Miller School Endocrinologists Pursue Comprehensive Understanding of Obesity
Summary
- The Miller School’s Dr. Rodolfo Galindo presented a review on obesity at the American Association of Clinical Endocrinology annual conference, reporting improved obesity rates over the last few years. Severe obesity is the exception.
- The Miller School’s Division of Endocrinology, Diabetes and Metabolism is focusing clinical and translational research efforts on advancing the understanding of cardiometabolic diseases and sleep disorders in obesity.
- Dr. Galindo says changes in diet and exercise help, but more effective weight loss drugs are a key part of treatment for severely obese people.
Obesity rates have increased consistently since the 1990s. The chronic condition has witnessed many shifts, from fad diets to new medications, with endocrinologists at the center of research and care.
Rodolfo Galindo, M.D., associate professor in the Division of Endocrinology, Diabetes and Metabolism at the University of Miami Miller School of Medicine, is taking a closer look at the disease. Earlier this year, he presented a review on obesity at the American Association of Clinical Endocrinology annual conference.
“Recent reports on obesity show improvements in the last few years, except in trends of severe obesity as measured by a body mass index greater than 35 kg/m2,” said Dr. Galindo, also director of the UHealth Comprehensive Diabetes Center. “The key for proper management of any chronic condition at personal and public health levels is prevention. For obesity, education in proper diet and lifestyle choices is the first and utmost step. Educational and awareness programs need to start in early life, and not just within the health care community but also at home.”
Primary Causes of Obesity
In the U.S., obesity in adults has reached pandemic levels, as observed by Dr. Galindo. Among people 20 and older, about 41% are obese. Out of the 100 million adults in the U.S., 22 million have severe obesity.
“The majority of adults with obesity have several potential contributors to excess adiposity that are either human or environmentally related,” Dr. Galindo said. “As in many other chronic diseases, the primary causes are usually multifactorial. Familial predisposition or polygenetic (affecting several genes), appetite regulation defects, aging, medications and, of course, lifestyle and dietary factors, can all play a role. Additionally, our society has experienced several changes over the years, including increased availability of energy-dense food, larger portions and a low-level energy expenditure lifestyle.”
The exceptions are rare conditions associated with single-gene defects (monogenic diseases), usually starting in early childhood and often accompanied by other syndromic presentations, such as Prader-Willi syndrome, Bardet-Biedl syndrome and MCR4 receptor mutations. These account for fewer than 5% of all adult cases.
Obesity and Endocrinology
Excess adiposity and its associated conditions are intrinsically linked to hormonal dysregulation of appetite centers and the accumulation of excess and ectopic fat. The American Association of Clinical Endocrinologists pioneered the current definition of obesity as a chronic disease. Accordingly, obesity is characterized by the accumulation of excess adipose tissue, which is often maldistributed in ectopic areas and associated with dysfunctional hormonal systems. The term “obesity” didn’t receive recognition as a chronic disease until 2014 by the American Medical Association.
Endocrinologists such as Dr. Galindo are experts in confronting obesity and its many effects. Ron Varghese, M.D., assistant professor in the Division of Endocrinology, Diabetes and Metabolism at the Miller School, has co-developed a comprehensive clinical and research program in obesity and obstructive sleep apnea in collaboration with Naresh Punjabi, M.D., Ph.D., professor and chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the Miller School. This translational initiative includes collaboration with Gianluca Iacobellis, M.D., Ph.D., professor in the Division of Endocrinology, Diabetes and Metabolism at the Miller School.
“The clinical and translational research efforts in the division are focused on advancing the understanding of cardiometabolic diseases and sleep disorders in obesity,” said Ernesto Bernal-Mizrachi, M.D., professor and chief of the division. “These are all highly accomplished, NIH-funded investigators whose expertise significantly strengthens the program’s scientific impact and potential for innovation.”
Within his UHealth clinic, Dr. Galindo has helped patients lose significant weight. Some stop most or all of their anti-diabetic medications.
“We have people losing 60 to 100 pounds in our practice,” Dr. Galindo said. “We have been treating people with obesity for several years, but there were few treatment options with a clinically significant impact. We have had medications approved for the treatment of obesity for years, but nationwide studies have shown than less 5% of people with obesity were using them.”
More than Diet and Exercise
Following a balanced diet may seem like an easy way to manage obesity and live a healthy lifestyle. But for many, it’s not that simple.
Intensive lifestyle interventions, such as the Diabetes Prevention Program, often result in a 5% to 7% loss of body weight. People with obesity and associated diseases such as diabetes, obstructive sleep apnea and cardiovascular disease, require a loss of at least 10% to 15% of their body weight. That loss must be maintained over time to improve those conditions.
“The lack of significant and long-term results with intensive lifestyle interventions for individuals with obesity, coupled with increased understanding of the intricate regulation of appetite and fat metabolism in humans and better treatment options, has led to increased recognition of obesity as a chronic disease. But much work still is needed,” Dr. Galindo said. “By now, most physicians should acknowledge that medications and/or surgery are required to properly treat this chronic condition, particularly if we are looking for long-term sustainable results”.
Pharmacological Therapy for Obesity
Initially, limited insurance coverage and modest effectiveness deterred widespread use of obesity medications. These drugs offered minimal weight loss and often had side effects. Bariatric surgery also has a similarly low uptake.
Newer medications that were initially developed for treatment of diabetes, such as semaglutide and tirzepatide, are better. These medications work by reducing appetite and helping the recipient feel full faster. In studies, obese people without diabetes taking semaglutide lost about 15% of their body weight. People who took tirzepatide lost up to 22%. Both medications improved blood sugar.
Additionally, there have been significant scientific advances in understanding the central nervous system’s effect on appetite and energy regulation, as well as the connection between the gut, brain and fat tissue.
“The future of pharmacotherapy for obesity and metabolic conditions is now a reality,” Dr. Galindo said. “From using single-receptor (GLP1) stimulation, we are now moving to dual- or triple-receptor agonism and/or antagonism. We are also using co-formulations with agents to preserve muscle mass. At least two new drugs have completed Phase 3 clinical trials already, so the next step will be regulatory approval within six to 12 months.”
Tags: diabetes, Division of Endocrinology Diabetes and Metabolism, Dr. Gianluca Iacobellis, Dr. Naresh Punjabi, Dr. Rodolfo Galindo, Dr. Ron Varghese, endocrinology, Newsroom, obesity, weight loss