A new report combining perspectives from a range of obesity experts
identifies genetic, epigenetic and neuro-hormonal differences between
individuals as one of the key challenges associated with weight loss and
long-term weight control. The authors, led by Paul MacLean, PhD, and
Rena Wing, PhD, reinforce that maintaining weight loss over the long
term can be a major challenge. They recommend a number of novel
approaches to improve obesity therapeutics, including more emphasis on
an individualized approach to weight-loss treatments and maintenance,
and the integration of physiology and behavioral psychology to identify
effective and sustainable interventions.
"Despite advancements in our understanding of obesity, weight regain
after weight loss remains the most substantial problem in obesity
treatment -- with both the body and the mind conspiring against
individual efforts to maintain weight loss," said Dr. MacLean, co-chair
of the National Institutes of Health (NIH) working group who authored
the report, "Innovative Research to Improve Maintenance of Weight Loss,"
published in the January 2015 issue of the journal Obesity.
"There are many differences in individuals ranging from genetic to
behavioral that lead some to do well on one approach, whereas others do
not. Therefore, what works for a friend or coworker may be very
different from a weight-loss program that's most effective and
sustainable for you over the long term."
The NIH Working Group report summarizes the results from a recent
conference and includes various perspectives from experts in integrative
physiology, genetics, endocrinology, and behavioral and cognitive
sciences.
The report is accompanied by a commentary in Obesity by
research and treatment pioneers and TOS past presidents, George Bray,
MD, of Pennington Biomedical Research Center and Thomas Wadden, PhD, of
the University of Pennsylvania. In their commentary, Drs. Bray and
Wadden called individualized weight-loss strategies "promising,"
highlighting it as the most important issue identified by the working
group to bridge the divide between basic and clinical sciences and
better target obesity treatments.
"In all weight loss trials, whether behavioral, dietary, exercise or
pharmacological, some individuals lose a great deal of weight, others an
average amount, and some even gain weight," they say in their response.
Drs. Bray and Wadden go further to call the area of personalized
treatment an "essential focus" that should be combined with political
and societal actions to change our food and activity environments, which
currently exacerbate the struggle for most people who are trying to
lose weight and keep it off.
"Personalized medicine is not a new idea; it is one that is applied
and encouraged across many areas of medicine. Why not apply it to
obesity treatment?" said Chris Ochner, PhD, TOS Public Affairs co-chair
and Assistant Professor of Pediatrics and Psychiatry at the Icahn School
of Medicine at Mount Sinai. "Weight loss is not a sprint; it's a
marathon."
Working group co-chair Dr. Wing also stresses that current treatment
approaches to improving maintenance of weight loss often do not
adequately counter the many physiological and behavioral changes that
occur when a person loses weight.
"Development of more effective approaches to weight-loss maintenance
requires the integration of physiological and behavioral perspectives
and a more concerted collaboration between basic and clinical
researchers," she said.
TOS agrees that collaboration between physiological and behavioral
researchers is needed to advance the science behind individualized
treatments and develop better weight-maintenance strategies. In 2013,
the Society launched the Bio-Behavioral Research Section to encourage
greater research into the complex interactions between biological,
behavioral and environmental factors that influence obesity. The
Section, led by Chair Myles Faith, PhD, of the University of North
Carolina at Chapel Hill, strives to bridge people, ideas and
methodologies from distinct scientific "silos."
"Understanding individual differences in treatment response requires
expertise in biology and behavior," Faith said. "Seasoned clinicians,
who are keenly observing and working to harness the strengths of
individual patients every day, are an integral piece of the puzzle.
Individual responses to treatment are at the scientific 'heart' of the
matter for understanding weight-loss maintenance."
The NIH working group report in full seeks to identify barriers to
successful weight loss, review strategies that have been previously
employed to improve success, and recommend novel solutions that could be
investigated in future long-term weight control studies. In addition to
more personalized weight-loss strategies, the authors recommend further
exploration into the following areas to improve weight-loss
maintenance:
• Pharmacological strategies to counter the physiological changes
that occur after weight loss, which require adjustments to the drug
development process (e.g. pairing different medications or combining
medication and behavioral approaches).
• New ways to improve adherence to physical activity programs.
• Foods engineered to maximize palatability and satiation to improve long-term adherence to a lower-calorie diet.
• Strategies to decrease the perceived reward value of foods and increase impulse control.
• Technologies (e.g. smart phones, tablets, GPS) and social networking to keep individuals engaged and goal-oriented.
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