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24 News and Trends Bariatric Times • February 2017 FAT SHAMING LINKED TO GREATER HEALTH RISKS Penn study finds patients with obesity who internalize negative stereotypes have a greater risk of cardiovascular, metabolic diseases P HILADELPHIA, Pennsylvania— Body shaming is a pervasive form of prejudice, found in cyber bullying, critiques of celebrities' appearances, at work and school, and in public places for everyday Americans. People who are battling obesity face being stereotyped as lazy, incompetent, unattractive, lacking willpower, and to blame for their excess weight. The pain of these messages may take a toll on health and increase risk of cardiovascular and metabolic disease, according to a new study published in Obesity, the journal of The Obesity Society, led by a research team from the Perelman School of Medicine at the University of Pennsylvania. The team led by Rebecca Pearl, PhD, an assistant professor of Psychology in Psychiatry and colleagues from Penn's Center for Weight and Eating Disorders found that, above and beyond the effects of body mass index (BMI) and depression, higher levels of weight bias internalization were associated with increased risk for cardiovascular and metabolic disease. "There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health," Pearl said. "We are finding it has quite the opposite effect. When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress. In this study, we identified a significant relationship between the internalization of weight bias and having a diagnosis of metabolic syndrome, which is a marker of poor health." The team examined 159 adults with obesity who were enrolled in a larger clinical trial testing the effects of weight loss medication, funded by Eisai Pharmaceutical Co. - the majority of whom were African American women, a group typically underrepresented in weight bias research - and completed baseline q uestionnaires measuring depression and weight bias internalization before any intervention was given. Weight bias internalization occurs when people apply negative weight s tereotypes to themselves, such as believing they are lazy or unattractive, and devalue themselves because of their weight. Participants also underwent medical examinations, which determined whether they had a diagnosis of metabolic syndrome, a cluster of risk factors, such as high triglycerides, blood pressure, and waist circumference, which are associated with heart disease, type 2 diabetes, and other obesity-related health problems. Initially, no relationship was observed between weight bias internalization and metabolic syndrome when controlling for participant demographics, such as age, gender and race. However, when patients were stratified into two groups, "high" and "low" levels of weight bias internalization, those with high internalization were three times more likely to have metabolic syndrome, and six times more likely to have high triglycerides as compared to participants with low internalization. "Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages," said co- author Tom Wadden, PhD, a professor of Psychology in Psychiatry and director of Penn's Center for Weight and Eating Disorders. "Providers can play a critical role in decreasing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management - behaviors everyone should display when interacting with people with obesity." Researchers note that previous studies have shown that exposure to weight bias and stigma negatively affects mental and physical health, specifically demonstrating that these e xperiences can lead to a physiological stress response such as increased inflammation and cortisol levels, and can escalate unhealthy behaviors such as overeating and a voiding physical activity. Additional research, specifically larger, longer- term studies, are needed to further explore the possible biological responses and behaviors that may explain why individuals with obesity who internalize weight bias might be at greater risk for cardio-metabolic disease. "Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity," added Pearl. "As health care practitioners, we can help challenge negative, internalized stereotypes by educating patients about the complex biological and environmental factors that contribute to obesity, while providing concrete strategies to help patients manage their weight and improve their health." To read the article abstract, visit https://www.ncbi.nlm.nih.gov/pubmed /28124502 SCIENTISTS AT THE SCRIPPS RESEARCH INSTITUTE FIND BRAIN HORMONE THAT TRIGGERS FAT BURNING LA JOLLA, California—Biologists at The Scripps Research Institute (TSRI) have identified a brain hormone that appears to trigger fat burning in the gut. Their findings in animal models could have implications for future pharmaceutical development. "This was basic science that unlocked an interesting mystery," said TSRI Assistant Professor Supriya Srinivasan, senior author of the new study, published today in the journal Nature Communications. Previous studies had shown that the neurotransmitter serotonin can drive fat loss. Yet no one was sure exactly how. To answer that question, Srinivasan and her colleagues experimented with roundworms called C. elegans, which are often used as model organisms in biology. T hese worms have simpler metabolic systems than humans, but their brains produce many of the same signaling molecules, leading many researchers to believe that findings in C. elegans m ay be relevant for humans. The researchers deleted genes in C. elegans to see if they could interrupt the path between brain serotonin and fat burning. By testing one gene after another, they hoped to find the gene without which fat burning wouldn't occur. This process of elimination led them to a gene that codes for a neuropeptide hormone they named FLP-7 (pronounced "flip 7"). Interestingly, they found that the mammalian version of FLP-7 (called Tachykinin) had been identified 80 years ago as a peptide that triggered muscle contractions when dribbled on pig intestines. Scientists back then believed this was a hormone that connected the brain to the gut, but no one had linked the neuropeptide to fat metabolism in the time since. The next step in the new study was to determine if FLP-7 was directly linked to serotonin levels in the brain. Study first author Lavinia Palamiuc, a TSRI research associate, spearheaded this effort by tagging FLP-7 with a fluorescent red protein so that it could be visualized in living animals, possible because the roundworm body is transparent. Her work revealed that FLP-7 was indeed secreted from neurons in the brain in response to elevated serotonin levels. FLP-7 then traveled through the circulatory system to start the fat burning process in the gut. "That was a big moment for us," said Srinivasan. For the first time, researchers had found a brain hormone that specifically and selectively stimulates fat metabolism, without any effect on food intake. Altogether, the newly discovered fat-burning pathway works like this: a neural circuit in the brain produces serotonin in response to sensory cues, such as food availability. This signals another set of neurons to begin producing FLP-7. FLP-7 then activates a receptor in intestinal cells, News and Trends FEBRUARY 2017