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Interviewer: In spring of 2022, there were some headlines going around almost every news outlet saying that the FDA had finally approved a new weight loss drug, one that would promised 10% to 25% weight loss with little more than just a weekly injection. The drug is called tirzepatide, or a brand name Mounjaro.

Now, it seems a little too good to be true. So, today, we're going to be looking at what exactly is the drug and what can it actually do for weight management.

Joining us today is Juliana Simonetti. She is the medical co-director of the Comprehensive Weight Management Program at U of U Health. So she knows a thing or two about weight management.

Dr. Simonetti, thank you so much for joining us.

Dr. Simonetti: Yes. Thank you so much for having me here today. I'm very excited to be talking about this new drug.

Interviewer: So why don't we start there? What is tirzepatide and what does it do to the body?

Dr. Simonetti: I'll start by just telling a short story. I was at an endocrine meeting in California two weeks ago when this drug got approved by the FDA for the treatment of diabetes. And we were doing a lecture, and all of a sudden, everyone started clapping and announced that this drug had been approved by the FDA for the treatment of the diabetes. So that's the kind of excitement we're getting with this drug.

It is a new class of medication for the treatment . . . Currently, it's only approved for the treatment of diabetes. However, we have seen really significant amounts of weight loss with the medication, and they are doing clinical trials at this point, and they have the results of the clinical trial for the treatment of obesity with this drug as well.

Tirzepatide is unique in the sense that is a dual incretin medication. It attaches to two different receptors. So we have a class of medication that has been in the market now for about 15 years called GLP-1 receptor agonist. And some of the drugs I think are well known at this point, both for diabetes and for weight loss. All those drugs were initially developed for the treatment of diabetes, and then they found that they led to significant amounts of weight loss.

So some of the drugs currently on the market that are GLP-1 receptor agonists are Victoza, Ozempic, Trulicity, and those drugs really have revolutionized the treatment of diabetes in the sense that they bind to receptors in our body that stimulates our own pancreas to produce insulin. And at the same time, they cross the receptors in our brain and tell us that we're full.

Therefore, when you start eating, you feel fuller sooner. It leads to induced satiety, so therefore people eat less, and it promotes the release of our own insulin so you have better glucose control, better sugar control for the treatment of diabetes. And we have this induced satiety that leads to people eating less, feeling fuller, and therefore losing significant amounts of weight.

Interviewer: So tirzepatide has been approved by the FDA to help manage and treat types of diabetes. But there's a lot of evidence in their, I guess, Phase 3 trials that are showing real potential to help with weight loss. What are they finding?

Dr. Simonetti: That's right. So their clinical trials for diabetes show . . . for those participants that had diabetes, it led to a significant amount of weight loss. And so they also then did clinical trials for this medication for those without diabetes for the treatment of obesity.

And what they found is that they highest dose of the medication, which is 15 milligrams, can reduce body weight on average by 28.4 pounds, which is nearly about 14% of the total body weight. So, for someone that weighs about 200 pounds, they will lose on average of about 28 pounds on this medication, which is really, really significant.

Interviewer: Wow. That sounds like a lot of weight loss for people without diabetes, but what does it do for people who do have type 2 diabetes? What kind of results have they been seeing with them?

Dr. Simonetti: Yeah, the results, it's really interesting because the results for those with type 2 diabetes, on the highest dose, show that those participants lost almost 21% of their total amount of weight, which is really, really impressive. This is more than anything else, any other medication we currently have in the market.

Interviewer: So if I get this correct, there are other . . . I've seen other drugs out there that fill your stomach up, the Plenity or whatever it's called, or they claim to impact your metabolic system, etc., but this drug actually impacts your pancreas in a way to help with glucose levels and help suppress hunger.

Dr. Simonetti: Yes. So the class of medication I was talking about is the GLP-1 receptor agonists that already exist that have been in the market now for about 15 years. The newer ones, one of them being semaglutide, or the other name is Ozempic, has been the latest.

They also got approved for the treatment of obesity and leads to very significant amounts of weight loss and improvement in the sugars in our blood because it stimulates the pancreas to release insulin and tells our brain . . . So it works on the appetite centers of the brain.

The difference between some of these drugs and what you're talking about, Plenity . . . So Plenity is considered a device because it's three capsules that kind of inflate in your stomach and therefore makes you feel fuller, so you have the physical sensation of fullness. However, the GLP-1 receptor agonists work in your brain and in the appetite centers of the brain. It works in the brain to tell you that you're full, so you don't have those cravings and then sensation that you wanted to keep on eating. It really leads to the feeling of feeling fuller.

With tirzepatide, why this is so exciting and different is that this not only works with the GLP-1 receptors, but also works in another receptor called GIP, which is a glucose-dependent insulinotropic peptide. It's a mouthful, but it's really another hormone in our body that is usually . . .

