I’m in Kuala Lumpur, Malaysia this week attending the 12th International Congress on Obesity. For a person that studies and reads and writes about obesity policy ad infinitum, events like this are a week in Disneyland. Except better. In that vein, I’m so fortunate to have the support of Magdalen College, Oxford, the Institute of Social and Cultural Anthropology at Oxford, the Malaysian Association for the Study of Obesity, and World Obesity. I took pages of notes from the conference, and there are many sessions to write up, but in the brief space between Day 1 and Day 2 I collected my summaries of the Willendorf Award Lecture given by the University of Copenhagen’s Dr. Arne Astrup and the Opening Ceremony.
Willendorf Award Presentation
The 2014 International Congress on Obesity began with the Willendorf Award, given to recognize outstanding clinical research into obesity. This year’s recipient, Dr. Arne Astrup (University of Copenhagen) was recognized for his work on appetite regulation via gastrointenstinal peptides. Setting the tone for his talk, Dr. Astrup said simply: “I do not think all calories are equal for their effect on appetite regulation.” While he certainly believes in the power of calorie restriction, he maintained that such an intervention is not helpful in the long run. He made his case by reviewing what we now know about the hormone glucagon-like peptide-1, or GLP-1. Beginning with studies that demonstrate increased satiety after infusing GLP-1 (while lamenting the still primitive visual-analog scale for measuring satiety) he then moved to link another gut hormone peptide YY (PYY) to the effect of GLP-1 on post-prandial satiety. After briefly reviewing research tying increased satiety following roux-en-y gastric bypass to GLP-1, Dr. Astrup moved on to the next major topic of his talk: diet composition. GLP-1, he noted, might account for at least part of dietary protein’s satiating effect relative to carbohydrates and fat.
To showcase some ongoing insights on dietary protein satiety, he drew on the pan-European DiOGenes Project, a large trial with collaborators across 14 countries and a massive total study population of 140,000 people. The component of DiOGenes Dr. Astrup reviewed initially enrolled 1209 adults (mean age = 41 years, mean BMI = 34 kg/m2), of which 938 began the initial calorie-restriction phase of the diet (800 calories until 8% weight loss, mean = 11.0 kg weight loss). The 773 participants who successfully completed the restriction phase were divided into five ad-libidum groups where weight maintenance or regain was tracked for 26 weeks. The groups included a control arm, a high-protein/high-glycemic-index arm, a high-protein/low-glycemic-index arm, a low-protein/high-glycemic-index arm, and a low-protein/low-glycemic-index arm. Of the 548 participants who completed the intervention, the most compelling results were sighted in the high-protein/low-glycemic-index group. Not only did this group demonstrate the lowest drop-out (22%, compared the the highest drop-out rate of 37% from the low-protein/high-glycemic-index arm), but the significant weight regain only appeared in the low-protein/high-glycemic-index arm. Perhaps just as compelling was a brief tangent by Dr. Astrup into the spontaneous reduction in prevalence of overweight among children of the participating adults, who were not formally participating in the trial intervention.
Dr. Astrup ended his talk with a short cautionary note on blanket solutions to obesity. Drawing on recent research on the interaction between the gene TFAP2B rs987237 and dietary protein/carbohydrate, he showed that high-protein diets were associated with greater weight gain among certain allele carriers. Ending his talk with the optimistic note that GLP-1 agonists (like liraglutide) may soon receive obesity indication, Dr. Astrup concluded a well-deserved award lecture with the refrain that diet composition matters.
Recognizing the international context of the conference, Malaysian Association for the Study of Obesity (MASO) President Ismail Noor began the opening ceremony with a moment of silence for the passengers aboard Malaysia Airlines Flight 370. In glowing remarks to the plenary, President Noor said it is a dream for any national or regional obesity organization to host the International Congress. He sees the conference tracks filling out every niche of obesity research, and told students in the crowd that this is their chance to “learn from the horse’s mouth, so to speak.” After thanking conference supports Novo Nordisk, the Cambridge Weight Plan, and the ICO Secretariat, he urged the audience to get to know Malaysia during their stay.
Following his address, the Deputy Health Minister of Malaysia Hilmi Yahaya spoke on behalf of Health Minister Subramaniam. Right at the outset Deputy Minister Yahaya recognized the peril of Malaysia’s non-communicable disease crisis, citing their 2011 National Health and Morbidity Survey to raise alarm at the country’s 2.6 million adults living with diabetes, 5.8 million with hypertension, 6.2 million with hypercholesterolaemia, and 2.5 million with obesity. In response, he highlighted the country’s National Strategic Plan for NCDs and the “whole-government approach” Malaysia is taking to integrate many public efforts for the promotion of health. These actions have led to food and beverage marketing guidelines for products targeting children, currently being implemented via industry self-regulation. A more recent initiative is KOSPEN, or Komuniti Sihat, Perkasa Negara (Empowering Communities, Strengthening the Nation) seeks to build on grassroots efforts. Noting these policies, the Malaysian government recognizes there is still more to do.
Rounding out the Opening Ceremony were talks by World Obesity President Philip James and ONEGOAL representative Mr. Liew Tong Ngan. President James meditated on the significance of ICO 2014 being held in Malaysia as obesity continues to rise there and more generally in Asia. Citing the need to go beyond studying obesity, he explained the rebranding of the International Association for the Study of Obesity to World Obesity, an apt identity for an organization that studies in addition to organizes, advises, advocates, trains, communicates, and more. Mr. Ngan spoke to the campaign ONEGOAL, which seeks to improve grassroots support for childhood physical activity and nutrition for all of Asia. Among the many driving factors of this campaign was a good-humored, candid ask: How will Asia win its first World Cup without proper nutrition and exercise? His presentation closed with a high-energy demonstration by ONEGOAL trainers showing their football skills. Following them was a multicultural dance drawing on the many cultures of Malaysia. Together, these performances ended the first day of the conference with a great deal of momentum for the meeting ahead.