![]() ![]() All this happens with just 5% weight loss, and it doesn't get much more severe with further weight loss.Īnd then we discovered, in 2011, in a paper that we published in The New England Journal of Medicine, that these hormone changes are long-lasting. The ghrelin level, the hunger hormone, rises after we lose weight, and all of the other hormones, the ones that take hunger away after a meal, and also leptin, drop dramatically after weight loss. The only hunger hormone we have that has physiological relevance is ghrelin, which comes from the stomach. We have eight hormones that are released after a meal, and they all take hunger away. The other bit of evidence that weight is genetic comes from the fact that the body vigorously defends weight. There's evidence that osteocytes can detect increased pressure, and then can send a signal to the brain to say, "Eat less." The second mechanism was only discovered about five years ago, and it appears that our bones weigh us. So as we accumulate fat, we make more and more of the hormone that tells us to stop eating. Now, these negative feedback systems, very briefly, are leptin, which is a very powerful hormone that inhibits hunger, and it's made by fat cells. So while lifestyle can cause mild two or three kilo weight gain, to develop obesity, you need to have a gene. Both from identical twin studies, adoption studies and, in addition to that, we have not one, but two negative feedback systems to prevent obesity. Now, the reason why it's genetic, there's very good evidence for that. There've already been three or four mechanisms for epigenetic obesity, and there will be more, I think. And these can be either the classical genetic mutations, or it can be epigenetics. So before we get into the medicines themselves, perhaps you can give us a little bit of a background as to how people become obese, and what drives obesity. Professor Proietto, welcome to the program. With me is Professor Joseph Proietto, an internationally renowned obesity researching clinician, and also from Austin Health in Melbourne, who has written an article entitled Medicines for Long-term Obesity Management. What role do they have to play in whom, and how can we navigate this space? I'm David Liew, your host for today, and a clinical pharmacologist and rheumatologist. So hard to ignore the increasing attention given to medicines for long-term obesity management. Obesity is less common, and it's hard to ignore the burden of disease it drives, but in amongst the struggles our patients have with it, it's frequently misunderstood. Independent, peer reviewed, and free.īeing overweight is common in our society. Welcome to the Australian Prescriber podcast. And most people need it also during weight loss. So, this is why I believe that we need some help with hunger suppression after weight loss. But this podcast definitely isn’t just for fellow fats anyone who wants to learn more about some of the latest and greatest health and nutrition fads of the recent past should give it a listen.And not only is there an increase in hunger after weight loss, there's also a reduction in energy expenditure by 300 calories. I learn a lot from listening to the episodes and can identify with a lot of the experiences that Gordon, fat-lady about town, had. They are uniformly well-researched and tell a wonderful story, whether it’s about Oprah and the Wagon of Fat episode or celery juice and master cleanses. Gordon and Hobbes have a great rapport together, and their energy, while sometimes chaotic, is infectious. There are currently 25 episodes available for your consumption (no calories involved). I’ve gotten into the podcast a little late since they got started in October 2020. When I need my fat liberationist fires stoked, I make sure to put on a new episode or at least an episode I haven’t heard yet. I could do a whole blog post about pretty much each episode. Aubrey Gordon, otherwise known as Your Fat Friend and author of What We Don’t Talk About When We Talk About Fat, and Michael Hobbes, writer and podcast co-host of You’re Wrong About, walk their audiences through a connect-the-dots journey through science and policy to figure out how we all got to where we are in the world of wellness and nutrition. Do you like well-researched podcasts about wellness? Are you a methodology queen? Do you want to sometimes laugh out loud in an inappropriate place like on a train or library? Then Maintenance Phase is the podcast for you. ![]()
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