Both of those hormones are released in response to us eating food. So when I eat carbs or sugar, it goes in my stomach and then reaches my stomach and my intestines, my gut. My body says, "Whoa, we got nutrients here." We release the GLP-1 and this other one called GIP hormones that then say, "We got food, we got carbs, we got sugar. Let's tell our pancreas to release insulin," because we just got some food in our body. We got some sugar in our body. And then it crosses the brain and tells the appetite centers in my brain that, "I just got nutrients. We should stop eating." It should make me feel a little fuller.

The issue with our natural hormones in our body is that they get taken down, they get broken down very quickly. They only last a few seconds. And these new drugs bind now to those two different kinds of hormones and lead to this really much heightened sensation of fullness and to a much more significant response lasting much longer than what our own body would produce.

Therefore, that's why they're so effective. And therefore, that's why they are also given once a week, which is really kind of neat for a lot of those medications. So you don't have to take a medication every day. It's a small injection once a week.

Interviewer: Wow. So I guess when I first came into this interview, I'm used to doing stories about how some new drug that came out is not actually going to help you with weight loss when you really look at the research. But with your professional opinion, as a doctor who works with patients suffering from obesity or helping them live healthier with their weight management, why is this drug so exciting like you keep saying?

Dr. Simonetti: It is so exciting because the amount of weight loss we are seeing with the clinical trials from this drug is much more significant than what we had seen previously.

So as a measure for FDA approval for a drug for weight loss is usually about 5%. And with the latest drug, which is semaglutide with the other name of Wegovy, we saw a significant more amount of weight loss, around 14%, 15% with the higher doses. And with tirzepatide, we are seeing weight loss of around 20% with the higher dose of the medication, which 20% is a lot of weight, right? So it's a really significant amount of weight loss that we are seeing with these new classes of medication.

And as we know, weight loss is extremely difficult, right? This idea that if we just diet and exercise, we should just be able to lose weight. And it's not true. Eighty-five percent of those that diet and exercise actually, unfortunately, end up gaining the weight back and this weight loss is not sustainable.

And there are a lot of reasons for that, right? There is genetics. So 60% to 70% of the way we are, we know that it's related to genetics or the way we accumulate fat.

There's also our environment, and then there is this regulation in a lot of the hormones. There are these regulation appetite hormones. There is this regulation with insulin. The more weight that we gain, the more insulin-resistant we become. Therefore, there is this combination of insulin resistance.

So 90% of those that have diabetes also have excess weight. And some of the older medications that we had for diabetes, like the glipizide, glimepiride, and even insulin would lead to more weight gain, which then meant more insulin resistance and then making the condition just worse.

And with these new drugs, we see significant improvement in weight. Therefore, you also see significant improvement in decreasing in insulin resistance and also improvement in the glucose control and the sugar control in the blood because it works in conjunction. You have the stimulation of the pancreas and decrease in appetite.

Reading through the clinical trials again, and I just had done a quick review before we sat down for this interview, really it's quite impressive. One of their trials, they compare this drug for participants that have diabetes that were taking insulin and they gave them the tirzepatide. And those that took the tirzepatide lost weight versus those that were taking insulin actually by itself gained weight. So this is, again, quite significant in the amount of weight loss as well as in the amount of glucose control that we get with this medication.

Interviewer: So for all of the people who are thinking, "Oh, hey, this is the drug that's going to make me lose all my weight, finally," it's not ready for them, right? Is that what I'm understanding correctly?

Dr. Simonetti: That's right. So this medication is not yet approved for weight loss. I believe it will be, hopefully, within the next year or two. They are just finishing the Phase 3 clinical trials for weight loss.

Currently, this medication is approved for those with diabetes, and I think it'll be a wonderful tool for those that have diabetes and excess weight, overweight or obesity. This would be just a wonderful medication because it leads to a significant amount of weight loss and improvement of their diabetes.

This is great, and I think this is going to really improve the care that we can provide. However, we need to remember that obesity is such a complex disease, right? There's a multitude of issues that go with it. So this is addressing maybe some of our physiology, but we still need to do lifestyle modifications with modifications in our diet, increasing physical activity.

Behavioral health is a really important piece. Oftentimes, we eat in response to feeling sad, depressed, because when we eat in particular foods that are sweet or high caloric foods, it releases dopamine and serotonin in our brain. So it actually makes us physically feel better at the moment. And therefore, we go back and eat more because then I need another hit and then I feel better. And it becomes that very vicious cycle that once you start eating certain things . . . know for me, it's a piece of chocolate, right? I'm having a bad day at work, I eat a little piece of chocolate and my life is better at that moment. However, that doesn't help me because then my sugars crash and it makes me want to crave it more.

So really trying to address as many things as possible, and that's why in our program, we have this multidisciplinary team approach. We have the registered dieticians. We have an exercise physiologist. We have two Ph.D. psychologists. We also have other options such as surgery. So we work with the bariatric surgeons.

So again, it's wonderful to have one more tool, a very effective tool in our toolbox, but this is a tool. We are able to use it, and the more tools that we have, I think the better offer we're going to be, but we have to address all these other pieces as well.

