Dr. Ania Jastreboff
Appearances
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
You look just like your mom. Just like your mom. Beautiful.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
I mean, and in terms of the education, none of us learned about this in medical school. You know, I was in medical school nearly three decades ago. We didn't have any education about obesity. I don't even think we had, maybe we had one lecture about nutrition or what food was. So there really wasn't any of that.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And the thing is, is we didn't have highly effective tools beyond bariatric surgery, which of course is a very highly effective tool, but we didn't have medications. And so in essence, there wasn't the education around it because we didn't have a medical way of treating.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And the medications, these highly effective medications, they come out and now we're playing catch up. We're trying to make sure there's enough education in medical schools and residencies and fellowships. We're trying to make sure that that happens, but it's playing catch up. And in terms of psychological support, super critical. Thank you so much. Thank you, Dr. Rachel.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Yeah, that's a wonderful question and one that we hear a lot. And, you know, the crux of the answer is that there are different types of obesity. So your obesity is likely different than Amy's and your response to a medicine, and Amy had bariatric surgery and took a medicine, is also different. And and that's that's not a bad thing. That's a that's a good thing. Right.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Your body is doing it at its pace, given the treatment that you are taking. And again, it's not a race. Right. So the thing is, is the weight did not come on overnight.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
and maybe it's a good thing that it's not coming off overnight right we want to do this safely we want to do this slowly it gives you the opportunity to make sure that you're getting enough nutrients that you can exercise and do all the things that you love to do so it's not a negative thing we just got to be patient right and then just know that over your lifetime you may need different therapies right and right now this is working for you and keep going
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Once you reach a plateau, if you're in a healthy place in terms of your health and how you're doing and how you're feeling, keep going with it. If you need additional treatment, just like Amy, reach out for additional treatment and grab it. With 107 pounds, have you plateaued?
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And then that is such a wonderful approach, right? Like you have such a wonderful, healthy approach. And to your mom's point about saying like, well, this is just how it is now and that you're starting to take things for granted. I actually want that for everybody within my lifetime. And I'm I'm almost 50. So we got to hurry up.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Yeah. And, you know, right now we're in this place where we're trying to educate as many providers as we can. And there are different specialists that can prescribe this. In fact, most of obesity care is going to come from primary care providers because they're on the front lines. They're seeing the most patients and they are going to provide the most of obesity care long term.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
That's what happens with diabetes, too. Right. Most people with diabetes are not treated by an endocrinologist like me. They're treated by their primary care. What I would say to you, Joel, is you did this amazing job because you said, uh-uh, this does not feel right. This is not right. And you listened to yourself. You talked to your mom about it.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And you went forward and you actually found the help that you needed, which is so amazing, right? And I think right now that's what we need to do. I think long-term we'll still need to do that, right? You got to find the right doctor. You have to bond with them. You have to trust them.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
You have to know that they truly believe and know that obesity is a disease and that they're going to help you through that process. And it's lifelong. It's a lifelong relationship with that provider.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Thank you.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Absolutely. And I think there's a difference in terms of obesity that it's external, right? So you could take that antihypertensive, that blood pressure medicine, and it's in your pocket. Nobody knows. But with obesity, it's external. Right. So it's experienced in a very different way.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
That's right. That's right.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And I agree with that. And I agree with the psychosocial, I think, has been talked about the least. Right. So we've talked about the diet and the exercise, the physical activity, but the psychosocial has not. And, you know, to Dr. Rachel's point, it affects so many things all at once. And it's because it's change and it's external change that we experience and others.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
That's why I wanted to do this show. That's right.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
That's right. And you helped normalize it. You absolutely did. And then you came out again so... vulnerably, so bravely. And you shared your story. And again, your voice carries so much. And so I think the fact that people are embracing this now and shifting from shaming people from taking these medicines or for seeking treatment for their obesity, you've had such an incredible impact on that.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And if we had those obesity medications, perhaps you would not have developed diabetes in the first place.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Yeah, well, the facts are that we have many studies now that are coming out all actually within the last year and a half or so about all these other diseases, about heart disease, about obstructive sleep apnea, about reducing knee pain. So there are over 200 obesity-related diseases. that are either caused or a major contributor is obesity.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
And now we're finding that treating obesity is actually impacting those diseases. But there's two parts to this. One is that it could be the weight itself, right? So people are always like, well, is it the weight loss? Is it the weight reduction? Or is it something else that the medicines are doing? And it's actually both. So the medicines work in the brain and that's how they lower weight.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
They also work on other tissues and organs in the body. There are receptors for these medicines on the heart, for some of them on the bone or the fat. So there are direct effects of the medicine on these disease states, these other obesity-related disease states, as well as reducing the weight.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Yeah. But we're not there yet. We're not there yet. We're not there yet for many reasons. One, we talked about in the last podcast, which is that many people are still not understanding that obesity is a disease, and it is clearly a neurometabolic disease. And insurance companies are among those people. Right. So the way that we're set up is we're treating the downstream effects of obesity.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
So we're putting Band-Aids on all these other diseases rather than treating the root cause, the root cause of all these other diseases. Yes. Right. And honestly, this is so key because we can transform medicine. By treating this one disease, we can impact hundreds of other diseases. There are 13, at least 13 types of cancers that are obesity related. We know this. So colon cancer is one.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
Another one is postmenopausal breast cancer, endometrial cancer. These are all cancers that are related to obesity. And one of the questions is, well, if we treat obesity, can we actually impact the development of those diseases? Can we actually prevent cancer? And we don't have the answers to those types of questions yet. But think about the impact.
