better treatments but we are not even offering them.”
These other treatments include medication and surgery, which for some may seem drastic. “I am not saying surgery is better than diet, or that medication is better than exercise. It is about getting the right treatment to the right patient at the right time. To do that, we have to provide information in a balanced way, because all treatments have advantages and disadvantages.”
The professor is now beginning to recruit for a large study taking place between MedFit and UCD. Up to 80 patients will be recruited for the trial, which involves a drug called liraglutide for the treatment of complications associated with obesity such as prediabetes, sleep apnoea, hypertension and diabetes. The plan is for patients to receive a combination of diet, exercise and medication to allow them to achieve 15 percent weight loss.
“The trial is about finding the responders – we want to know which patients will respond to this treatment. Only the patients who lose weight will stay in the study. We want to give people treatments that will work.”
19/3/2017 The Sunday Times Advertorial