Interviewer: So, obesity, it is not as simple to treat as just getting a new injection, even with some of these great new drugs. So I guess we'll just keep a look on the headlines, see if this is approved for obesity treatment in the next couple years, and maybe we'll have you back on and we can talk about how you guys can utilize it in your toolbox to battle obesity.

Thank you so much for joining us, Dr. Simonetti. I really appreciate you taking some time to talk to us about this new drug.

Dr. Gellner: Kids love sugar. That's a known fact. But are kids eating too much hidden sugar? Could that be contributing to childhood obesity rates? I'll discuss this on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Kids are born with a sweet tooth. That's why babies and young kids like fruits more than veggies. Sugar can actually be in more foods than you think. And often, parents aren't good about figuring out how much sugar is really in their kids' diet. So what does this all mean?

Well, more than 18% of elementary school aged kids in the United States actually meet the criteria for obesity. A child is obese if their body mass index or BMI is above the 95th percentile. If you don't know what your child's BMI is, ask at the next doctor's appointment. Often, it can easily be calculated by your child's pediatrician using your child's weight and height and plotting in on a chart based on their age.

While there are many causes of childhood obesity, too much sugar in the diet is definitely a factor. In 2015, the World Health Organization recommended that everyone, regardless of their age, should have less than 10% of all of their calories every day from sugar. For kids, this means no more than about 45 grams of sugar a day. Well, of course, kids can't figure that out on their own. If it was up to them, many of them would eat cookies for lunch every day. I know some adults that would too. That's where parental control comes in.

Just for some examples. Think about what foods that a lot of kids like, juice, yogurt, pizza, ketchup, pretty much the staples in a lot of kids' diets. Then think about sugar content in terms of sugar cubes. A sugar cube contains about three grams of sugar. So doing the math, kids should have about 15 sugar cubes a day.

When researchers studied parent's abilities to estimate how much sugar is in certain foods, they found that about 75% of parents underestimated sugar content. For example, about 90% of parents underestimated the amount of sugar in yogurt. Yogurt is considered a healthy food, but can have a lot of sugar, especially if kids had bigger portions or more than one serving a day.

One thing that researchers found even more concerning was that those children who are more overweight had parents who underestimated sugar content the greatest. Think about juice. Parents think that 100% juice means it's healthy. Their kids are drinking fruit, but it's juice loaded with sugar.

So how can you help your child keep their sugar content under control? Serve more veggies and real fruit. Read food labels and avoid foods that are high in sugar. Watch out for that hidden sugar like high fructose corn syrup. That's basically sugar, but that's not what it's called on the label. And keep your child's portion appropriate for their age.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Kids, technology and obesity. What do these three things have to do with one another? I'll talk about kids using technology to help childhood obesity and if it's a good thing or not on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Childhood obesity is a significant issue, with the Centers for Disease Control reporting 12.7 million children and adolescents between the ages of 2 and 19 years being obese. It's no secret what the long-term effects of obesity are. With how prevalent it is in children, it's even more important to find ways to get kids active and help them take charge of their health. One way adults do this is with fitness and calorie counting devices, like a Fitbit for example. More and more children are starting to use these devices as well.

The primary goal of using technology like these devices is to help children do self-monitoring. It's actually a sneaky way of changing their behavior. Kids are naturally competitive, so by letting them track their activity in the form of number of steps taken or time spent on a certain activity, it encourages them to keep going and meet milestones. Kids get immediate feedback on how they're doing, another aspect that kids love about technology, and finding out how they are doing at any given moment is huge to kids.

Some fitness trackers even make it more fun for kids by giving them examples of how far they've walked, like telling them they've walked the entire length of the Eiffel Tower. It gives them a visual reference that they can understand and help shape healthy behaviors.

Using technology like this also allows parents to have the conversation with kids to emphasize healthy behaviors. Many kids use technology to sit and play video games, but when you use devices or apps which encourage kids to be active, it helps remind them. Think about Pokemon Go for example. It's a video game, but kids have to do a lot of walking to get to poke stops, to get more poke balls, to catch more Pokemon. Kids will walk for 30 minutes or more and not even realize how far they've walked or how much exercise they've gotten.

A lot of parents think that kids get a lot of activity at recess at school, and in some cases that's true, but for other kids they may just be sitting on the ground socializing and not being active at all. Kids need to have fun to keep active. When parents try to increase physical activity for kids, it often backfires. Putting a kid on a treadmill isn't as exciting as encouraging them to go out and play games they really enjoy.

The bottom line here is there are a lot of different technologies out there that can help your child meet their fitness goals and needs. What works for one child may not work for another. The most important thing to remember is to make whatever your child does fun. That's the main way to keep them active.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: The United States has an increasing rate of childhood obesity, so why can't we seem to improve on this problem? I'm Dr. Kyle Bradford Jones, family physician at the University of Utah. We'll talk about this next, coming up on The Scope.

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Dr. Jones: Childhood obesity has long been a significant concern in the United States. The rate of childhood obesity has increased three to four times in the last 30 years. Approximately one-third of kids are either overweight or obese.

