Echoes from ECO 2024 Expert opinion Weight management

Michele Sculati: Evolution of the dietary medical approach of obesity

Echoes from ECO2024 - Michele Sculati - YINI

YINI attended the 2024 ECO congress to gather scientific updates and expert’s advice on the role of diet and dairy in the management and prevention of obesity. The congress offered a great opportunity to meet with experts from various fields of expertise.

Here Dr Michele Sculati, Medical Doctor, specialized in Clinical Nutrition, PhD Public Health in Italy, speaks about the significance of addressing obesity with a comprehensive approach that includes newly available drugs, lifestyle changes, dietary adjustments, and the beneficial roles of prebiotics, probiotics, and fermented foods on the gut microbiota.

Key messages:

  • Personalized dietary prescriptions and new drugs are crucial for effective obesity treatment, emphasizing the importance of tailoring diets to individual needs and habits.
  • Recent research highlights the significant role of the microbiota in weight regulation and liver health, with diets rich in fiber and probiotics, like yogurt, showing promising benefits.
  • The FDA’s recognition of yogurt’s role in preventing type 2 diabetes underscores its potential health benefits, supported by decades of research linking yogurt consumption to lower diabetes risk and overall healthier dietary habits.

Can you introduce yourself?

I am a medical doctor specializing in Clinical Nutrition, with a strong focus on diet and dietotherapy, areas typically managed by dietitians. My passion lies in understanding how food and dietary habits can influence our health. Additionally, I have a deep interest in endocrinology and metabolism. This Congress, the ECO 2024, covers many of these topics extensively, making it an exciting and relevant event for me.

What do you believe are the key learnings from the ECO 2024 Congress?

There are numerous key messages to consider, given that the scientific program is an extensive 300-page document! Obesity has garnered significant interest, particularly with the advent of new treatment results. One of the most discussed topics is the efficacy of new drugs, including not only GLP-1 agonist but also others DUAL GIP/GLP-1 receptor agonists and emerging medications. Currently, we have around 20 new molecules in development, making it possible to treat obesity with drugs, in addition to surgery.

However, prescribing drugs alone is not sufficient. When treating a patient with obesity, it’s crucial to remember that better results are achieved if the patient’s habits are changed. Therefore, a dietician or a medical doctor treating obesity should emphasize the importance of personalized dietary prescriptions. These prescriptions should be tailored to the patient’s needs and habits, ensuring they are practical and achievable in real life. This includes considering the patient’s taste preferences, food preparation time, daily schedule, and activities such as sports or the use of lunch boxes.

Beyond the combination of drug development, clinical approaches and personalized dietary prescriptions, are there new targets in obesity research?

An area of growing interest among scientists is how dietary habits affect the microbiota, which plays a significant role in weight regulation. The microbiota aids in regulating weight through GLP-1. A diet rich in fiber and a healthy microbiota can lead to the production of short-chain fatty acids. These acids stimulate G protein on enterocytes, which in turn promotes the secretion of glucagon-like peptide-1 (GLP-1), the same target as many GLP analog drugs.

In recent years, there has been a shift towards prescribing diets that positively impact the microbiota by enhancing the fermentation of short-chain fatty acids. This can be achieved through diet, prebiotics, and probiotics. Probiotics are not limited to pills or supplements but can also be found in foods like yogurt, which naturally contain probiotics.

Many foods have potential probiotics. However, the way we cook, prepare, and store these foods affects their probiotic content. In contrast, yogurt is a standardized food with known probiotic content and substantial scientific backing.

Based on the sessions you attended here at ECO 2024, can you think of new benefits yogurt may bring to the microbiota?

Definitely! For example, I attended sessions on Metabolically Associated Steatohepatitis (MASH), previously known as Non-Alcoholic Steatohepatitis (NASH). These sessions highlighted the connection between the microbiota and the liver. Poorly differentiated microbiota, lacking healthy taxa, can lead to a thinner mucus layer in the gut, causing a condition known as leaky gut. This allows chemicals like lipopolysaccharides to pass through enterocytes into the bloodstream, reaching the liver directly.

Lipopolysaccharides impact inflammation mediators in the liver, contributing to chronic inflammation associated with non-alcoholic fatty liver disease (NAFLD) and MASH. Once again, as previously stated, modulating the microbiota through dietary habits and probiotics can play a crucial role in managing these conditions.

In March, the FDA accepted a claim that yogurt can help prevent type 2 diabetes. How significant is this claim for clinicians, and will it impact their recommendation of yogurt?

This claim is the result of decades of research, marking a significant milestone. I don’t believe any other food has such a strong claim related to a globally prevalent health issue like type 2 diabetes, making this incredibly important.

It’s not just based on a few years of research; it’s the culmination of extensive studies. While the FDA doesn’t consider the evidence entirely conclusive, the claim they approved is still very strong. We know there’s a negative association between yogurt consumption and the incidence of diabetes: the more yogurt you consume, the lower your risk of developing diabetes.

The exact reasons for this observation are still under investigation. It could be due to bioactive peptides in yogurt or its influence on the microbiota. As mentioned earlier, diet can affect the endogenous secretion of GLP-1, which was initially developed as a drug for diabetes therapy. This might give us some insight into why these observations occur.

Besides diabetes, yogurt offers numerous benefits: it is a nutrient-dense food, which likely explains the negative association between yogurt consumption and BMI. Additionally, yogurt consumption is associated with overall healthy dietary habits.

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