WEBVTT - The Quest for a Weight-Loss Drug That Actually Works 0:00:03.040 --> 0:00:07.280 Two studies out today. They draw the same disturbing conclusion. 0:00:07.680 --> 0:00:11.800 Americans are not winning their battle against obesity. One study 0:00:11.840 --> 0:00:18.000 found that obesity raised for adults actually obesity. It seems 0:00:18.040 --> 0:00:22.160 like it should be easy to treat calories in, calories out, simple, 0:00:22.840 --> 0:00:26.239 but it's actually incredibly difficult. And that goes both for 0:00:26.280 --> 0:00:28.080 the people who are trying to slim down and the 0:00:28.160 --> 0:00:32.240 drugmakers who have struggled to find treatments to help. Welcome 0:00:32.280 --> 0:00:36.280 to Prognosis, a podcast about health, medical technology, and the 0:00:36.360 --> 0:00:40.040 mind blowing innovation underway across the globe. I'm your host, 0:00:40.080 --> 0:00:46.520 Michelle fay Cortes. More than seven hundred million people around 0:00:46.560 --> 0:00:49.360 the world are considered obese. If you're five ft eight 0:00:49.360 --> 0:00:52.440 inches tall and way more than two hundred pounds, that's obese. 0:00:53.200 --> 0:00:55.520 If you're shorter, say five ft four inches and more 0:00:55.560 --> 0:00:59.480 than a hundred seventy five pounds, that's also obese. It's 0:00:59.520 --> 0:01:02.040 about much more than how you look. It increases the 0:01:02.120 --> 0:01:06.160 risk of diabetes, heart disease, and cancer, and it's expensive. 0:01:09.200 --> 0:01:11.280 The health costs in the US alone top a hundred 0:01:11.319 --> 0:01:15.640 and fifty billion dollars a year. If drug makers could 0:01:15.680 --> 0:01:17.760 find a way to help people achieve safe and significant 0:01:17.800 --> 0:01:21.839 weight loss, it would spur profound benefits, not to mention profits. 0:01:22.680 --> 0:01:25.800 It hasn't happened yet. Every few years there is a 0:01:25.840 --> 0:01:29.080 new hyped drug that seems to show up with outsized expectations, 0:01:29.560 --> 0:01:33.440 but they've generally turned out to be disappointments. Some believe 0:01:33.480 --> 0:01:38.440 that's about to change. Most people who succeed in losing 0:01:38.440 --> 0:01:41.640 weight quickly gain it right back. Our bodies are programmed 0:01:41.680 --> 0:01:44.800 to do that. Now, a promising new approach in the 0:01:44.880 --> 0:01:47.760 lab aims to both suppress appetite and switch off the 0:01:47.840 --> 0:01:50.720 signal that tells your slim down body to conserve energy. 0:01:51.400 --> 0:01:53.760 That may be just the key to keeping those pounds off. 0:01:55.000 --> 0:02:00.800 Here's Bloomberg's James Peyton with the story. To understand the 0:02:00.840 --> 0:02:04.240 obesity crisis today, we need to start with some history. 0:02:04.880 --> 0:02:07.720 Ancient history, like all the way back to the Stone 0:02:07.760 --> 0:02:14.600 Age history. So let's rewind tens of thousands of years. 0:02:15.480 --> 0:02:18.760 Humans are hunters and gatherers, and in order to survive 0:02:18.880 --> 0:02:21.640 the cycles of feast and famine, they needed to consume 0:02:21.800 --> 0:02:26.320 extra calories and hold onto them. Mad's CROs Guard Thompson, 0:02:26.480 --> 0:02:28.959 the chief science Officer and Nova and orders the Danish 0:02:29.000 --> 0:02:32.800 drug company puts it like this, so so we would 0:02:32.840 --> 0:02:34.840 simply have a situation wherein the one half of the 0:02:34.919 --> 0:02:37.960 year we would be really good at putting on a 0:02:38.040 --> 0:02:40.640 lot of weight by eating a lot of food, and 0:02:40.680 --> 0:02:42.960 then in the other half, the cold half of the year, 0:02:43.040 --> 0:02:46.200 where the buffalo were no longer there to be hunted 