So this impacts multiple areas of health, both short-term and long-term, for these children such as impacting their heart, their lungs, their joints, and the possibility of developing diseases such as diabetes. It impacts their mental health as well as many other things.

Now, over the last few years there has been shown to be some mild improvement in the rate of obesity among young children age two to five years, so there is some bright side coming with hope on the horizon. However, a recent evaluation shows that the United States has the fifth highest rate of childhood obesity in the world. Now, in markers like this we tend to be number one in the world. However, I think this really underscores the problem. If we are number five that means this is a really big issue across the world and it's not just us.

So why is our rate so high? There are multiple factors. We're going to touch just on three.

Number one, our culture. It's changed a lot in the last 30 years. Our kids and adolescents and us as adults participate in a lot of screen time; so television, computers, video games, phones. Many households have more screens than people. So spending so much time in front of a screen leads us to be more sedentary and leads our kids to be more sedentary and not getting the activity they need.

When you combine this with concerns about safety outdoors, as well as the availability and cost of healthy fresh food, this can be a very important thing that leads to obesity. Soda and junk food tend to be ubiquitous and extremely damaging to our health. They are all over.

Number two, and this can be a little more controversial, but advertising to children for junk food. Young children cannot tell the difference between an advertisement and a show, and small children are often unable to understand good food choices. Now, advertisers have been shown to very carefully study what are the most effective ways to target children to get them to take these products and that seems to be having a big impact on childhood obesity.

Number three, school lunches. This is something that we're getting improvements very slowly but are getting some improvements, big efforts by people such as Michelle Obama to continually improve the health of school lunches. Now, this can include many different forms such as eliminating vending machines, decreasing the amount of fatty food, increasing options that are healthy. But this is a big contributor to the problem of childhood obesity.

Childhood obesity continues to rise in the United States, making us one of the worst in the world in this marker. Our culture, certain advertising methods, and food exposures at school among many other factors all contribute to the problem. So let's hope we can make some changes as a society to improve the health of our children.

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Interviewer: Turning unwanted white fat into good fat. We'll talk about that research next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Claudio Villanueva. He's assistant professor in the Department of Biochemistry and an investigator in the Center for Diabetes and Metabolism at the University of Utah. He was just awarded a grant from the National Institutes of Health to investigate fat biology with an eye towards developing innovative approaches to the obesity problem. Dr. Villanueva, your work is looking at differences between white fat and brown fat. I think a lot of people may not really know what brown fat is. Can you talk about that?

Dr. Villanueva: Sure. There are two different types of fat cells that are known as white and brown fat and the white fat is probably most known to people because the white fat cells can store lots of energy. When you consume excess calories that extra energy goes to your white fat cells and is stored at lipids. And over time these white fat cells increase in size and they also increase in number. They are the ones that you would sort of point to when you look at someone who is obese or overweight, they have lots of white fat. Brown fat on the other hand, its function is to generate heat to use that lipid and turn that chemical energy into heat. This process consumes a lot of energy.

Interviewer: So brown fat, is that something that you and I have normally?

Dr. Villanueva: Yes, adults have brown adipose tissue, some more than others. There is this correlation that obese individuals have less brown adipose tissue and individuals that are lean tend to have more. There's this correlation with obesity and diabetes as well where individuals that are protected against diabetes tend to have more brown fat.

Interviewer: So brown fat is kind of a good fat in a way.

Dr. Villanueva: That's right

Interviewer: Part of your project is to investigate how to convert white fat into brown fat, right? First of all why would you want to do that?

Dr. Villanueva: If we can turn on mechanisms that switches the balance from energy storage to energy expenditure this could be a therapeutic target to combat obesity. And there are these other types of fats cells called beige fat cells. They behave just like brown fat cells, they're thermogenic, they consume lots of energy, but typically they appear in the white adipose tissue or the white fat cells after prolonged cold exposure, so several days of cold exposure.

Interviewer: If your goal is to turn white fat cells into beige fat cells, I imagine first you need to do is understand what goes on within the cell in order to make that happen. What do we know about that, have you found out?

Dr. Villanueva: We've been interested in understanding how different types of fat cells are programmed and we found an auxiliary factor that works with a central transcription factor that makes all fat cells. And this auxiliary factor programs cells to become white fat cells. And it turns out that this auxiliary factor, if you inhibit it, if you knock it out in mice, or if you delete it in mice I should say, this results in a switch from storing energy to burning energy and this results in the appearance of more beige adipocytes.

So the way we're thinking about this is if we can find ways to inhibit this molecule, it's called TLA3, we might be able to shift the balance towards energy expenditure and have more beige adipocytes.

Interviewer: So where are you taking this research now?

Dr. Villanueva: We're trying to understand the molecular action between this auxiliary factor TLA3 and another factor called PRDM16. PRDM16 is important in making brown fat cells and we have some evidence that TLA3 is able to inhibit the activity of PRDM16. These auxiliary factors are talking to one other in a sense. Understanding how this crosstalk is occurring, we may be able to identify ways of inhibiting that negative interaction between TLA3 AND PRDM16. And to do that we really need to understand how this molecular interaction occurs.

