Search for tag: "obesity"

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, 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.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today, "The Specialists" with Dr. Tom Miller is on The Scope.

Interviewer: Fatty liver disease affects more than 80 million Americans, and many of them don't even know they have it. Dr. Tom Miller, why does fatty liver disease concern you as a doctor?

Dr. Miller: Well, fatty liver disease is becoming the most common chronic liver disease in the industrialized Western world, and especially in the United States. And it used to be, we had viral hepatitis as a cause of liver disease and a major cause of transplantation, which it still is, but very shortly the major reason for liver transplantation due to liver failure is going to be fatty liver.

Interviewer: And not necessarily caused by alcohol. I always thought it was, you know, people that drank a lot tend to get fatty liver disease.

Dr. Miller: Well, they get liver disease. It's not necessarily fatty liver disease as you would think about it, and it was and still continues to be a cause of liver disease, but because of our lifestyle and the fact that 30% of the people living in the United States have obesity, fatty liver disease is now the most common cause of chronic liver disease.

Interviewer: Yeah, 80 million Americans, that's quite a . . . that's almost an epidemic, isn't it? Like, if 80 million Americans had any other sort of disease, we would be freaking out.

Dr. Miller: Right. I think the term might be just a little bit . . . The categorization of it is a little bit misleading because not everyone with fatty liver disease goes on to develop liver failure. In fact, a small percentage of those people end up with liver failure, but given the large number of people with fatty liver disease, a significant number of Americans will end up with end-stage liver disease.

Interviewer: And what exactly is going on? So I think the name implies that there's some fat, maybe excess fat deposits in the liver, but why is that bad?

Dr. Miller: Fat is a cause, a driver of inflammation, and we don't exactly know why, but when people gain weight, some of that weight is stored centrally and also stored between the cells in the liver. So if you look at a person's tissue from the liver, you will see if they have fatty liver, which is called non-alcoholic fatty liver. You'll see fat stores or globules in between the cells. For whatever reason, this causes inflammation, and inflammation predisposes to damage, fibrosis, and destruction of the active cells in the liver which help us cleanse our body of toxins.

Interviewer: And you're talking about scarring.

Dr. Miller: I'm talking about scarring.

Interviewer: That's why I used those words, yeah.

Dr. Miller: Fibrosis leads to scarring.

Interviewer: Yeah.

Dr. Miller: Now, again, most people with fatty liver don't end up with inflammation, and we don't exactly understand why some people have problems with inflammation related to their fatty liver versus those who don't. And not everyone who has inflammation in the liver goes on to develop cirrhosis.

Interviewer: But it's certainly a path you don't want to go down and find those things out.

Dr. Miller: No, definitely not, and it can be treated.

Interviewer: All right. So, when a patient comes into your office, can you look at them and tell if they have the bad kind of fatty liver disease that could lead to transplant or death?

Dr. Miller: I think the way that we think about it now, I believe the way we think about it now is if you're obese, that is you have a body mass index greater than 30, your chances are pretty high of having non-alcoholic fatty liver disease. So, basically, the same thing that we've talked about on these shows in the past, right diet, right weight, right exercise is your best treatment to prevent it. This is a problem with industrialized countries having too much food and the wrong kinds of food available.

Interviewer: Yeah. And once that scarring happens, there's no cure for it. It eventually will lead to liver failure.

Dr. Miller: Once you start down a path of scarring, your chances of ending up with end-stage liver disease and needing a transplant are pretty high. Not only that, you are predisposed, with that scarring, to liver cancer.

Interviewer: And if you start to lose some weight, I understand it doesn't take, necessarily, a lot of weight reduction to reduce the number of fat cells in the liver and kind of start backing that thing up if scarring hasn't occurred.

Dr. Miller: Right. I think one, again, wants to head for a normal BMI, which is between 18.5 and 25.

Interviewer: Okay.

Dr. Miller: And that's not easy. I mean, I tell you that that's the treatment, but attaining that treatment for everybody is difficult because we don't have a medication for weight loss that works, and basically it's a lifestyle adjustment, which is hard for people given the abundance of food.

Interviewer: And there are tests that you can do to determine, for sure, if there are.

Dr. Miller: There are. So we basically start looking at the issue of inflammation in people who we think might have fatty liver disease by looking at the enzymes that the liver produces on a blood test. If these are elevated, there are a number of causes, but eventually, if you can rule out sort of the medical, the drug-associated causes and other causes, that is if they're not drinking, you can think that this is probably related to a non-alcoholic fatty liver disease. And if you really want to know damage to the liver, you're going to have to do a liver biopsy. There's another test now that's non-invasive, but liver biopsy is still the gold standard.

