www.webmd.com/obesity/video/r...
-- TRANSCRIPT --
JOHN WHYTE Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD and Medscape. We spent a lot of time talking about GLP-1s and obesity, especially as it relates to cardiovascular disease, metabolic disease, but what about its role in depression? Which is coming first, the depression treatment and then obesity or the other way around?
To sort all this out as what might be the role of obesity medications is Dr. Roger McIntyre. He is professor of psychiatry and pharmacology at the University of Toronto. Dr. McIntyre thanks for taking time today.
ROGER MCINTYRE John, great to be with you and especially speaking to such an interesting topic.
JOHN WHYTE You cannot read medical news and not be seen about the latest in obesity treatment. And when it comes to depression and even other mental health conditions, sometimes we see that the treatment causes obesity and then other times when we know people are depressed they don't exercise, they don't eat healthy, don't go to the doctor. So how do you sort all this out Dr. McIntyre? How do you know what's the root cause of everything?
ROGER MCINTYRE: Such a great starting point John and you know there's been really a confluence of study findings and where they converge is on a fairly consistent finding that people who live with depression are much more likely to also be obese. And that's quite a statement because as you know John the rate of obesity in the general population is already very high to begin with. And what's important to underscore is that this relationship between depression and obesity is bidirectional, it goes both ways.
In other words depression can lead to obesity and obesity can lead to depression. In the case of depression leading to obesity, you touched on a couple of matters with respect to not being as active, perhaps being exposed to psychiatric drugs. But in addition there's a biology of depression, that is a biological signature of depression that predisposes the phenotype of obesity. So there's a number of conspirators here that are increasing the likelihood of obesity and depression.
JOHN WHYTE And you recently sent me an article that you've been involved with, a study about this phenotyping as it relates to depression and obesity. What else did you find?
ROGER MCINTYRE What's interesting is that what we have found is that people who have obesity and depression when compared to people with depression and not obese are persons who tend to have what's called inflammatory balance more often. They tend to have elevation of markers in their blood that are an index of inflammation, acute phase reactants like hsCRP or increase in pro-inflammatory cytokines like interleukin-1.
JOHN WHYTE But to be fair nonspecific, these are nonspecific in terms of what might be the source.
ROGER MCINTYRE Absolutely and also a nonspecific probability is higher that you'll see more impaired insulin signaling in this group. Here's the part though that for me really in fact grabbed my attention John, everyone knows that people who live with depression struggle with their cognitive functions as well as struggle with what we call anhedonia or hedonic tone.
If someone has obesity and depression, the extent of those cognitive difficulties, the extent of the impairment in hedonic tone or reward function is even greater. Therein is why we think there's something overlapping not just neurobiologically but also phenotypically.
JOHN WHYTE As we think about the management of obesity and some of the latest medications such as the GLP-1s, depression doesn't factor into most decisions around treatment right now as it relates to what medications we should use for the treatment of obesity. How should we be thinking about the latest therapies as we think about this confluence of obesity and depression? Roger, what needs to change?
ROGER MCINTYRE I think what fundamentally needs to change John is still what appears to be an attitude that obesity is something other than a chronic disease, it is a chronic disease. Secondly, I think most people when put on the spot during a pop quiz, what are the medical complications of obesity? They're going to list some of the familiar such as some forms of cancer, cardiovascular disease, diabetes, and others.
What people should be really contemplating is brain health and disease. In other words, we know that the brain which is about maybe 3% to 5% of our total body weight consumes about 25% of our total body energy. Well, guess what? The brain is especially susceptible to changes in energy and we know that energy or metabolism is affected by obesity.
Transcript in its entirety can be found by clicking here:
www.webmd.com/obesity/video/r...