The Oprah Podcast
Oprah and Dr. Ania Jastreboff on How People Treat You Differently After Weight Loss
We are at the dawning.
The Oprah Podcast
Dr. Ania Jastreboff
That's right. That's absolutely right. And to get to your question of, well, is this the easy way out? Is taking medications the easy way out? It's not. Think about it. Think about when we treat someone who has, let's say, high blood pressure.
The Oprah Podcast
Dr. Ania Jastreboff
And they come to see us and we say— Lots of Americans have high blood pressure.
The Oprah Podcast
Dr. Ania Jastreboff
Lots of black people have high blood pressure. Exactly. So we say, okay— low-salt diet is very helpful, and here are some medications that can treat the disease biology.
The Oprah Podcast
Dr. Ania Jastreboff
And we need to do the same for obesity. We need to say, yes, healthy diet and exercise are critical, and they're very important for optimizing health. And to treat the biology, the biology of obesity, here's a medicine or medicines or surgery or what have you that will help actually treat that biology.
The Oprah Podcast
Dr. Ania Jastreboff
Exactly. And so diabetes is another perfect example. We say we recommend a low glycemic index diet, so less sugar.
The Oprah Podcast
Dr. Ania Jastreboff
And here are the medicines. And for your mom, if it was insulin. And here are the medicines. So we pair them together to help that person's health, whether it's to help prevent all those downstream complications that can develop or whether it's to treat that disease in and of itself.
The Oprah Podcast
Dr. Ania Jastreboff
That's right. That's exactly right. And with obesity, for whatever reason, we have this different perspective, and we need to change that.
The Oprah Podcast
Dr. Ania Jastreboff
It's absolutely critical. And when I approach this, so when I see a patient, the first thing I do is one, I set the stage and I say, this is a no judgment zone. And the first thing I ask them after that is, tell me about your weight journey. Tell me about your struggles. Tell me, just tell me, tell me. And then I listen. And as I listen to them,
The Oprah Podcast
Dr. Ania Jastreboff
I mean, they cry, I cry. And the thing is, there's something that happens in that moment where people begin that journey of understanding that it's not their fault. And it's not something that they chose. And we're here to help them to treat that biology.
The Oprah Podcast
Dr. Ania Jastreboff
That's right. That's absolutely right. Why wouldn't you change it if you could? You can have the healthy foods. And still, our body is so smart. It's so smart that it's like, no, I want you to hang on.
The Oprah Podcast
Dr. Ania Jastreboff
And if you begin the discussion of this is really about biology and that your body's smart and that the hormones are communicating with your brain and all these organs in your body and your body's doing exactly what it was meant to do, exactly what it was meant to do, and then, again, patients start to... start to let go.
The Oprah Podcast
Dr. Ania Jastreboff
And there's something magical that happens in that moment because they become curious, curious about the disease of obesity and open to treatment.
The Oprah Podcast
Dr. Ania Jastreboff
So as we talked about hormones, nutrient-stimulated hormones, they communicate with our brain to let our brain know how much energy to store, how much fat to store. The medicines, they target the same receptors as these nutrient-stimulated hormones.
The Oprah Podcast
Dr. Ania Jastreboff
In your brain. And those receptors are all over the brain, including reward motivation regions of the brain.
