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For the lucky ones, weight gain is limited to a few extra pounds put on over the holidays and lost in the weeks thereafter. But for those with a predisposition for overweight, the “battle of the bulge” is a lifelong struggle punctuated by physical and emotional challenges.
Given the range of serious medical issues associated with overweight, from diabetes, hypertension, cardiovascular disease and cancer to infertility, sleep apnea and skeletal pain it comes as no surprise that the medical community considers obesity as a disease unto itself.
Shocking statistics indicate that 90% to 95% of people with obesity who diet and lose weight will gain it back within the first year, often with ‘interest.’ The urgent need for an innovative approach to treat and cure this disease has led to the establishment of the Israeli Center for Obesity Management, a division of the Department of Endocrinology at Sheba Medical Center. In the words of Dr. Gabriella Lieberman, Senior Specialist at Sheba’s Endocrine Institute and director of the Center: “There’s no one obesity, but obesities. People who suffer from overweight have different problems. That’s why the one-size-fits-all approach often fails.”
When seeking the main culprit responsible for the obesity epidemic, a phenomenon identified only in the last 50 years, it’s impossible to ignore the advent of processed foods and the accompanying plastic packaging and preservatives. “We’re exposed to hundreds of chemical additives, categorized by the FDA as GRAS (generally recognized as safe) but whose long-term effects have not been thoroughly examined,” explains Professor Amir Tirosh, director of the Division of Endocrinology, Diabetes and Metabolism at Sheba Medical Center. “We can assume that most are indeed safe, but we don’t need more than a couple dozen that are not so safe to suffer the consequences.”
In a ground-breaking study conducted together with colleagues from Harvard University, Prof. Tirosh observed the effects of propionate, a common preservative found in bread and baked goods. The findings indicated that the chemical can cause elevated glucose levels, impacting insulin sensitivity and metabolism. While the findings are not yet thoroughly validated in humans to warrant a recommendation to ban propionate, they do point to the need to more closely assess the potential long-term effects of this chemical, and perhaps others.
Personalized Medicine
At the Obesity Center in Sheba, patients undergo a thorough assessment by a team of experts, including an endocrinologist, dietitian, psychologist, and sports medicine expert. After measuring the patient’s metabolic rate as well as body composition, the experts will consult and evaluate all this information to build a tailor-made plan that will suit the individual’s distinctive needs and parameters.
After receiving their individualized plan, patients come periodically to the clinic to meet with the professionals and track their weight loss. Depending on the circumstances, patients might be candidates for GI procedures such as intra-gastric balloons and duodenal devices, endoscopic gastroplasty or bariatric surgery. Additionally, there are relatively new weight loss drugs available today that have taken the medical community by storm.
Saxenda and Belviq work by suppressing appetite and have relatively few side effects, which usually disappear with time. Naturally, the first question that people ask is, “How much weight will I lose with this drug?” Dr. Lieberman is quick to explain that there is no way she can predict weight loss. “There is an average weight loss, but each individual will experience different results. Some people may lose more than the average; for others, the drug may be less effective.” Although she’s seen patients make tremendous progress with the help of meds, Dr. Lieberman makes it clear that the drug can never replace lifestyle modification.
The good news is that it doesn’t take much to achieve a drastic improvement in health. According to Prof. Tirosh, “in order to treat metabolic disorder, prevent diabetes, and improve high blood pressure, the goal is to lose 7% of body weight. If a patient can maintain that long term, I’m very pleased.”
In the Pipeline
According to Prof. Tirosh, one of the most exciting breakthroughs in obesity research is in the field of genetic screening. “We’re performing clinical studies here at Sheba, and can now screen for mutations to determine if patients have a genetic propensity to obesity. It’s extremely validating for patients who have been struggling all their lives with obesity to know that they’re not to blame; it’s not because they’re lazy, or because they lack willpower.”
In a departure from conventional methods, Dr. Ruth Percik, senior specialist at the Endocrinology Institute at Sheba Medical Center, is researching weight loss solutions to obesity employing neurofeedback – training the brain and harnessing its power to gain greater self-awareness and increase self-control, willpower, and mindfulness. The notion that obesity could be treated via the brain occurred to her during her stint at the Max Plank Institute for Brain Research in Leipzig, where she learned that the behavior patterns linked to obesity were clearly evident in brain scans.
“Scientists at Max Plank observed that the people who had lost their excess weight and kept it off for a decade, so-called Sustained Weight Losers, all had something in common: a high level of self-discipline, which is clearly discernible in brain imaging,” Dr. Percik explains. “To illustrate, when obese people were shown an image of their favorite food, all the pleasure centers in their brain lit up, light those of an addict. By contrast, when SWLs were shown their favorite food, only part of their brains were stimulated; the rest was quiet. This indicates an internal restraint mechanism, which translates as their ability to adhere to their menu plan.”
A year and a half after the study, 70 percent of participants have managed to keep the weight off, corroborating Dr. Percik’s hypothesis.
In clinical studies at Max Plank, neurofeedback is measured via fMRI, which is not economically feasible for widespread use. Dr. Percik and her team are currently exploring a device that is compact, portable and user-friendly, to be incorporated at heba’s Obesity Center.
Nutritional ‘Blues’
After all is said and done, it comes down to food intake. Dana Weiner, director of the Department of Nutrition at Sheba Medical Center, debunks the myths of traditional dieting.
“When people come to me, they expect me to hand them a diet. But I don’t believe in one diet that suits everyone. Even the Mediterranean diet, which I agree is an excellent food plan, is not suited to everyone.”
Dana believes that like all areas in medicine, nutritional science is moving in the direction of a more personalized diet, based on a person’s genetic makeup and where they live. She brings evidence from study of the “Blue Zones,” five areas in the world whose inhabitants exhibited greatest longevity and quality of life, yet each have distinctively different diets. What they all do have in common in terms of regimen is a plant-based diet, strategies to prevent overeating, limited alcohol consumption, and physical activity as a way of life.
“My dream as a dietician at Sheba is to establish nationwide programs to educate families about healthy lifestyle and proper eating habits — along with food security for everyone,” Dana shares.
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