For a recent Facebook Live event, NIDDK Director Dr. Griffin P. Rodgers interviewed Dr. Susan Z. Yanovski, co-director of the NIDDK Office of Obesity Research, and Dr. Marc L. Reitman, chief of the NIDDK Diabetes, Endocrinology, and Obesity Branch, about NIDDK research efforts that aim to improve the prevention and treatment of obesity in adults. Their wide-ranging conversation explored strategies for weight loss, coordinated approaches to research by the NIH Obesity Research Task Force, and the NIDDK Strategic Plan for Research.

“Obesity affects more than 40% of adults in the United States, a trend that continues to rise,” Dr. Rodgers said during the event. “Just modest weight loss, say 5% or 7%, can result in significant and clinically important reductions of disease risk factors such as blood pressure level, type 2 diabetes incidence, and osteoarthritis pain.”

Dr. Yanovski described risk factors for obesity such as diet, physical activity, stress, sleep, genetic predispositions, a child’s prenatal environment, and social determinants of health. “A seemingly simple question — ‘What should I eat to be healthier to lose weight?’ — isn’t really simple at all, and nor is it the same for people of different ages or sizes,” Dr. Yanovski said. “In addition to intervening at the individual level, we also need environmental and community-based approaches, that is, shaping policies to make the healthy choice the easy choice.”

For many people, clinically meaningful weight loss can be achieved through behavior change counseling tools such as goal setting, feedback, self-monitoring, social support, and problem solving. “But even with the best available behavioral treatment programs, about half of people can’t lose enough weight to improve their health,” Dr. Yanovski said.

Many people find weight loss difficult to sustain and eventually gain the weight back. “There is some very interesting physiology that the body does not want to lose weight,” Dr. Reitman said. “People who have lost weight actually have a higher hunger drive and become metabolically more efficient, so they have to continue eating less to maintain that weight-reduced state.”

A new NIDDK research project, The Physiology of the Weight Reduced State Clinical Trial Consortium, is seeking to better understand why some people can lose weight and maintain weight loss while many others struggle. The researchers are working to learn more about what happens to appetite, energy expenditure, and energy efficiency after losing weight. Understanding these mechanisms can hopefully lead to more weight loss treatments designed for the individual.

Other studies conducted by the NIDDK Diabetes, Endocrinology, and Obesity Branch are advancing the scientific understanding of the physiology of obesity. These studies help other researchers to conduct more targeted and successful clinical trials in humans. “Some of the specific examples of research going on in our branch include trying to study the differences in energy metabolism between mice and humans to better inform those human studies,” Dr. Reitman said. Other researchers are looking at the gut microbiome, brown fat tissue, and brain circuits that influence eating behavior.

Watch the full discussion in the video above, and like and follow NIDDK on Facebook to be notified about our next Facebook Live event.