The Oprah Podcast
Dr. Ania Jastreboff
No. Obesity is a neurometabolic or a neuroendocrine disease. It's literally a disease. In the brain. Yes. And so what happens in obesity is that there's something that is dysregulated or broken in terms of the set point, in terms of how much energy we want to store. And the medicines, what we think that they do is that they re-regulate that set point. They decrease that set point.
The Oprah Podcast
Dr. Ania Jastreboff
So as you start taking a medicine during that first phase when you're losing weight, what happens is your body is trying to chase energy. a lower defended fat mass, a lower set point. And so that's why people eat less in that first phase. Then once they plateau, once their weight plateaus out, then some of the hunger and cravings and things can return, but the weight does not.
The Oprah Podcast
Dr. Ania Jastreboff
And we have to reassure our patients that that's exactly what's supposed to happen because once you get to a new weight plateau, you're not chasing a new defended fat mass. So the medicines lower or reset the defended fat mass or the set point, and then basically they re-regulate it to a new place.
The Oprah Podcast
Dr. Ania Jastreboff
And it's different for every person. Because there's more than one type of obesity. There's many different types of obesities. We just haven't defined them yet. But let's say, so somebody starts at 200 pounds, and let's say they start one of these medicines. Maybe with the first or the second dose, that set point goes down to, let's say, 180 pounds, right?
The Oprah Podcast
Dr. Ania Jastreboff
And then they keep on taking the medicine. And after some time, their doctor increases the dose. And then their set point decreases, let's say, to 170 pounds. So with every dose escalation, you're chasing a new lower reset defended fat mass or set point.
The Oprah Podcast
Dr. Ania Jastreboff
Okay. So in terms of that first question, right now, there aren't really great definitions. Yeah. So we used to use definitions of BMI. Yeah. But BMI is really a screening tool. It's not something that was actually ever designed to be a diagnostic tool. So technically, overweight was defined as a BMI of greater than 25 and obesity as a BMI of greater than 30.
The Oprah Podcast
Dr. Ania Jastreboff
I mean, I can't agree more. You literally can't win. You cannot win. You're shamed if you have obesity. You're shamed if you don't try and lose weight. You're shamed if you lose weight. You're shamed if you use the medicines. If you don't use the medicines, there's literally no winning. So, you know, I wholeheartedly agree.
The Oprah Podcast
Dr. Ania Jastreboff
You are sharing your story so vulnerably and bravely online and you're fighting for what's right. And what's right is to stop shaming and blaming people. Just let people do what they do. You're taking care of your health.
The Oprah Podcast
Dr. Ania Jastreboff
Yes, body mass index. BMI is body mass index. Now we're really starting to rethink what that means. What does it mean to have obesity? And the indications for the medications were based on these initially. And now that's also evolving and changing as well because we're really trying to understand what is obesity? How does it affect our health?
The Oprah Podcast
Dr. Ania Jastreboff
Because ultimately, when we're treating obesity, the point is not just weight reduction. It's improving and optimizing overall health.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. Yeah. I mean, I think that's a great question. It's probably one of the top questions, if not the most commonly asked questions that my patients come to me with. Right now, you know, what we do know is that obesity is a chronic disease. It's a chronic disease. So let's say that you had high blood pressure and you started taking a blood pressure medicine.
The Oprah Podcast
Dr. Ania Jastreboff
What would happen if you were to stop taking that blood pressure medicine? your blood pressure would go back up. Same thing with diabetes. If you were taking insulin, if you stopped taking the insulin, your blood sugars would go back up.
The Oprah Podcast
Dr. Ania Jastreboff
And what we're seeing not just in clinic but also in trials, we just conducted a trial, it was three years, with one of the medications, is that the weight was completely maintained while people were taking the medicine. And then when the medicine was stopped, people started gaining back the weight. Now, what I can say is we see the same thing in clinic.
The Oprah Podcast
Dr. Ania Jastreboff
So that is the case with most of my patients. What I usually do when patients say, well, I really like to see what happens when I stop, is I decrease the dose. I go down on the dose by just a little bit, by one step. And then I say, come back and see me in two, three months. And they come back and see me and we see how they're doing.
The Oprah Podcast
Dr. Ania Jastreboff
If they're maintaining their weight and the food noise isn't back and they're not struggling, then great, we stay on that dose. But if their weight is starting to trend up or if that food noise is coming back and they're having a really hard time, then we go back up on the dose.
