Tackling obesity as a brain disease

Obesity is one of the world’s biggest health challenges, impacting on rich and poor nations. (opens in a new window)Professor Carel le Roux is a global research leader into what he regards primarily as a disease of the brain.  

Despite major advances in medical research, there is much that scientists still don’t know about what drives obesity. For years, it was widely regarded as something simply due to intake of excess calories, or poor lifestyle choices, but Prof. le Roux believes it is a brain disease shaped by biochemical and environmental factors. 

Prof. Carel le Roux work focuses on deciphering the links between the brain, gut and obesity. In doing so, he is challenging how obesity has been thought of and treated in our society. 

According to Prof. le Roux, “The brain plays a key role in obesity with three regions affected in the disease  - the hypothalamus, the area postrema and the nucleus tractus solitarius. The brain is in constant communication with the gut, regulating our appetite. If these connections are disrupted, then obesity will be the result.” 

Since the 1980s, there has been a noticeable surge in obesity around the world, in both wealthy and not-so-wealthy countries. As society evolved, so did the factors triggering obesity but scientists still struggle to pinpoint these triggers. 

“We need more research to uncover the environmental factors that have changed our landscape over the last few decades,” said Prof. le Roux. “Understanding these shifts is crucial for prevention strategies.” 

Treatments 

There has been progress recently with drug treatments, such as the use of GLP-1 agonists to treat obesity and type 2 diabetes. These medications that mimic glucagon-like peptide 1, a natural hormone that regulates blood sugar, appetite and digestion, have shown great promise. 

“We are witnessing significant weight loss and improved health outcomes in patients who previously struggled with obesity and diabetes,” said Prof. le Roux. However, he said that it was still a challenge to get effective new treatment options into widespread use, and ensure that they will reach those who need them most. 

To achieve that, Prof Le Roux, working in collaboration with Nova UCD, has established a company called (opens in a new window)Beyond BMI. This company aims to scale up innovative treatments for obesity so that more people can avail of them around the world. 

Prof. le Roux advocates using personalised medicine to treat obesity saying, “Interventions must be tailored to each patient to achieve sustainable results. Obesity is a highly individualised disease. What works for one person may not work for another.” 

When it comes to obesity, Prof Le Roux believes that the one-size-fits-all treatment approach is increasingly being seen as insufficient. 

Stigma 

Despite the advances in our scientific knowledge of obesity, the social stigma around it persists according to Prof. le Roux, and this is complicating the discourse around treatment and understanding. 

There are parallels, said Prof. le Roux between how obesity today remains widely misunderstood, and how other diseases such as epilepsy and clinical depression were misunderstood in the past. In earlier times, people suffering such conditions faced societal judgement, which hindered their access to needed care. 

“It’s essential to debunk the notion that obesity arises solely from poor lifestyles. It should be seen through the lens of scientific evidence and medical understanding,” he said.

There should be support and understanding from society for people with obesity instead of adverse judgements. “Just as we have come to understand epilepsy or depression as medical conditions, the same must apply to obesity,” said Prof. le Roux. 

Policy 

A collective societal response to obesity is required, and the input and collaboration of scientists, clinicians and policymakers is needed to tackle this multifaceted problem effectively. 

“Obesity is not just a personal battle; it’s a public health challenge that requires a coordinated effort,” said Prof. le Roux. 

On the research front, there are exciting times ahead, including the promising results emerging from the largescale REDEFINE study, of which Prof. le Roux is a principal investigator. 

This trial amalgamated GLP-1 analogues together with analogues of amylin - a natural hormone that tells us when we are full - into a powerful new treatment for type 2 diabetes and obesity. 

“Early results indicate significant weight loss, coupled with improved glycemic (sugar) control, highlighting the potential of these new strategies,” said le Roux. 

Against the backdrop of Ireland grappling with its rising obesity rates – the disease now affects one quarter of the adult population – Prof. le Roux said that understanding obesity scientifically and tackling it effectively is more urgent and important than ever. 

As scientists work to tackle the public health issue of obesity, Prof. le Roux urges people to reconsider how they view it. “Obesity is not due to a lack of willpower or certain behaviour, but rather an interplay of biological, environmental and social factors. 

“The journey towards effective prevention and treatment of obesity is ongoing, but with a collaborative and informed mindset, the goal of reversing this epidemic may soon come within reach.” 

In conversation with journalist, Sean Duke