Is obesity a chronic disease?

Yes, obesity is a chronic disease that is defined by the World Health Organization (WHO) as abnormal or excessive fat accumulation that may impair health. The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have published practice guidelines for treating patients with obesity.

How many people in the US have obesity?

Obesity is one of the most prevalent diseases in the US, affecting approximately 108 million adults. By comparison, there are 78 million adults in the US who could benefit from cholesterol medicine, and about 108 million adults in the US have high blood pressure.

What factors contribute to obesity?

The main contributing factors of obesity can be broken into three categories: societal, environmental, and genetic. Societal and environmental factors include changes in food production and availability, decreases in energy expenditure due to more sedentary lifestyles, socioeconomic status, cultural influences, and societal changes such as overeating and reduced physical activity. Genetic factors may determine the extent to which these societal and environmental factors will impact a patient’s weight.

What physiological mechanisms contribute to obesity?

Weight loss from reduced-caloric intake triggers a physiological process called metabolic adaptation. Weight loss causes the body to react by slowing the metabolism and altering appetite-regulating hormones, which can make long-term weight management difficult.

Does obesity increase the risk of mortality?

Yes, increased BMI results in a higher risk of mortality. For every 5 kg/m2 BMI increment above the range of 22.5-25 kg/m2, there is a 30% increase in overall mortality.

How does obesity impact patients aside from their physical health?

Patients with obesity can face a multitude of challenges, both socially and psychologically, including self-esteem issues as well as weight biases in both social and workplace situations.

What types of patients could benefit from pharmacological treatments for weight loss?

Patients with overweight or obesity who have tried lifestyle changes but can’t reach a healthier weight, are having difficulty with weight management, have a BMI of ≥27 kg/m2 and a weight-related comorbidity, or have a BMI that is >30 kg/m2 may benefit from pharmacological treatments.

Is there a strategy I should use when talking with patients about weight management?

The 5As model is recommended: ASK for permission to discuss weight, ASSESS obesity class and stage, ADVISE on obesity risks, AGREE on realistic weight-loss expectations, and ASSIST by providing education, resources, and support.

What are some conversation starters I can use when discussing weight management with patients?

Start with a discussion on weight history, including changes in weight over time, factors in weight changes, past weight-management efforts, and current habits.

What percent weight loss should most patients aim for?

A modest weight loss of 5% or more can have a clinically meaningful impact, improving cardiovascular risk factors such as glycemic control, blood pressure, HDL cholesterol, and triglycerides. Higher levels of weight loss can be associated with greater improvements in some comorbidities.

How can I work with my patients to set and achieve their weight-management goals?

Set long-term goals for patients and create a plan to help them achieve them using SMART goals: SPECIFIC, MEASURABLE, ACHIEVABLE, RELEVANT, and TIMELY.

Where can I find more tools to help me learn how to improve discussions with my patients?

The Obesity Treatment Modules Educational Series provides practical tools designed for HCPs and their office staff. It includes strategies and tips for diagnosing and discussing obesity with patients.

How can advocacy help support my patients with obesity?

Partnering with patients to develop comprehensive and individualized approaches to weight loss and weight management can make a significant impact. Advocacy helps fill gaps in health care that are keeping patients from successful weight loss.

How can I get more involved with patient advocacy for obesity?

Contact the Obesity Care Advocacy Network (OCAN) to advocate for individual patients, reach out to legislators, and understand current policy.

What is the relationship between COVID-19 and obesity?

Obesity puts individuals at a higher risk of severe illness with COVID-19. It is important to discuss weight-management care with patients who have obesity.

Why is it important to address weight-loss strategies in adolescents with obesity?

Obesity in adolescence has increased significantly, and many weight-related conditions seen in adults are now common in adolescents. Ongoing monitoring and treatment are required, including lifestyle modification, pharmacotherapy, or surgical intervention.

How do cultural factors impact obesity?

Cultural factors can influence weight goals, acceptance of body images, and the willingness to seek medical help. It's important to consider these factors when setting weight-management goals with patients.

If there is a connection between obesity and many comorbidities, will losing weight improve those conditions?

Obesity is associated with numerous comorbidities, including obstructive sleep apnea, type 2 diabetes, and hypertension. Studies show that even a weight loss of as little as 5% can help improve many of these comorbidities.