The Oprah Podcast
Dr. Ania Jastreboff
And I do think that just as there's differences in how much weight people lose, we will see differences in terms of how much people gain back. So we'll see variability in that weight regain. But right now, for most patients, on average, what we see, and in the studies we've seen this as well, most people, yes, you have to continue taking the medicine because it's targeting your biology.
The Oprah Podcast
Dr. Ania Jastreboff
That's right. That's absolutely right. And that is why when we, these medicines... I just had that aha. It's a beautiful aha. And it's such an important one because, again, these are not.
The Oprah Podcast
Dr. Ania Jastreboff
Absolutely. And this is why this is actually critical when we think about the words we use. These are not weight loss drugs. They are medicines that treat obesity. They treat the disease processes in the brain.
The Oprah Podcast
Dr. Ania Jastreboff
And that is why I think so many patients ask us that for that exact reason. They're like, well, I lost the weight. I'm cured. I'm cured. Success. But it's the same way with diabetes, hypertension. Just because your blood pressure decreases or your blood sugars decrease doesn't mean you're cured.
The Oprah Podcast
Dr. Ania Jastreboff
Just like the high blood sugars are the symptom of diabetes. And the high blood pressure is hypertension. So the analogy is perfect with diabetes, especially.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. I mean, there are studies coming out about heart disease, about heart failure, about improving knee pain, obstructive sleep apnea, and all of these are obesity-related diseases. I even heard Alzheimer's. Well, and that is also being looked at. What are the effects in the brain in terms of, again, improving that? And we'll have to see that.
The Oprah Podcast
Dr. Ania Jastreboff
Those studies haven't yet been conducted out as far as these other ones. So the heart disease, the
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. So those studies are being done. We think that, again, it's similar pathways in the brain that are being targeted. So just as your craving or your hunger may come down as you're taking these medications, in the same way you're craving for other things, other things that maybe pleasurable, goes down. Now, that doesn't mean that makes you unhappy. You can just take it or leave it.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. And that is such an important and critical question. So as you said, so many people have obesity now. And two-thirds of Americans and half of the world population did not wake up one morning and decide to have obesity. Obesity is not a choice. It is about biology. So what is obesity and why do so many people have it?
The Oprah Podcast
Dr. Ania Jastreboff
So that's a great question and another very common question that we get from our patients. And first, you know, I'll start off by saying that as you've identified, there are risks to having obesity in and of itself, right? And when we treat patients for any disease, we say, okay, what are the benefits of treatment? What are the risks of treatment?
The Oprah Podcast
Dr. Ania Jastreboff
What are the benefits of not treating or treating, right? We really look at all that very, very carefully. And right now, all the data is pointing to the fact that these are very beneficial, but that doesn't mean that we don't have to do our due diligence, be very careful and monitor everything long-term because millions of people are taking these medicines and millions more will take them.
The Oprah Podcast
Dr. Ania Jastreboff
Having said that, GLP-1 receptor agonists have been used for the treatment of diabetes for 20 years. Now, all of these medications also for diabetes.
The Oprah Podcast
Dr. Ania Jastreboff
The first one was FDA approved in 2005. So it was nearly 20 years ago that these medications were first FDA approved. 20 years. I know, 20 years. So the earlier ones were a little bit different than the newer ones and they were shorter acting and they had to be taken more daily rather than weekly. So there are differences there. But the point is, is that we do have data, all the trials.
The Oprah Podcast
Dr. Ania Jastreboff
That's why we do all the trials. That's why I do all the trials, right? To make sure that the FDA has the information that it needs, not only to know that these medicines are effective, but to know that they are safe and well tolerated. And if there's a signal that they're not, then the FDA says, no, we're not moving forward. So what we have to do is keep on doing the studies.
The Oprah Podcast
Dr. Ania Jastreboff
We need to gather real world data. What health impacts are these medicines having on those diseases?
The Oprah Podcast
Dr. Ania Jastreboff
And why is it so difficult not just to lose weight but to maintain that weight loss?
The Oprah Podcast
Dr. Ania Jastreboff
It's like once you have diabetes, you always have diabetes. It can be treated or controlled diabetes. Same thing with obesity. Once you have obesity, you always have obesity. Is it treated and controlled? That's the question.
The Oprah Podcast
Dr. Ania Jastreboff
And so our body is amazing. It has this amazing, beautiful biology. And basically what it was designed to do is to make sure that we stored enough energy or enough fat because we store energy by storing fat. I'm tracking that. Yeah. And so it said, okay, how are we going to do this? Well, there are these hormones. They're stimulated when we eat food. They're called nutrient-stimulated hormones.