We've also identified a new player that may be able to disrupt this interaction in cells and this factor is called AES and it's induced with prolonged cold exposure in rodents during the time when these beige adipocytes appear. What we think might be happening is that AES is turned on to prevent interaction between these two auxiliary factors and allow the activation of the beige program.

Interviewer: So what have you seen in mice so far? What kind of manipulations have you done and which ones sort of makes the biggest impact?

Dr. Villanueva: One of the impacts that we've seen so far is that in mice that lack TLA3 and adipose tissue, we see pockets of these beige adipocytes. And so now what we're doing is studying the physiological consequence of that. We know that beige adipocytes consume glucose and lipids and so if they consume glucose, we might be able to see effects on glucose metabolism which has implications for diabetes. One of the findings that we've had is that these knockout mice have improvements in glucose when we challenge them with prolonged cold exposure.

Interviewer: The ultimate goal is to get I would imagine, the best conversion from white fat to beige fat.

Dr. Villanueva: As far as developing therapeutics, the way that we're thinking about it is that it's oftentimes easier to make a drug that will be able to inhibit a pathway rather than activate it. So since we know that TLA3 is able to inhibit this beige program, the idea would be to inhibit the actions of TLA3. We're starting to develop assays to be able to do that and to search for drugs to disrupt this interaction.

So I think there are going to be two ways to do this effectively and one way is to reprogram the cells and the other way is to stimulate these cells. They need to be activated and so typically they're activated with cold or they can be activated with drugs that activate the Beta 3 adrenergic receptor. One way to do this is if you could find sort of common [inaudible 00:07:18] therapies that would reprogram cells and then also activate these cells then you would have highly active beige fat cells that are metabolizing glucose and metabolizing lipids. The average American puts on about a pound of fat, which is around 3500 calories.

Interviewer: A pound of fat per...?

Dr. Villanueva: Per year.

Interviewer: Per year.

Dr. Villanueva: A pound of fat doesn't sound like a lot in a year. And if you break down those 3500 calories over days it's about 10 calories a day that you're consuming in excess of what you're burning. And so if you can have small effects on energy expenditure which would consume those calories you might be able to prevent the average weight gain that most Americans have.

Announcer: Interesting, informative, and all in the name of better heath. This is the Scope Health Sciences Radio.

Research indicates that if kids are overweight at 5 years old, they have a pretty good chance of being obese adults.

You've heard me talk about it before. Obesity is becoming a really big problem for kids. And there's a lot of things that you need to remember. Obese kids are at risk for diabetes. They have high cholesterol. I see kids already, kids that aren't even 10, and they have insulin resistance, which is pre-diabetes. They have high cholesterol, high triglycerides. I've seen kids who are barely 10, barely into double digits, and they have triglyceride levels double what an adult should have.

If your child is obese and has asthma, it's going to make their asthma worse. A lot of kids will complain that they're short of breath because they're carrying so much weight. They'll have back pain, knee pain, things like that, and they just can't keep up with other kids. So that's the physical problems that go along with obesity.

The psychological ones, that too, a lot of kids who are overweight, they aren't liked by many kids. They're teased by many kids, bullying, and they don't feel good about themselves. You know, it really weighs on their self-esteem.

So it's important as a parent that you pay attention to this and especially pay attention before they become kindergarteners. See your pediatrician and ask them, you know, "What is my child's weight, what is their height, and what is their body mass index?" All kids over 2 can have their body mass index calculated, and it's just a math formula. It takes their height and their weight into consideration, and it comes up with a number. You need to look at their percentage for their body mass index, and if they're over 95 percentile, they're considered in the obese category.

So a new study came out in "The New England Journal of Medicine," and it showed that half of childhood obesity occurred in children who had been overweight during the preschool years. One thing it pointed out was that kindergarteners who were heavy babies, which is 8.8 pounds or more at birth, were actually more prone to being overweight toddlers and overweight kindergarteners.

We usually associate healthy babies with chubby babies. And the realism is I'm not surprised at this study. I'm seeing a lot of kids who are overweight in their toddler years, who get to just graze all the time with eating, whose parents, you know, they think that they just need to constantly be eating for growth. And actually, kids normally go through what's called the toddler appetite slump. Between ages 1 through 5, they just don't eat that much. They're not growing like they were in the first year of life. They're not growing like they will be during their second growth spurt around the kindergarten, first grade years. So they don't need as many calories in as they did before, so they normally are going to thin out by age 4.

For kids who are overweight before kindergarten, it's like they've already gotten their destiny predetermined. One-third of kids who are overweight in kindergarten were actually obese by eighth grade. I mean, that's when they're around 11 years old. And the concerning thing is almost every child remained that way.

So you don't want to wait until they're, you know, in later elementary years or in middle school before you start going, "Hmm, my child looks a little bit more overweight than some of these other kids." You actually want to start paying attention when they're in preschool. See how their weight is in preschool, because that's going to tell you what things are going to be like once they get older.

