How “obesity gene” triggers weight gain

An international team of researchers has discovered why people with a variation of the FTO gene that affects one in six of the population are 70 per cent more likely to become obese.

A new study led by scientists at UCL, the Medical Research Council (MRC) and King’s College London Institute of Psychiatry shows that people with the obesity-risk FTO variant have higher circulating levels of the ‘hunger hormone’, ghrelin, in their blood. This means they start to feel hungry again soon after eating a meal.

Real-time brain imaging reveals that the FTO gene variation also changes the way the brain responds to ghrelin, and to images of food, in the regions linked with the control of eating and reward.

Together these findings explain for the first time why people with the obesity-risk variant of the FTO gene eat more and prefer higher calorie foods compared with those with the low-risk version, even before they become overweight. The research, funded by the MRC and the Rosetrees Trust, is published today in the Journal of Clinical Investigation.

– See more at: this UCL news article 

Individuals with two copies of the obesity-risk FTO variant are biologically programmed to eat more. Not only do these people have higher ghrelin levels and therefore feel hungrier, their brains respond differently to ghrelin and to pictures of food – it’s a double hit.

Dr Rachel Batterham, UCL metabolism & Experimental Therapeutics

NHS commissioning groups restricting weight loss surgery, surgeons warn – at a cost to patients and the public healthcare bill

A freedom of information (FOI) request made to all NHS commissioning groups (CCGs) shows that several have adopted policies which attempt to ration weight loss surgery to the super-obese, and ignore official advice on who should be eligible for surgery.

This has made it more difficult for overweight and obese people to get effective treatment to help them lose weight despite evidence that it is safe, effective and saves healthcare costs, according to the findings of a joint report from The British Obesity and Metabolic Surgery Society (BOMSS) and the Royal College of Surgeons (RCS).

Some CCGs either require patients to stop smoking or for patients to have a Body Mass Index (BMI) of over 50, despite NHS England and the National Institute for Health and Care Excellence (NICE) stating that surgery is cost effective and should be considered for patients with a BMI of over 35 with a co-morbidity (a further medical condition) such as Type II diabetes, or a BMI of 40 without a co-morbidity.

NHS England is currently delegating the commissioning of bariatric surgery to CCGs although most groups (80%) have yet to decide their own policies. Six CCGs admit they are not complying with the NHS England and NICE guidance. East Riding CCG says patients must have a BMI of at least 50 before they will be considered for surgery. Wolverhampton CCG imposes the same condition but will also consider some patients at a lower BMI who have diabetes. Solihull considers patients at BMI 50 with certain co-morbidities and will consider patients at BMI 45 or higher who have diabetes. Vale of York will look at patients at BMI or 50 or more but will consider patients at a lower BMI with certain co-morbidities. Mid-Essex is restricting treatment to non-smokers at the time of referral and NE Essex says smokers must be referred to a cessation service before they can be considered.

BOMSS and the RCS are warning this could harm patients and are demanding they revise their policies to bring them in line with the official guidelines.

The report showed that most CCGs have not yet adopted their own bariatric surgery policies – but will have to do so by next month under a phased government NHS reform.

Shaw Somers, Consultant surgeon and BOMSS President, said: “Our survey reveals worrying evidence that some CCGs are effectively taking the law into their own hands and defying official guidance on surgical interventions which have been proved to help people with a serious medical condition and also save healthcare costs.

“It typifies the second-class citizen manner in which bariatric patients seem to be viewed by some CCGs.

“We are calling on NHS England and NICE to make it clear to CCGs that they must comply with the guidelines on who is eligible for this safe and effective treatment, not try to ration it in a misguided attempt to save money in the short-term.”

Royal College of Surgeons President Clare Marx said: “Study after study shows bariatric surgery is highly effective, particularly in treating type 2 diabetes associated with obesity. It is therefore astounding that commissioning groups are effectively indicating that obese patients should get even more obese before they will consider surgery. This makes no sense and contradicts our very strong public health messages about the benefits of losing weight. Bariatric surgery is a significant medical innovation which should be made available to those patients who meet criteria which NICE have considered and published.”

BOMSS and the RCS make five recommendations to health bosses.

  • The six CCGs with arbitrary requirements for bariatric surgery should revise their policies in line with national clinical guidance.
  • NHS England should reiterate that access to NHS bariatric surgical treatment should be based on clinical need and uniform across the UK.
  • NICE and NHS England should continue to highlight the benefits of bariatric surgery.
  • NHS England should confirm that all CCGs will be responsible for commissioning bariatric surgery from 1 April to address the confusion over who is responsible.
  • NHS England should provide CCGs with clinical guidance for commissioning bariatric surgery, in advance of the transfer of responsibilities.

As well as calling on the six CCGs to fall in line with guidance the RCS and BOMSS have pledged to review the policies of all CCGS once new commissioning rules are in place.

Gut Reactions to Obesity

We know that bariatric surgery leads to weight loss and reduces type 2 diabetes – but until now we haven’t really known about why.

Professor Rachel Batterham – an expert on and champion of bariatric surgery in the UK – tells Kim Hill the answer is a lot more complicated than previously thought.

Listen to the interview

“We know now that it changes the hormones that come from the gut that tell your brain whether you’ve eaten or not … What it does it is effectively tricking the brain into thinking you’ve eaten a large meal, when often you’ve only eaten a small amount. It also changes how the brain sees food – so rather than food being really interesting and really rewarding, food becomes less interesting.”

Professor Rachel Batterham has played a key role in identifying that gut hormones play a large role in feelings of hunger and food intake – and researching how that information might be used in the fight against obesity.

She is in New Zealand to speak on targeting the gut to treat obesity and type 2 diabetes at the Diabesity Symposium, jointly organised by two National Science Challenges – A Better Start and Healthier Lives – and the University of Otago’s Edgar Diabetes and Obesity Research Centre.