The Oprah Podcast
Dr. Ania Jastreboff
Yes, and it takes time. So the more highly effective a medication is, we're seeing it may take longer to see the effects. That's why the trials are getting longer.
The Oprah Podcast
Dr. Ania Jastreboff
And that is the question that we were starting to answer. And the last thing is, for some patients, maybe. But right now, we don't know how to determine that ahead of time, a priori. So basically, that's why when patients, if they ask me to go off, or some patients ask to go down on the dose, we try that, but then bring them in quickly.
The Oprah Podcast
Dr. Ania Jastreboff
Because the hard part is, if you start gaining back weight, that is so, you know, people think, again, it's my fault. And it's not their fault. It's not their fault. It's biology. It's biology. If you decrease your blood pressure medicine, what's going to happen?
The Oprah Podcast
Dr. Ania Jastreboff
Same thing with your blood sugars for diabetes. It's no different with obesity.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah, that's a great question. And side effects do occur, right, with any medicine for any disease. Is there any medicine for any disease that doesn't have side effects?
The Oprah Podcast
Dr. Ania Jastreboff
Well, it depends how much weight someone loses and how quickly. Because losing weight is a stress. It's a stress on our body, right? So we've actually seen the hair loss with things like bariatric surgery, right? And now with people who lose a large amount of weight in a short period of time, we're also seeing those types of effects that we saw with bariatric surgery.
The Oprah Podcast
Dr. Ania Jastreboff
But let's focus in on the most common side effects as you were asking about. So the most common side effects are gastrointestinal. So they are things like feeling nauseated, having diarrhea, constipation, and for some people, vomiting. But there are ways that we can really combat those side effects. And again, they don't happen in everybody.
The Oprah Podcast
Dr. Ania Jastreboff
So number one, what physicians or providers can do is invite their patients to share the side effects with their provider and make sure that the provider says, look, I'm not going to stop the medicine. Let's work through these together. The main thing that a healthcare provider can do when they're prescribing these medications to help avoid or mitigate those side effects is start low and go slow.
The Oprah Podcast
Dr. Ania Jastreboff
Always start with the lowest dose. And then you do not have to go up once a month. You do not have to go up once a month. You go up as is right for that patient. So if a patient is having nausea, I do not go up on the dose. I let them stay on the dose, let their body get used to the medicine.
The Oprah Podcast
Dr. Ania Jastreboff
Absolutely, absolutely. Then, you know, look around, see if there's another health care provider, somebody who really knows how to treat obesity and understands that it's a disease, that this is not about weight loss. This is about weight reduction and optimizing health and knows to pair them with the diet, the correct nutrition, the exercise, someone who really knows.
The Oprah Podcast
Dr. Ania Jastreboff
And they communicate with our brain, how hungry are we? How full are we? How much energy do we have? And so this beautiful biology. So hormones inform the brain. And this is in every person's body. In every person's body. Every person's body. And so basically it says, okay, this is how much energy you're storing. This is how much fat you're storing.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah, absolutely. I mean, I always say, people ask me, well, how did you know that you wanted to do this? The first time that I helped a patient lose a meaningful amount of weight for that person, I was like, I'm never doing anything ever again. This is it. And I'm so grateful that I get to do this. And I'm so grateful that patients trust me. They trust me to care for them.
The Oprah Podcast
Dr. Ania Jastreboff
Absolutely. And, again, it's, you know, there's good and bad things about everything, everything in life. These medicines are right now what we're seeing. They're helping people transform their lives in so many ways in terms of their health, in terms of their overall life. They're just really incredible in terms of helping people.
The Oprah Podcast
Dr. Ania Jastreboff
And so you would think, oh, we have this beautiful biology. Wonderful. Then why do so many people have obesity if this is so carefully regulated? Why?
The Oprah Podcast
Dr. Ania Jastreboff
Well, it turns out that our obesogenic environment, an environment that is filled with ultra-processed food, lack of sleep, lack of physical activity, all this stress on a population level, that obesogenic environment that developed so much more quickly than the biology, it basically pushes up how much energy or how much fat our body wants to store.
