We are waist-deep in the season that is firmly associated with over-indulgence. Well, apart from Easter. Hopefully the kids have had time to finish the sweets from Halloween too. But at Christmas, the adults also have carte blanche to stuff themselves with anything that isn’t nailed down.
It was with interest, then, that I noted a presentation at the wonderful Gathering Around Cancer conference last month, delivered by the inimitable Prof Donal O’Shea, Consultant Endocrinologist and pioneer for improved health for the increasing cohort of the population with obesity.
Prof O’Shea provided thought-provoking statistics and opinions during this talk on obesity. He said it was clear that patients are accessing weight-loss drugs that are still in clinical trials through compound pharmacies in the US. Prof O’Shea said this issue had been noted in conversation with other doctors at the conference.
“These are being fairly widely used,” he said. “More widely used than I had realised until recently.” Since his talk, Prof O’Shea has participated in the recent RTÉ documentary on the black market in weight-loss therapies.
During his career, population obesity has doubled and instances of a BMI over 50 have gone up 1,200 per cent, all in an environment that encourages over-consumption and a sedentary lifestyle.
Prof O’Shea took aim at the food and drinks industry: “It designs products for the bliss point of a three-year-old and five-year-old palate. It then packages them in a packaging that is attractive to the three-year-old, five-year-old, or seven-year-old brain, and places them at the child’s eye level. And we allow that to happen.”
Prof O’Shea referenced a study from 1952 on London bus workers, divided into conductors and drivers. There were 16,000 participants in each group, matched for age, sex, ethnicity, and smoking status. “The drivers were three times more likely to have a heart attack and three times more likely to die in the first three days after the heart attack,” said Prof O’Shea. “It wasn’t that the bus conductor was going to the gym; the bus conductor just wasn’t sitting and was moving around.” We know a lot more about the dangers of a sedentary lifestyle these days, but in 1952, this was ground-breaking stuff.
In more recent years, two areas that have emerged strongly in weight management are sleep and stress, he explained. “All of your patients are stressed and I would imagine their sleep hygiene is not as good as it could be, because of the stress,” he said. “That’s an area that we are working on with patients attending our clinic.”
Our modern understanding is that iNKT cells also play a key role in obesity, although that’s too deep a topic to delve into in this limited space.
In a nutshell, the iNKT cell – also known as the ‘Swiss army knife’ of the immune system – is capable of many tasks but is best left in a regulatory role. Patients with obesity are decimating their iNKT cell population and this may explain why they develop so many complications associated with obesity.
The “old story” was to advise patients with obesity to “eat less, move more, more insulin, further weight gain”, said Prof O’Shea. “We now have new tools… the old story has to be replaced by a new story that is one of complex, chronic disease, with your genes and the environment ‘protecting’ you from weight loss and the new treatments we have based on our improved understanding.
“We have to own that and we have to deliver that message to patients and we have to deliver that message to wider society.”
The battle against obesity will still be waiting for Prof O’Shea and colleagues in a couple of weeks. For now, everybody at the Medical Independent wishes you a happy, healthy, and peaceful Christmas and New Year.
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