Once obesity is established early in life, it actually tracks through adulthood. The only time there's really exceptions is when you make a conscious effort to change the eating habits and the activity habits of the children that you're concerned about.

For a lot of kids there is concern about, you know, what is the ethnicity? You know, everyone says, "Oh, well, I'm from this type of ethnic group, and we always are big-boned people." Or, you know, same with race or family income. A lot of people say, "Well, I don't have the family income to be able to afford all these healthy foods, so I'm going to feed them what I can because I want my children to eat." But, regardless, a lot of people say, "Well, that's how it is in my family." But the truth is, after age 5, those factors no longer affect their risk for being overweight in the later years.

So what parents really need to do is focus on checking their child's growth from early on, seeing how they are on the growth curves. And again, your pediatrician will tell you what their growth is, their weight, their height, and, after age 2, their body mass index at every single well visit.

Parents also need to pay attention to what your child is eating and their eating habits. You want to make sure you're instilling healthy eating and activity habits early on before there's a problem. And if you're worried that there might be a problem, the study reinforces that genetic influences do show up early in life, but exercise and a healthy diet can actually reduce the effect of the genes. You can actually overcome your genetics, to a point. Unfortunately, you can't change your genes. You can change how you eat and how you exercise.

So the important thing is to prevent the problems from happening rather than reacting to the problem once they've already happened. Pay attention to 5210, five servings of fruits and vegetables a day, two hours or less of screen-time, television, computers, video games, one hour of physical activity, and it doesn't have to be one hour all at once. You can do 20 minutes here, 10 minutes here, 5 minutes here, round off with a half an hour, just being active. And finally, zero sugary drinks. That includes juice, that includes soda. You will be shocked to find out how much sugar and how many calories are in a 20-ounce bottle of soda or a 12-ounce cup of juice. It's as much as a candy bar. So eliminating the bad stuff like that from the diet, making them treats instead of daily or weekly parts of your diet can actually go a long way to prevent the problems of childhood obesity.

If your child can make it through their first five years at a healthy weight, the chances that they will remain at a healthy weight for the rest of their lives really improves. So it's worth making the effort early on to give them the best start in life that you can.

updated: December 6, 2021
originally published: March 4, 2014

Announcer: Examining the latest research, and telling you about the latest breakthroughs, The Science and Research Show is on The Scope.

Host: One day will there be a pill that cures obesity? Jared Rutter, a professor of biochemistry at the University of Utah is researching ways to combat obesity and diabetes at their source by fixing problems with the body's metabolism. Dr. Rutter, what do you think about the argument that the reason that obesity and diabetes are such huge problems today is that our bodies' metabolism is really designed for our caveman ancestors' who lived in a very different world.

Dr. Jared Rutter: I remember when I first heard that concept and it just made so much sense to me. The pressures that our ancestors were under were completely different than the pressures we're under. When I say pressures, I mean from a survival sort of context and as a result, there was a much greater selector pressure to avoid starvation, because especially in a historical context, we may not eat for a couple of days and if we're not good at storing the energy we ate today, we may starve in 36 hours when we haven't eaten. And so our bodies are very good at taking the energy we consume and putting it into a storage form that can then be accessed over the course of the next days, week, months. And so now when we essentially have access to unlimited food, or many of us, most of us do, and don't have an imperative to do extensive exercise, that now puts our bodies in a situation as you said that they are not optimized for.

Host: It seems today the answer is fad diets. Every year there's a new one, the paleo diet, the Mediterranean diet, what's your opinion of fad diets?

Dr. Jared Rutter: There are obviously good aspects to all dietary regimes. At the end of the day, if that diet is a balanced diet that enables us to consume a smaller number of calories, that brings it more into balance with the number of calories we expend via exercise and our body's basal metabolism, then that's probably a good thing. I do think, however, that highly unbalanced diets that are focused around one key element or principle and don't enable us to have a balanced diet to provide our body with the nutrients we need, are probably unbalance, unhealthy and should probably be avoided.

Host: Why is it important to study metabolism? What do we still need to know?

Dr. Jared Rutter: We understand in most cases the steps, you know when we eat a carbohydrate, we understand most of the steps by which that carbohydrate is converted into energy that our body can use. What we don't know as well is how does the body do what it needs to do with the nutrients that we bring in through our diet. And how does that change when we've eaten a lot, how does it change when we haven't eaten, how does it change when we've just, you know, run 15 miles, how does it change when we're sitting on the couch watching TV? We need to understand what that difference is and what the body is perceiving to make that change and then how does it enact that change. And if we can understand that at a deep level, that may be where we can use therapeutics, be they behavioral therapeutics or pharmacologic, or other means to manipulate that process and maybe put us into a healthier state given our environment.

Host: So what exactly are you researching?

