1 00:00:03,040 --> 00:00:07,280 Speaker 1: Two studies out today. They draw the same disturbing conclusion. 2 00:00:07,680 --> 00:00:11,800 Speaker 1: Americans are not winning their battle against obesity. One study 3 00:00:11,840 --> 00:00:18,000 Speaker 1: found that obesity raised for adults actually obesity. It seems 4 00:00:18,040 --> 00:00:22,160 Speaker 1: like it should be easy to treat calories in, calories out, simple, 5 00:00:22,840 --> 00:00:26,239 Speaker 1: but it's actually incredibly difficult. And that goes both for 6 00:00:26,280 --> 00:00:28,080 Speaker 1: the people who are trying to slim down and the 7 00:00:28,160 --> 00:00:32,240 Speaker 1: drugmakers who have struggled to find treatments to help. Welcome 8 00:00:32,280 --> 00:00:36,280 Speaker 1: to Prognosis, a podcast about health, medical technology, and the 9 00:00:36,360 --> 00:00:40,040 Speaker 1: mind blowing innovation underway across the globe. I'm your host, 10 00:00:40,080 --> 00:00:46,520 Speaker 1: Michelle fay Cortes. More than seven hundred million people around 11 00:00:46,560 --> 00:00:49,360 Speaker 1: the world are considered obese. If you're five ft eight 12 00:00:49,360 --> 00:00:52,440 Speaker 1: inches tall and way more than two hundred pounds, that's obese. 13 00:00:53,200 --> 00:00:55,520 Speaker 1: If you're shorter, say five ft four inches and more 14 00:00:55,560 --> 00:00:59,480 Speaker 1: than a hundred seventy five pounds, that's also obese. It's 15 00:00:59,520 --> 00:01:02,040 Speaker 1: about much more than how you look. It increases the 16 00:01:02,120 --> 00:01:06,160 Speaker 1: risk of diabetes, heart disease, and cancer, and it's expensive. 17 00:01:09,200 --> 00:01:11,280 Speaker 1: The health costs in the US alone top a hundred 18 00:01:11,319 --> 00:01:15,640 Speaker 1: and fifty billion dollars a year. If drug makers could 19 00:01:15,680 --> 00:01:17,760 Speaker 1: find a way to help people achieve safe and significant 20 00:01:17,800 --> 00:01:21,839 Speaker 1: weight loss, it would spur profound benefits, not to mention profits. 21 00:01:22,680 --> 00:01:25,800 Speaker 1: It hasn't happened yet. Every few years there is a 22 00:01:25,840 --> 00:01:29,080 Speaker 1: new hyped drug that seems to show up with outsized expectations, 23 00:01:29,560 --> 00:01:33,440 Speaker 1: but they've generally turned out to be disappointments. Some believe 24 00:01:33,480 --> 00:01:38,440 Speaker 1: that's about to change. Most people who succeed in losing 25 00:01:38,440 --> 00:01:41,640 Speaker 1: weight quickly gain it right back. Our bodies are programmed 26 00:01:41,680 --> 00:01:44,800 Speaker 1: to do that. Now, a promising new approach in the 27 00:01:44,880 --> 00:01:47,760 Speaker 1: lab aims to both suppress appetite and switch off the 28 00:01:47,840 --> 00:01:50,720 Speaker 1: signal that tells your slim down body to conserve energy. 29 00:01:51,400 --> 00:01:53,760 Speaker 1: That may be just the key to keeping those pounds off. 30 00:01:55,000 --> 00:02:00,800 Speaker 1: Here's Bloomberg's James Peyton with the story. To understand the 31 00:02:00,840 --> 00:02:04,240 Speaker 1: obesity crisis today, we need to start with some history. 32 00:02:04,880 --> 00:02:07,720 Speaker 1: Ancient history, like all the way back to the Stone 33 00:02:07,760 --> 00:02:14,600 Speaker 1: Age history. So let's rewind tens of thousands of years. 34 00:02:15,480 --> 00:02:18,760 Speaker 1: Humans are hunters and gatherers, and in order to survive 35 00:02:18,880 --> 00:02:21,640 Speaker 1: the cycles of feast and famine, they needed to consume 36 00:02:21,800 --> 00:02:26,320 Speaker 1: extra calories and hold onto them. Mad's CROs Guard Thompson, 37 00:02:26,480 --> 00:02:28,959 Speaker 1: the chief science Officer and Nova and orders the Danish 38 00:02:29,000 --> 00:02:32,800 Speaker 1: drug company puts it like this, so so we would 39 00:02:32,840 --> 00:02:34,840 Speaker 1: simply have a situation wherein the one half of the 40 00:02:34,919 --> 00:02:37,960 Speaker 1: year we would be really good at putting on a 41 00:02:38,040 --> 00:02:40,640 Speaker 1: lot of weight by eating a lot of food, and 42 00:02:40,680 --> 00:02:42,960 Speaker 1: then in the other half, the cold half of the year, 43 00:02:43,040 --> 00:02:46,200 Speaker 1: where the buffalo were no longer there to be hunted 44 00:02:46,240 --> 00:02:48,839 Speaker 1: and there were no vegetables and so on, we would 45 00:02:48,880 --> 00:02:51,800 Speaker 1: have a situation where where people would typically go into 46 00:02:51,880 --> 00:02:56,960 Speaker 1: their caves and basically just try to survive quite quite honestly, 47 00:02:57,040 --> 00:02:59,840 Speaker 1: and burn off as little energy as possible so that 48 00:03:00,000 --> 00:03:02,799 Speaker 1: they were still alive when the next spring would rise. 49 00:03:03,280 --> 00:03:06,000 Speaker 1: So those who were best at conserving energy and storing 50 00:03:06,040 --> 00:03:08,720 Speaker 1: fat endured the harsh winters and went on to reproduce. 