UCSF Clinical Pediatrics Researcher Robert Lustig, MD has dedicated his life to studying obesity and type 2 diabetes. Lustig believes that obesity is not a manifestation of voluntary behavior (eating too much or not exercising enough) but instead involves a complex biochemical and neuroendocrine process involving energy balance. The notion that the recent obesity epidemic is the result of "gluttony and sloth" ignores the physiological mechanisms involved in controlling energy balance.

"Think of obesity as energy storage gone haywire," he says.

The "Energy Balance Pathway," as it is known, is an enormously complex system that involves sending hormones such as leptin to the brain with instructions on how the brain should burn and store food. To maintain a normal weight, it is important to maintain an appropriate energy balance on this pathway.

When this pathway is disrupted, the body may produce too much insulin, often because the body's vagus nerve becomes overactive and stimulates the beta cells. When this happens, the body stores the excess insulin in fat. Thus, approximately 20% of all obese patients produce too much insulin. Fortunately, researchers have found that drugs such as octreotide can keep beta cells from releasing insulin and promote weight loss.

Conversely, nearly 80% of obese patients have challenges with insulin resistance, a condition where the body does not respond to the action of insulin even though they produce insulin in sufficient quantity. Drugs such as metformin help tackle insulin resistance by acting on the liver to reduce blood glucose output. As the liver improves its sensitivity to insulin, the pancreas reduces insulin output, and insulin levels fall.

Studies have shown that people react to fat storage very differently. Approximately 50% of people are successful in losing weight through behavior modification (diet and exercise). However, the rest of the population must pursue biochemical solutions to their weight issues -- such as those described above that are designed to manage excessive insulin. Each obese individual must be carefully analyzed and an effective treatment plan must be developed. By taking a proactive stand on the weight issue, it is hoped that type 2 diabetes can be avoided.

Even though Dr. Lustig's career has been focused on obesity and type 2 diabetes, as a pediatric endocrinologist he is especially concerned about obesity in children - he is anxious to treat kids before they develop diabetes. He and colleagues at the Center for Weight and Health at UC Berkeley and the Oakland YMCA have been funded by the USDA to initiate a program to decrease the risk for obesity and Type 2 diabetes in African-American youth through family lifestyle intervention.

In July 2003, Dr. Lustig helped to launch the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF. This interdisciplinary program will help to identify obese, pre-type 2 children from a number of different disciplines (endocrinology, lipidology, cardiology, pulmonary, orthopedics, etc.) Once identified, Dr. Lustig and his team will work to medically intervene in the hopes of improving weight and preventing type 2 diabetes in these children. Any referrals can be directed by fax to 415-502-8674 (after Jan 1).

This program, along with other obesity programs at UCSF, are attracting the attention of both local and state elected officials who have recognized that obesity in children has become a serious health crisis with profound and devastating medical, societal and economic implications.