Nature Versus Appetite Suppression

November 10, 2011 Dr Sadaty Uncategorized

Lately it seems impossible to surf the internet or to listen to the news without being warned, yet again, about the adverse consequences of excessive weight gain. Many conditions such as Arthritis, Diabetes, and even Sleep Disorders are now found to be caused in part by obesity. Fortunately, a successful weight loss program can eliminate these problems and return us back to good health. Although that may sound like good news, the problem is that most people fail miserably in achieving long term, sustainable weight loss.

Aside from surgical procedures such as the Lap Band and the Gastric Bypass, there really haven’t been any new, effective medical interventions that can assist us in achieving successful weight loss. And just when it appears that a new medicine promises to act as a potent appetite suppressant, the FDA inevitably withdraws the drug, citing lack of evidence for long term clinical efficacy and/or the presence of worrisome adverse side effects. This has been most frustratingly true of medications that work as appetite suppressants, that is, drugs that try to trick our brains into thinking that we aren’t hungry so we don’t eat as much. There are at least ten drugs that ultimately failed in real life and are no longer prescribed.

Why has it been so difficult to develop a drug that can reduce our appetite and make us eat less? After all, scientists have been fairly successful in manipulating human biology in so many other areas of medicine. We have cancer drugs that annihilate tumor cells while preserving healthy tissue.  We also have other drugs that can drive down cholesterol levels to that of a healthy 12 year old. Nonetheless, we still can’t do anything to control the human appetite for food?

One explanation relates to the basic evolutionary role of appetite. Lets imagine that you were asked to design the most efficient living organism that could survive famine, infection, physical hardship and every other possible onslaught that a successful creature must confront. Its most important feature would probably rest in its ability to continually acquire energy in the form of calories. Why? Because in order to breath, think, and exist in this world you need energy every day, all day long. And in order to acquire energy, you need to have a very powerful and reliable system for reminding you to go out and get food. Without this system which we call our appetite, we would not seek food as regularly and aggressively as we do. Since nature recognizes the central importance of appetite for survival, it has devised hundreds of back up mechanisms to make sure that our appetite instinct remains powerfully intact. In essence, nature has created an elaborate system of  back ups for the back ups, just in case all other back ups fail. So if one pathway for sustaining appetite is broken, the brain moves to plan B, then C, and if those fail, it has many more trump cards in its arsenal. Like sending an astronaut to the moon, multiple back up plans for communication failures and other worse case scenarios are created in order to ensure a successful return to earth.

In the end, you cannot win the game of appetite suppression. Nature simply will not allow it. This is not to say that nature has committed us to a species of junk food seeking glutens who have no control over what we eat and how often we eat. Certainly the human brain will accommodate a reduction in calorie intake both temporarily and in the long term. However, the idea that we can reduce our intake of calories by trying to play games with our appetite mechanism is doomed for failure. You might find more success trying to dunk on Shaquille O’Neill.

All of this reminds me of my time in Africa as a medical resident. I can honestly say that I did not see even ONE overweight person during my stay. They regularly ate breakfast, lunch, and dinner. The food was basic and lower in total calories and was consumed in quantities just enough to satisfy the appetite. Absent were liter sized sodas, 3000 calorie hamburgers, and night-time snack foods processed in some far away factory. I am not sure why they eat so differently than we do. Perhaps their eating methods are the result of limited access to high calorie food. In any event, I am pretty sure that appetite suppressing pills are not part of their secret. I hope that some conclusions can be drawn from here.


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