51 00:03:09,160 --> 00:03:12,440 Speaker 1: Those famine beating genes are a problem for us today. 52 00:03:12,639 --> 00:03:15,959 Speaker 1: Matt says. Our unhealthy habits, combined with our genetic tendency 53 00:03:16,040 --> 00:03:18,840 Speaker 1: to hang onto calories, add up to a double whammy 54 00:03:18,960 --> 00:03:22,640 Speaker 1: a weight gain. Nowadays, we are living in a constant 55 00:03:23,000 --> 00:03:26,960 Speaker 1: feast situation. We're eating, eating, eating, and we're not exercising much. 56 00:03:27,440 --> 00:03:30,400 Speaker 1: So those very genes that were good for our survival, 57 00:03:30,840 --> 00:03:34,040 Speaker 1: that made those people survive with longer lives and have 58 00:03:34,200 --> 00:03:36,440 Speaker 1: more babies in the old days because they were good 59 00:03:36,480 --> 00:03:39,760 Speaker 1: at preserving energy and building fat stores in their bodies. 60 00:03:40,240 --> 00:03:43,400 Speaker 1: They are now at risk of obesity, type two diabetes, 61 00:03:43,440 --> 00:03:46,520 Speaker 1: and other conditions. So that's where we are now. Our 62 00:03:46,560 --> 00:03:50,080 Speaker 1: ancestors relied on storing fat to survive, but our current 63 00:03:50,120 --> 00:03:53,600 Speaker 1: lifestyle blows that out of proportion. It took society a 64 00:03:53,640 --> 00:03:57,200 Speaker 1: while to realize what was happening, though it's only within 65 00:03:57,240 --> 00:04:00,560 Speaker 1: the last few decades that scientists have come to understand 66 00:04:00,640 --> 00:04:05,400 Speaker 1: the biology behind obesity. Years ago, an increase in body 67 00:04:05,440 --> 00:04:10,480 Speaker 1: weight or obesity wasn't considered to be a disease. We 68 00:04:10,560 --> 00:04:16,520 Speaker 1: really didn't understand anything about weight regulating mechanisms. It was 69 00:04:16,560 --> 00:04:20,599 Speaker 1: thought to be purely a disorder of of willpower, that 70 00:04:20,800 --> 00:04:26,159 Speaker 1: people with obesity were lazy, they couldn't control themselves, and 71 00:04:26,279 --> 00:04:31,560 Speaker 1: therefore it wasn't something that was worthy of being treated 72 00:04:31,600 --> 00:04:36,599 Speaker 1: by a physician. Another important point is that the relationship 73 00:04:37,040 --> 00:04:41,680 Speaker 1: between obesity and other illnesses like diabetes, high blood pressure, 74 00:04:41,760 --> 00:04:46,760 Speaker 1: heart disease, sleep disorders was not understood at all. That's 75 00:04:46,839 --> 00:04:50,240 Speaker 1: Lewis Roney, a doctor and obesity specialist at wild Cornell 76 00:04:50,279 --> 00:04:53,000 Speaker 1: Medicine in New York. He started a weight Control Center. 77 00:04:53,040 --> 00:04:58,240 Speaker 1: There Now, groups such as the American Medical Association classified 78 00:04:58,240 --> 00:05:01,320 Speaker 1: obesity as a disease. The centers for Disease Control and 79 00:05:01,360 --> 00:05:04,560 Speaker 1: Prevention acknowledge that genes are a factor based on the 80 00:05:04,600 --> 00:05:07,919 Speaker 1: different ways people respond to an environment of high calorie food. 81 00:05:08,839 --> 00:05:12,640 Speaker 1: Although obesity is still often seen as a self inflicted condition, 82 00:05:13,080 --> 00:05:16,919 Speaker 1: there's a growing realization that its causes are more complex. 83 00:05:18,200 --> 00:05:21,599 Speaker 1: Louis is especially fascinated by how hard it is for 84 00:05:21,640 --> 00:05:24,799 Speaker 1: people to lose weight and keep it off. He suspects 85 00:05:24,920 --> 00:05:28,080 Speaker 1: that's because consuming too much fatty food can damage the 86 00:05:28,160 --> 00:05:30,679 Speaker 1: nerves that tell the brain how much fat is stored. 87 00:05:31,279 --> 00:05:36,359 Speaker 1: Faulty signals can trick the body into erroneously storing unnecessary amounts. 