Interviewer: And we haven't really hit on this, but it often doesn't have symptoms.

Dr. Miller: The vast majority of people with non-alcoholic fatty liver disease are not symptomatic.

Interviewer: Yeah.

Dr. Miller: And, in fact, you're only symptomatic towards the end . . .

Interviewer: When it's kind of too late.

Dr. Miller: . . . with this disease when you have fibrosis and scarring or liver cancer. So, again, we want to look at obesity and lifestyle as a response to prevent this.

Interviewer: So get that body mass index back into a reasonable area?

Dr. Miller: Well, it's the same thing we talk about for all of the things that we now kind of associate with the Western world diet, which is high blood pressure, heart disease, metabolic syndrome, type 2 diabetes. They're all in a basket, including this non-alcoholic fatty liver disease. And, again, the treatment is at our hand, but it's not easy to achieve.

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.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

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.

Announcer: Five things for better sleep that you're probably not doing. That's coming up next on The Scope. Medical news and research from University Utah specialists and physicians you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're in the studio today with Dr. Kyle Bradford Jones, family physician at the University of Utah. First of all, let's explain to the audience how important sleep is. We know that sleep is important because we all need it, but exactly how important is the amount of sleep that we get?

Dr. Jones: It's huge both from an issue of quantity as well as quality. Making sure that you're sleeping long enough but also making sure that you're doing the things that you get good quality sleep. So getting adequate sleep improves your thinking, it allows us to better handle stress. Getting too little or too much actually can cause us to die prematurely. It can cause heart disease, it can cause obesity, and if we're trying to lose weight, it keeps us from losing weight. It just kind of affects everything and when you think about little kids in school, if they get adequate sleep they're going to do much better. They're going to do better in school, they're going to be better behaved and they're going to be smarter overall.

Interviewer: So in a nutshell it's pretty important.

Dr. Jones: Exactly. And especially as a nation, we're basically all sleep deprived and so this becomes a huge issue to make sure we're doing the best we can to kind of optimize our body.

Interviewer: So five things to better sleep then, to increase that amount of people getting the right amount of sleep and the quality of it as well. So number one?

Dr. Jones: Avoid caffeine, nicotine and alcohol four to six hours before sleep. So some people think that some of these things kind of calm them down and help them get to sleep, but it actually decreases the quality of your sleep. And so you're not getting as much rest and it actually can be detrimental for you.

Interviewer: So no coffee before bed?

Dr. Jones: Exactly.

Interviewer: All right. Number two?

Dr. Jones: Next one, set a comfortable environment. You want it to be dark; you want it to have a comfortable temperature and things like turning off the TV, turning off the radio. Those types of things can actually keep your mind working a little bit more then actually decreases the quality of your sleep.

Interviewer: But turn off the radio is a little bit surprising to me personally because I always sleep with my iPod on with music kind of low. Is that not good then?

Dr. Jones: Some people do better with a small amount of noise, whether it's typically . . . white noise can actually help a lot of people. Having the music or something that's constantly changing, your mind wants to focus on that and so it can actually kind of detract your mind from getting the quality of sleep you need.

Interviewer: That's probably why I'm not falling asleep as fast as I could be. All right. It makes sense.

Dr. Jones: Maybe.

Interviewer: Number three?

Dr. Jones: Turn off your screens. So cell phone, TV, computers, try to avoid using them for an hour before you go to bed. Now, I realize that's very difficult and this may be the most difficult thing for all of us.

Interviewer: I'm thinking in my head too. I'm failing at all of these but especially this one.

Dr. Jones: Exactly, most of us do. But again, it disrupts sleep quality. It makes it harder to fall asleep. It actually increases depression, decreases your attention span, lots of things that are attached with using these too much, especially right before bedtime.

Interviewer: Okay. Well, number four?

Dr. Jones: Number four is getting exercise during the day. So especially cardiovascular exercise.

Interviewer: Like walking and jogging?

Dr. Jones: Exactly.

Interviewer: Okay.

Dr. Jones: Making sure your body is moving, making sure you're increasing the blood flow, especially to your brain. That then helps your body to be able to get a better rest and fall asleep quicker, but also try to avoid exercise a couple of hours before bedtime because that can actually ramp up your body and make your sleep a little worse.

Interviewer: All right. Five things for better sleep. The last one, number five?

Dr. Jones: The last one is consistency. So making sure you're going to bed the same time each night, making sure you're waking up the same time each morning, and making sure you're having the same rituals before you go to bed, kind of doing things in the same order because that helps structure your mind and your body and prepare you to go to sleep.

Interviewer: Seems like I'm just failing at all five of these and they're so simple. I feel like a lot of Americans or people in the world in general, I want to say, don't really do these. And they're so simple and they're so easy and they lead to better health, but we're not doing them.