0:02:46.240 --> 0:02:48.839 and there were no vegetables and so on, we would 0:02:48.880 --> 0:02:51.800 have a situation where where people would typically go into 0:02:51.880 --> 0:02:56.960 their caves and basically just try to survive quite quite honestly, 0:02:57.040 --> 0:02:59.840 and burn off as little energy as possible so that 0:03:00.000 --> 0:03:02.799 they were still alive when the next spring would rise. 0:03:03.280 --> 0:03:06.000 So those who were best at conserving energy and storing 0:03:06.040 --> 0:03:08.720 fat endured the harsh winters and went on to reproduce. 0:03:09.160 --> 0:03:12.440 Those famine beating genes are a problem for us today. 0:03:12.639 --> 0:03:15.959 Matt says. Our unhealthy habits, combined with our genetic tendency 0:03:16.040 --> 0:03:18.840 to hang onto calories, add up to a double whammy 0:03:18.960 --> 0:03:22.640 a weight gain. Nowadays, we are living in a constant 0:03:23.000 --> 0:03:26.960 feast situation. We're eating, eating, eating, and we're not exercising much. 0:03:27.440 --> 0:03:30.400 So those very genes that were good for our survival, 0:03:30.840 --> 0:03:34.040 that made those people survive with longer lives and have 0:03:34.200 --> 0:03:36.440 more babies in the old days because they were good 0:03:36.480 --> 0:03:39.760 at preserving energy and building fat stores in their bodies. 0:03:40.240 --> 0:03:43.400 They are now at risk of obesity, type two diabetes, 0:03:43.440 --> 0:03:46.520 and other conditions. So that's where we are now. Our 0:03:46.560 --> 0:03:50.080 ancestors relied on storing fat to survive, but our current 0:03:50.120 --> 0:03:53.600 lifestyle blows that out of proportion. It took society a 0:03:53.640 --> 0:03:57.200 while to realize what was happening, though it's only within 0:03:57.240 --> 0:04:00.560 the last few decades that scientists have come to understand 0:04:00.640 --> 0:04:05.400 the biology behind obesity. Years ago, an increase in body 0:04:05.440 --> 0:04:10.480 weight or obesity wasn't considered to be a disease. We 0:04:10.560 --> 0:04:16.520 really didn't understand anything about weight regulating mechanisms. It was 0:04:16.560 --> 0:04:20.599 thought to be purely a disorder of of willpower, that 0:04:20.800 --> 0:04:26.159 people with obesity were lazy, they couldn't control themselves, and 0:04:26.279 --> 0:04:31.560 therefore it wasn't something that was worthy of being treated 0:04:31.600 --> 0:04:36.599 by a physician. Another important point is that the relationship 0:04:37.040 --> 0:04:41.680 between obesity and other illnesses like diabetes, high blood pressure, 0:04:41.760 --> 0:04:46.760 heart disease, sleep disorders was not understood at all. That's 0:04:46.839 --> 0:04:50.240 Lewis Roney, a doctor and obesity specialist at wild Cornell 0:04:50.279 --> 0:04:53.000 Medicine in New York. He started a weight Control Center. 0:04:53.040 --> 0:04:58.240 There Now, groups such as the American Medical Association classified 0:04:58.240 --> 0:05:01.320 obesity as a disease. The centers for Disease Control and 0:05:01.360 --> 0:05:04.560 Prevention acknowledge that genes are a factor based on the 0:05:04.600 --> 0:05:07.919 different ways people respond to an environment of high calorie food. 0:05:08.839 --> 0:05:12.640 Although obesity is still often seen as a self inflicted condition, 0:05:13.080 --> 0:05:16.919 there's a growing realization that its causes are more complex. 0:05:18.200 --> 0:05:21.599 Louis is especially fascinated by how hard it is for 0:05:21.640 --> 0:05:24.799 people to lose weight and keep it off. He suspects 0:05:24.920 --> 0:05:28.080 that's because consuming too much fatty food can damage the 0:05:28.160 --> 0:05:30.679 nerves that tell the brain how much fat is stored. 