Category: Obesity

Obesity, weight, overweight, food, diet, nutrition, metabolic disease

Semaglutide – the “skinny jab”

TL:DR – Semaglutide is known to US celebrities as the “skinny jab” and has apparently been the subject of a weight-loss craze. It has now been approved in the UK for weight-loss in the clinically obese.

Semaglutide is a pharmaceutical that can help control the symptoms of Type 2 diabetes for which it was first used. The nickname, the “skinny jab” comes from the drug’s activity as an appetite suppressant used in helping overweight people and the obese reduce their body weight. It is sold under the brand names Ozempic, Wegovy and Rybelsus and was originally developed by Novo Nordisk in 2012. Clinical trials of the weekly injected drug were completed in 2017.

Semaglutide

In March 2023, the UK’s National Institute for Health and Care Excellence (NICE) recommended provision of the drug to specialist treatment centres under the National Health Service (NHS).

The main mode of action of the drug, according to the NICE website, is to activate the GLP-1 (glucagon-like peptide-1) receptor, which increases activity in the pancreas to boost insulin secretion into the blood. Insulin is the hormone that raises the concentration of glucose in the bloodstream.

Semaglutide also suppresses glucagon secretion. Glucagon is insulin’s counterpart hormone produced by the pancreas. It raises the concentration of glucose and fatty acids in the bloodstream.

The drug slows the rate at which the stomach empties its contents into the next portion of the gastrointestinal tract, the duodenum (the first section of the small intestine). This sustains a person’s feeling of fullness, or satiety, for longer and so can reduce the frequency with which they feel they need to eat.

The NICE website lists several cautions, side-effects, and contraindications for this expensive drug. Nevertheless, in February 2022 it put a case based on both risk-benefit and cost-benefit analyses for its use under the NHS for people with at least one weight-related condition and an exceptionally high body-mass index. In March 2022, NICE recommended provision of the drug for a sub-group of obese patients who might see a ten percent weight reduction if the drug is used in parallel with improvements in diet (less processed food and a reduction in calorie intake, fundamentally) and increased activity and exercise.

Calories in, calories out

I’m halfway through Tim Spector’s excellent book Spoon Fed, which is a bit like a food and nutrition version of my 2012 book Deceived Wisdom in which he debunks pretty much all of the myths we’ve been told over the years about cholesterol, fat, caffeine, gluten, reduced-fat foods, diet drinks etc.

Spector points out that we are all different, our genes play a major part in our response to food and that most of the claims about this or that food or drink are mainly driven by the marketing departments of the food and drink manufacturers who spend millions on advertising and lobbying policymakers to put messages out there that fundamentally conflict with good advice to sell more of their products.

One of the big myths Spector debunks is with regard to exercise and weight loss. The bottom line, as it were, is that we should exercise for general physical and mental health, but exercising does very little to help you lose weight. In fact, exercising may see you gain weight as you add muscle mass but more likely because it makes you hungry and you end up eating more than you need to after exercising (often in the form of “health” smoothies, protein bars, energy boosters and the like). Your body also slows your metabolic rate after exercise in the short term so that you end up storing more of your food intake as fat.

On what basis does he make this claim? Well, in one sense basic thermodynamics, but he puts it more simply in terms of the way the body uses energy.

We get all of our energy, 100% from food.

We “burn” 70% of that energy just saying alive, metabolic resting rate.

10% of our energy is used to digest the food we eat.

20% is used for physical activity. However, 10% of that is used just sitting, standing, or fidgeting.

The last 10% of the energy we burn can be manipulated through exercise. That’s a tenth of the energy we take in being available to us to burn through exercise.

If you’re an average overweight bloke running an hour a day four times a week, then at best you can knock off 2 kilograms a month. That sounds great, I could get to my ideal weight within a year doing that. But, in order to make this work, you have to NOT overcompensate for the fatigue by eating or drinking more and you have to avoid the extra storage, the slowing of metabolism and the bounceback if you lapse on your calorie counting (You have to be strict with yourself and not eat more even if you feel tired and hungry). It’s mostly sugary-rich food and obesity in a bottle smoothies that are the problem…and alcoholic beverages.