Dr. Jones: And that seems to be a lot of things that optimize our health. But you're right, we're all sleep deprived and doing some of these things with them being fairly simple can really improve our sleep. So again, focusing on these things even though they seem very simple, they're kind of hard for a lot of us to do. So make sure we're doing those to improve our sleep, which actually makes us happier as well as can make us more productive and improve our wellbeing.

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Interviewer: Tracking Health on Twitter, up 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. Quynh Nguyen, Assistant Professor of Health Promotion and Education at the University of Utah.

Dr. Nguyen, every day we make choices that affect our health. You know, we decide whether we're going to eat that donut or smoke that cigarette. But I think you would argue there's forces beyond our own decisions that influence our health.

Dr. Nguyen: Yes, as an epidemiologist, a lot of what I see in the research is focused on individualized risk factors, like their own health behaviors, what people decide to do or not do. Exercise, eat that donut, eat that burger, or French fry. But our behaviors are in a setting, in a context. That's not looked at enough.

Interviewer: So what are the things that drive certain behaviors that impact our health?

Dr. Nguyen: There's definitely some hot topics in this area. We're interested in the term "food desert" so that's one particularly growing field. Food deserts are places where there is a lack of healthy foods. There you would find small convenience stores rather than supermarkets, or fast food chains instead of more local restaurants. Perhaps that's influencing your behavior. Maybe it's easier to grab that burger instead of making a chicken meal.

Interviewer: So how do you go about measuring that?

Dr. Nguyen: We are looking at tweets, the Twitter data in particular. What people are saying they're eating and tweeting about. We can also use particularly like people mention fast food chains. We're also keeping track of whether they're mentioning McDonald's or KFC. And also, social media data can be used because people check into places, so you can use their check in indicators as how they're utilizing the neighborhood resources.

Then we kind of look at that as an alternative to what has been conventionally done, and hopefully using social media data is going to be cheaper, more efficient, and can be updated more easily than other types of neighborhood data.

Interviewer: How do you go about measuring that? What has been the problem up to this point?
Dr. Nguyen: Well I think that the idea for this dataset called "Hashtag Health" came about during my post-doc years when I was preparing data for five urban cities, Boston, Chicago, New York, Baltimore, and Los Angeles. The face value of it, you think, "That's not going to be a problem at all. Those cities are well-known." But it was very hard to get consistent data across geographies. The only consistent data we had were [inaudible 00:02:46] data, and violent crime rates, and everything else varied. So if you're a neighborhood researcher, you find it very hard to study beyond a city.

I wanted to overcome the data problem by using a relatively vague and cheap, and hopefully once we build that algorithm, cost-efficient way to categorize neighborhoods, and also to categorize it in a different way than has been before. Because a lot of it has been focused on the fiscal resources of a neighborhood, the transit, like is there a bus or train that runs through the neighborhood, or is there a grocery store.

But what about the people who live there, how are they interacting with each other, what are they saying? So we want to capture more of the cultural and social processes. So it's both an untapped source that we're using and also, we're capturing a different side of neighborhoods that hasn't been captured.

Interviewer: I mean, the old way of doing things, you have to commission someone to look at one very specific thing, but you're just taking advantage of something that people are doing anyway.

Dr. Nguyen: I think Twitter data, like you said, is very good. For one thing, it's continuous. There's always a continuous stream. There's someone tweeting in the middle of the night. Instead of getting participants for maybe 30 minutes, you're going to get a continuous stream and you can update your data very easily. Also, it can allow for more massive studies for the project I'm working on. It's first going to try to capture neighborhood data for the entire state of Utah. For each census track, we're going to have indicators of food, exercise, and happiness as a starting point. Then we're going to grow from Utah to the U.S., so it's kind of imagining a bigger type of neighborhood study, than could be possible with more conventional data.

Interviewer: We had talked the food example before, the fast food example, where you can look for words like McDonald's What about happiness? How would you gauge happiness? What are you looking for?

Dr. Nguyen: Yes. That's a really great question. Happiness has actually been the hardest out of the three indicators we proposed to grade for Utah, because we're using a machine learning algorithm to do that, and so you're imagining, "How can a computer program predict the sentiment of a tweet?" And that's going to be quite difficult.

So we're starting with a continuous scale of one to nine, so we're using a data set that has about 10,000 words that have been scored for happiness. Each word is assigned a happiness value, and then each tweet we summarize the happiness values for that tweet. So we compared it with human ratings, so that's the gold standard. If a human is reading it, what are they seeing? Is this tweet neutral, negative, or positive? The agreement is around 73%.

