Beverly G. Tchang, MD Profile picture
May 3, 2023 6 tweets 3 min read Read on X
SO EXCITED FOR THIS

Dr. Rudy Leibel of @ColumbiaMed, everyone Image
Key quote:
"The RISK of developing obesity comes from genes."

Note that he doesn't say obesity itself is caused by genes. This would be an oversimplification!

2/ Image
You've seen this graph in several versions. This is what happens when genes set a risk level and the environment selects for it, resulting in a specific phenotype

3/ Image
The usual (known) monogene culprits. If you're studying for obesity boards, know these.

4/ Image
An excellent explanation of the genome wide polygenic risk score (GPRS). Using data of 2.1 million SNPs as markers for ↑weight or ↓weight, we can predict with SOME accuracy what the #weight differential will be at middle age, comparing highest and lowest risk cohorts

5/ Image
We're not just studying obesogenic genes but also those that protect against #obesity

science.org/doi/10.1126/sc…

6/6 Image

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Beverly G. Tchang, MD

Beverly G. Tchang, MD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @BevTchangMD

Feb 20
This is a beautiful study, answering many of the questions we clinicians and our patients are asking:

🤔What happens if I stop the GLP1?

Here's one punch line that we all could've guessed:
⭐️Exercise mitigates #weight regain when anti #obesity #medicine is stopped⭐️

But there's a lot more to observe here:

🧵1/Image
Here's the study method:

There's an "induction" phase 1 where #weightloss is caused by a low-calorie #diet over 8 weeks

Then everyone is randomized to 1 of these 4 groups

After 1 year, all of these interventions are stopped, and researchers just watch to see what happens to #weight

2/Image
Going back to this main figure, interesting things pop out:

👉We all slowly find our ways back to baseline weight regardless of #obesity treatment type
👉All groups (not just those with meds) rebounded to higher than what the weight was before the treatment phase, but greatest rebound was with liraglutide alone
👉Greatest additional weight loss was seen with combination lira+exercise

3/Image
Read 4 tweets
May 4, 2023
Packed room with Richard J. Auchus, MD, PhD, FACE on #adrenal #hypertension

- drugs can cause false negative screens but not false positive screens
- you can probably just treat with mineralocorticoid antagonist instead of going through the diagnostic steps

#AACE2023

1/ Image
This is such an excellent talk that I don’t have much commentary to add. Just sharing high yield slides!

2/ Image
3/ Image
Read 7 tweets
May 4, 2023
Interesting to see anti #obesity and #diabetes #medication management from the perspective of PharmDs

I'm always pro-collaborative care!

Here are some learning points and fact checks:

#AACE2023 #endocrine #endocrinology #pharmacology

1/
- "Tirzepatide is a dual agonist"
👉It ↑GIP activity but GLP-1R agonism is less than that of endogenous GLP-1
- "Hypoglycemia is not a concern if you're not on insulin"
👉Risk of hypoglycemia ~1.4% vs. 0.2% in placebo in SURMOUNT-1

nejm.org/doi/full/10.10…

2/
- "In this pt with uncontrolled #diabetes, A1c 7.4, we decreased glargine by 10% [when we started tirzepatide]"

👉 Not sure where the evidence is here, but the SURPASS-5 trial protocol reduced basal by 20% in participants with baseline A1c<8

jamanetwork.com/journals/jama/…

3/ Image
Read 5 tweets
May 4, 2023
@DrKarlNadolsky presents the overarching themes and calls to action of @TheAACE 's new #obesity guidelines:

#AACE2023
1/ Image
👉Reduce #WeightStigma
The bidirectional relationship between #weightbias and #obesity is unequivocal

I'm moved by the enormous consensus among multiple professional societies, MDs PhDs MPHs experts etc, on how important this is

@ConscienHealth @scottkahan
2/ Image
👉Refocus on the Psychological Health and Social Determinants of Health

3/ Image
Read 5 tweets
May 3, 2023
@alpanashuklamd takes the stage at the @ColumbiaMed @WeillCornell #Obesity Conference Image
@alpanashuklamd et al examined the effect of macronutrient sequencing (carbs first vs carbs last) in ppl with diabetes, prediabetes, or gestational diabetes

This study looked at those with prediabetes:
dom-pubs.onlinelibrary.wiley.com/doi/abs/10.111…

2/
Among those with prediabetes, we saw significant differences in glucose, insulin, ghrelin, and GLP-1 -- all favoring the "carbohydrates-last" food order

3/ ImageImageImageImage
Read 5 tweets
May 3, 2023
Always a pleasure to listen to @KevinH_PhD discuss his testing of hypotheses in contributors to #obesity
1/ Image
Many people remember his 14-day study of ultra processed foods (UPF) vs unprocessed foods (n=20) that found energy intake was ~500 kcal/d LESS with unprocessed meals

cell.com/cell-metabolis…
2/ Image
Details you might not know:
- Groups were not matched for type of sugar
- No hint of a difference in insulin sensitivity between groups based on OGTT results
- Groups were not matched for beverage amount (and implication for speed of food intake)

3/
Read 7 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(