Exercise is a potent drug we all need to take in moderation regularly. Moderate exercise is not a weightloss drug. The only way to lose weight is to eat less and to choose foods better matched to your own metabolism and gut microbes, Spector writes. (There are exceptions to the rules, in the same way that everyone knows a chainsmoking whiskey drinker who died in bed with their mistress aged 97.

As to all that nonsense about 10000 steps? Well, that spurious health notion was invented by a Japanese company that made and sold pedometers in the 1960s…based on nothing more scientific than that 10000 is a nice round number and although it is quite large it is not unachievable in a normal day for a lot of people. But, recent studies have shown that people using pedometers and smart health watches and the like actually gain more weight over the course of a year than those who don’t use these gadgets.

If you’re overweight it would seem that you can’t win…unless you eat less…you can win, if you eat less. It’s not the calories out that count, it’s really just the calories in.

Losing weight is easier than you think

The tabloids were recently full of nonsense about metabolic rate, diets, weight loss, obesity…hold on…when are they not full of nonsense? The latest story claimed that it’s twice as hard to lose weight than current guidelines suggest. Is it? Here’s what the NHS has to say on the matter.

It also offers advice on the best way to lose weight and suggests that shedding just 5% of your body mass, if you’re overweight can reduce high blood pressure and lower your risk of developing type 2 diabetes.

The NHS also links out to the NIH online weight simulator tool, which allows you to input your age, gender and weight and then calculates how many calories you need to cut from your diet in order to achieve a target weight loss. It is actually a research tool and includes no advice on diet or exercise, so it’s useful but not a substitute for personal medical advice on diet and weight loss.

10 body myths debunked by science

Myth 1: Calories Counting Is All That Matters for Weight Management – Calories are the energy content as measured by complete combustion of the food. But, our bodies don’t burn food, they digest, ingest and metabolise it, so different foods even if they have the same “calories” can have a very different effect on our bodies.

Myth 2: Body Hair Grows Back Thicker When You Shave It – Nope. It doesn’t.

Myth 3: You Need Eight Hours of Sleep Per Day – Well, some people do, others need more and some kind survive on half that or less with no apparent ill effects.

Myth 4: Reading in Dim Light Ruins Your Eyes – it can “strain” your eyes, tiring them, but there’s no permanent damage to vision or the structure of the eye even from nightly reading in dim light.

Myth 5: Urinating on a Jellyfish Sting will Sooth the Pain – You should rinse with vinegar or seawater. Ammonia solution, urine and alcoholic preparations can cause the nematocysts (stinging cells) embedded in your skin to fire, making things worse.

Myth 6: Your Slow Metabolism Makes You Fat – It’s obviously not true. The bigger you are the more calories you burn to keep going, that’s a higher basal metabolism than someone lean who burns fewer calories and so has a lower basal metabolism.

Myth 7: You’ll Catch a Cold from Cold (and Wet) Weather Conditions – Nope. Colds are caused by viral infection not by snowballs and wet feet.

Myth 8: More Heat Escapes Through Your Head – Heat does escape through your head, but the rate of heat loss is the same as from any other area of your skin, it’s just that unless you usually wear a hat it’s the bit most often uncovered and so putting a hat on will reduce total heat loss.

UPDATED Myth 9: High Cholesterol Causes Heart Disease – The picture is complicated, there is some evidence that a raised level of an entirely different compound, homocysteine is a better indicator of risk. Of course, deposits of the waxy cholesterol and other lipid within the lining of the arteries that supply the heart does cause heart problems. Actually, it’s not strictly true to say that cholesterol doesn’t cause heart disease. You can be perfectly healthy with high cholesterol, but if waxy deposits form on the inside of the arteries supplying your heart and elsewhere then that’s not good, but this is not a given. if you’re arteries are chocked with lipids then that will raise your blood pressure. But not all hypertension is caused by that. Blood pressure can be higher than “normal”, just because that’s your body’s operating pressure.

Myth 10: It’s Dangerous to Wake a Sleepwalker – The reverse is probably true as a sleepwalker is more likely to trip and fall downstairs or wander off. They might get a shock when you wake them, but a shock isn’t likely to do much harm.