88 00:05:37,120 --> 00:05:40,360 Speaker 1: That explains why trying to shed pounds can be agonizing 89 00:05:40,400 --> 00:05:44,039 Speaker 1: for some patients. It's very frustrating for people trying to 90 00:05:44,120 --> 00:05:47,120 Speaker 1: lose weight. If if and I would challenge anyone who 91 00:05:47,160 --> 00:05:50,320 Speaker 1: doesn't think so to try to lose weight. You get hungry, 92 00:05:50,560 --> 00:05:52,400 Speaker 1: you think about food. You may wake up in the 93 00:05:52,400 --> 00:05:55,039 Speaker 1: middle of the night thinking about food. And in the 94 00:05:55,080 --> 00:05:57,640 Speaker 1: past people thought they were going crazy, that there was 95 00:05:57,720 --> 00:06:01,480 Speaker 1: something wrong with them, but now we know it's the 96 00:06:01,520 --> 00:06:07,280 Speaker 1: result of these physical changes in signaling that caused us 97 00:06:07,279 --> 00:06:10,560 Speaker 1: to occur. Six years ago, not a single state in 98 00:06:10,600 --> 00:06:14,080 Speaker 1: the US had an adult obesity rate above thirty that's 99 00:06:14,120 --> 00:06:18,200 Speaker 1: according to the CDC. Recent data show that seven states 100 00:06:18,400 --> 00:06:22,120 Speaker 1: have since moved into that danger zone. One is Louisiana, 101 00:06:22,360 --> 00:06:25,359 Speaker 1: where there's abundant fatty food, a lack of physical activity, 102 00:06:25,720 --> 00:06:29,400 Speaker 1: and all the other usual culprits. And now more regions 103 00:06:29,440 --> 00:06:32,800 Speaker 1: around the globe are starting to look like Louisiana. Eric 104 00:06:32,839 --> 00:06:35,960 Speaker 1: Rabson is an obesity expert who works at Pennington Biomedical 105 00:06:36,000 --> 00:06:40,000 Speaker 1: Research Center in Baton Rouge, the state's capital. Despite the warnings, 106 00:06:40,200 --> 00:06:43,240 Speaker 1: he says, many people simply don't comprehend the gravity of 107 00:06:43,279 --> 00:06:47,120 Speaker 1: the situation. It's like global warming. You know, what does 108 00:06:47,160 --> 00:06:50,440 Speaker 1: it take to be concerned? I mean, it takes these 109 00:06:50,560 --> 00:06:54,119 Speaker 1: climate disasters and all that, and we're going to face 110 00:06:54,160 --> 00:06:59,120 Speaker 1: the same when it comes to public health. Eric is 111 00:06:59,160 --> 00:07:02,159 Speaker 1: a former research or at pharma company Eli Lily, and 112 00:07:02,200 --> 00:07:04,920 Speaker 1: so he's well aware of the industry's long battle against 113 00:07:04,920 --> 00:07:07,800 Speaker 1: the condition. It's been a humbling experience for many of 114 00:07:07,839 --> 00:07:12,280 Speaker 1: the people pursuing a solution. The whole treatment of obesity 115 00:07:12,360 --> 00:07:16,640 Speaker 1: has been very disappointing, and this has been a train 116 00:07:16,760 --> 00:07:21,040 Speaker 1: wreck of failures. UH, and it started, you know, in 117 00:07:21,080 --> 00:07:26,200 Speaker 1: the nineteen thirties. Early products to tackle obesity included laxatives, 118 00:07:26,200 --> 00:07:29,120 Speaker 1: thyroid hormones and fetaments, and other drugs that came with 119 00:07:29,160 --> 00:07:33,800 Speaker 1: severe side effects. Similar approaches continued through the nineteen sixties. 120 00:07:34,520 --> 00:07:37,640 Speaker 1: Many of these products were pulled from the market. Then 121 00:07:37,960 --> 00:07:41,520 Speaker 1: in the nineteen nineties, researchers thought they had finally found 122 00:07:41,520 --> 00:07:48,960 Speaker 1: an answer. It was called fed fen, a weight loss 123 00:07:48,960 --> 00:07:52,800 Speaker 1: treatment that combined fin fleuramine, a nineteen seventies era diet drug, 124 00:07:53,240 --> 00:07:58,280 Speaker 1: with fentamine and appetite suppressant. The treatment became a huge success, 125 00:07:58,880 --> 00:08:03,520 Speaker 1: but the frenzy soon turned into a fiasco. Very early 126 00:08:04,240 --> 00:08:08,320 Speaker 1: we discovered that fan frew i mean, was causing heart 127 00:08:08,400 --> 00:08:14,440 Speaker 1: valve problems, and this was also withdrawn from the market. Personally, 128 00:08:14,440 --> 00:08:17,920 Speaker 1: I went to Eli Lily in the nineties late nineties 129 00:08:17,960 --> 00:08:21,880 Speaker 1: to work on obesiti drugs, and UH, at that time 130 00:08:21,920 --> 00:08:25,600 Speaker 1: there is a real hope that new drugs we're going 131 00:08:25,680 --> 00:08:30,520 