0:05:31.279 --> 0:05:36.359 Faulty signals can trick the body into erroneously storing unnecessary amounts. 0:05:37.120 --> 0:05:40.360 That explains why trying to shed pounds can be agonizing 0:05:40.400 --> 0:05:44.039 for some patients. It's very frustrating for people trying to 0:05:44.120 --> 0:05:47.120 lose weight. If if and I would challenge anyone who 0:05:47.160 --> 0:05:50.320 doesn't think so to try to lose weight. You get hungry, 0:05:50.560 --> 0:05:52.400 you think about food. You may wake up in the 0:05:52.400 --> 0:05:55.039 middle of the night thinking about food. And in the 0:05:55.080 --> 0:05:57.640 past people thought they were going crazy, that there was 0:05:57.720 --> 0:06:01.480 something wrong with them, but now we know it's the 0:06:01.520 --> 0:06:07.280 result of these physical changes in signaling that caused us 0:06:07.279 --> 0:06:10.560 to occur. Six years ago, not a single state in 0:06:10.600 --> 0:06:14.080 the US had an adult obesity rate above thirty that's 0:06:14.120 --> 0:06:18.200 according to the CDC. Recent data show that seven states 0:06:18.400 --> 0:06:22.120 have since moved into that danger zone. One is Louisiana, 0:06:22.360 --> 0:06:25.359 where there's abundant fatty food, a lack of physical activity, 0:06:25.720 --> 0:06:29.400 and all the other usual culprits. And now more regions 0:06:29.440 --> 0:06:32.800 around the globe are starting to look like Louisiana. Eric 0:06:32.839 --> 0:06:35.960 Rabson is an obesity expert who works at Pennington Biomedical 0:06:36.000 --> 0:06:40.000 Research Center in Baton Rouge, the state's capital. Despite the warnings, 0:06:40.200 --> 0:06:43.240 he says, many people simply don't comprehend the gravity of 0:06:43.279 --> 0:06:47.120 the situation. It's like global warming. You know, what does 0:06:47.160 --> 0:06:50.440 it take to be concerned? I mean, it takes these 0:06:50.560 --> 0:06:54.119 climate disasters and all that, and we're going to face 0:06:54.160 --> 0:06:59.120 the same when it comes to public health. Eric is 0:06:59.160 --> 0:07:02.159 a former research or at pharma company Eli Lily, and 0:07:02.200 --> 0:07:04.920 so he's well aware of the industry's long battle against 0:07:04.920 --> 0:07:07.800 the condition. It's been a humbling experience for many of 0:07:07.839 --> 0:07:12.280 the people pursuing a solution. The whole treatment of obesity 0:07:12.360 --> 0:07:16.640 has been very disappointing, and this has been a train 0:07:16.760 --> 0:07:21.040 wreck of failures. UH, and it started, you know, in 0:07:21.080 --> 0:07:26.200 the nineteen thirties. Early products to tackle obesity included laxatives, 0:07:26.200 --> 0:07:29.120 thyroid hormones and fetaments, and other drugs that came with 0:07:29.160 --> 0:07:33.800 severe side effects. Similar approaches continued through the nineteen sixties. 0:07:34.520 --> 0:07:37.640 Many of these products were pulled from the market. Then 0:07:37.960 --> 0:07:41.520 in the nineteen nineties, researchers thought they had finally found 0:07:41.520 --> 0:07:48.960 an answer. It was called fed fen, a weight loss 0:07:48.960 --> 0:07:52.800 treatment that combined fin fleuramine, a nineteen seventies era diet drug, 0:07:53.240 --> 0:07:58.280 with fentamine and appetite suppressant. The treatment became a huge success, 0:07:58.880 --> 0:08:03.520 but the frenzy soon turned into a fiasco. Very early 0:08:04.240 --> 0:08:08.320 we discovered that fan frew i mean, was causing heart 0:08:08.400 --> 0:08:14.440 valve problems, and this was also withdrawn from the market. Personally, 0:08:14.440 --> 0:08:17.920 I went to Eli Lily in the nineties late nineties 0:08:17.960 --> 0:08:21.880 to work on obesiti drugs, and