A common question I am asked when speaking to the public or keen students on obesity research, or even friends outside of work, is how far along the road in obesity research we are. In reply I initially draw upon an old joke, sometimes sent to friends in their birthday card. The card depicts a person sitting on the side of the hill looking over the landscape. The caption underneath reads, ‘you’re not over the hill yet but you’ve good a pretty good view’. I would use this analogy to depict how far we have come in obesity research and how far we have to go - although some may argue we already know so much.
Whichever such ideas that we have had already, patting ourselves on the back for considering how clever we may have been, reminds me of the story of a US patent office official who resigned and recommended that the patent office be closed back in the 1840's as he thought that everything that could possibly be invented had already been done! Whilst this has been a funny story passed around the globe, it appears to be just a myth. There was no apparent patent officer who resigned and in fact this story may have been taken out of context from a report from the Patent Office Commissioner Henry Ellsworth 1843 report to US Congress, who suggested that “The advancement of the arts, from year to year seems to presage the arrival of that period when human improvement must end.” However, the original myth seems to perpetuate much more than the commissioner’s comments. Each generation may now consider that they have been the brightest and cleverest people to consider such novel new insights.
This analogy could be easily used in the field of obesity. Haven’t we discovered the main pieces of evidence to solve the problem? It is true that we have made significant advances and to a certain extent one could argue we know what we should do to reverse obesity through surgical and weight loss intervention programmes. However, we still aren’t good at working out individual personal risk profiles to manage the individual effectively or providing a long-term cost effective treatment platform considering the obesity pandemic.
Certainly it seems that future obesity research will invest heavily into determining the impact of functional foods on our health, understanding the value of food produce - their extracts and even individual components. Particularly as food manufacturers are even keener to investigate what health benefits their foods may have on us all. So does obesity research seem to align to that mythical patent office official who said it was time to pack up and go as there are no new advances? Absolutely not, as whilst it is true there has been an upscale in functional food research we now have much more sophisticated tools to be able to understand what is going on and to address whole body metabolism as well as at the molecular level. Furthermore, if you are one of those researchers who haven’t noticed the many new nutritional and health departments or institutes and staff title changes that have sprung up in this area, then where have you been?
Obesity research which has led to discoveries of the links between specific genes such as FTO and obesity, microRNAs and the change in our understanding of adipose tissue, amongst others, has not only been highly interesting but at times shocking. Therefore, as we look out on the side of the hill considering how far we have travelled in understanding obesity, are we further up or lower down the hill? Very few may agree exactly where we are and how long it might take us to reach the peak or final destination. In terms of treatment and weight loss interventions, will we pursue weight loss drugs, as well as ways of reducing metabolic risk without weight loss via a functional food or other diet interventions? Will we use prevention programmes with obesity never becoming apparent? We know that for those patients with morbid obesity bariatric surgery is often a way to limit multiple co-morbidities - although this is not feasible for all. For most of the population where diet is the key it is apparent we need ways to necessarily fool our bodies into thinking or feeling full, whilst considering we may not be dieting! Part of the solution in our diet is also trying to ensure that what we eat doesn’t aggregate our tissues into a pro-inflammatory state, so that perhaps we can live with a bit more fat without the metabolic complications. This may arise with diets including functional foods which may limit systemic inflammation.
The question of what the future holds depends largely on which obesity strategies we will ultimately deliver to patients as this changes where we might consider ourselves to be sitting on the side of that hill and the view from it, which currently still appears up for grabs. And in response to speaking to the public, students and friends, I never say how high up the hill we are or how long it might take to get to the peak, just that the outlook is good!