Speaker 1: to target very specific receptors and being very efficacious, but 132 00:08:30,600 --> 00:08:33,720 Speaker 1: it didn't pan out. A high point that same decade 133 00:08:33,800 --> 00:08:37,120 Speaker 1: was the discovery of leptin, a hormone tied to hunger 134 00:08:37,600 --> 00:08:41,120 Speaker 1: When people at fat, leptin levels increase, telling the brain 135 00:08:41,160 --> 00:08:43,840 Speaker 1: that the body has had enough to eat. But leptin 136 00:08:44,040 --> 00:08:47,280 Speaker 1: also failed to live up to expectations. When researchers found 137 00:08:47,440 --> 00:08:50,640 Speaker 1: that many of these people were resistant to its effects, 138 00:08:51,559 --> 00:08:57,120 Speaker 1: several more dead ends followed. So why do scientists and 139 00:08:57,120 --> 00:09:01,400 Speaker 1: farming companies keep trying? Quite simply because an effective weight 140 00:09:01,440 --> 00:09:04,640 Speaker 1: loss drug would be among the holy Grail of meds, 141 00:09:04,760 --> 00:09:08,880 Speaker 1: right up there with treatments for cholesterol and arthritis. Novos 142 00:09:08,920 --> 00:09:11,280 Speaker 1: focused on a weight loss treatment dates back to the 143 00:09:11,360 --> 00:09:15,640 Speaker 1: nineteen nineties, so slightly more than twenty years ago. We 144 00:09:15,679 --> 00:09:18,520 Speaker 1: had a very philosophical discussion in the management of the 145 00:09:18,520 --> 00:09:24,120 Speaker 1: company whether obesity was a disease or a a lifestyle 146 00:09:24,200 --> 00:09:27,200 Speaker 1: driven condition, and we actually came to the conclusion that 147 00:09:27,240 --> 00:09:32,000 Speaker 1: it was not only a chronic diseased that was genetically predisposed, 148 00:09:32,200 --> 00:09:36,520 Speaker 1: it was also the precursor stage to diabetes. Lately, the 149 00:09:36,600 --> 00:09:38,760 Speaker 1: focus is on a hormone that plays a role in 150 00:09:38,800 --> 00:09:42,480 Speaker 1: regulating blood sugar and body weight. It's called glucagon like 151 00:09:42,600 --> 00:09:45,400 Speaker 1: peptide or g lp one, and it was first used 152 00:09:45,480 --> 00:09:49,559 Speaker 1: to treat diabetes. No Vo is now repurposing its new 153 00:09:49,600 --> 00:09:52,400 Speaker 1: diabetes drugs and relying on a synthetic version of the 154 00:09:52,440 --> 00:09:56,439 Speaker 1: hormone to mimic what's produced naturally in the body. This 155 00:09:56,480 --> 00:09:58,800 Speaker 1: work is at the core of the company's strategy to 156 00:09:58,840 --> 00:10:03,280 Speaker 1: develop a more effect of obesity treatment. The company developed 157 00:10:03,280 --> 00:10:06,960 Speaker 1: an injectable g LP one drug called Sassenda, designed to 158 00:10:07,040 --> 00:10:10,040 Speaker 1: make you feel less hungry. It's one of several available 159 00:10:10,040 --> 00:10:12,160 Speaker 1: today that deliver weight loss in the five to ten 160 00:10:12,200 --> 00:10:16,000 Speaker 1: percent range. But these drugs are expensive and the results 161 00:10:16,040 --> 00:10:19,520 Speaker 1: tend to stall after several months, prompting some patients to 162 00:10:19,559 --> 00:10:23,840 Speaker 1: stop taking them. Many insurers, employers, and governments are reluctant 163 00:10:23,880 --> 00:10:28,199 Speaker 1: to cover the cost, so no Vo is pushing the boundaries. 164 00:10:28,679 --> 00:10:31,320 Speaker 1: Its researchers are testing a next generation drug in the 165 00:10:31,400 --> 00:10:34,760 Speaker 1: same class, with hopes of getting closer to delivering fifteen 166 00:10:34,840 --> 00:10:38,280 Speaker 1: percent weight loss that's considered a kind of magical level 167 00:10:38,559 --> 00:10:40,960 Speaker 1: the drug companies figure they need to reach to really 168 00:10:40,960 --> 00:10:44,240 Speaker 1: open up the market. The company has just started a 169 00:10:44,320 --> 00:10:47,600 Speaker 1: late stage trial to evaluate the treatment's heart benefits in 170 00:10:47,640 --> 00:10:51,240 Speaker 1: more than seventeen thousand people. It's the largest study in 171 00:10:51,280 --> 00:10:55,120 Speaker 1: the company's history. Now, if Nova can show the medicine 172 00:10:55,120 --> 00:10:58,640 Speaker 1: extends lives, reducing heart attacks and strokes on top of 173 00:10:58,720 --> 00:11:01,559 Speaker 1: slashing weight will no doubt bolster the case for the 174 00:11:01,640 --> 00:11:05,400 Speaker 1: drug and help the