The Oprah Podcast
Dr. Ania Jastreboff
So our body ends up defending a higher amount of fat the defended fat mass or the set point. These are terms that you may have heard, but that's exactly what our body's doing. So our body's doing what it needs to be doing, what it should be doing, but a little bit too much in this environment.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. And that's a really great question and one that we're trying to sort out and figure out. What we do know is that for most people, maybe, you know, over centuries and millennia, we evolved in this way where basically you wanted to make sure that you didn't starve, right? So you wanted to store enough energy so that if there was a famine, you would not starve.
The Oprah Podcast
Dr. Ania Jastreboff
But if you think about this, this is actually very, very tightly regulated. So we all eat incredibly... We all eat a lot more than what we actually need. So our body actually figured out how to burn extra. But after a while, with this obesogenic environment, it actually says, no, store it. Maybe I need it for later, right?
The Oprah Podcast
Dr. Ania Jastreboff
So when we try and lose it, our body fights back and it says, no, no, no, no, no. Okay.
The Oprah Podcast
Dr. Ania Jastreboff
They may be, or your brain. Because obesity is a neurometabolic disease, or neuroendocrine. Hormones inform the brain. So maybe in your body... your body's like, I'm really good at holding on to that energy. I'm really good at holding on to some extra fat just in case I need it later. And somebody else's body says, no, I don't need that.
The Oprah Podcast
Dr. Ania Jastreboff
But for most people, where we started the conversation, for most people... We want to store more. We want to store extra. And that is where our body is happy. And that is what our body defends. And it's because of the environment we live in. And that tells us two things. One is we have to change the obesogenic environment. We have to because if we don't, we're not going to be able to prevent it.
The Oprah Podcast
Dr. Ania Jastreboff
An obesogenic environment, so one that is filled with ultra-processed food, lots of stress, lack of sleep, lack of physical activity. All these things are built into our environment right now.
The Oprah Podcast
Dr. Ania Jastreboff
And here's the thing. So those pathways... And is that my hormones? It's your hormones and your brain. And my brain. And your brain. So for example, for you, maybe it's potato chips. When you consume those foods, when you eat those foods, that signals to your brain something positive.
The Oprah Podcast
Dr. Ania Jastreboff
So, these hormones, they communicate with all sorts of areas of our brain, including reward motivation areas of the brain. So, we find these foods highly rewarding. Our brain does. And the thing is, again, we were designed to function this way. Because let's say that we— Well, some people find them rewarding.
The Oprah Podcast
Dr. Ania Jastreboff
They don't do a thing. It's something—and that is actually why I started doing the research that I do. Because I thought to myself, well, why is it that some people crave potato chips and other people want the cheesecake or the— Or Krispy Kremes. Or Krispy Kremes. So why is that? And the answer is right now we don't know.
The Oprah Podcast
Dr. Ania Jastreboff
But initially I was doing these brain studies to really try and understand what that was about and what reward regions of the brain were actually responding. Let's say you saw a picture of a potato chip. How would your brain respond differently than somebody else's? And again, that has to do with genetics.
The Oprah Podcast
Dr. Ania Jastreboff
And this is the thing. Maybe we'll talk about food noise, but that's what it is. If there is a bowl of brownies on the table, I would not be able to focus on you. I'd be like, I want the ice cream and the brownies.
The Oprah Podcast
Dr. Ania Jastreboff
They knew. they had called you but to your point about the fact that you're eating very healthfully and you have for a majority of your life um again the amount that we eat and again our body craves a larger amount of food the amount that we eat is a lot more than what we actually need so our body actually burns a lot it's just that different people may hold on to less of that food than others so
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. I mean, I couldn't agree with you more. And your story is one. First of all, I'm so sorry that you went through all this and in such a public way.
The Oprah Podcast
Dr. Ania Jastreboff
I just you're so strong. and to have that so publicly, and you just... I thank you for that. Yeah.
The Oprah Podcast
Dr. Ania Jastreboff
And it's absolutely the opposite. It's absolutely the opposite. And none of this is in our control. Somehow in society, we think that how much we weigh is in our control. And it's not. It's not. Our brain is in control.
The Oprah Podcast
Dr. Ania Jastreboff
Yeah. And just like with alcohol, those reward motivation pathways, those regions in the brain really respond in a certain way when someone who has alcohol use disorder is drinking alcohol. In terms of obesity, those are the same brain pathways. Now, obesity is not an addiction. the thoughts of food and the wanting of food, that is something different.
The Oprah Podcast
Dr. Ania Jastreboff
And again, that's- The food noise, we call that. It's a manifestation of the biology.