1/DAY 1 of #OW2022 in the books.

My highlight 🧵:
2/The Effect of COVID on Clinical Research by Drs. Laughlin and Evans:
—Significant increase in new onset diabetes
—A lot of COVID specific research for years to come
—COVID19 disproportionately impacted female scientists, parents and caregivers #OW2022
3/Update on the Use of Genetic Information to Tailor Obesity Treatment by Dr. Kaplan:
—People respond uniquely to treatments
—Genetic info can be used to predict treatment response and risk for weight gain over one’s life
—Precision genetic research IS EARLY #OW2022
4/New Developments in Anti-Obesity Pharmacotherapy by @AniaJastreboff:
—We are entering a new era of obesity treatments
—Nutrient-stimulated hormone (NuSH)-based therapies will revolutionize obesity treatment and MEDICINE
**credit to Ania for NuSH. She owns it. 😂 #OW2022
5/ GIP/GLP1-RA changed the game!
- -
>95% lost a clinically significant amount of weight at 15 mg dose!!!🤯

**many more exciting studies investigating the health benefits of this combo! #OW2022
6/Before there was tirzepatide, there was semaglutide.

So many exciting options! #OW2022
7/The future of NuSH-based therapies is bright! An incredible number of NuSH-based molecules in development!!! #OW2022
8/Novel therapeutics treat OBESITY!
- -
They are not weight loss drugs. They treat the underlying pathophysiology‼️ It’s time to move beyond weight-centric conversations and start talking about disease treatment and health benefits! 👏🏻👏🏻#OW2022
9/Reducing Barriers to Treatment: Insurance Coverage by @ConscienHealth:

We’ve created a broken system of care for obesity founded on scientific ignorance and structural racism. #OW2022
10/Biases rationalized care denial…FORTUNATELY, things are changing!! People are noticing and policies are changing. #OW2022
11/Metabolically Healthy Obesity by Dr Klein:
—Metabolically healthy obesity exists
—With strict criteria, it likely represents 7-13% of PwO
—Adiposity-related complications associated with insulin pathophysiology #OW2022
12/Questioning dogma related to obesity complications:
—Adipose expansion or spillover hypothesis is not supported
—Adipocyte size dysfunction hypothesis is not supported
—Inflammatory hypothesis is not supported
👉🏻IS IT ALL ABOUT INSULIN? 🧐🤔 #OW2022

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More from @MichaelAlbertMD

Oct 17
My living 🧵 on the highlights from 'Causes of obesity: theories, conjectures and evidence.' #RScausesobesity
@royalsociety

Link: causes-obesity.royalsociety.org
DAY 1 -- From genetics to nutrient-dependent conditioned eating, variable mitochondrial energy efficiency, neuroendocrine feedback systems, and nutrient-sensing food liking, obesity is very clearly more complicated than CICO. Energy balance is a constraint, that is all.
GENETIC SUBTYPING OBESITY by Dr. Loos
👉Genes contribute to genetic susceptibility, but it is hard to say how much.
👉Obesity subtyping will require more than genetic information. #RScausesobesity ImageImageImage
Read 26 tweets
Sep 25
1/Bariatric surgery is often described as "barbaric" and "radical." I believe most of these polarizing opinions are derived from ignorance, so let's explore the science of bariatric surgery to better understand what is happening. 🧵
2/The greatest misconception is that surgery works through the "radical mutilation of the small intestine" or that wt loss is 2/2 to malabsorption.

In fact..."extensive small bowel resection is associated with a compensatory increase in food intake." Cosnes et al., 1990 h/t LK Image
3/What about after an intestinal bypass?
Bypass decreases food intake, which is associated with weight reduction and a new appetite steady-state (or defended fat mass).

Bray et al., AJCN 1976 Image
Read 11 tweets
Aug 30
While GLP1 therapies primarily exert their weight loss effect through a reduction in food intake, I’m increasingly convinced the most important mechanism behind the decrease in Ein is an attenuation of motivation-reward. I suspect homeostatic modulation plays a smaller role LT.
Mind you that this is speculative, but as my friend, @DavidMacklinMD often says, all roads lead to hedonic hunger. Do you WANT to eat? Are you compelled? Most people describe having better control, less interest, and a lack of compulsion while on GLP1s. It’s hedonics!
@MichaelMossC does a brilliant job describing the history behind the modern food environment and how it hijacks our biology in #Hooked. GLP1 therapies seem to turn off the feedback systems that drive a lot of the conditioned wanting & eating. Anticipatory drive improves as well.
Read 4 tweets
May 15
1/ NOT THE THREAD DIGITAL HEALTH WANTS TO READ, BUT THE THREAD IT NEEDS TO READ. Walk with me…🧵
2/ Many people know about the darling of digital health — Livongo. Arguably the highest profile digital health company ever due to an $18.5 billion dollar merger with Teladoc back in 2020. medcitynews.com/2020/10/telado…
3/ Livongo is/was known for its digital diabetes program. Unfortunately, the market never demanded that Livongo prove their program works. By the time Teladoc published an RCT, it turned out that the program was NO BETTER THAN USUAL CARE. ncbi.nlm.nih.gov/pmc/articles/P…
Read 13 tweets
May 14
Why is losing weight hard? Evolutionary adaptations to prevent starvation and death constrain weight loss. Conversely, hypothalamic inflammation can promote wt gain affecting the fxn of the homeostatic feedback system that constrains wt.
-Dr. Katherine Saunders #YWM2022Virtual
Weight Loss Goal? Not a number but a health improvement. With modern treatments, I would argue we should aim for 10% TBWL. #YWM2022Virtual
An example of a patient's AOM weight loss journey. Weight loss journeys should be realized over years as virtually no one gains all their weight in 3-6 months. Setting expectations early on is essential!! #YWM2022Virtual
Read 5 tweets
May 14
"If someone has myopia, you wouldn't tell them to try harder to see. You would not shame them for needing glasses." -Lee Kaplan

Yet, in obesity, we shame people for seeking evidence-based treatments and implore them "to eat less and move more" harder. #YWM2022Virtual
The legacy bias in bariatric surgery qualification #YWM2022Virtual
Weight stigma worsens the AEs of obesity. onlinelibrary.wiley.com/doi/full/10.10…
Read 5 tweets

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