company win over skeptics. But that 175 00:11:05,440 --> 00:11:09,160 Speaker 1: would be just step one. No Vo has bigger plans 176 00:11:09,160 --> 00:11:13,200 Speaker 1: in mind. It's betting on combinations of complementary hormones to 177 00:11:13,240 --> 00:11:15,920 Speaker 1: try to create a super drug that will overcome the 178 00:11:15,920 --> 00:11:19,079 Speaker 1: body's tendency to put the pounds back on after weight loss, 179 00:11:19,840 --> 00:11:26,640 Speaker 1: or in other words, fight our caveman like tendencies. It's 180 00:11:26,640 --> 00:11:31,240 Speaker 1: a radical approach and ambitious weight loss north of tent 181 00:11:31,640 --> 00:11:35,120 Speaker 1: or even more. To get there. No those scientists will 182 00:11:35,160 --> 00:11:38,400 Speaker 1: have to attain results comparable to gastric bypass and other 183 00:11:38,400 --> 00:11:41,800 Speaker 1: weight loss surgeries, but the idea is that the treatments 184 00:11:41,880 --> 00:11:44,880 Speaker 1: won't have the risks and complications such as blood clots 185 00:11:44,920 --> 00:11:49,520 Speaker 1: and infections that can occur with those major operations. No 186 00:11:49,679 --> 00:11:51,920 Speaker 1: Vo has been able to extend the impact of an 187 00:11:51,920 --> 00:11:56,080 Speaker 1: appetite regulating hormone called ammlin by boosting its half life. 188 00:11:56,600 --> 00:11:59,839 Speaker 1: It was just a few minutes, now it's about one week. 189 00:12:00,760 --> 00:12:03,160 Speaker 1: Early studies suggest that increasing the amount of time it 190 00:12:03,240 --> 00:12:06,040 Speaker 1: circulates in the body could enable weight loss of roughly 191 00:12:06,120 --> 00:12:10,040 Speaker 1: one percent every seven days. And the good news is 192 00:12:10,040 --> 00:12:12,520 Speaker 1: that this is an effect that seems to be additive 193 00:12:12,520 --> 00:12:14,719 Speaker 1: to what we know from GLP one. So if you 194 00:12:14,760 --> 00:12:18,679 Speaker 1: actually add the two compounds together, you get twice as 195 00:12:18,760 --> 00:12:21,360 Speaker 1: much if you can see twice as much bank for 196 00:12:21,360 --> 00:12:23,640 Speaker 1: the box, so to speak. This is often what human 197 00:12:23,640 --> 00:12:27,679 Speaker 1: beings need because if you don't deal the system and 198 00:12:27,800 --> 00:12:30,200 Speaker 1: one to blow, so to speak, then there will be 199 00:12:30,240 --> 00:12:34,400 Speaker 1: compensation compensatory mechanisms that are kicking in to try to 200 00:12:34,480 --> 00:12:37,920 Speaker 1: regain the body weight. So we believe to real large 201 00:12:37,920 --> 00:12:40,920 Speaker 1: extent that combination therapist will be a good way forward 202 00:12:40,960 --> 00:12:44,520 Speaker 1: for people with the cbobt ma's. This team is working 203 00:12:44,600 --> 00:12:47,079 Speaker 1: hard to come up with drug combinations that boost the 204 00:12:47,120 --> 00:12:49,760 Speaker 1: amount of energy the body burns while it's the same 205 00:12:50,040 --> 00:12:56,880 Speaker 1: time suppressing appetite that takes us to mitochondria. Mitochondria, you 206 00:12:57,000 --> 00:12:59,800 Speaker 1: may recall from your high school biology class, are those 207 00:13:00,000 --> 00:13:04,000 Speaker 1: any structures inside cells that, among other things, converted sugars 208 00:13:04,080 --> 00:13:08,120 Speaker 1: into energy. Nov researchers are looking at ways to stimulate 209 00:13:08,280 --> 00:13:11,400 Speaker 1: energy expenditure in a way that doesn't affect heart rate 210 00:13:11,440 --> 00:13:14,679 Speaker 1: and blood pressure, a feat that others have tried but 211 00:13:14,920 --> 00:13:19,080 Speaker 1: failed to pull off safely. Eric, the researcher in Louisiana 212 00:13:19,320 --> 00:13:23,160 Speaker 1: recognizes how beneficial that could be. He studied contestants from 213 00:13:23,160 --> 00:13:27,199 Speaker 1: the reality TV show The Biggest Loser. Previously on The 214 00:13:27,280 --> 00:13:30,360 Speaker 1: Biggest Loser at the Way in the red en Blute 215 00:13:30,640 --> 00:13:33,559 Speaker 1: had disappointing numbers. We have to reassess what is going 216 00:13:33,640 --> 00:13:40,120 Speaker 1: on because sometimes gotta changshing. The contestants metabolism slowed dramatically 217 00:13:40,200 --> 00:13:42,880 Speaker 1: after shedding significant amounts of weight, and many of the 218 00:13:42,880 --> 00:13:45,840 Speaker 1: Biggest Losers regained a lot of the weight they had dropped. 