Obesity Injection (Horizon prog)

The story

On June 7th 2016 overweight and obese people were given a hope – a false hope – that their weight will simply be injected away.

Fast forward ten years, obesity won’t be a problem. They’ll have the injections, they will be painless, no side-effects and actually really inexpensive and freely available.” Sir Steve Bloom, Professor of Medicine at Imperial College, London.

A miracle injection to end the obesity epidemic. How marvellous!

Something else you should know about Sir Bloom is that a company called Thiakis was founded in 2004to develop novel medicines for the treatment of obesity and co-morbidities based on original research of Professor Steve Bloom and his colleagues at Imperial College London.” The main product range being developed was “synthetic versions of the natural gastrointestinal peptide oxyntomodulin”. Look at the bottom line of text: “Wyeth Pharmaceuticals acquires Thiakis in a transaction worth up to £100m.”

That’s a sum worth raving about a product for. It wasn’t mentioned on the Horizon programme, which covered the story on June 7th 2016.

The product

The injection involves three hormones being administered in a jab before each meal: OXM (oxyntomodulin), PYY and GLP1. All three are understood to suppress appetite – here are a couple of articles on this – ooh look who wrote them!

The jab is supposed to work by making people feel full, as with bariatric surgery. Writing in the Daily Mail, Dr Giles Yeo, the presenter of the Horizon programme, said of the injection: “it appears it can indeed mimic gastric bypass and make the brain think you are full, so patients ate less.”

Two other points made by Dr Yeo in this article are important to address:

1)     “Put simply, we eat too much and move too little. It is physics.”

2)     “Gene research shows, however, that some people eat more than others because they feel a little more hungry all of the time.”

Why this injection is NOT going to end the obesity epidemic

1)     Overeating isn’t about appetite.

The Jab is supposed to work by making people feel full – like gastric surgery – but gastric surgery doesn’t work for many people. Men in white coats seem to have no understanding of why people overeat. They don’t seem to understand addiction – both physical addiction & psychological/ emotional addiction. Food is a drug of choice for many people – the most accessible drug of choice. Food is a ‘prop’ – researchers need to understand what happens when that prop is taken away.

The issues that people have with food, and the issues for which food is used, don’t get taken away with an operation or an injection. People with an eating disorder eat WAY beyond feeling full. Feeling full has nothing to do with most weight problems. Feeling less full is going to make no difference to someone who eats for every reason other than genuine hunger.

The ‘benefit’ that gastric surgery has over hormones trying to ‘mimic’ gastric surgery is that people physically can’t eat as much after effectively having their oesophagus attached to their anus! People report being physically sick and/or ‘dumping’ (a collection of very unpleasant symptoms, from nausea to sweating), when more is eaten than can be digested post surgery. There are mechanisms to prevent people from eating as much post bariatric surgery. These are by no means fool proof. People work out how to liquidise chocolate; they find jelly and ice cream easier to digest than meat and vegetables and they ‘graze’, so that the restricted amount they can eat at any one time becomes less relevant.

People find ways around bariatric surgery – finding ways around this injection will be even easier. Plus – an injection before every meal?! (it’s actually four hours before every meal to be precise!) “…painless, no side-effects and actually really inexpensive and freely available…” Seriously?!

2)     The obesity epidemic can’t be explained by genetics.

Yeo’s Mail article covered “gene research”. In the Horizon programme Yeo says: “I believe that genetics play an important part in why some people eat more than others.”

This makes no sense.

UK obesity has increased from 2.7% (men and women) in 1972 to 22.6% for men and 25.8% for women by 1999 (Michael Wadsworth et al., 2006). The UK obesity epidemic has emerged in a generation therefore. Genetics surely can’t explain something that has happened within one generation.

3)     The obesity epidemic can’t be solved by eating less.

We have known since the Benedict study almost 100 years ago (Francis G. Benedict, 1919); through the Minnesota Starvation experiment (Keys et al., 1950) and the Stunkard and McLaren Hume research (Stunkard A, 1959) to the comprehensive Marion Franz review of 2007 (Franz et al., 2007) that eating less does not produce sustained weight loss. A 2015 study of 176,000 people, showed that the chance of someone with a BMI of 30-34.9 achieving normal body weight (in any year of the 9 year study) was 1 in 210 for men and 1 in 124 for women!(Fildes et al., 2015) The 2016 review of the Biggest Loser contestants scientifically confirmed the metabolic changes that defeated dieters long term (Fothergill et al., 2016).