The Role Of Hormones In Obesity

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THE ROLE OF HORMONES IN OBESITY

Obesity is a chronic disease characterized by disrupted energy balance, partly driven by altered peripheral hormonal signaling that influences eating behavior^2,3

Some of the peripheral hormones regulating eating behavior include ghrelin, which drives hunger, and GLP-1, leptin, insulin, and amylin, which promote satiety and satiation.¹

GLP-1

GLP-1 is a nutrient-stimulated intestinal hormone with multiple roles, including appetite regulation.^4-6

Ghrelin

Ghrelin is a stomach-derived hormone that stimulates hunger and promotes meal initiation.⁴

Leptin

Leptin is an adipose-derived hormone that signals long-term energy sufficiency and normally suppresses appetite.^4,5

Insulin

Insulin is released from the pancreas in response to meals and helps regulate appetite in the brain.^1,4

Amylin

Amylin has a specific role.  Amylin is a nutrient-stimulated hormone that plays a role in satiation, glucose regulation, and bone remodeling.^7,8

Beyond its role in eating behavior and energy balance, the mechanistic effects of amylin described in preclinical studies include:

Reduction of appetite and energy intake, with increased satiety⁹

Delayed gastric emptying, and decreased postprandial glucagon secretion^7,9,10

Inhibition of osteoclast-mediated bone resorption, thereby supporting bone formation⁸

Your questions answered about obesity, hormones, and appetite regulation

Appetite regulation

Hormone Roles

Which hormones play a role in appetite regulation?

Ghrelin, amylin, leptin, insulin, and GLP-1 all play a role in appetite regulation.¹

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What are the multiple pathways which influence obesity?

Appetite regulation is complex and mediated by activation of multiple receptors. By targeting different receptors, different hormones can have complementary action.¹

Do all appetite-regulating hormones work in the same way?

No. Ghrelin stimulates hunger and promotes meal initiation, while GLP-1 promotes satiety by reducing appetite and slowing gastric emptying. Leptin signals long-term energy stores and normally suppresses appetite, insulin signals energy stores and helps regulate appetite, and amylin plays a role in satiation.^1,4

Where do appetite-regulating hormones come from?

GLP-1 is a nutrient stimulated intestinal hormone released after meals. Ghrelin is a stomach-derived hormone, leptin is an adipose-derived hormone, and both insulin and amylin are released from the pancreas in response to meals.^1,7

What different roles do appetite-regulating hormones play?

Ghrelin stimulates hunger and promotes meal initiation. GLP-1 promotes satiety by reducing appetite and slowing gastric emptying, and it also plays a role in glucose-regulation. Leptin signals long-term energy stores and normally suppresses appetite. Insulin signals energy stores and helps regulate appetite by acting on hypothalamic pathways and reducing food reward. Amylin plays a role in satiation, glucose regulation, and bone remodeling.^1,4,7

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References

1. Apovian CM, Aronne L, Barenbaum SR. Clinical Management of Obesity. 3rd ed. Professional Communications, Inc.; 2024.  

2. Austin J, Marks D. Hormonal regulators of appetite. Int J Pediatr Endocrinol. 2009;2009:141753.  

3. Morton GJ, Meek TH, Schwartz MW. Neurobiology of food intake in health and disease. Nat Rev Neurosci. 2014;15(6):367-378.   

4. Druce MR, Small CJ, Bloom SR. Minireview: gut peptides regulating satiety. Endocrinology. 2004;145(6):2660-2665.

5. Cassidy RM, Tong Q. Hunger and satiety gauge reward sensitivity. Front Endocrinol. 2017;8:104.    

6. Shah M, Vella A. Effects of GLP-1 on appetite and weight. Rev Endocr Metab Disord. 2014;15(3):181-187.

7. Hay DL, Chen S, Lutz TA, Parkes DG, Roth JD. Amylin: pharmacology, physiology, and clinical potential. Pharmacol Rev. 2015;67(3):564-600.

8. Dacquin R, Davey RA, Laplace C, et al. Amylin inhibits bone resorption while the calcitonin receptor controls bone formation in vivo. J Cell Biol. 2004;164(4):509-514.

9. Reidelberger RD, Haver AC, Arnelo U, Smith DD, Schaffert CS, Permert J. Amylin receptor blockade stimulates food intake in rats. Am J Physiol Regul Integr Comp Physiol. 2004;287(3):R568-R574. doi:10.1152  

10. Gedulin BR, Rink TJ, Young AA. Dose-response for glucagonostatic effect of amylin in rats. Metabolism. 1997;46(1):67-70. doi:10.1016   

11. Yamaguchi M, Watanabe Y, Ohtani T, et al. Calcitonin receptor signaling inhibits muscle stem cells from escaping the quiescent state and the niche. Cell Rep. 2015;13(2):302-314. doi:10.1016