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George Bray Part 3, Obesity Breakthroughs on the Horizon

In part 3, the conclusion of this Exclusive Interview, George Bray talks with Diabetes in Control Medical Editor Joy Pape about the possible obesity breakthroughs we may see in the future: methods and strategies for curtailing the obesity epidemic.

George A. Bray, MD, MACP, MACE is Professor of Medicine Emeritus at the Louisiana State University Medical Center in New Orleans.


Transcript of this video segment:

Pape: So, I was going to ask you if there are any important breakthroughs that you see now or on the horizons. So, it’s sounds like that’s one.

Bray: Well, that’s certainly one.

Pape: Anything else? Yes.

Bray: That’s certainly one. We know a great deal about some of the things that you can change and which have — it’s probably been changed to ask do they impact the food intake, the beverage intake in the population. There are trials and there’s actually a court case at the moment trying to overthrow the tax that Philadelphia has put on soft drinks. But it’s very clear that where soft drinks are taxed, the consumption goes down and where the follow-up’s long enough, body mass index begins to go down. So, it’s clear that that strategy does work. Is this population prepared to make choices of that kind? Well, we haven’t had the political will to do anything about it yet. And is that what’s going to be required? Well, it may be.  

Pape: It may be.

Bray: And the question is if the problems with the sugar containing beverages isn’t just weight gain, but it’s their association with liver disease, so-called non-alcoholic fatty liver disease which is clearly related to beverage consumption. And the major cause at the moment for a liver transplants are people who have non-alcoholic fatty liver disease. Not cirrhosis, not other poisons that do it, but basically a function of our dietary consumption of sugar-sweetened beverages. So, I am optimistic that we can somehow bite the bullet and that the taxes that Berkeley has put in place and Philadelphia put in place, and some others have put in place. Mexico has done it to all their beverages. It’s nationwide in Mexico. They have a very serious problem with–

Pape: Yes.

Bray: –obesity and diabetes. And they’ve decided they need to do something, because the long-term outcome for diabetics is not good. It’s very unhappy, with blindness, amputations, heart disease, kidney failure, kidney dialysis. None of those are really happy outcomes. And you can’t predict that they’re going to occur to you but they occur to all too many people who get diabetes. So, it’s something we need to tap down before it gets too far out of control. The other interesting — there are some challenges on the horizon, some new interesting strategies. We know that the brain has a number of mechanisms for modulating food intake. We also know that food intake has a pleasure component to it. It activates the same systems that sex, drugs, tobacco and the like activate. They activate the so-called mid-brain dopamine neurogenic pathway. And so, it’s got a regulatory sense and a hedonic pleasure sense. And if we’re going to have all — it’s probably the people who sense the pleasure from their food in excess that get the problems with obesity. And there are numbers of very interesting studies coming out using techniques to look at brain imaging that suggest that this is a serious issue. So, the pleasure part combined with this overwriting these feedback parts are areas we need to understand better. The other component of the feeding system of the messages that come from outside the brain to the brain, telling the body that it either needs or doesn’t need food. And the messages from the GI tract are the earliest ones. You get your taste — the sight, smell, and taste of food is either a positive or a negative feature. Some foods smell very good, you like to eat them, and you do. So, we’d like to prevent the problem or if we can’t prevent it we’d like to have some effective therapies and these seem to be potentially good ones for the future.

Pape: Well, I can’t thank you enough. And tell you that all you’ve told me today and I’m sure others feel the same way, only wants me to ask you more questions. But for lack of time, I guess I’ll ask you just one question.

Bray: Uh-hmm.

Pape: What’s your ZIP code?

Bray: My ZIP code is 94107.

Pape: Okay.

Bray: It’s a San Francisco ZIP code.

Pape: Okay. Well — and so, what’s the rate of obesity there?

Bray: I don’t know.

Pape: Okay.

Bray: The West Coast doesn’t have much. The coasts tend to be less problematic than the center. San Francisco is a high rent area. And the number of people who have weight problems doesn’t appear as high as it does when I go to Disneyland for example, which is a little different.

Pape: A lot different.

Bray: A lot different.

Pape: Well, from all over.

Bray: All over.

Pape: Again, thank you very much!

Bray: Pleasure.

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