Q&A: UT Southwestern Perspectives from ObesityWeek

Dr. Jeffrey Zigman (left) and Dr. Jaime Almandoz
Dr. Jeffrey Zigman (left) and Dr. Jaime Almandoz

The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) combined efforts for the recent ObesityWeek 2017, an international conference in Washington, D.C., that brought together health care providers, policymakers, researchers, and industry representatives interested in the treatment and prevention of obesity. The annual event included a scientific program with world-renowned experts in obesity to collaborate and present their research and clinical trial results. UT Southwestern’s Dr. Jeffrey Zigman, Professor of Internal Medicine and Psychiatry, and Dr. Jaime Almandoz, Assistant Professor of Internal Medicine, played pivotal roles in planning of the conference and shared the following insights about new research in this field.

How important is it for researchers and clinicians in so many disciplines to gather for information sharing and discussion?

Dr. Zigman: The multidisciplinary approach to obesity is the essence of ObesityWeek – and is of utmost importance. The program is designed to bring together practitioners of different disciplines, basic science and clinical investigators, researchers studying the brain and peripheral organs, health care practitioners and policymakers, and providers interested in the care of individual patients and diverse populations. It is only through these types of interactions that we will best be able to make progress in implementing the most effective and meaningful research, prevention plans, treatment initiatives, and policies to combat the growing problem of obesity. 

Dr. Almandoz: Obesity is a multifactorial disease that results from a chronic positive energy imbalance. It shortens life span, affects multiple organ systems, and increases health care spending. The rising prevalence of obesity and associated comorbidities, like Type 2 diabetes, calls for preventive strategies and better therapies. The complex nature of obesity is evidenced by the struggle that many of us have with achieving and maintaining a healthy body weight. ObesityWeek is an opportunity for researchers and clinicians from across the spectrum of disciplines to gather with the common goal of understanding and better addressing obesity. The conference brings together people with unique perspectives and abilities – in fields ranging from cellular level to animal model research, clinical studies, neuroscience, health care policy, population health, and frontline medical care – to learn from each other and devise new strategies to fight obesity.

What specific scientific areas or discoveries were of particular interest?

Dr. Zigman: In my role as this year’s Chair of the TOS Annual Program Committee, we tried something new and provided numerous perspectives on two key topics in obesity management – physical activity/exercise and dietary intervention. We covered these topics from the perspectives of six different content “Tracks” – Metabolism & Integrative Physiology; Neuroscience; Intervention & Clinical Studies; Population Health; Clinical/Professional Practice; and Health Care Policy/Public Health Policy.

Dr. Almandoz: Dr. Zigman had the monumental task of coordinating the entire program, while I got to focus on the Clinical/Professional Practice Track. The delivery of obesity care has been changing over the past decade as we have shifted to recognizing it as a disease with a complex biological and hormonal basis that interacts with our environment and access to food – and not just a brief recommendation at the end of an office visit to “eat less and move more.” We have recognized that patients need to be managed in more individualized, compassionate, meaningful, and integrated ways to be successful. To this end, we organized symposia on weight biases (stigma against those with obesity), innovative patient interactions (including technologies like smartphone applications), interdisciplinary care after bariatric surgery, eating disorders, and food addiction – all to help providers be more understanding and effective in their patient interactions.

Many health care providers are reluctant to prescribe weight-loss medications and are not familiar with the more recently approved options, which are tools to lower calorie consumption. Due to the complex etiology and physiology of obesity, it has become more popular to simultaneously prescribe weight-loss medications that work synergistically on different pathways either as fixed-dose combinations or separately. One of our keynote lecturers gave practical advice on how to use these medications together.

Are there instances of the work at UTSW leading the way or dovetailing into others’ investigations?

Dr. Zigman: UT Southwestern is one of the world’s leading academic centers for obesity research. This year, ObesityWeek was honored to have Dr. Joel Elmquist as one of its two key lecturers in Neuroscience. Dr. Elmquist spoke on hypothalamic integration of exercise and metabolism. Another UTSW investigator, Dr. Shawn Burgess, talked about the multiple mechanisms of muscle-based thermogenesis, while Dr. Nancy Puzziferri presented findings related to brain imaging that showed bariatric surgery-induced changes involving response inhibition, impulse control, and self-monitoring.

Dr. Almandoz: At UT Southwestern, one clinical example is our Weight Wellness Clinic, which is an interdisciplinary clinic within the Division of Endocrinology that provides integrated weight management solutions and care for those with complications or weight regain following bariatric surgery.

Are there certain areas that have seen significant progress in treatment or prevention of obesity-related conditions?

Dr. Zigman: Over the past decade, we have seen an exponential increase in our understanding of the neurohormonal control of eating behavior, body weight, and bariatric surgery-associated metabolic improvements. While significant and exciting, the development of new, more effective treatments for obesity has unfortunately lagged behind the growth and prevalence of obesity and related comorbid conditions. Nonetheless, the momentum to find better and more effective prevention and treatment strategies is growing, and I am hopeful that we will have a much better toolbox with which to challenge the obesity epidemic within the next 10 years. 

Dr. Almandoz: Recent research has shown us that keeping weight off can be more difficult than losing it in the first place – it truly is a chronic disease. There are a host of complex physiological and neurohormonal changes that occur when we lose weight that aim at restoring (or sabotaging) our weight-loss efforts. This helps to explain why many of us struggle to maintain our weight loss and why bariatric surgery has not been the cure for obesity that many had hoped. Understanding these complicated changes better will allow us to address them with a better combination of behavioral and pharmacological approaches.  

What advances in obesity treatment and research do you foresee over the next decade?

Dr. Zigman: The new technologies that have recently come online – such as CRISPR-Cas9 gene editing, single-cell RNA sequencing, and induced pluripotent stem cell development – should help facilitate the basic science community’s efforts to discover the determinants of an individual’s obesity. At the same time, organizations such as The Obesity Society and health care providers such as Dr. Almandoz will be intensifying efforts to provide comprehensive, cost-effective, personalized, and community-wide approaches to obesity prevention and treatment.

Dr. Almandoz: From a clinical practice perspective, we are moving toward value-based care by starting to manage excess body weight before we develop costly complications like Type 2 diabetes and cardiovascular disease. This requires us to intervene early at the level of the primary care provider and pursue opportunities such as workplace wellness initiatives.

Dr. Elmquist holds the Carl H. Westcott Distinguished Chair in Medical Research and the Maclin Family Distinguished Professorship in Medical Science, in Honor of Dr. Roy A. Brinkley.

Dr. Zigman holds the Kent and Jodi Foster Distinguished Chair in Endocrinology, in Honor of Daniel Foster, M.D.; the Mr. and Mrs. Bruce G. Brookshire Professorship in Medicine; and The Diana and Richard C. Strauss Professorship in Biomedical Research.