Interviewer: I imagine you're selecting for sort of a young population. It's probably the 20, 30-year-old set mostly tweeting.

Dr. Nguyen: More people use Twitter are younger. So we're going to pilot our social media database looking at young adult outcomes, that was intentional because we recognize social media users tend to be younger.

Interviewer: How do even you find out what they're unhappy about?

Dr. Nguyen: For us, we think that happiness is important because happiness might be related to an array of different things. Our first [pilots] will look at whether these indicators are going to predict young adult obesity, but then I could see it also predicting perhaps suicide, or depression in the community.

As health professionals, we know that health is not just the absence of disease. It's like a little bit more. I think the ultimate goal is happiness. When you're around happy people, maybe that also breeds happiness. It might be a contagion effect, and vice-versa. If you're in a sad community, maybe that's also detrimental to your own mental health.

Announcer: Interesting. Informative. And all in the name of better health. This is the Scope Health Sciences Radio.

Interviewer: You hear it all the time, avoid sugar like the plague. But is it really that bad for our body? Find out if sugar free is really the way to be - next on The Scope.

Announcer: Medical news and research of University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We have Ashley Quadros, a health educator from University of Utah Department of Health, here to help explain if sugar is really the enemy. All right, so is it true? Is sugar really that bad for us, Ashley?

Ashley: Well, no it's not actually. It's sort of been vilified, like you say, but it's very more complex. There are so many more things that can be classified as sugar. So, to say that all around that sugar is bad is actually very misleading.

Interviewer: Why do you think sugar is vilified?

Ashley: Well, it's vilified for good reasons. It's the main culprit of what's causing obesity today in the United States. It's added calories but not a lot of nutrition and it creeps up in a lot of foods. It's in some things that you might not expect them to be, things like salad dressing and pasta sauce, so we're getting a lot but we're not necessarily realizing that we're eating all that extra sugar.

Interviewer: Sneaky sugars, I see what you're saying. Do you need sugar to function properly?

Ashley: Yes, you do need sugar. You can think of sugar as added white sugar that you put in things to make them sweet but also, sugar can come in the form of carbohydrate, which we know we definitely need. Our body breaks down carbohydrates pretty quickly into sugar, and those are definitely necessary for function, for our body's functions. So, you do need sugar.

Interviewer: If you do need sugar, what is considered too much sugar?

Ashley: The best way to start is to make a distinction. Natural sugar, sugar that occurs naturally in food, that is good for us and that there really is no limit. That would come from things like fruit and milk. But other sorts of sugar, things like added sugar that come from sodas, or sweets, pastries, that sort of thing, you generally want to limit that to six teaspoons for women, if that's a good way to visualize it, and nine teaspoons for men. So, that would include your dessert after dinner and also your soda with lunch. All of that is in that six to nine teaspoon range.

Interviewer: When you do eat too much sugar - say that you just went to a party and you had at it with all the candy and cakes and cookies that were there - what happens to your body?

Ashley: When you eat a lot of sugar at one time, what it does is it raises your blood sugar - the level of sugar in your blood - very quickly. And for most people, that's not a really big problem, especially if it's only around the holidays. But, when you start to do that regularly, day after day, it's sort of an assault on your body and it can be a real problem if you are struggling with something like type II diabetes and that can cause damage to your body - that high level of sugar in your blood. So, a little bit occasionally is fine, but when you're starting to do it day after day, that's when the real problem comes.

Interviewer: Okay, so I guess I'll have to scale back a little bit. Any tips on how to keep an eye out on your sugar intake to make sure that you're not taking in too much?

Ashley: Generally what I like to say is, when you're at the store, and you're buying things, if it doesn't have a label, generally it's probably fine. So, things that don't have labels, like fruits and vegetables, poultry, all of that is fine and you can eat that really without worrying about sugar. The problem comes when you're getting something that's packaged or somewhat processed. In that case you want to look at the label and you want to look at sugars.

Interviewer: I've heard something about this new food label that's going to be coming out. Can you tell us a little bit more about that and how it will help us figure out which things have good or bad sugars in them?

Ashley: Yes. So, I'm really happy about this because it can be tricky to determine, when you're buying a product at the store, if it's good for you and doesn't have a lot of added sugar or if it has a lot of added sugar. But, it's sometimes confusing. The new food label will hopefully distinguish between what's naturally occurring in the product and what's added. That will be great, because as a consumer you'll be able to decide if you want to buy that product, because you'll know it's either coming from a natural source or that it's not and it's coming from something that they added to it.

Interviewer: Great. That's definitely something to look forward to and will help out a lot.

Ashley: Yes, we hope it passes. We're not sure if it will.

Interviewer: Cross fingers.

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