219 00:13:46,920 --> 00:13:50,240 Speaker 1: Eric realized the importance of somehow keeping energy expenditure up. 220 00:13:50,400 --> 00:13:53,679 Speaker 1: After someone sheds pounds, Let's say you lose ten percent 221 00:13:53,760 --> 00:13:57,320 Speaker 1: of your weight, you have a decrease in your resting 222 00:13:57,400 --> 00:14:00,400 Speaker 1: metabolic rate, which is going to be more than ten percent. 223 00:14:00,920 --> 00:14:04,000 Speaker 1: We did studies in the Biggest Loser who lose up 224 00:14:04,120 --> 00:14:07,560 Speaker 1: to half of their body weight, and these people become 225 00:14:07,800 --> 00:14:12,520 Speaker 1: tremendously energy efficient. In other words, they have a very 226 00:14:12,720 --> 00:14:16,079 Speaker 1: very low metabolic create. And I believe that in the 227 00:14:16,200 --> 00:14:22,280 Speaker 1: first phase of treatment in appetite suppression, drug is the 228 00:14:22,680 --> 00:14:28,200 Speaker 1: most adequate way to go. But after reaching a plateau 229 00:14:28,960 --> 00:14:33,000 Speaker 1: let's say five, ten or even fifteen percent weight loss, 230 00:14:33,440 --> 00:14:36,320 Speaker 1: you need to introduce something else which is going to 231 00:14:36,440 --> 00:14:41,560 Speaker 1: boost up your energy metabolism. One mixture of drugs won't 232 00:14:41,600 --> 00:14:45,040 Speaker 1: work for everyone, and scientists are seeking to understand why 233 00:14:45,920 --> 00:14:49,240 Speaker 1: Eric is optimistic. They will thread the needle. I have 234 00:14:49,440 --> 00:14:52,720 Speaker 1: heard many times, you know, within ten years will have 235 00:14:52,920 --> 00:14:58,000 Speaker 1: this magic pill or whatever. And and now I've I'm 236 00:14:58,120 --> 00:15:01,040 Speaker 1: wise enough not to say that at but I know 237 00:15:01,240 --> 00:15:05,720 Speaker 1: we are making progress, and these progress are important, and 238 00:15:05,880 --> 00:15:09,479 Speaker 1: I think that eventually, yes, we will be more successful 239 00:15:09,600 --> 00:15:13,520 Speaker 1: in treating people. No Vo isn't the only entity trying 240 00:15:13,560 --> 00:15:16,280 Speaker 1: to better understand that rate at which the body converts 241 00:15:16,320 --> 00:15:19,760 Speaker 1: food to energy. Scientists at a number of universities are 242 00:15:19,840 --> 00:15:24,480 Speaker 1: finding answers that reside inside the brain. Rachel Lippert was 243 00:15:24,560 --> 00:15:27,520 Speaker 1: previously involved in studies in mice at Vanderbilt and the 244 00:15:27,640 --> 00:15:30,640 Speaker 1: University of Michigan. She studied the function of a brain 245 00:15:30,760 --> 00:15:33,520 Speaker 1: protein called m C three R and how it helps 246 00:15:33,560 --> 00:15:36,040 Speaker 1: balance the amount of energy we take in and use. 247 00:15:36,880 --> 00:15:40,320 Speaker 1: The workings of m C three R have long baffled scientists, 248 00:15:40,880 --> 00:15:43,120 Speaker 1: and a better understanding of the protein may open up 249 00:15:43,160 --> 00:15:46,960 Speaker 1: a new path towards obesity drugs. Rachel now works at 250 00:15:47,000 --> 00:15:50,920 Speaker 1: the Max Planck Institute for Metabolism Research, in Germany. She 251 00:15:51,040 --> 00:15:53,840 Speaker 1: says epigenetics, the study of how genes are turned on 252 00:15:54,080 --> 00:15:56,840 Speaker 1: or off by factors in the environment, are also providing 253 00:15:56,880 --> 00:16:00,400 Speaker 1: new clues. There's so many layers of complex city that 254 00:16:00,480 --> 00:16:04,359 Speaker 1: have been discovered recently because of all of the advancement 255 00:16:04,440 --> 00:16:08,520 Speaker 1: and genetic tools that we have in the basic research laboratories. 256 00:16:09,120 --> 00:16:12,280 Speaker 1: That is really just kind of it's like peeling back 257 00:16:12,400 --> 00:16:14,960 Speaker 1: layers of an onion in terms of the levels of 258 00:16:15,040 --> 00:16:18,600 Speaker 1: complexity that we deal with in the basic research. Because 259 00:16:18,680 --> 00:16:22,720 Speaker 1: obesity leads to so many other serious diseases, the potential 260 00:16:22,840 --> 00:16:25,840 Speaker 1: impact from an ultra effective drug could have a big 261 00:16:26,040 --> 00:16:29,120 Speaker 1: ripple effect on patients and help governments all over the 262 00:16:29,200 --> 00:16:32,560 Speaker 1: world deal with the obesity crisis. So just imagine that 263 00:16:32,680 --> 00:16:35,440 Speaker 1: you take the medicine, you lose the weight, and you 264 00:16:35,520 --> 00:16:38,000 Speaker 1: don't have to take something for your pre diabetes or 265 00:16:38,080 --> 00:16:41,480 Speaker 1: your blood pressure or your cholesterol, and your sleep disorder 266 00:16:41,560 --> 00:16:45,960 Speaker 1: gets better. You know, that is the promise of obesity treatment. 