UH, at that time 0:08:21.920 --> 0:08:25.600 there is a real hope that new drugs we're going 0:08:25.680 --> 0:08:30.520 to target very specific receptors and being very efficacious, but 0:08:30.600 --> 0:08:33.720 it didn't pan out. A high point that same decade 0:08:33.800 --> 0:08:37.120 was the discovery of leptin, a hormone tied to hunger 0:08:37.600 --> 0:08:41.120 When people at fat, leptin levels increase, telling the brain 0:08:41.160 --> 0:08:43.840 that the body has had enough to eat. But leptin 0:08:44.040 --> 0:08:47.280 also failed to live up to expectations. When researchers found 0:08:47.440 --> 0:08:50.640 that many of these people were resistant to its effects, 0:08:51.559 --> 0:08:57.120 several more dead ends followed. So why do scientists and 0:08:57.120 --> 0:09:01.400 farming companies keep trying? Quite simply because an effective weight 0:09:01.440 --> 0:09:04.640 loss drug would be among the holy Grail of meds, 0:09:04.760 --> 0:09:08.880 right up there with treatments for cholesterol and arthritis. Novos 0:09:08.920 --> 0:09:11.280 focused on a weight loss treatment dates back to the 0:09:11.360 --> 0:09:15.640 nineteen nineties, so slightly more than twenty years ago. We 0:09:15.679 --> 0:09:18.520 had a very philosophical discussion in the management of the 0:09:18.520 --> 0:09:24.120 company whether obesity was a disease or a a lifestyle 0:09:24.200 --> 0:09:27.200 driven condition, and we actually came to the conclusion that 0:09:27.240 --> 0:09:32.000 it was not only a chronic diseased that was genetically predisposed, 0:09:32.200 --> 0:09:36.520 it was also the precursor stage to diabetes. Lately, the 0:09:36.600 --> 0:09:38.760 focus is on a hormone that plays a role in 0:09:38.800 --> 0:09:42.480 regulating blood sugar and body weight. It's called glucagon like 0:09:42.600 --> 0:09:45.400 peptide or g lp one, and it was first used 0:09:45.480 --> 0:09:49.559 to treat diabetes. No Vo is now repurposing its new 0:09:49.600 --> 0:09:52.400 diabetes drugs and relying on a synthetic version of the 0:09:52.440 --> 0:09:56.439 hormone to mimic what's produced naturally in the body. This 0:09:56.480 --> 0:09:58.800 work is at the core of the company's strategy to 0:09:58.840 --> 0:10:03.280 develop a more effect of obesity treatment. The company developed 0:10:03.280 --> 0:10:06.960 an injectable g LP one drug called Sassenda, designed to 0:10:07.040 --> 0:10:10.040 make you feel less hungry. It's one of several available 0:10:10.040 --> 0:10:12.160 today that deliver weight loss in the five to ten 0:10:12.200 --> 0:10:16.000 percent range. But these drugs are expensive and the results 0:10:16.040 --> 0:10:19.520 tend to stall after several months, prompting some patients to 0:10:19.559 --> 0:10:23.840 stop taking them. Many insurers, employers, and governments are reluctant 0:10:23.880 --> 0:10:28.199 to cover the cost, so no Vo is pushing the boundaries. 0:10:28.679 --> 0:10:31.320 Its researchers are testing a next generation drug in the 0:10:31.400 --> 0:10:34.760 same class, with hopes of getting closer to delivering fifteen 0:10:34.840 --> 0:10:38.280 percent weight loss that's considered a kind of magical level 0:10:38.559 --> 0:10:40.960 the drug companies figure they need to reach to really 0:10:40.960 --> 0:10:44.240 open up the market. The company has just started a 0:10:44.320 --> 0:10:47.600 late stage trial to evaluate the treatment's heart benefits in 0:10:47.640 --> 0:10:51.240 more than seventeen thousand people. It's the largest study in 0:10:51.280 --> 0:10:55.120 the company's history. Now, if Nova can show the medicine 0:10:55.120 --> 0:10:58.640 extends lives, reducing heart attacks and strokes on top of 0:10:58.720 --> 0:11:01.559 slashing