Dr. Jared Rutter: One major area of research interest for us is how does the cell decide, how does the body decide really what to do with the carbohydrates that we take in and one of the possible options for the fate for carbohydrates in our body is to convert them into fats. And that's done quite efficiently in, among other places, our liver. And we study the process by which that happens, and again how that is regulated, how the body decides when to do that, how much to do that. I think it's quite clear now, from studies around the world, that this process is fundamentally important in obesity and I think there's emerging evidence that it's fundamentally important also in diabetes. And I think there's emerging evidence that's not quite as clear yet, but that this process is also important in other diseases like cancer.

Host: So is there a particular pathway or a particular protein that you're focusing on?

Dr. Jared Rutter: Yeah, we focus on a protein that has the name PAS kinase and so its role is a regulatory role; it controls the activity of other proteins and enzymes that participate in this process of lipogenesis, this process of converting carbohydrates to fat among other things that it does so we are now are trying to understand how this regulator, PAS kinase, controls the activity of this lipogenesis process and how that relates to the disease processes of obesity and diabetes in people.

Host: So the idea is that if you understand how PAS kinase work, then you can manipulate that protein, or that pathway and possible influence how well lipids are made or how lipids are stored as fat?

Dr. Jared Rutter: Exactly. Yeah, that's exactly right. Unless we understand what's going wrong with the disease, we don't know what target we're shooting at, right? We don't know what to hit. What we have found is that we think this process is misregulated at the cellular level in context of obesity and diabetes and so, yeah, we think that we now understand enough that we know at least a few targets that we'd want to try and change the disease process in obesity and diabetes.

Host: But is that what we really want? Do we want a magic pill or a magic therapy. I mean, wouldn't it be best to just have people exercise more or eat a better diet?

Dr. Jared Rutter: There's no doubt that that would be the best thing to do. There are benefits to exercise that, in my opinion, will never be compensated by a pill. There are benefits to a healthy diet that will never be compensated by a pill. The sad reality, however, is that in spite of us understanding this, and we've really understood this for decades now, the importance of diet and exercise, globally, at least in our country, and in most others, that isn't working so well. And to deal with that, myself and many other scientists around the world are trying to come up with stop-gap measures that can keep us from having the devastating consequences of obesity and diabetes on a pandemic epidemic scale while we figure out how to encourage ourselves and especially our children to live a healthier lifestyle.

Host: So you must think this has real promise.

Dr. Jared Rutter: That seems like the best therapeutic strategy to me rather than you know, to use another analogy, putting a Band-Aid on the wound if we can really go to the heart of the wound and fix it that seems like such a better strategy than just trying to repair the damage that the disease causes. And so that's really the strategy I believe in and the strategy that my laboratory tries to take toward the understanding of the disease.

Host: What got you into studying metabolism?

Dr. Jared Rutter: Most of the reason is I've come to be convinced that alterations in metabolism lie at the heart of really almost every human disease and just like in any other area of human behavior there are fads and trends in science. And metabolism has been on the wrong side of the fad and trends for many, many years and it's just over the past five, ten years or so, is sort of seeing a reemergence and I decided that if I really want to make a contribution to understanding human physiology and human disease, that metabolism and really the underpinnings of metabolism and how it's regulated would probably be the best thing I could do. To some extent a scientist is like an explorer and we've really just been following our nose ever since that initial decision.

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Dr. Cindy Gellner: Hi, I'm Dr. Cindy Gellner. I'm a pediatrician at the University of Utah's Westridge Health Center.

Interviewer: Let's talk about childhood obesity for a second, one of your passions.

Dr. Cindy Gellner: Right.

Interviewer: Why is childhood obesity one of your passions?

Dr. Cindy Gellner: Just because I see a lot of it. It's a big, growing problem nowadays. We see a lot of kids who are overweight and actually kids that are normal weight seem really, really skinny but they're actually normal. We have such a high prevalence of childhood obesity now that it's just something I started doing routinely and then I did a project about it and it's just been something that I've been the specialist for at this clinic for the past three years.

Interviewer: Childhood obesity. Do you think that's one of the most important things facing our children today?

Dr. Cindy Gellner: It's one of the biggest problems that we're facing in child's health, yes.

Interviewer: Why is that?

Dr. Cindy Gellner: There's a lot of theories going around. The biggest one is you don't have PE in school as much as you used to. In neighborhoods there's a lot of places where kids can't go and play as much as they used to. Foods, obviously there's a whole lot more variety for foods out there and quite often it's expensive to eat healthy. So a lot of people can't afford to eat a lot of the healthy foods that would be better for the children.

Interviewer: We know childhood obesity, for those that have it, it's a threat. How prevalent is it among our children?

Dr. Cindy Gellner: A lot of kids. I would say in my patient population there's probably about a third of my patients who actually meet the criteria for childhood obesity.

Interviewer: Have you noticed that increasing over the years?

Dr. Cindy Gellner: I have, yes.

Interviewer: How do I know if my child is obese? Is there a definition?