267 00:16:46,560 --> 00:16:50,000 Speaker 1: I joke around with our younger doctors and tell them 268 00:16:50,080 --> 00:16:53,520 Speaker 1: it's like one of those late night infomercials where you 269 00:16:53,600 --> 00:16:58,840 Speaker 1: get the miracle knives, and you get the friar and 270 00:16:59,520 --> 00:17:02,320 Speaker 1: you get every thing thrown into one. When you treat 271 00:17:02,360 --> 00:17:06,000 Speaker 1: the obesity, you get all the health benefits. Still, there 272 00:17:06,040 --> 00:17:09,240 Speaker 1: are plenty of naysayers out there. They say the focus 273 00:17:09,320 --> 00:17:12,280 Speaker 1: should be on preventing obesity, not treating it, and they 274 00:17:12,400 --> 00:17:15,280 Speaker 1: question whether drugs should be part of the strategy at all. 275 00:17:16,240 --> 00:17:19,359 Speaker 1: Others want to tax products such as sodas to really 276 00:17:19,440 --> 00:17:23,000 Speaker 1: make a difference. Lewis says he's even gotten pushed back 277 00:17:23,080 --> 00:17:26,719 Speaker 1: from some of his own colleagues. As many resources as 278 00:17:26,760 --> 00:17:31,280 Speaker 1: we can we should apply to preventing obesity, but the 279 00:17:31,400 --> 00:17:37,200 Speaker 1: fact is that once obesity is established, using strategies to 280 00:17:37,359 --> 00:17:41,960 Speaker 1: prevent obesity don't work. They're not enough. It's kind of 281 00:17:42,040 --> 00:17:47,760 Speaker 1: like someone's diagnosed with lung cancer and you tell them, Okay, 282 00:17:48,359 --> 00:17:50,679 Speaker 1: you have lung cancer now, and your treatment is going 283 00:17:50,760 --> 00:17:55,159 Speaker 1: to be to stop smoking. Right. That sounds absurd, but 284 00:17:55,680 --> 00:18:00,679 Speaker 1: trying to prevent the disease once it's established doesn't usually 285 00:18:00,960 --> 00:18:05,960 Speaker 1: work as a therapy because something physical has changed. For now, 286 00:18:06,480 --> 00:18:11,240 Speaker 1: few doctors and patients are relying on medicines to treat obesity. Diet, exercise, 287 00:18:11,280 --> 00:18:14,480 Speaker 1: and other changes are vital, but if those measures don't work, 288 00:18:15,000 --> 00:18:17,680 Speaker 1: some people should be treated with drugs before their situation 289 00:18:17,760 --> 00:18:22,800 Speaker 1: gets worse before they develop diabetes and other complications. That's 290 00:18:22,840 --> 00:18:26,560 Speaker 1: the view of experts, including Lewis. He believes more patients 291 00:18:26,560 --> 00:18:28,760 Speaker 1: will get drugs in the future as the science and 292 00:18:28,800 --> 00:18:32,960 Speaker 1: awareness among physicians accelerates. An Obesity board set up seven 293 00:18:33,040 --> 00:18:35,679 Speaker 1: years ago in the US certified more than six hundred 294 00:18:35,760 --> 00:18:38,960 Speaker 1: doctors in the past year. He says, that's comparable to 295 00:18:39,040 --> 00:18:41,560 Speaker 1: the branch of medicine focused on the digestive system and 296 00:18:41,640 --> 00:18:50,760 Speaker 1: its disorders. So these drugs are playing a limited role 297 00:18:50,880 --> 00:18:53,400 Speaker 1: right now. Are we at any kind of turning point? 298 00:18:53,480 --> 00:18:55,200 Speaker 1: Do you think when it comes to the treatment of 299 00:18:55,240 --> 00:18:59,159 Speaker 1: obesity with medicine. I can't tell you when the turning 300 00:18:59,359 --> 00:19:06,760 Speaker 1: point will come where there's widespread adoption of medical therapies 301 00:19:06,840 --> 00:19:11,280 Speaker 1: for obesity, but I strongly believe that it is coming, 302 00:19:12,240 --> 00:19:16,040 Speaker 1: and I'm not sure we're going to be able to 303 00:19:17,760 --> 00:19:23,560 Speaker 1: change the course of the obesity epidemic and the health 304 00:19:23,800 --> 00:19:30,159 Speaker 1: complications through behavioral management alone. While it's hard to know 305 00:19:30,520 --> 00:19:34,160 Speaker 1: when that might happen, researchers at least have a roadmap. 