Ask the Doctor (2017–…): Season 1, Episode 1 - Obesity - full transcript

Why do the majority of people that diet and lose weight put it back on? Plus, the hidden environmental triggers that encourage us to eat too much.

Humans.

We number more than 7 billion,

and yet no two of us are exactly alike.

But despite our differences, we all
have one thing in common our bodies.

And each of us only has one
to last us our lifetime.

But how does it actually work,
and how do we look after it?

Well, that's where we come in.

Meet Doctors Renee and Sandro,
and I'm Shalin.

We're serious medical professionals...

most of the time.

Regardless of what stage
of life you're in,



we'll have some advice
on how to look after your health.

Ew, he's pooping!

Putting our bodies to the test...
Ow!

...to find out how we can
all live healthier...

- Oh!
- ...for longer.

That's extraordinary.

In this episode, we tackle a question
that's been plaguing society as we ask,

why is it so hard to lose weight?

It's a major health issue that will end up
killing more people than wars.

And reveal why it's even harder
to keep the weight off.

It's not necessarily your fault.

My body is saying,
"I want to be 50kg heavier."

It's like I'm fighting
this constant battle.

And my endurance is tested,



as I'm frozen in a giant magnet
in a world-first experiment...

Here we go.

...with the hope of one day
creating a pill to combat obesity.

Pretty tight in here.
Feel like I'm trapped.

Why are we so overweight
in the first place?

Dr Sandro is someone with a whole lot
of knowledge on the expanding problem.

Australian-born,

Sandro has worked all over the world
as a medical doctor.

He's also a good Italian boy
who loves his mama,

and did a Postdoctoral Fellowship
at Harvard

following his PhD.

I think that makes him Dr Dr Sandro.

He is internationally recognised

for his work in both nutrition
and childhood obesity.

Oh, and he has amazing hair.

Think about this for a sec.

If you had a class of 30 students

and one of those students
was getting bad grades,

you could reasonably assume that
the problem lay with that one student.

But what if 20 out of those 30 students
were getting bad grades?

Surely you'd redirect your blame
towards the teacher or the school, right?

So why is it that in our community,

where almost one third of the world's
population are overweight or obese,

we still blame the individual
for their weight

and not the society and environment
they live in?

Now, I work with researchers
and governments

to find ways to address
growing global obesity,

and I want to show you how the health
cards are stacked against many of us

in such a way that makes health
increasingly beyond reach

and obesity the path of least resistance.

Let's start by talking location,
location, location.

Research tells us that your risk
of being overweight changes,

depending on where you live.

This is in part because of
poor urban planning.

We're talking whole suburbs
that lack adequate footpaths,

without places where kids can run
and kick a ball,

and where parents can't find fresh food
without having to drive for miles.

On top of all of this,

a lot of food advertising clearly comes
with an attitude of "get 'em young."

Many TV stations around the world
advertise food during kids' programming,

and often those ads are for foods
with low nutritional value.

However, the situation isn't hopeless.

In fact, if we can ensure our kids
develop the right eating habits early on,

we could cut obesity rates
in just one single generation.

Studies show only 5%
of healthier-weight kids

will grow up to become obese,

whereas up to 79% of obese kids
will become overweight adults.

Now, I understand that nobody likes
to be told what to drink or eat,

not by our parents,
not by institutions,

and certainly not by people like me.

But aren't we already being
constantly told what to eat?

So next time you hear a bold idea

that offers even a chance of making
our kids and our communities healthier,

instead of writing it off as telling us
what we can or can't eat,

let's ask ourselves

is this an idea that could help us
win the battle for our health?

Mmm.

So in Sandro's expert opinion,
we're becoming more overweight

partly because of poor urban planning
and fast food ads targeting our children.

We've also asked you on social media,
why do you think we're overweight?

While guidelines for
physical activity vary around the world,

being physically active
for at least 30 minutes a day

will make a difference
to your health and wellbeing.

But with so many of us now overweight,
obesity has become a health crisis.

So, as a medic of 14 years

with a passion for diet, nutrition
and holistic health,

there's no-one better than Dr Renee

to get to the somewhat flabby bottom
of our weight loss woes.

She also likes... dancing?

Oh, interpretive dancing.

As a doctor, I come face-to-face
with the obesity problem all the time.

Long-suffering patients who do
everything they can to lose the weight,

but often it just comes back.

So maybe we shouldn't just be asking
the question, "How do you lose weight?"

We should also be asking,
"How on earth do you keep it off?"

Professor Joe Proietto is on the
front line of the obesity problem,

running a weight control clinic
in Melbourne, Australia.

He also likes gardening.

Hi, Professor Proietto?