Adapted from a recent Lifehacker post: 10 Stubborn Body Myths

Alchemy, estrogen and obesity

This week, The Alchemist learns more about the link between estrogen and obesity, discovers that the colours of autumn leaves are not as degraded as was once thought, and how mineral tests can inform healthcare workers addressing the issue of night blindness. In Finland, we hear, researchers are converting food waste into fuel while a new theory explains Type 1.5 superconductivity. Finally, Chip Cody earns himself this year’s Anachem Award for his outstanding contribution to analytical chemistry.

Read on in The Alchemist Newsletter: Oct 28, 2011.

Cancer, Gulliver, cat and mouse

Forget fruit and veg. Lose weight and cut the booze to reduce cancer risk
People should be warned that cancer is linked to obesity and alcohol, rather than urged to eat more fruit and vegetables to protect against the disease.

UK trialling testing sugar-coated salt on roads
Although they’ve been using molasses for years in Nebraska and other places to help salt stick to the roads, it’s only just occurred to us Brits to give it a try now that we’re entering a period of severe cold weather (again). Add salt to water and it lowers its freezing point so that it has to be that bit colder for the roads to stay frozen. However, salt kicks up too easily, add molasses and the salt gets more of a purchase on the icy roads and helps defrost them (ever so slightly) producing a nice brown slush.

Stuart Little does a Benjamin Button
Researchers have identified targets (related to the enzyme telomerase) that could help produce old-age-defying drugs and a fountain of youth for the baby boomer population… but haven’t we heard this all before? Of course, we have. It’s unlikely ever to come to anything more than next-generation Botox.

Gulliver Turtle is looking for candidates for BioMed Central’s 5th Annual Research Awards
BioMed Central’s Research Awards are now in their fifth year and apparently growing in popularity. The awards were set up to recognize excellence in research that has been made universally accessible by open access publication, so get your nominations in and see if Gulliver picks you.

Cat and mouse
No sooner do the US authorities begin stealing web domains illegally (actually just taking out the domain from DNS servers), than users find a way to fight back using a DNS system that cannot be touched by any governmental institution and works a P2P network. The problem being that an innocent party might have their domain blocked by the US before due process has taken place and on spurious grounds (and all this before the legislation even comes into effect).

Smoking cadmium and benchtop X-rays

Latest science news including this week’s round up from my SpectroscopyNOW column:

  • Smoking out cadmium problem – A statistical analysis of spectroscopic data is helping scientists home in on the problem of decreased fruit and vegetable consumption being associated with an elevated concentration of cadmium in the blood of male smokers.
  • Short, sharp outburst – A new approach to generating ultra-short, high-density electron pulses for the production of advanced X-ray sources has been developed. The approach could lead to a bench-top X-ray synchrotron for materials science, pharmaceutical research and nanotechnology research.
  • Metabolic obesity – Evidence from NMR spectroscopic studies of individual metabolic profiles would suggest that the way our bodies digest and process nutrients in the food we eat is different for every person and could ultimately affect overweight and obesity problems.
  • Heavy metal and hardened arteries – The way in which arterial plaques form, atherogenesis, is not yet completely understood despite a significant number of research studies in this area. Now, a study using rabbits on a high-fat diet (HFD) has investigated the effects of changes in the concentrations of heavy metalsin several tissues using spectroscopy.
  • Electronic ‘nose’ can predict pleasantness of novel odours – Our sense of smell may not be as subjective as we thought, as scientists develop an electronic nose that can distinguish between pleasant and unpleasant odours.
  • Scientists embrace openness – "Everybody makes mistakes. And if you don't expose your raw data, nobody will find your mistakes." –Jean-Claude Bradley [no relation]

Antimony, x-rays, childhood obesity

Science news links for March 12-15, including the latest on my SpectroscopyNOW.com column:

  • Feverish New World X-ray – X-ray crystallography has allowed US researchers to discover exactly how one type of New World hemorrhagic fever virus latches on to and infects human cells. The work offers a much-needed lead for new treatments.
  • Marking up childhood obesity – Metabolic fingerprinting has been shown to be a powerful tool for exploring Biomarkers in a range of disorders and the pathophysiological mechanisms of disease. A new study has now applied the technique to childhood obesity to intriguing effect.
  • Myrtle medicine – German researchers have successfully devised and implemented a total synthesis of myrtucommulone A, tracking progress and structures using NMR spectroscopy. The compound is physiologically active in anticancer and antibacterial screens, and the synthesis opens up the potential for making simpler, but active analogues.
  • Antimony analysed in food packaging – A simple, yet sensitive, method for detecting inorganic antimony in food packaging has been developed using cloud point extraction combined with electrothermal atomic absorption spectrometry (ETAAS).
  • Unlocking the opium poppy’s biggest secret – Researchers at the University of Calgary have discovered the unique genes that allow the opium poppy to make codeine and morphine
  • What is the difference between a heart attack and cardiac arrest? –
  • Antibiotics against stomach cancer – Helicobacter pylori often causes stomach ulcers and, in extreme cases, gastric cancer. f1000 Medicine Reports, Seiji Shiota and Yoshio Yamaoka discuss the possible eradication of H. pylori infections using antibiotics.
  • How cars are killing us – Cars are lethal, but nowhere more so than in the developing world.

Treating the Obesity Epidemic

Drugmaker Vivus saw its experimental weight-loss medication, Qnexa, pass two Phase III clinical trials C&EN reported on September 10, and the company’s share price skyrocketed.

The rewards of developing a safe and effective anti-obesity medication will be in the tens of billions of dollars, according to Bloomberg. Of course, such apparent breakthroughs are going to hit the headlines, big time. After all, who wants to reduce calorie intake and increase exercise levels when popping a pill could solve one’s weight problems?

In the developed world, overweight and obesity (BMI > 30) and other diet-related problems, such as cardiovascular disease, diabetes, and metabolic syndrome, are on the increase. And, while it might be assumed that the billions of people who live in abject poverty with the daily threat of acutely lethal diseases, such as malaria, have other things to worry about, the diseases we commonly associate with the “Western” lifestyle are emerging across the globe. The WHO says that, perhaps with the exception of sub-Saharan Africa, deaths caused by chronic diseases dominate the mortality statistics.

Astoundingly, WHO figures from 2005 suggested that there are more people suffering from overweight-related problems than malnutrition. At the time, globally there were more than 1.6 billion people aged over 15 years who were overweight and 400 million of those were clinically obese, while around 800 million suffered from malnutrition. Those numbers are already changing. The WHO predicts that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.

The costs in terms of loss of quality of life and impact on healthcare providers in the developed world are likely to be unsustainable in terms of demands on surgical and drug treatments.

While much of the focus on the obesity epidemic is aimed at the US, high rates of cardiovascular disease associated with poor nutritional choices, dietary trends, and exercise issues ring just as true in the UK.

Andreas Anastasiou of the Department of Agricultural and Food Economics at the University of Reading, and a quantitative risk analyst at the Bank of Santander, London, UK and Athanasios Anastasiou a lecturer at the Technological Education Institute of Patras, Greece and an economist at the University of Patras, recently highlighted the sorry state of the British diet and the burden the growing obesity problem will ultimately have on the economy and society as a whole.

Here are just a few of the UK obesity facts and figures cited by the authors:

  • 30,000 – deaths a year
  • 9 years – average life reduction
  • 18 million – working days lost
  • £1 billion – cost to National Health Service
  • £2.5 billion – cost to the economy

Obesity and associated chronic diseases are a serious threat to a nation’s health and well-being, the researchers say. “Their impact on the economy and society as a whole is tremendous exhibiting enormous healthcare costs and losses in working hours and years of life.” They suggest that improvements will happen if long-term changes to food choices and dietary habits are made, whether this should come top down from government and healthcare providers is difficult to say. How ever it is achieved, you can be almost certain that popping a pill will not be the cure all, despite what pharmaceutical share prices might suggest.

Research Blogging Icon Andreas G. Anastasiou, & Athanasios Anastasiou (2009). The effects of current dietary trends and consumption patterns on health: evidence from the UK Int. J. Behavioural and Healthcare Research, 1 (3), 318-333

Catching Obesity

Obesity overweightUPDATED: Is it possible that obesity, like the common cold is infectious? You’d think so if you believed research that’s been carried out over the last decade and hits the tabloid headlines again this week.