weight will no doubt bolster the case for the 0:11:01.640 --> 0:11:05.400 drug and help the company win over skeptics. But that 0:11:05.440 --> 0:11:09.160 would be just step one. No Vo has bigger plans 0:11:09.160 --> 0:11:13.200 in mind. It's betting on combinations of complementary hormones to 0:11:13.240 --> 0:11:15.920 try to create a super drug that will overcome the 0:11:15.920 --> 0:11:19.079 body's tendency to put the pounds back on after weight loss, 0:11:19.840 --> 0:11:26.640 or in other words, fight our caveman like tendencies. It's 0:11:26.640 --> 0:11:31.240 a radical approach and ambitious weight loss north of tent 0:11:31.640 --> 0:11:35.120 or even more. To get there. No those scientists will 0:11:35.160 --> 0:11:38.400 have to attain results comparable to gastric bypass and other 0:11:38.400 --> 0:11:41.800 weight loss surgeries, but the idea is that the treatments 0:11:41.880 --> 0:11:44.880 won't have the risks and complications such as blood clots 0:11:44.920 --> 0:11:49.520 and infections that can occur with those major operations. No 0:11:49.679 --> 0:11:51.920 Vo has been able to extend the impact of an 0:11:51.920 --> 0:11:56.080 appetite regulating hormone called ammlin by boosting its half life. 0:11:56.600 --> 0:11:59.839 It was just a few minutes, now it's about one week. 0:12:00.760 --> 0:12:03.160 Early studies suggest that increasing the amount of time it 0:12:03.240 --> 0:12:06.040 circulates in the body could enable weight loss of roughly 0:12:06.120 --> 0:12:10.040 one percent every seven days. And the good news is 0:12:10.040 --> 0:12:12.520 that this is an effect that seems to be additive 0:12:12.520 --> 0:12:14.719 to what we know from GLP one. So if you 0:12:14.760 --> 0:12:18.679 actually add the two compounds together, you get twice as 0:12:18.760 --> 0:12:21.360 much if you can see twice as much bank for 0:12:21.360 --> 0:12:23.640 the box, so to speak. This is often what human 0:12:23.640 --> 0:12:27.679 beings need because if you don't deal the system and 0:12:27.800 --> 0:12:30.200 one to blow, so to speak, then there will be 0:12:30.240 --> 0:12:34.400 compensation compensatory mechanisms that are kicking in to try to 0:12:34.480 --> 0:12:37.920 regain the body weight. So we believe to real large 0:12:37.920 --> 0:12:40.920 extent that combination therapist will be a good way forward 0:12:40.960 --> 0:12:44.520 for people with the cbobt ma's. This team is working 0:12:44.600 --> 0:12:47.079 hard to come up with drug combinations that boost the 0:12:47.120 --> 0:12:49.760 amount of energy the body burns while it's the same 0:12:50.040 --> 0:12:56.880 time suppressing appetite that takes us to mitochondria. Mitochondria, you 0:12:57.000 --> 0:12:59.800 may recall from your high school biology class, are those 0:13:00.000 --> 0:13:04.000 any structures inside cells that, among other things, converted sugars 0:13:04.080 --> 0:13:08.120 into energy. Nov researchers are looking at ways to stimulate 0:13:08.280 --> 0:13:11.400 energy expenditure in a way that doesn't affect heart rate 0:13:11.440 --> 0:13:14.679 and blood pressure, a feat that others have tried but 0:13:14.920 --> 0:13:19.080 failed to pull off safely. Eric, the researcher in Louisiana 0:13:19.320 --> 0:13:23.160 recognizes how beneficial that could be. He studied contestants from 0:13:23.160 --> 0:13:27.199 the reality TV show The Biggest Loser. Previously on The 0:13:27.280 --> 0:13:30.360 Biggest Loser at the Way in the red en Blute 0:13:30.640 --> 0:13:33.559 had disappointing numbers. We have to reassess what is going 0:13:33.640 --> 0:13:40.120 on because sometimes gotta changshing. The contestants metabolism slowed dramatically 0:13:40.200 --> 0:13:42.880 after shedding significant amounts of weight, and many of the 0:13:42.880 --> 0:13:45.840 Biggest Losers regained a lot of the weight they had dropped. 