The Horizon programme showed two men (yes two), fed one meal (yes one), and eating 203-240 calories fewer respectively with the TV cameras there. Sorry – after the injection. Dr Yeo is obviously a calorie theory man. He got really excited “Over even a few months, the amount of weight you’d lose would be incredible.” Even IF this injection could achieve less intake (and no evidence was presented that the body wouldn’t just adapt to the injection, as it tries to adapts to all change), and even IF this did lead to weight loss, we have a hundred years of evidence showing that weight lost with a calorie deficit is so rarely sustained.

What might work?

*      As I’ve said so many times before, we need to eat better, not less. This video explains why calories are not equal and why we need to eat fewer of some and likely more of others.

*      If the Holy Grail of dieting is appetite suppression, then we have the solution already. The trouble is, it’s freely available. There’s no £100m company to sell. We eat the most satiating macro nutrients naturally provided – fat and protein – and shun the one – carbohydrate – that is the least satiating and least nutritious. The most common statement made by people on a low carbohydrate diet is “I don’t feel hungry”.

*      The psychological side still needs to be addressed and people need support to find a healthy prop, or to get through life without an addictive-like prop, but the eating strategy is there.

Or, to use Bloom’s own words, but just to change the subject: “Fast forward ten years, obesity won’t be a problem. They’ll have the low carb diets, they will be painless, no side-effects and actually really inexpensive and freely available.”

Now that really would be a miracle!

References

Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A. T., and Gulliford, M. C. (2015) Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. Vol.105(9), pp.e54-9.

Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., Chen, K. Y., Skarulis, M. C., Walter, M., Walter, P. J., and Hall, K. D. (2016) Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. pp.n/a-n/a.

Francis G. Benedict. (1919) Human Vitality and efficiency under prolonged restricted diet. Carnegie Institution of Washington.

Franz, M. J., VanWormer, J. J., Crain, A. L., Boucher, J. L., Histon, T., Caplan, W., Bowman, J. D., and Pronk, N. P. (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. Vol.107(10), pp.1755-67.

Keys, A., Brožek, J., Henschel, A., Mickelsen, O., and Taylor, H. L. (1950) The biology of human starvation. University of Minnesota Press.

Michael Wadsworth, Diana Kuh, Marcus Richards, and Hardy., R. (2006) Cohort Profile: The 1946 National Birth Cohort (MRC National Survey of Health and Development). Int J Epidemiol. Vol.35 pp.49-54.

Stunkard A, M.-H. M. (1959) The results of treatment for obesity: A review of the literature and report of a series. A.M.A. Archives of Internal Medicine. Vol.103(1), pp.79-85.

 

13 thoughts on “Obesity Injection (Horizon prog)

  • avatar
    June 9, 2016 at 8:25 pm
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    Genes plus environment …the environment has changed, so now particular genes plus new obesogenic environment interaction now comes into play .

    No one disputes heritability of height yet people have been getting taller throughout history .yes again it’s the genes plus environment story .
    body weight has even more heritibility as indicated from twin studies . And again it’s s story of genes plus Obesogenic environment pushing susceptible individuals into thresholds of overweight and obesity . I don’t get why people are so resistant to the idea of genetics playing a role .

    All the susceptibility genes on body weight are linked to the brain and indicate regulation of appetite are playing a crucial role .

    The program on the injection of glp1 peptide were double blinded and were only unlocked for these two individuals to illustrate for the show. Please it’s about making a point for TV!! but of course the trial is correctly controlled and sufficient power for correct statistical rigour. The effects are remarkable and consistent , it is one of the key feedback appetite pathways that work on every meal to indicate a sufficient meal has been consumed .the issue will be how we can get round the need for an injection prior to every meal . The key is that overall it worked for most people of course there will be indiviviuals that wont be suitable for this treatment as all clinical trials for all drugs . It’s called natural variation and a diverse outbread population will never behave identically.

    Reply
    • avatar
      June 13, 2016 at 9:16 am
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      Jane,

      I don’t think it is so much that people are resistant to the idea that genes affect our susceptibility to obesity – quite clearly they do as genes affect everything – it’s just that they see other factors as being more important. Regarding genes the question is how much influence do they have and is it of major importance? Gerald Reaven (Syndrome X The Silent Killer) concludes that genetic influence most likely does not account for more than a 4% difference in energy efficiency (P90).

