Looking for the Obesity Reset Button

The notion of a set point for body weight is a simple way of understanding what goes awry in obesity. Metabolic changes set in motion by weight gain establishes a new set point for fat storage and body weight that the body systematically defends. New evidence just published in Obesity describes how bariatric surgery might have the effect of pushing the obesity reset button and restoring a healthy metabolic set point.

Zheng Hao and colleagues from the Pennington Biomedical Research Center studied mice with varying degrees of obesity and given Roux-en-Y gastric bypass surgery (RYGB). They found that the surgery led to changes in weight regulation, unrelated to restricted food intake. They concluded:

The results provide additional evidence for reprogramming of a new defended body weight as an important principle by which RYGB lastingly suppresses body weight. RYGB appears to selectively abolish defense of a higher fat mass level, while remaining sensitive to the defense of lean mass.

For some time, popular culture — even popular medical thought — has regarded bariatric surgery as some sort of drastic “last resort” akin to wiring one’s mouth shut for a liquid diet. Knowledgeable clinicians, researchers, and patients have known this thinking is wrong. More fundamental changes are at work, correcting the metabolic defects caused by obesity.

In a companion editorial, Henriette Frikke-Schmidt and Randy Seeley comment:

Let’s hope this important work from Berthoud and colleagues can help us retire the words “restriction” and “malabsorption” from our descriptions of how bariatric surgeries wield their impressive effects.

Yes, we should.

Click here for the study and  here for the commentary.

Reset, photograph © sublimeobserver / flickr

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February 11, 2016

2 Responses to “Looking for the Obesity Reset Button”

  1. February 11, 2016 at 6:13 am, Joe Gitchell said:

    Ted – it sure seems like that bariatric surgery fills a similar space in obesity research and policy to alternative nicotine products with tobacco–could have substantial positive impacts, but because it runs so counter to the prevailing narrative/framing, acceptance and adoption are slower than they otherwise would’ve been.

    Clearly this kind of science is critical, but I have become increasingly cynical that “science” will resolve these more worldview/identify/moral conflicts.

    Do we need some Red Rover, Paintball, or even dance contests to help us bring resolution?

    Psilocybin? (See for some perspective).

    I’m not really kidding.


    • February 11, 2016 at 7:42 am, Ted said:

      I would need an RCT to persuade me that psilocybin would work, but dance gets a pass. I’m sure that would work, Joe.

      But seriously, Joe, I both share your perspective that science is not the sticking point. At the same time, it can be helpful when it is crystal clear. So as more people get good outcomes, primitive thinkers become isolated.