306 00:19:34,800 --> 00:19:38,399 Speaker 1: Two decades ago, Matt says type two diabetes was as 307 00:19:38,480 --> 00:19:43,240 Speaker 1: misunderstood as obesity is today, but that changed when scientists 308 00:19:43,240 --> 00:19:46,520 Speaker 1: showed controlling blood sugar levels would extend lives and lower 309 00:19:46,600 --> 00:19:49,520 Speaker 1: hearts and stroke risks. I do believe that we are 310 00:19:49,560 --> 00:19:52,960 Speaker 1: now standing at the inflection point where obesity in the 311 00:19:53,040 --> 00:19:56,200 Speaker 1: next few years to come will undergo the same you 312 00:19:56,280 --> 00:20:00,800 Speaker 1: can say, mitamaphosis from being considered a life style disorder 313 00:20:01,000 --> 00:20:03,760 Speaker 1: to being considered a serious chronic disease. And part of 314 00:20:03,840 --> 00:20:06,200 Speaker 1: that job is for us to do the studies I'm 315 00:20:06,240 --> 00:20:09,760 Speaker 1: discussing and and proving to society, just like we did 316 00:20:09,880 --> 00:20:11,960 Speaker 1: with diabetes twenty years ago, that this is the case, 317 00:20:12,280 --> 00:20:15,359 Speaker 1: and that will then drive rational uptake of of of 318 00:20:15,520 --> 00:20:18,920 Speaker 1: new therapists in that marketplace, giving people a healthier and 319 00:20:19,040 --> 00:20:22,359 Speaker 1: a longer life. We hope it's a new era for 320 00:20:22,480 --> 00:20:26,520 Speaker 1: obesity drugs. Novo is developing treatments that act like natural 321 00:20:26,640 --> 00:20:29,160 Speaker 1: hormones to try to avoid the bad side effects see 322 00:20:29,200 --> 00:20:31,919 Speaker 1: in the medicines the past that affected the central nervous system. 323 00:20:32,600 --> 00:20:35,159 Speaker 1: The company is also learning more about the hormones that 324 00:20:35,280 --> 00:20:38,199 Speaker 1: allow the stomach and the brain to talk to each other, 325 00:20:38,680 --> 00:20:42,760 Speaker 1: what he calls the gut brain access. I think combinations 326 00:20:42,960 --> 00:20:47,600 Speaker 1: of these mediators that exist in the so called dialogue 327 00:20:47,640 --> 00:20:49,639 Speaker 1: between the gut and the brain. They will be very 328 00:20:49,720 --> 00:20:54,280 Speaker 1: important to investigate, and also the ability to co administer 329 00:20:54,400 --> 00:20:58,120 Speaker 1: them so that you actually get maybe one, maybe two, 330 00:20:58,240 --> 00:21:03,440 Speaker 1: or maybe even through red signals that either signal society 331 00:21:03,800 --> 00:21:07,399 Speaker 1: or increase the energy expenditure. Mad says sometime in the 332 00:21:07,480 --> 00:21:10,400 Speaker 1: distant future, we may evolve in a different way, become 333 00:21:10,480 --> 00:21:13,840 Speaker 1: better at burning off energy and consuming less. For now, 334 00:21:14,440 --> 00:21:18,080 Speaker 1: Novo wants to help patients fight their inner caveman. I'm 335 00:21:18,200 --> 00:21:21,919 Speaker 1: quite optimistic that ten years from now, if people um 336 00:21:22,920 --> 00:21:25,720 Speaker 1: are actually treated, they will have longer and better lives. 337 00:21:25,800 --> 00:21:28,240 Speaker 1: And this is not wishful thinking. This is based on 338 00:21:28,440 --> 00:21:41,240 Speaker 1: clinical evidence that we're creating as we speak. And that's 339 00:21:41,280 --> 00:21:44,960 Speaker 1: it for this week's prognosis. Thanks for listening. Do you 340 00:21:45,040 --> 00:21:46,760 Speaker 1: have a story about help here in the US or 341 00:21:46,760 --> 00:21:49,480 Speaker 1: around the world, We want to hear from you. You 342 00:21:49,560 --> 00:21:52,120 Speaker 1: can email me at m Cortes at Bloomberg dot net 343 00:21:52,400 --> 00:21:55,680 Speaker 1: or find me on Twitter at the Cortes. If you 344 00:21:55,720 --> 00:21:57,840 Speaker 1: were a fan of this episode, please take a moment 345 00:21:57,960 --> 00:22:00,520 Speaker 1: to rate and review us. It helps new centers find 346 00:22:00,560 --> 00:22:05,199 Speaker 1: the show. This episode was produced by Lindsay Craterwell. Our 347 00:22:05,240 --> 00:22:08,520 Speaker 1: story editor was Rick Shine. Thanks also to Drew Armstrong 348 00:22:09,320 --> 00:22:12,399 Speaker 1: francesco Leavie is head of Bloomberg Podcasts. We'll see you 349 00:22:12,480 --> 00:22:12,920 Speaker 1: next week.