Understanding the Biology of Weight and Weight Regain to Assist those Challenged with Obesity

Transcription

1 Understanding the Biology of Weight and Weight Regain to Assist those Challenged with Obesity Diana L Lawlor MN RN-NP Oct 2017

2

3

4 Our World Has Changed

5 Our world has changed

6

7

8

9

10

11 Energy In Vs Energy Out

12 The Epidemic of Obesity

13

14 1. Woods SC et al. Int J Obes Relat Metab Disord. 2002;26 Suppl 4:S8 S Ludwig DS. JAMA. 2014;311: Speliotes EK et al. Nat Genet. 2010;42: Garvey WT et al. Endocr Pract. 2014;20: Bray GA and Ryan DH. Ann NY Acad Sci. 2014;1311:1-13.

15 Obesity is a complex and multifactorial disease Energy intake Energy expenditure Obesogenic environment Hedonic input Highly palatable, energy-dense foods; physical inactivity Experienced palatability or pleasure Genetics Adipose tissue Gut Medications 1. Woods SC et al. Int J Obes Relat Metab Disord. 2002;26 Suppl 4:S8 S Ludwig DS. JAMA. 2014;311: Speliotes EK et al. Nat Genet. 2010;42: Garvey WT et al. Endocr Pract. 2014;20: Bray GA and Ryan DH. Ann NY Acad Sci. 2014;1311:1-13.

16 Hunger, satiety and desire are regulated by a number of hormones Stomach Ghrelin BBB Hypothalamus Reward circuitry * & cortex Hunger Desire Pancreas Gut BBB Hypothalamus Satiety Amylin Insulin PYY GLP-1 CCK Reward circuitry * & cortex Desire Adipose tissue Leptin Adiponectin BBB = blood-brain barrier; CCK = cholecystokinin; GLP-1 = glucagon-like peptide-1; PYY = peptide YY. *the brain s reward circuitry, especially in the ventral tegmental area and nucleus accumbens. especially the dorsolateral pre-frontal cortex. Suzuki K et al. Exp Diabetes Res. 2012;2012:824305; Berthoud HR. Curr Opin Neurobiol. 2011;21(6):

17 With Obesity. Stomach BBB Hypothalamus Pancreas Amylin Insulin Ghrelin Too Much All the Time Intestines PYY GLP-1 (Not enough Ever) BBB Hypothalamus Feeling Hungry Never Full Constantly Satiety? Never CCK BBB, blood-brain barrier; CCK, cholecystokinin; GLP-1, glucagon-like peptide-1; PYY, peptide YY. 1. Suzuki K et al. Exp Diabetes Res. 2012;2012:

18

19 The brain is designed to protect against famine and to ensure a constant supply of nutrients/sugar for energy. The higher the weight the better the brain likes it Swim against the current message Understanding why change is so tough may help to create change

20 Hunger, mm Weight (kg) Weight Loss Increases Hunger and Chronic Hormonal Adaptation Significant weight loss was observed in participants after being on a very-lowenergy diet for 10 weeks * * As early as week 10 Significant hormonal changes that favour weight regain and were still evident a year later Insulin PYY GLP-1 Leptin CCK Ghrelin Week 0 Week 10 Week Week Postprandial time interval (minutes) Adapted from Sumithran P et al. N Engl J Med. 2011;365:

21 Physiologic and metabolic responses to weight loss favor weight regain 1-3 Energy intake Energy expenditure Hunger Desire to eat Leptin GLP-1, CCK, PYY, Ghrelin Adipose tissue Stomach and gut CCK, cholecystokinin; GLP-1, glucagon-like peptide-1; PYY, peptide YY. 1. Schwartz A & Doucet É. Obes Rev. 2010;11: Sumithran P et al. N Engl J Med. 2011;365: Rosenbaum M et al. Am J Physiol Regul Integr Comp Physiol. 2003;285:R183 R192.

22 Following weight loss, physiologic and metabolic responses favour weight regain Stomach BBB Hypothalamus Ghrelin Hunger Pancreas Gut BBB Hypothalamus Desire to eat Amylin Insulin PYY GLP-1 CCK Satiety Adipose tissue Leptin Adiponectin Hormonal changes persist long-term BBB, blood-brain barrier; CCK, cholecystokinin; GLP-1, glucagon-like peptide-1; PYY, peptide YY. Suzuki K et al. Exp Diabetes Res. 2012;2012:824305; Schwartz A & Doucet É. Obes Rev. 2010;11: Sumithran P et al. N Engl J Med. 2011;365: Rosenbaum M et al. Am J Physiol Regul Integr Comp Physiol. 2003;285:R183 R92.

23 Summary Low levels of GLP1 High levels of Ghrelin Brain Hypothalmus always striving for pleasure and to achieve the highest weight The Biology/Pathophysiology will be a constant battle which is why behavior changes need to be long lasting and the ability to quickly get back in the game after a slip is key to success

24 Why Does Understanding the Biology Matter You have to learn the rules of the game. And then, you can play better than anyone else Albert Einstein Knowledge is Power To Know the Rules You Have to be Educated Why Mothers?...early education/re set of the set point/get the ideal weight for children in place early