0:13:46.920 --> 0:13:50.240 Eric realized the importance of somehow keeping energy expenditure up. 0:13:50.400 --> 0:13:53.679 After someone sheds pounds, Let's say you lose ten percent 0:13:53.760 --> 0:13:57.320 of your weight, you have a decrease in your resting 0:13:57.400 --> 0:14:00.400 metabolic rate, which is going to be more than ten percent. 0:14:00.920 --> 0:14:04.000 We did studies in the Biggest Loser who lose up 0:14:04.120 --> 0:14:07.560 to half of their body weight, and these people become 0:14:07.800 --> 0:14:12.520 tremendously energy efficient. In other words, they have a very 0:14:12.720 --> 0:14:16.079 very low metabolic create. And I believe that in the 0:14:16.200 --> 0:14:22.280 first phase of treatment in appetite suppression, drug is the 0:14:22.680 --> 0:14:28.200 most adequate way to go. But after reaching a plateau 0:14:28.960 --> 0:14:33.000 let's say five, ten or even fifteen percent weight loss, 0:14:33.440 --> 0:14:36.320 you need to introduce something else which is going to 0:14:36.440 --> 0:14:41.560 boost up your energy metabolism. One mixture of drugs won't 0:14:41.600 --> 0:14:45.040 work for everyone, and scientists are seeking to understand why 0:14:45.920 --> 0:14:49.240 Eric is optimistic. They will thread the needle. I have 0:14:49.440 --> 0:14:52.720 heard many times, you know, within ten years will have 0:14:52.920 --> 0:14:58.000 this magic pill or whatever. And and now I've I'm 0:14:58.120 --> 0:15:01.040 wise enough not to say that at but I know 0:15:01.240 --> 0:15:05.720 we are making progress, and these progress are important, and 0:15:05.880 --> 0:15:09.479 I think that eventually, yes, we will be more successful 0:15:09.600 --> 0:15:13.520 in treating people. No Vo isn't the only entity trying 0:15:13.560 --> 0:15:16.280 to better understand that rate at which the body converts 0:15:16.320 --> 0:15:19.760 food to energy. Scientists at a number of universities are 0:15:19.840 --> 0:15:24.480 finding answers that reside inside the brain. Rachel Lippert was 0:15:24.560 --> 0:15:27.520 previously involved in studies in mice at Vanderbilt and the 0:15:27.640 --> 0:15:30.640 University of Michigan. She studied the function of a brain 0:15:30.760 --> 0:15:33.520 protein called m C three R and how it helps 0:15:33.560 --> 0:15:36.040 balance the amount of energy we take in and use. 0:15:36.880 --> 0:15:40.320 The workings of m C three R have long baffled scientists, 0:15:40.880 --> 0:15:43.120 and a better understanding of the protein may open up 0:15:43.160 --> 0:15:46.960 a new path towards obesity drugs. Rachel now works at 0:15:47.000 --> 0:15:50.920 the Max Planck Institute for Metabolism Research, in Germany. She 0:15:51.040 --> 0:15:53.840 says epigenetics, the study of how genes are turned on 0:15:54.080 --> 0:15:56.840 or off by factors in the environment, are also providing 0:15:56.880 --> 0:16:00.400 new clues. There's so many layers of complex city that 0:16:00.480 --> 0:16:04.359 have been discovered recently because of all of the advancement 0:16:04.440 --> 0:16:08.520 and genetic tools that we have in the basic research laboratories. 