Dr. Cindy Gellner: There is. The hard thing is, when you think about adults you think about obesity as having a body mass index of 30 or higher, and a body mass index is actually a math formula that takes height and weight into consideration and so for kids you can't just say a body mass index over 30 because it's going to change based on the gender of the child and the age of the child.
So on the graphs that we do for all children over age 2, there's a body mass index chart when we do a visit and we check their height and we check their weight. If a child is between 85th and 90th percentile on the body mass index we start talking about how their weight is starting to creep up there. Let's talk about ways that we can bring it down into a more healthy range.
Kids that are in the 90th to 95th percentile or even the 95th to the percentile we're like, okay, we really need to start talking more seriously about it because they are getting into the overweight categories. Children who have a body mass index above the 99th percentile for their age and gender technically meet the criteria for childhood obesity.
Genetics plays a big part of it too. You've got to figure out is the child obese because that's their genetic makeup, or are they overweight and they just have other risk factors like too much television, things like that.
So it's not as cut and dry as just saying, yes, your child is overweight and this is what we need to do. But we do have a lot of things that we can tell them that these are things that you can do to help increase the chance that your child is going to be a healthy weight and to help your child be healthy on the inside as well, which is what we strive for.

Interviewer: All right. So let's talk about this for a moment. A parent brings a child in and you determine that they're obese. What's the first step then?

Dr. Cindy Gellner: In the program that I do we have a very long conversation about weight. They'll actually come back for a consult with me, and if the child is old enough, usually we say over 10 but I've done it in younger kids as well, we'll check for their cholesterol, we check their sugars, we check their thyroid, although it's very rare that the kids actually have a true thyroid problem, and we just check to see what their overall health is. I've caught kids who have liver abnormalities because there's fat in their liver already.
So we do that and then we sit down and we find out: what is your lifestyle like at home? What are your eating habits? Do you eat regular meals or do you graze all day? Does your family eat together? Do you eat enough fruits and vegetables? You're supposed to have five servings of fruits and vegetables a day.
Do you watch a lot of television? You should have two hours or less of screen time, and that includes television, computers, video games, Facebook, things like that.
There's a lot of kids that are emotional eaters. They get stressed out or they're bored and they will sit and just eat even though it's not meal time and they're not hungry but they're bored so they reach for something to eat.
Then kids don't get a lot of exercise. During the summer you have a lot of outside things that they can be doing and during the school year a lot of them have PE or they'll walk to school, but they should have a cumulative of one hour of activity a day.
Then the biggest thing I find is kids are just shocked when they find out how many calories are in juice in soda. I actually have a chart that I give them where a soda and juice are actually called liquid candy because a 20 ounce regular soda has as much calories and sugar as a candy bar.
So they don't realize all this stuff. They don't realize the portions they're eating and they don't realize this until you sit down and you talk with them about their individual habits at that time and then they're like, "Oh, wow."
We just choose one small change to make at every visit because it takes about a month of them doing a particular change before it actually becomes part of their routine and then we just slowly see how they're doing. I do pick up a lot of kids that have insulin resistance where they have a lot of sugar in their body and their pancreas is just overloaded.
They can't make enough insulin for their body to use to get all the sugar that they eat turned into energy and whatever sugar is left over gets turned into fat. There's a lot of kids that have that. There's a lot of kids I find with high cholesterol at a young age, so we do have a lot of discussions about all that.

Interviewer: So it's more than just being overweight. You need to eat less, you need to get out and move around more. There are a lot of other factors it sounds like.

Dr. Cindy Gellner: Exactly, there are.

Interviewer: That's kind of an old-fashioned way of looking at it.

Dr. Cindy Gellner: Right.

Interviewer: All right. So after that first consultation, how often do you see those steps solving the problem, letting them know how many calories they're actually consuming, looking and seeing if they're stress eating, how much screen time they're getting?

Dr. Cindy Gellner: Right. Again, the child comes up with one goal. They can ask for my input, they can ask for their parent's input, but the bottom line is they're in charge. Giving them the autonomy to make these choices actually helps improve the outcomes.

Interviewer: So you give them that one goal and you see them a month later?

Dr. Cindy Gellner: Yes.

Interviewer: And then, generally, 90 percent of the time the problem is solved?

Dr. Cindy Gellner: Nope. No, no, no. We see them every month and if they have a slip-up, it's like, okay, don't get discouraged. Let's see where we can tweak things. We keep on them because quite often just having that reinforcement of, "You're doing a good job," or, "You know what, it's okay. It's the holidays. We all understand," and just say, "Okay, how can we get you back on track?" just having that support system there, the parents and the kids really respond to.

Interviewer: All right. So what are some other factors and we'll talk about these in future podcasts that might play into it? Kind of tease us, if you will.

Dr. Cindy Gellner: Genetics is huge. There is a lot of diabetes, high blood pressure, heart disease, things like that going around.

Interviewer: That you might miss in the first initial screening?

Dr. Cindy Gellner: Well, actually, we talk about that in the first initial screening. We ask about family history because that is such an important thing. You can change your eating habits, you can change your activity, you cannot change your genetics.

Interviewer: Okay.

Dr. Cindy Gellner: As much as some of us would like to, we cannot change that. But there are ways that by doing things on a more healthy level you can actually prolong or reduce the chance of you actually having those chronic diseases.

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