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 2004 “to 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 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!
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.