Speaker 1: Two studies out today. They draw the same disturbing conclusion.
Speaker 1: Americans are not winning their battle against obesity. One study
Speaker 1: found that obesity raised for adults actually obesity. It seems
Speaker 1: like it should be easy to treat calories in, calories out, simple,
Speaker 1: but it's actually incredibly difficult. And that goes both for
Speaker 1: the people who are trying to slim down and the
Speaker 1: drugmakers who have struggled to find treatments to help. Welcome
Speaker 1: to Prognosis, a podcast about health, medical technology, and the
Speaker 1: mind blowing innovation underway across the globe. I'm your host,
Speaker 1: Michelle fay Cortes. More than seven hundred million people around
Speaker 1: the world are considered obese. If you're five ft eight
Speaker 1: inches tall and way more than two hundred pounds, that's obese.
Speaker 1: If you're shorter, say five ft four inches and more
Speaker 1: than a hundred seventy five pounds, that's also obese. It's
Speaker 1: about much more than how you look. It increases the
Speaker 1: risk of diabetes, heart disease, and cancer, and it's expensive.
Speaker 1: The health costs in the US alone top a hundred
Speaker 1: and fifty billion dollars a year. If drug makers could
Speaker 1: find a way to help people achieve safe and significant
Speaker 1: weight loss, it would spur profound benefits, not to mention profits.
Speaker 1: It hasn't happened yet. Every few years there is a
Speaker 1: new hyped drug that seems to show up with outsized expectations,
Speaker 1: but they've generally turned out to be disappointments. Some believe
Speaker 1: that's about to change. Most people who succeed in losing
Speaker 1: weight quickly gain it right back. Our bodies are programmed
Speaker 1: to do that. Now, a promising new approach in the
Speaker 1: lab aims to both suppress appetite and switch off the
Speaker 1: signal that tells your slim down body to conserve energy.
Speaker 1: That may be just the key to keeping those pounds off.
Speaker 1: Here's Bloomberg's James Peyton with the story. To understand the
Speaker 1: obesity crisis today, we need to start with some history.
Speaker 1: Ancient history, like all the way back to the Stone
Speaker 1: Age history. So let's rewind tens of thousands of years.
Speaker 1: Humans are hunters and gatherers, and in order to survive
Speaker 1: the cycles of feast and famine, they needed to consume
Speaker 1: extra calories and hold onto them. Mad's CROs Guard Thompson,
Speaker 1: the chief science Officer and Nova and orders the Danish
Speaker 1: drug company puts it like this, so so we would
Speaker 1: simply have a situation wherein the one half of the
Speaker 1: year we would be really good at putting on a
Speaker 1: lot of weight by eating a lot of food, and
Speaker 1: then in the other half, the cold half of the year,
Speaker 1: where the buffalo were no longer there to be hunted
Speaker 1: and there were no vegetables and so on, we would
Speaker 1: have a situation where where people would typically go into
Speaker 1: their caves and basically just try to survive quite quite honestly,
Speaker 1: and burn off as little energy as possible so that
Speaker 1: they were still alive when the next spring would rise.
Speaker 1: So those who were best at conserving energy and storing
Speaker 1: fat endured the harsh winters and went on to reproduce.
Speaker 1: Those famine beating genes are a problem for us today.
Speaker 1: Matt says. Our unhealthy habits, combined with our genetic tendency
Speaker 1: to hang onto calories, add up to a double whammy
Speaker 1: a weight gain. Nowadays, we are living in a constant
Speaker 1: feast situation. We're eating, eating, eating, and we're not exercising much.
Speaker 1: So those very genes that were good for our survival,
Speaker 1: that made those people survive with longer lives and have
Speaker 1: more babies in the old days because they were good
Speaker 1: at preserving energy and building fat stores in their bodies.
Speaker 1: They are now at risk of obesity, type two diabetes,
Speaker 1: and other conditions. So that's where we are now. Our
Speaker 1: ancestors relied on storing fat to survive, but our current
Speaker 1: lifestyle blows that out of proportion. It took society a
Speaker 1: while to realize what was happening, though it's only within
Speaker 1: the last few decades that scientists have come to understand
Speaker 1: the biology behind obesity. Years ago, an increase in body
Speaker 1: weight or obesity wasn't considered to be a disease. We
Speaker 1: really didn't understand anything about weight regulating mechanisms. It was
Speaker 1: thought to be purely a disorder of of willpower, that
Speaker 1: people with obesity were lazy, they couldn't control themselves, and
Speaker 1: therefore it wasn't something that was worthy of being treated
Speaker 1: by a physician. Another important point is that the relationship
Speaker 1: between obesity and other illnesses like diabetes, high blood pressure,
Speaker 1: heart disease, sleep disorders was not understood at all. That's
Speaker 1: Lewis Roney, a doctor and obesity specialist at wild Cornell
Speaker 1: Medicine in New York. He started a weight Control Center.
