Roots of Obesity: The Search for Causes and Cures in the Midst of a Growing Global Epidemic

Roots of Obesity: The Search for Causes and Cures in the Midst of a Growing Global Epidemic

Two-X beamed proudly as he slipped his arms into the bright yellow athletic warm-up jacket he''d been waiting for. The label inside bore not just his new size, but his new nickname. "Congratulations, Two-X," we all tell him. From his laughter and his smile, we know he loves his new name as much as he loves his new gear. "C''mon, Bloomers," Two-X tells his nurse. "Let''s walk! C''mon, J.J., we''ll all help ya if ya can''t catch your breath! I used to be just like you!" J.J. offers Two-X an elbow for balance so he doesn''t fall. And off they go, leading an entourage of newly arrived psychiatric patients, Nurse Bloomers puffing behind them. Their goal today is 43 hallway laps in 30 minutes - just about a mile.

Two-X and his team of walkers are the remarkable residents of a tiny psychiatric facility tucked away in a remote West Virginia mountain village.

Two-X is without a doubt the most remarkable resident of all.

Mentally ill since adolescence and now almost 50, Two-X entered the facility just a few months ago, wearing a four-X hospital gown and weighing 350 pounds. Neurologically handicapped and nearly blind, he was taking almost 60 pills a day for all of his medical problems.many of them the direct result of his obesity. He''s down to almost 30 pills now.

Most scientific studies from the last half century aimed at understanding the underlying causes of obesity have focused on biological processes that regulate food intake and metabolism in normal-weight individuals. Obesity has been presumed to result from a disturbance in these normal biological processes. Our idea that obesity can sometimes be genetic is a result of this historical trend in obesity research. It has long been recognized that certain areas of the brain control appetite and food intake; patients with diseases of the brain have been particularly excluded from these studies. For many years, it was believed by obesity researchers that obesity and mental illness had nothing to do with each other.

Nobody in Two-X''s family is obese. Two-X is not obese because he chooses to be that way. And, at least lately, he is far from lazy and far from being a glutton, or any of the other attributes that we once callously ascribed to individuals who struggle with weight. Two-X would love to eat as much as the rest of us, but he lives on half the calories of most men his size.

Two-X is obese because of his mental illness. Within that fact lies cause for shame and cause for joy. Severely persistently mentally ill individuals have some of the poorest healthcare of any segment of the world''s population. Shamefully, this is true even in our country, where the per capita expenditure for healthcare exceeds all other societies.

Ironically, the same scientific advances that have helped mentally ill individuals avoid chronic institutionalization have, unforeseeably, created a population of individuals who now suffer not only from diseases of the brain, but from obesity and all of its associated diseases (i.e. diabetes, hypertension, heart disease) as well. One of the previously unrecognized - but now well-recognized - side effects of many medications for mental illness is obesity. The hope now is that further understanding of how altering brain chemistry with these medications leads to obesity will soon lead to safer treatments for mental illness and better treatments for obesity.

Unlike Two-X, J.J., his new walking buddy, suffers from alcoholism and drug addiction. One of the most exciting developments in the study of brain diseases that contribute to obesity is the finding that food, alcohol and drugs affect the brain in similar ways. All of these substances interact with specific chemicals in the brain in areas called reward centers. When reward centers are stimulated by certain substances, we experience a sense of pleasure. Reward centers are thought to help us survive and reproduce by rewarding healthy behaviors. Bad-for-us substances can hijack these same reward centers, causing us to keep doing things that feel good, but become increasingly harmful as we continue doing them.

The ability of certain substances to cause addictions is related to the intensity of the reward (pleasurable) feeling, so it may be that highly refined, artificially flavored unhealthy foods can act like drugs in these areas of the brain. Brain-imaging procedures such as MRIs, PETs and SPECTs are used to see where certain substances might "hijack" these brain areas, leading to altered behaviors such as compulsive overeating or drug-taking. Changes have already been found in obese individuals, some of whom have family histories of drug or alcohol addiction, but who have instead become addicted to food. It has also been observed that some obese individuals develop other addictions after undergoing bariatric surgery, replacing compulsive eating with smoking, drinking or even compulsive sex or gambling.

Right now, all of this is new research and the brain-imaging techniques described above are limited to patients who volunteer for studies at major research centers. But already, the study of brain mechanisms in addictions has led to a new medication, Accomplia, for the treatment of obesity.

All of these discoveries contribute to our understanding of just how complex we are as human beings. Food, medications, drugs and even exciting but potentially dangerous activities such as sex and gambling can cause changes in our brains that lead to changes in behavior, ultimately causing diseases of mind and body.

While Two-X, J.J. and millions of others await new cures for these closely intertwined physical and mental diseases, they remind us that resilience - the essence of ourselves that enables us to survive against overwhelming odds - is perhaps our greatest medicine.

When asked what he''d like to teach others about mental illness, Two-X said, "Tell them it can take away your home, your family, your freedom, your judgment.even your will to live. It can break your spirit if you let it."

"And what do you want to tell the reader about obesity?" I asked, as we walked the hallway laps together.

"Tell them if I can do it.they can, too. But tell them they have to keep on walking. Tell them they have to walk like we do.everyday!"

Michele Hines, M.D., received her medical degree from Columbia University College of Physicians & Surgeons and completed her residency training in New York City . She is a board-certified psychiatrist and addiction psychiatrist and a member of the American Society of Bariatric Physicians. She has been in practice for 15 years.