The research suggests that a highly infectious virus might be behind some cases of obesity. There is constant talk of an epidemic of overweight in the developed world. Overindulgence, lack of exercise, sedentary lifestyles are usually blamed. Occasionally, the words genetics or glands are mentioned, but rarely is the obesity epidemic thought of as a disease like, flu or winter vomiting virus, a disease you can “catch”, in other words. But, this research detracts from those genuine causes of overweight and might even do more harm than good, giving those with a less than healthy appetite another excuse to over indulge and avoid raising their heart rate above the average.

The research is highlighted today in several UK news papers and apparently lends weight to the idea that a highly infectious cold-like virus, known as AD-36 could cause obesity in some people.

It’s perhaps not surprising that, aside from the Daily Telegraph, most of the other outlets that report this work without real commentary are tabloids, the Daily Express, the Daily Mail, and Fox News, for instance. The original research is by Nikhil Dhurandhar of the Pennington Biomedical Research Centre in Louisiana and colleagues and will also be highlighted on the supposedly reputable BBC Horizon TV program this evening in an episode that attempts to answer the question, Why are thin people not fat?

Dhurandhar’s answer to that question is that those people simply haven’t yet caught the obesity bug. Apparently, the “virus goes to the lungs and spreads through the body. It goes to various organs and tissues such as the liver, kidney, brain and fat tissue…causes fat cells to replicate.” Moreover, the team’s latest paper published 22nd January 2009 in the journal Obesity, suggests that fat cells, known as 3T3-L1 cells, accumulate fat molecules (lipids) faster than normal when a person is infected with AD-36.

None of this is new, however. Dhurandhar and colleagues have been searching for an obesity “bug” for at least a decade. They published preliminary results in 1996 and 1997 and since then have apparently tested their theory in chickens, mice and marmosets. My good friend Tabitha Powledge wrote about the theory back in 2000 for Salon). Dhurandhar’s work on the viral theory of obesity also hit the news in the summer of 2007 when he reported details to the 234th national meeting of the American Chemical Society. At the time, the studies revealed that almost a third of people with obesity were infected with the AD-36 virus compared to just over one in ten of lean individuals. But does the presence of such a virus truly imply some obesity is due to catching an infection?

Last year, R.L. Atkinson of the Obetech Obesity Research Center, in Richmond, Virginia, reviewed the field and concluded that, “a portion of the worldwide epidemic of obesity since 1980 could be due to infections with human adenoviruses” (Int J Pediatr Obes. 2008;3 Suppl 1:37-43). More recently, Dutch researchers Vincent van Ginneken, Laura Sitnyakowsky, and Jonathan Jeffery, discussed Dhurandhar’s work in the journal Medical Hypotheses and agree with the findings: “We postulate that AD-36 may be a contributing factor to the worldwide rising problem of obesity,” they say, “We suggest the extension of comparative virological studies between North America and Europe, and studies between discordant twins (both dizygous and monozygous).”

The key phrases are “could be due” and “may be a contributing factor”.

It is very unlikely that, even for a proportion of individuals, will the viral theory prove to be the cause of their obesity. This is not the straightforward case we saw with peptic ulcers and the discovery of Helicobacter pylori. Even the link between gum disease bacteria and heart problems, while tentative, is more substantial.

It’s ironic that this research should come to the fore (again) within a week of the European Union giving the go ahead for pharmacists to sell the obesity drug Orlistat over the counter (OTC).

It is possible that for a small number of people the best defence against obesity would be to avoid catching this so-called obesity bug? Best way to avoid bugs? Enjoy a good diet, do not overindulge, and get plenty of fresh air and exercise and perhaps follow the how to avoid colds and flu tips too. Good nutrition, moderation and exercise will cover you for the biggest obesity risk factors, boost your immune system to a degree, and help you avoid adenoviruses infection. It’s a well-padded strategy, I’d say.

Research Blogging IconMiloni A. Rathod, Pamela M. Rogers, Sharada D. Vangipuram, Emily J. McAllister, Nikhil V. Dhurandhar (2009). Adipogenic Cascade Can Be Induced Without Adipogenic Media by a Human Adenovirus Obesity DOI: 10.1038/oby.2008.630