Speaker 1: There Now, groups such as the American Medical Association classified
Speaker 1: obesity as a disease. The centers for Disease Control and
Speaker 1: Prevention acknowledge that genes are a factor based on the
Speaker 1: different ways people respond to an environment of high calorie food.
Speaker 1: Although obesity is still often seen as a self inflicted condition,
Speaker 1: there's a growing realization that its causes are more complex.
Speaker 1: Louis is especially fascinated by how hard it is for
Speaker 1: people to lose weight and keep it off. He suspects
Speaker 1: that's because consuming too much fatty food can damage the
Speaker 1: nerves that tell the brain how much fat is stored.
Speaker 1: Faulty signals can trick the body into erroneously storing unnecessary amounts.
Speaker 1: That explains why trying to shed pounds can be agonizing
Speaker 1: for some patients. It's very frustrating for people trying to
Speaker 1: lose weight. If if and I would challenge anyone who
Speaker 1: doesn't think so to try to lose weight. You get hungry,
Speaker 1: you think about food. You may wake up in the
Speaker 1: middle of the night thinking about food. And in the
Speaker 1: past people thought they were going crazy, that there was
Speaker 1: something wrong with them, but now we know it's the
Speaker 1: result of these physical changes in signaling that caused us
Speaker 1: to occur. Six years ago, not a single state in
Speaker 1: the US had an adult obesity rate above thirty that's
Speaker 1: according to the CDC. Recent data show that seven states
Speaker 1: have since moved into that danger zone. One is Louisiana,
Speaker 1: where there's abundant fatty food, a lack of physical activity,
Speaker 1: and all the other usual culprits. And now more regions
Speaker 1: around the globe are starting to look like Louisiana. Eric
Speaker 1: Rabson is an obesity expert who works at Pennington Biomedical
Speaker 1: Research Center in Baton Rouge, the state's capital. Despite the warnings,
Speaker 1: he says, many people simply don't comprehend the gravity of
Speaker 1: the situation. It's like global warming. You know, what does
Speaker 1: it take to be concerned? I mean, it takes these
Speaker 1: climate disasters and all that, and we're going to face
Speaker 1: the same when it comes to public health. Eric is
Speaker 1: a former research or at pharma company Eli Lily, and
Speaker 1: so he's well aware of the industry's long battle against
Speaker 1: the condition. It's been a humbling experience for many of
Speaker 1: the people pursuing a solution. The whole treatment of obesity
Speaker 1: has been very disappointing, and this has been a train
Speaker 1: wreck of failures. UH, and it started, you know, in
Speaker 1: the nineteen thirties. Early products to tackle obesity included laxatives,
Speaker 1: thyroid hormones and fetaments, and other drugs that came with
Speaker 1: severe side effects. Similar approaches continued through the nineteen sixties.