      The problem I have with all studies and procedures proposed and recommended for weight loss and/or control is that they turn what is, for a vast majority of people, a simple problem into a complex one which needs gene manipulation, surgery, pills etc. to resolve. To me this is a clear case for the application of Occam’s razor in that the simplest solution (and many would argue the most obvious) is the correct one. Yes, I agree that people very clearly differ in their response to carbohydrate between those that can stuff themselves and remain slim (but not necessarily healthy) and those that put on weight walking past a cake shop. There are numerous reasons for this which are beyond (for a full understanding) the scope of a comment section. However the fundamental issue is purely one of eating too much of the wrong type of food and that food is carbohydrate – in particular the processed variety. The source of this problem is the flawed hypothesis that natural fats are bad – an idea that would have died a long time ago if it wasn’t so profitable for the food and pharmaceutical industries.

      As a simple analogy – if I put the wrong fuel in my car and the engine fails to run correctly I don’t start tinkering with the mechanics of the engine (gastric surgery) nor do I attempt to reprogram the engine control module (genetic modification). The answer is to use the correct fuel. So I would turn your question around and ask why are some people so resistant to the idea of food playing a role? Anyone who has followed Zoë’s blogs or read her books will be well aware of the answer to that question.

      Reply
  • avatar
    June 8, 2016 at 6:05 pm
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    While I agree with you as to your point in #2 (that obesity cannot be explained by genetics, since genetics did not change in one generation but obesity did), I also think Yeo’s correct. This is what you say: In the Horizon programme Yeo says: “I believe that genetics play an important part in why some people eat more than others.”

    I think this is true: some people are better than others at processing insulin/sugar and not becoming insulin resistant. I know people who eat lots of fruit, low fat, etc., and still are thin. Meanwhile, if I look at too much fruit or low fat fare, I’ll gain weight. So, genetics plays a role overall, in terms of who gets fat, but does not explain the incredible change in society.

    Reply
    • avatar
      June 8, 2016 at 6:54 pm
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      Hi Bob
      I agree with all you say.
      Best wishes – Zoe

      Reply
  • avatar
    June 8, 2016 at 4:15 pm
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    Hi Zoë,

    I can’t watch these idiot programs any more – feel like throwing things at the TV. BBC seems particularly prone to running “The Truth About” programs that all too often are anything but and this program is yet another sad example of the ilk. That the current dietary advice is setting up another generation to be predisposed towards obesity (as mentioned by Marcia Fletcher) because the mothers are hyperinsulinemic is also overlooked. Vested interests, flawed logic, twisted and distorted “research” and all in order to support the flawed logic of CICO and that the key to controlling weight revolves around it. Doesn’t matter whether it is a pill, a regime or surgery it all comes back to eating too much and doing too little despite God knows how many studies have proved it is anything but. It is particularly sad when doctors, who should know better, buy into and preach this nonsense. BTW – I agree with Tom Welsh regarding Richard Feinman’s book, which hopefully will become available at a more reasonable price.

    Your excellent video sums it up the issue but, even with the facts laid out before them, there are still those (the majority in fact) who just cannot or will not see the truth (evidence in the comments). To some extent I can understand how some people fall for the CICO nonsense as it seems, on the surface, so logical but at the same time, with the clear evidence of its failure all around us, how does the CICO brigade explain the rise in obesity which mirrors the change in official dietary guidelines that pushed for less fat and more carbs? How do they not see that at least since the time of Banting until the 70’s any decent doctor or nutritionist recognized that excessive carbs were the issue? Those who do not learn the lessons of history are destined to repeat the mistakes. Perhaps those that still think CICO applies should read this (The Whoo does not mince words) http://itsthewooo.blogspot.be/2014/05/calories-are-not-cause-of-obesity-i-am.html . Plenty more on her website for those that are interested.

    As for the often quoted Mediterranean Diet few people understand the origins (in the mid 80’s) of what is called the MD. The two people that started the ball rolling were Antonia Trichopoula (a professor at the University of Athens Medical School and Anna Ferro-Luzzi (a research director at the National Institute of Nutrition in Rome). In addition, no surprise where flawed and cherry-picking research is involved, our old friend Ancel Keys pops up with data from the Greek portion (in Crete) of the Seven Countries study. That others have followed the same path is no surprise as, in general, there is money for those repeating the dogma that supports the pharmaceutical and food industry (who certainly don’t want people to recognise that a vast majority of what they produce will make you fat and ill) but not for those arguing against it (just like statins).

