Obesity management: Facts, fallacies and the future
Prior to considering pharmacotherapy or surgery, weight reduction can be achieved through dietary modification and management of meal habits, sleep hours and stress.
“Management of obesity through lifestyle and dietary modifications is important because obesity is a growing problem in Southeast Asia,” commented Dr Suwimol Sapwarobol of the Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalungkorn University, Thailand. [https://www.adb.org/sites/default/files/publication/320411/adbi-wp743.pdf]
“Current fads in weight reduction, such as high-fat [ketogenic] diet, the use of meal replacements and intermittent fasting, are very commonly practiced nowadays but are not very healthy or effective in the long run. Dietary supplements that promote weight loss are generally costly and involve commercially prepared combinations of various components, while intermittent fasting is unsustainable because it is against our natural tendency to have three meals per day,” Sapwarobol commented.
“Intermittent fasting, which involves 16 hours of fasting followed by eating during the 8 hours afterwards, is patterned after fasting during Ramadan. We all know for a fact that fasting during Ramadan is practiced by Muslims for around 30 days per year, which makes intermittent fasting difficult to maintain in the long term,” Sapwarobol explained.
An in vivo study demonstrated that time-restricted feeding results in consumption of equivalent calories vs ad libitum access to food. Time-restricted feeding, however, was shown to protect against obesity, hyperinsulinaemia, hepatic steatosis, and inflammation. The study results suggest that altering eating habits by time-restricted feeding can be an effective nonpharmacological strategy against obesity. [Cell Metab 2012;15:848-860]
“Taking note of sleeping habits is also important in managing obesity. Studies have shown that sleeping less than 6 hours or more than 8 hours per day is associated with low leptin and high ghrelin levels, with resultant obesity,” Sapwarobol noted. [PLoS Med 2004;1:e62; Sleep 2008;31:619-626]
“Stress also contributes to obesity by disturbing homeostasis of the hypothalamic-pituitary-adrenal axis, resulting in increased cortisol and adipose tissue accumulation,” she added.
“In terms of pharmacotherapeutic options, researchers are focusing on the development of new agents for the treatment of obesity. Most of the currently available weight reduction medications are either not approved in Southeast Asia or can cause serious adverse effects,” commented Sapwarobol.
A recent study showed that an orally administrable gut-coating formulation (LuCI) is capable of forming a transient physical barrier on the luminal surface of the gastrointestinal tract, emulating a critical part of bariatric surgery in a noninvasive way. According to authors of the study, this may be a good alternative to bariatric surgery, which is not widely accepted due to the permanent changes to the gastrointestinal anatomy associated with the procedure. [Nat Mater 2018, doi: 10.1038/s41563-018-0106-5]