Speaker 1: Many of these products were pulled from the market. Then
Speaker 1: in the nineteen nineties, researchers thought they had finally found
Speaker 1: an answer. It was called fed fen, a weight loss
Speaker 1: treatment that combined fin fleuramine, a nineteen seventies era diet drug,
Speaker 1: with fentamine and appetite suppressant. The treatment became a huge success,
Speaker 1: but the frenzy soon turned into a fiasco. Very early
Speaker 1: we discovered that fan frew i mean, was causing heart
Speaker 1: valve problems, and this was also withdrawn from the market. Personally,
Speaker 1: I went to Eli Lily in the nineties late nineties
Speaker 1: to work on obesiti drugs, and UH, at that time
Speaker 1: there is a real hope that new drugs we're going
Speaker 1: to target very specific receptors and being very efficacious, but
Speaker 1: it didn't pan out. A high point that same decade
Speaker 1: was the discovery of leptin, a hormone tied to hunger
Speaker 1: When people at fat, leptin levels increase, telling the brain
Speaker 1: that the body has had enough to eat. But leptin
Speaker 1: also failed to live up to expectations. When researchers found
Speaker 1: that many of these people were resistant to its effects,
Speaker 1: several more dead ends followed. So why do scientists and
Speaker 1: farming companies keep trying? Quite simply because an effective weight
Speaker 1: loss drug would be among the holy Grail of meds,
Speaker 1: right up there with treatments for cholesterol and arthritis. Novos
Speaker 1: focused on a weight loss treatment dates back to the
Speaker 1: nineteen nineties, so slightly more than twenty years ago. We
Speaker 1: had a very philosophical discussion in the management of the
Speaker 1: company whether obesity was a disease or a a lifestyle
Speaker 1: driven condition, and we actually came to the conclusion that
Speaker 1: it was not only a chronic diseased that was genetically predisposed,
Speaker 1: it was also the precursor stage to diabetes. Lately, the
Speaker 1: focus is on a hormone that plays a role in
Speaker 1: regulating blood sugar and body weight. It's called glucagon like
Speaker 1: peptide or g lp one, and it was first used
Speaker 1: to treat diabetes. No Vo is now repurposing its new
Speaker 1: diabetes drugs and relying on a synthetic version of the
Speaker 1: hormone to mimic what's produced naturally in the body. This
Speaker 1: work is at the core of the company's strategy to
Speaker 1: develop a more effect of obesity treatment. The company developed
Speaker 1: an injectable g LP one drug called Sassenda, designed to
Speaker 1: make you feel less hungry. It's one of several available
Speaker 1: today that deliver weight loss in the five to ten
Speaker 1: percent range. But these drugs are expensive and the results
Speaker 1: tend to stall after several months, prompting some patients to
Speaker 1: stop taking them. Many insurers, employers, and governments are reluctant
Speaker 1: to cover the cost, so no Vo is pushing the boundaries.
Speaker 1: Its researchers are testing a next generation drug in the
Speaker 1: same class, with hopes of getting closer to delivering fifteen
Speaker 1: percent weight loss that's considered a kind of magical level
Speaker 1: the drug companies figure they need to reach to really
Speaker 1: open up the market. The company has just started a
Speaker 1: late stage trial to evaluate the treatment's heart benefits in
Speaker 1: more than seventeen thousand people. It's the largest study in
Speaker 1: the company's history. Now, if Nova can show the medicine
Speaker 1: extends lives, reducing heart attacks and strokes on top of
Speaker 1: slashing weight will no doubt bolster the case for the
Speaker 1: drug and help the company win over skeptics. But that
Speaker 1: would be just step one. No Vo has bigger plans
Speaker 1: in mind. It's betting on combinations of complementary hormones to
Speaker 1: try to create a super drug that will overcome the
Speaker 1: body's tendency to put the pounds back on after weight loss,
Speaker 1: or in other words, fight our caveman like tendencies. It's
Speaker 1: a radical approach and ambitious weight loss north of tent
Speaker 1: or even more. To get there. No those scientists will
Speaker 1: have to attain results comparable to gastric bypass and other
Speaker 1: weight loss surgeries, but the idea is that the treatments
Speaker 1: won't have the risks and complications such as blood clots
Speaker 1: and infections that can occur with those major operations. No
Speaker 1: Vo has been able to extend the impact of an
Speaker 1: appetite regulating hormone called ammlin by boosting its half life.
Speaker 1: It was just a few minutes, now it's about one week.
Speaker 1: Early studies suggest that increasing the amount of time it
Speaker 1: circulates in the body could enable weight loss of roughly
Speaker 1: one percent every seven days. And the good news is
Speaker 1: that this is an effect that seems to be additive
Speaker 1: to what we know from GLP one. So if you
Speaker 1: actually add the two compounds together, you get twice as
Speaker 1: much if you can see twice as much bank for
Speaker 1: the box, so to speak. This is often what human
Speaker 1: beings need because if you don't deal the system and
Speaker 1: one to blow, so to speak, then there will be
Speaker 1: compensation compensatory mechanisms that are kicking in to try to
Speaker 1: regain the body weight. So we believe to real large
Speaker 1: extent that combination therapist will be a good way forward
Speaker 1: for people with the cbobt ma's. This team is working
Speaker 1: hard to come up with drug combinations that boost the
Speaker 1: amount of energy the body burns while it's the same
Speaker 1: time suppressing appetite that takes us to mitochondria. Mitochondria, you
Speaker 1: may recall from your high school biology class, are those
Speaker 1: any structures inside cells that, among other things, converted sugars
Speaker 1: into energy. Nov researchers are looking at ways to stimulate
Speaker 1: energy expenditure in a way that doesn't affect heart rate
Speaker 1: and blood pressure, a feat that others have tried but
Speaker 1: failed to pull off safely. Eric, the researcher in Louisiana
Speaker 1: recognizes how beneficial that could be. He studied contestants from
Speaker 1: the reality TV show The Biggest Loser. Previously on The
Speaker 1: Biggest Loser at the Way in the red en Blute
Speaker 1: had disappointing numbers. We have to reassess what is going
Speaker 1: on because sometimes gotta changshing. The contestants metabolism slowed dramatically
Speaker 1: after shedding significant amounts of weight, and many of the
Speaker 1: Biggest Losers regained a lot of the weight they had dropped.