    A little off-topic but directly related to the Western diet is this http://foodmed.net/2016/06/07/low-carb-fatty-liver-no-brainer-lchf-cardiologist/ . This is where the anti-fat, pro-carb guidelines have got us along with a “food” industry more interested in profit than decent food.

    Reply
  • avatar
    June 8, 2016 at 2:06 pm
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    “Put simply, we eat too much and move too little. It is physics.”

    How very depressing that those who really should know better still peddle thus pseudo-scientific rubbish.

    Amongst many other things, Dr Yeo should read Tim Spector’s new(ish) book, The Diet Myth. Spector is mostly concerned with microbes, of course, as am I after I lost 2 inches around my waste after taking the probiotic Symprove for 3 months (NOTE: no connection to the product, it just worked for me). I am not aware of making any modification to my diet in that time and yet I can now fit into trousers I have not worn for years. I was rather suprised at my weight loss until I started reading the literature (interesting beginners article here: http://www.bbc.co.uk/news/magazine-35193414 ) and discovered the profound affect gut bacteria can have on weight.

    Spector himself discusses a very pertinent study involving mice, fed identical diets, in which those mice given an antibiotic (who therefore had impaired gut microbes) gained twice as much fat as the mice with a healthy gut micobiome.

    Dr Yeo, no doubt, would argue that the fat mice must have been moving around a lot less than the other mice…

    Reply
    • avatar
      June 8, 2016 at 2:10 pm
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      Ho ho! lazy mice!
      Tim Spector got some nice coverage in the programme last night. Did you see the woman who had put on weight after a gut re-population which cured her C-Diff? C-Diff is known to cause nausea, sickness, diarrhea, appetite loss and weight loss. So the C-Diff is eliminated overnight and she gained weight. Didn’t take a genius to work that one out!
      Best wishes – Zoe

      Reply
  • avatar
    June 8, 2016 at 1:07 pm
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    I’d like to recommend Richard David Feinman’s book “The World Turned Upside Down”, which bears on the present discussion in several ways. (It’s fairly expensive and could have used much better editing and proofreading – but it’s always comprehensible even if the odd word is left out).

    Dr Feinman, who will be well known to Zoe and many readers of this blog, is a professor of biochemistry and thus has a rather different point of view about many things from doctors and nutritionists. He is always inclined to go directly to the actual biochemical reactions, and explains that metabolism is dominated mostly by control systems (hormones), not gross inputs of food.

    Among many other useful ideas, he has a chapter of thermodynamics in which he provides conclusive and crushing arguments against those annoying people who keep citing the laws of thermodynamics or (like Professor Bloom) “physics”. Not only does he refute those arguments completely, he even gives reasons why the laws of thermodynamics lead to exactly the opposite conclusions. The Second Law states explicitly that the total entropy of an isolated system always increases over time, or remains constant in ideal cases where the system is in a steady state or undergoing a reversible process. Thus all metabolic processes are inefficient, and to different degrees.

    For example, we have all read that the “energy content” of protein and carbohydrate is about 4 calories per gram. (Feinman reminds us that this is just the maximum energy released by a given chemical reaction – so it is a characteristic of that reaction, not of the foodstuff itself). It is known that gluconeogenesis costs energy. Yet all it does is change protein into carbohydrate! Lo and behold, 1 gram of protein “contains” 4 calories, yet it costs further energy to change it into 1 gram of carbohydrate which also “contains” 4 calories! QED – or rather, reductio ad absurdum.

    Reply
  • avatar
    June 8, 2016 at 10:51 am
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    Good article and I totally agree that with awareness of the genetics ie more fat cells developing in the fetus in the womb as a result of the mother’s high sugar or alcohol diet, will allow the individual to control the amount of new sugar intake as they grow. And yes it all boils down to a low carb diet which is becoming more known and accepted in the West and not before time!!!

    Reply
  • avatar
    June 8, 2016 at 10:14 am
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    Thanks. It was in a dream last night! It seems to be original. I thought you’d Tweet the Barcelona study on fat. Keep up the tremendous work and all the best.

    Reply
  • avatar
    June 8, 2016 at 9:18 am
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    Counting the calories in a meal is as useful as counting the words in a novel.

    Reply
    • avatar
      June 8, 2016 at 9:37 am
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      Ha ha – I like that one :-)

      Reply

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