0:16:09.120 --> 0:16:12.280 That is really just kind of it's like peeling back 0:16:12.400 --> 0:16:14.960 layers of an onion in terms of the levels of 0:16:15.040 --> 0:16:18.600 complexity that we deal with in the basic research. Because 0:16:18.680 --> 0:16:22.720 obesity leads to so many other serious diseases, the potential 0:16:22.840 --> 0:16:25.840 impact from an ultra effective drug could have a big 0:16:26.040 --> 0:16:29.120 ripple effect on patients and help governments all over the 0:16:29.200 --> 0:16:32.560 world deal with the obesity crisis. So just imagine that 0:16:32.680 --> 0:16:35.440 you take the medicine, you lose the weight, and you 0:16:35.520 --> 0:16:38.000 don't have to take something for your pre diabetes or 0:16:38.080 --> 0:16:41.480 your blood pressure or your cholesterol, and your sleep disorder 0:16:41.560 --> 0:16:45.960 gets better. You know, that is the promise of obesity treatment. 0:16:46.560 --> 0:16:50.000 I joke around with our younger doctors and tell them 0:16:50.080 --> 0:16:53.520 it's like one of those late night infomercials where you 0:16:53.600 --> 0:16:58.840 get the miracle knives, and you get the friar and 0:16:59.520 --> 0:17:02.320 you get every thing thrown into one. When you treat 0:17:02.360 --> 0:17:06.000 the obesity, you get all the health benefits. Still, there 0:17:06.040 --> 0:17:09.240 are plenty of naysayers out there. They say the focus 0:17:09.320 --> 0:17:12.280 should be on preventing obesity, not treating it, and they 0:17:12.400 --> 0:17:15.280 question whether drugs should be part of the strategy at all. 0:17:16.240 --> 0:17:19.359 Others want to tax products such as sodas to really 0:17:19.440 --> 0:17:23.000 make a difference. Lewis says he's even gotten pushed back 0:17:23.080 --> 0:17:26.719 from some of his own colleagues. As many resources as 0:17:26.760 --> 0:17:31.280 we can we should apply to preventing obesity, but the 0:17:31.400 --> 0:17:37.200 fact is that once obesity is established, using strategies to 0:17:37.359 --> 0:17:41.960 prevent obesity don't work. They're not enough. It's kind of 0:17:42.040 --> 0:17:47.760 like someone's diagnosed with lung cancer and you tell them, Okay, 0:17:48.359 --> 0:17:50.679 you have lung cancer now, and your treatment is going 0:17:50.760 --> 0:17:55.159 to be to stop smoking. Right. That sounds absurd, but 0:17:55.680 --> 0:18:00.679 trying to prevent the disease once it's established doesn't usually 0:18:00.960 --> 0:18:05.960 work as a therapy because something physical has changed. For now, 0:18:06.480 --> 0:18:11.240 few doctors and patients are relying on medicines to treat obesity. Diet, exercise, 0:18:11.280 --> 0:18:14.480 and other changes are vital, but if those measures don't work, 0:18:15.000 --> 0:18:17.680 some people should be treated with drugs before their situation 0:18:17.760 --> 0:18:22.800 gets worse before they develop diabetes and other complications. That's 0:18:22.840 --> 0:18:26.560 the view of experts, including Lewis. He believes more patients 0:18:26.560 --> 0:18:28.760 will get drugs in the future as the science and 0:18:28.800 --> 0:18:32.960 awareness among physicians accelerates. An Obesity board set up seven 0:18:33.040 --> 0:18:35.679 years ago in the US certified more than six hundred 0:18:35.760 --> 0:18:38.960 doctors in the past year. He says, that's comparable to 0:18:39.040 --> 0:18:41.560 the branch of medicine focused on the digestive system and 0:18:41.640 --> 0:18:50.760 its disorders. So these drugs are playing a limited role 0:18:50.880 --> 0:18:53.400 right now. Are we at any kind of turning point? 0:18:53.480 --> 0:18:55.200 Do you think when it comes to the treatment of 0:18:55.240 --> 0:18:59.159 obesity with medicine. I can't tell you when the turning 0:18:59.359 --> 0:19:06.760 point will come where there's widespread adoption of medical therapies 0:19:06.840 --> 0:19:11.280 for obesity, but I strongly believe that it is coming, 0:19:12.240 --> 0:19:16.040 and I'm not sure we're going to be able to 0:19:17.760 --> 0:19:23.560 change the course of the obesity epidemic and the health 0:19:23.800 --> 0:19:30.159 complications through behavioral management alone. While it's hard to know 0:19:30.520 --> 0:19:34.160 when that might happen, researchers at least have a roadmap. 