Speaker 1: Eric realized the importance of somehow keeping energy expenditure up.
Speaker 1: After someone sheds pounds, Let's say you lose ten percent
Speaker 1: of your weight, you have a decrease in your resting
Speaker 1: metabolic rate, which is going to be more than ten percent.
Speaker 1: We did studies in the Biggest Loser who lose up
Speaker 1: to half of their body weight, and these people become
Speaker 1: tremendously energy efficient. In other words, they have a very
Speaker 1: very low metabolic create. And I believe that in the
Speaker 1: first phase of treatment in appetite suppression, drug is the
Speaker 1: most adequate way to go. But after reaching a plateau
Speaker 1: let's say five, ten or even fifteen percent weight loss,
Speaker 1: you need to introduce something else which is going to
Speaker 1: boost up your energy metabolism. One mixture of drugs won't
Speaker 1: work for everyone, and scientists are seeking to understand why
Speaker 1: Eric is optimistic. They will thread the needle. I have
Speaker 1: heard many times, you know, within ten years will have
Speaker 1: this magic pill or whatever. And and now I've I'm
Speaker 1: wise enough not to say that at but I know
Speaker 1: we are making progress, and these progress are important, and
Speaker 1: I think that eventually, yes, we will be more successful
Speaker 1: in treating people. No Vo isn't the only entity trying
Speaker 1: to better understand that rate at which the body converts
Speaker 1: food to energy. Scientists at a number of universities are
Speaker 1: finding answers that reside inside the brain. Rachel Lippert was
Speaker 1: previously involved in studies in mice at Vanderbilt and the
Speaker 1: University of Michigan. She studied the function of a brain
Speaker 1: protein called m C three R and how it helps
Speaker 1: balance the amount of energy we take in and use.
Speaker 1: The workings of m C three R have long baffled scientists,
Speaker 1: and a better understanding of the protein may open up
Speaker 1: a new path towards obesity drugs. Rachel now works at
Speaker 1: the Max Planck Institute for Metabolism Research, in Germany. She
Speaker 1: says epigenetics, the study of how genes are turned on
Speaker 1: or off by factors in the environment, are also providing
Speaker 1: new clues. There's so many layers of complex city that
Speaker 1: have been discovered recently because of all of the advancement
Speaker 1: and genetic tools that we have in the basic research laboratories.
Speaker 1: That is really just kind of it's like peeling back
Speaker 1: layers of an onion in terms of the levels of
Speaker 1: complexity that we deal with in the basic research. Because
Speaker 1: obesity leads to so many other serious diseases, the potential
Speaker 1: impact from an ultra effective drug could have a big
Speaker 1: ripple effect on patients and help governments all over the
Speaker 1: world deal with the obesity crisis. So just imagine that
Speaker 1: you take the medicine, you lose the weight, and you
Speaker 1: don't have to take something for your pre diabetes or
Speaker 1: your blood pressure or your cholesterol, and your sleep disorder
Speaker 1: gets better. You know, that is the promise of obesity treatment.
Speaker 1: I joke around with our younger doctors and tell them
Speaker 1: it's like one of those late night infomercials where you
Speaker 1: get the miracle knives, and you get the friar and
Speaker 1: you get every thing thrown into one. When you treat
Speaker 1: the obesity, you get all the health benefits. Still, there
Speaker 1: are plenty of naysayers out there. They say the focus
Speaker 1: should be on preventing obesity, not treating it, and they
Speaker 1: question whether drugs should be part of the strategy at all.
