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Editorial 2018 Current Opinion in Endocrinology

Apovian, Caroline M.a,b

Current Opinion in Endocrinology, Diabetes and Obesity: October 2018 - Volume 25 - Issue 5 - p 291
doi: 10.1097/MED.0000000000000437
OBESITY AND NUTRITION: Edited by Caroline M. Apovian

aDepartment of Medicine, Boston University School of Medicine

bDepartment of Medicine, Section of Endocrinology, Diabetes and Nutrition, Center for Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts, USA

Correspondence to Caroline M. Apovian, Department of Medicine, Boston University School of Medicine, Center for Nutrition and Weight Management, Boston Medical Center, Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston 02118, MA, USA. E-mail: Caroline.Apovian@bmc.org

This year's selection of topics for review spans current areas of obesity research and controversy. The cause of obesity is complex and multifactorial, encompassing genetics and environmental triggers among other factors. The interaction between the current obesogenic environment and the neurobiology of appetite and satiety are explored in the article by Uribe-Cerda, Morselli, Perez-Leighton (pp. 292–297), with a focus on how the body interacts with the environment to defend a higher body weight ‘set point’. Distinctions between the homeostatic and hedonic brain centres and identified as well as how novel food items in the general dietary environment could have complicated the interaction between the diet and the human body to produce the current obesity epidemic, and that the science of cravings to certain foods could hold the key to understanding that relationship (Apolzan et al., pp. 298–302).

The controversy of the best diet for health and weight maintenance is far from over and Gower et al. (pp. 303–309) explore the relationship between insulin and other glycaemic parameters, the glycaemic index of foods and weight maintenance based on the new studies that have come out in the past year (Gower). It may be true that once we establish the genetic underpinnings of risk of diabetes with obesity, a best diet based on these genetics can be prescribed and precision medicine can rise to take over the treatment of obesity with lifestyle as well as medications and surgery.

The development of nonalcoholic steatohepatitis (NASH) and its links to other comorbidities is an area of interest in establishing the initiating injury leading from excess adipose tissue to cardiovascular disease and type 2 diabetes mellitus. Investigation into the causes of NASH and how it links to inflammation at the adipose tissue level are important research questions that will lead to better treatments for obesity and metabolic dysfunction.

The role of physical activity in weight maintenance has always been emphasized, and the article by Spartano et al. (pp. 310–314) highlights the assessment of physical activity. Assessment of physical activity in a more detailed manner can certainly assist in defining its role in obesity management especially as our tools become more sophisticated.

The stigma of obesity is real and has improved only in the last year. There is a long way to go towards changing the mindset of the public and practitioners that obesity is indeed a disease and should be treated like other diseases such as hypertension and diabetes. The article by Phelan et al. (pp. 321–325) highlights the stigma of obesity in its most effective treatment, which is bariatric surgery. Even though bariatric surgery is known as a definitive treatment that can reduce weight and resolve diabetes, uptake in the USA and beyond has been slow and stagnant, such that 1% of patients eligible for this treatment in the USA receive a procedure per year. This is not the case with other diseases for which a surgical procedure can be life-saving. In addition, bariatric surgery has been shown to prolong life, in addition to resolving comorbidities and being cost-effective in the short and long term.

Obesity is a chronic relapsing disease for which treatments are evolving. In the next 10 years, the landscape will dramatically change for this disease and its treatment, as more and more effective and well tolerated tools are developed, and more physicians are trained to use them.

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