0:19:34.800 --> 0:19:38.399 Two decades ago, Matt says type two diabetes was as 0:19:38.480 --> 0:19:43.240 misunderstood as obesity is today, but that changed when scientists 0:19:43.240 --> 0:19:46.520 showed controlling blood sugar levels would extend lives and lower 0:19:46.600 --> 0:19:49.520 hearts and stroke risks. I do believe that we are 0:19:49.560 --> 0:19:52.960 now standing at the inflection point where obesity in the 0:19:53.040 --> 0:19:56.200 next few years to come will undergo the same you 0:19:56.280 --> 0:20:00.800 can say, mitamaphosis from being considered a life style disorder 0:20:01.000 --> 0:20:03.760 to being considered a serious chronic disease. And part of 0:20:03.840 --> 0:20:06.200 that job is for us to do the studies I'm 0:20:06.240 --> 0:20:09.760 discussing and and proving to society, just like we did 0:20:09.880 --> 0:20:11.960 with diabetes twenty years ago, that this is the case, 0:20:12.280 --> 0:20:15.359 and that will then drive rational uptake of of of 0:20:15.520 --> 0:20:18.920 new therapists in that marketplace, giving people a healthier and 0:20:19.040 --> 0:20:22.359 a longer life. We hope it's a new era for 0:20:22.480 --> 0:20:26.520 obesity drugs. Novo is developing treatments that act like natural 0:20:26.640 --> 0:20:29.160 hormones to try to avoid the bad side effects see 0:20:29.200 --> 0:20:31.919 in the medicines the past that affected the central nervous system. 0:20:32.600 --> 0:20:35.159 The company is also learning more about the hormones that 0:20:35.280 --> 0:20:38.199 allow the stomach and the brain to talk to each other, 0:20:38.680 --> 0:20:42.760 what he calls the gut brain access. I think combinations 0:20:42.960 --> 0:20:47.600 of these mediators that exist in the so called dialogue 0:20:47.640 --> 0:20:49.639 between the gut and the brain. They will be very 0:20:49.720 --> 0:20:54.280 important to investigate, and also the ability to co administer 0:20:54.400 --> 0:20:58.120 them so that you actually get maybe one, maybe two, 0:20:58.240 --> 0:21:03.440 or maybe even through red signals that either signal society 0:21:03.800 --> 0:21:07.399 or increase the energy expenditure. Mad says sometime in the 0:21:07.480 --> 0:21:10.400 distant future, we may evolve in a different way, become 0:21:10.480 --> 0:21:13.840 better at burning off energy and consuming less. For now, 0:21:14.440 --> 0:21:18.080 Novo wants to help patients fight their inner caveman. I'm 0:21:18.200 --> 0:21:21.919 quite optimistic that ten years from now, if people um 0:21:22.920 --> 0:21:25.720 are actually treated, they will have longer and better lives. 0:21:25.800 --> 0:21:28.240 And this is not wishful thinking. This is based on 0:21:28.440 --> 0:21:41.240 clinical evidence that we're creating as we speak. And that's 0:21:41.280 --> 0:21:44.960 it for this week's prognosis. Thanks for listening. Do you 0:21:45.040 --> 0:21:46.760 have a story about help here in the US or 0:21:46.760 --> 0:21:49.480 around the world, We want to hear from you. You 0:21:49.560 --> 0:21:52.120 can email me at m Cortes at Bloomberg dot net 0:21:52.400 --> 0:21:55.680 or find me on Twitter at the Cortes. If you 0:21:55.720 --> 0:21:57.840 were a fan of this episode, please take a moment 0:21:57.960 --> 0:22:00.520 to rate and review us. It helps new centers find 0:22:00.560 --> 0:22:05.199 the show. This episode was produced by Lindsay Craterwell. Our 0:22:05.240 --> 0:22:08.520 story editor was Rick Shine. Thanks also to Drew Armstrong 0:22:09.320 --> 0:22:12.399 francesco Leavie is head of Bloomberg Podcasts. We'll see you 0:22:12.480 --> 0:22:12.920 next week.