Speaker 1: Others want to tax products such as sodas to really
Speaker 1: make a difference. Lewis says he's even gotten pushed back
Speaker 1: from some of his own colleagues. As many resources as
Speaker 1: we can we should apply to preventing obesity, but the
Speaker 1: fact is that once obesity is established, using strategies to
Speaker 1: prevent obesity don't work. They're not enough. It's kind of
Speaker 1: like someone's diagnosed with lung cancer and you tell them, Okay,
Speaker 1: you have lung cancer now, and your treatment is going
Speaker 1: to be to stop smoking. Right. That sounds absurd, but
Speaker 1: trying to prevent the disease once it's established doesn't usually
Speaker 1: work as a therapy because something physical has changed. For now,
Speaker 1: few doctors and patients are relying on medicines to treat obesity. Diet, exercise,
Speaker 1: and other changes are vital, but if those measures don't work,
Speaker 1: some people should be treated with drugs before their situation
Speaker 1: gets worse before they develop diabetes and other complications. That's
Speaker 1: the view of experts, including Lewis. He believes more patients
Speaker 1: will get drugs in the future as the science and
Speaker 1: awareness among physicians accelerates. An Obesity board set up seven
Speaker 1: years ago in the US certified more than six hundred
Speaker 1: doctors in the past year. He says, that's comparable to
Speaker 1: the branch of medicine focused on the digestive system and
Speaker 1: its disorders. So these drugs are playing a limited role
Speaker 1: right now. Are we at any kind of turning point?
Speaker 1: Do you think when it comes to the treatment of
Speaker 1: obesity with medicine. I can't tell you when the turning
Speaker 1: point will come where there's widespread adoption of medical therapies
Speaker 1: for obesity, but I strongly believe that it is coming,
Speaker 1: and I'm not sure we're going to be able to
Speaker 1: change the course of the obesity epidemic and the health
Speaker 1: complications through behavioral management alone. While it's hard to know
Speaker 1: when that might happen, researchers at least have a roadmap.
Speaker 1: Two decades ago, Matt says type two diabetes was as
Speaker 1: misunderstood as obesity is today, but that changed when scientists
Speaker 1: showed controlling blood sugar levels would extend lives and lower
Speaker 1: hearts and stroke risks. I do believe that we are
Speaker 1: now standing at the inflection point where obesity in the
Speaker 1: next few years to come will undergo the same you
Speaker 1: can say, mitamaphosis from being considered a life style disorder
Speaker 1: to being considered a serious chronic disease. And part of
Speaker 1: that job is for us to do the studies I'm
Speaker 1: discussing and and proving to society, just like we did
Speaker 1: with diabetes twenty years ago, that this is the case,
Speaker 1: and that will then drive rational uptake of of of
Speaker 1: new therapists in that marketplace, giving people a healthier and
Speaker 1: a longer life. We hope it's a new era for
Speaker 1: obesity drugs. Novo is developing treatments that act like natural
Speaker 1: hormones to try to avoid the bad side effects see
Speaker 1: in the medicines the past that affected the central nervous system.
Speaker 1: The company is also learning more about the hormones that
Speaker 1: allow the stomach and the brain to talk to each other,
Speaker 1: what he calls the gut brain access. I think combinations
Speaker 1: of these mediators that exist in the so called dialogue
Speaker 1: between the gut and the brain. They will be very
Speaker 1: important to investigate, and also the ability to co administer
Speaker 1: them so that you actually get maybe one, maybe two,
Speaker 1: or maybe even through red signals that either signal society
Speaker 1: or increase the energy expenditure. Mad says sometime in the
Speaker 1: distant future, we may evolve in a different way, become
Speaker 1: better at burning off energy and consuming less. For now,
Speaker 1: Novo wants to help patients fight their inner caveman. I'm
Speaker 1: quite optimistic that ten years from now, if people um
Speaker 1: are actually treated, they will have longer and better lives.
Speaker 1: And this is not wishful thinking. This is based on
Speaker 1: clinical evidence that we're creating as we speak. And that's
Speaker 1: it for this week's prognosis. Thanks for listening. Do you
Speaker 1: have a story about help here in the US or
Speaker 1: around the world, We want to hear from you. You
Speaker 1: can email me at m Cortes at Bloomberg dot net
Speaker 1: or find me on Twitter at the Cortes. If you
Speaker 1: were a fan of this episode, please take a moment
Speaker 1: to rate and review us. It helps new centers find
Speaker 1: the show. This episode was produced by Lindsay Craterwell. Our
Speaker 1: story editor was Rick Shine. Thanks also to Drew Armstrong
Speaker 1: francesco Leavie is head of Bloomberg Podcasts. We'll see you
Speaker 1: next week.