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Obesity a key issue in rheumatology disease

On average, obesity delivers 14 years of a chronic illness before you pass away,” he commented, acknowledging that obesity is having a significant impact on rheumatology and orthopaedic patients and their functional ability.

The best weight loss that 90 per cent of patients can achieve is 10 per cent of their weight, therefore the medical community must redouble its efforts on obesity prevention, Prof O’Shea said.

“Weight gain is 90 per cent irreversible for 90 per cent of people… we should be preventing our way out of obesity, not treating it,” he told the Meeting, saying that doctors must have “realistic targets” for patient weight loss “and empathy for the defence that the body puts in place against weight loss”. 

He also highlighted the ‘friends’ connection, ie, people are 70 per cent more likely to become overweight or obese if their friends are. He noted that while bariatric surgery is a successful mode of weight loss, it is far from a ‘cure-all’ and has limitations. “It gives 30 per cent weight loss. It doesn’t give a normal weight.”

Prof O’Shea criticised soft drinks and junk food manufacturers for marketing their products at children, despite pledging not do so. 

He cited Coca-Cola for its very successful bottle-naming campaign, which he said was very popular among young people, and saw the drinks manufacturer printing a wide range of popular boys’ and girls’ names on its bottles. He was also critical of the Doritos ‘roulette’ game, which is also attractive to young children, and he reiterated his support for plans to introduce a sugar tax in Ireland.

Prof O’Shea also called for a change to the Irish food pyramid, saying more fruit and vegetables need to be added to the largest, bottom section. He revealed that he had made efforts to change it with the Department of Health but had not been successful to date.

Looking at the latest research on obesity, including some of his own, he highlighted its impact on the immune system, which creates a vicious circle where obesity drives further obesity by switching off the immune system. Fatty infiltration of immune cells disrupts function generically, driving multiple comorbidities. “Weight regulates the immune system and vice-versa”, Prof O’Shea summarised.

Irish research on the effects of GLP-1 and other type 2 diabetes medications on innate immune cells and inflammation has shown how obesity and obesity-related comorbidities negatively impact innate immune cells. 

A novel clinical finding uncovered the positive effect that a GLP-1 analogue elicited on the psoriatic inflammatory condition. This gave rise to a number of in vitro studies attempting to uncover the mechanism by which GLP-1 reduces inflammation. 

Prof O’Shea also highlighted how various factors that alter certain cytokines impact metabolism and hence weight, independent of the simple ‘energy in, energy out’ equation by altering thermogenesis. He also explained how invariant natural killer T-cells play a key role in weight loss – when they are depleted, people get heavier.

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