- How are you, Renee? Welcome, welcome.
- Thank you.

But it's the professor's research
into weight loss

that's breaking new ground.

He believes our hormones push us
to regain weight as soon as we lose it.

So, what happens after weight loss
is that the hunger hormone increases,

the hunger-suppressing hormones
decrease,

and then what we discovered in 2011
is that they stay there permanently.

Well, at least in our study,
we looked at 12 months after weight loss,

they were still different.
- Right.

But now we have evidence at six years
that they're still different.

So in other words,

the biology doesn't give up
trying to get you back to your set point.

We're here now.

It's what's often referred to as
the famine response.

After sustained weight loss,

hormones are released,
urging us to eat more,

and then the whole cycle

of dieting and eating more repeats.

So, a lot of people think that
obese people are really just not trying.

If you understand the condition,

you know that these people are hungrier
than people who are lean.

Appetite is regulated
by hormones

that send signals from our gut,
fat and pancreas

to the hypothalamus in the brain,
controlling our hunger.

The hypothalamus is actually wired
to make us look for food all the time,

and that makes sense,
in an evolutionary sense.

- Things have changed.
- Well, things have changed,

but they've changed so fast that
our biology hasn't optimised yet.

We are not making any progress
in stemming the obesity epidemic.

It's a major health issue

that will end up killing more people
than wars or infections or anything else.

The problem seems overwhelming,
and it is.

According to Professor Proietto's
research,

a whopping 90% to 95% of us

fail to keep weight off
after we've lost it

because our hormones make us hungrier.

But what about the tiny minority
that succeeds?

Could they hold the key to
understanding weight loss?

To find out, I've come to Ararat,

a quiet, idyllic town
200km outside of Melbourne.

It was named as Australia's heaviest town
in the 2011 national census.

A few years ago, reality show
The Biggest Loser arrived here

to help the townsfolk lose weight.

- Hello!
- Hello, Sharon?

- Yes, how you going?
- Nice to meet you. I'm Renee, how are you?

- Good, how you going? Come in.
- Good, thank you.

I'm at the home of Sharon Basset,
one of the contestants.

- Oh, my gosh, your wedding photos.
- Yeah.

How long ago was that?

Wait, I don't know.

Wait, no, it has to be 2007,
'cause she's a baby. OK.

How much did you weigh back then?

- Probably 100kg in that photo.
- OK.

It wasn't my heaviest, though.

Heaviest, probably 120.

During the show,
Sharon lost a whopping 50kg,

41% of her body weight,

a truly impressive achievement.

Would you do the show again?

- Yes.
- Yeah?

Yes, as hard as it was, I would still
recommend it and I would still do it.

You know,
they taught me how to eat properly,

they taught me how to keep active and fit,
and the right things to do.

And I keep all that
and I use that every day.

It literally saved my life.

It's good.

Sharon's weight loss
was indeed a game changer,

but the real miracle is that
three years later,

she defied the odds and has kept it off.

Yeah, we can feed the chooks.

- Oh, you have chooks?
- Yeah.

Her secret is something
we all have at our disposal

good old-fashioned hard work,
and a clean, healthy diet.

- Oh, my gosh, look at all your...
- Yes, the pig's here.

Hello! Hello, pig.
What's his name? Her name?

- Damon.
- Damon? Oh, that's a great name.

Hi, chookies!

So, tell me about your day.

I get up at 5am,
I go for a walk around town.

- Yeah, right.
- Try to jog. Not very good at it.

And then I go to work,
so, I work full-time in Ararat.

And then after work,
go to the town gym, an hour.

And then go pick up the kids
from the sitter's.

I mean, your entire day is full.

Yeah, pretty much. But if I get time
at the end, you know, late at night,

I might try to get in a quick workout
or something.

That's crazy.
And so on top of that as well,

you're going to have to be thinking
about food and what you're going to cook.

Yes, we try to keep everything
really clean and healthy.

It's hard. It really is hard.

No-one should have to exercise
three hours a day,

but Sharon needs to,
just to maintain her weight.

Thanks to the hunger hormones
triggered by her weight loss,

she needs to burn 300 calories a day more

than someone who hasn't
lost so much weight.

It's a hard slog,
and her resilience is inspiring.

How do you feel about the fact that
you have to keep working so hard?

It's a little upsetting that
I can't just be normal.

- Mm-hm.
- Like, I just want to be normal.

I knew it was going to be hard,
but I didn't think this hard.

And I thought that maybe over time
everything would settle down,

so it would get a little bit easier.

- Yep.
- But it's not. It's constant.

So your body hasn't decided
that this is normal.

No. My body is saying,
"This is not your size.

I want to be 50kg heavier
and I want to be bigger,

and so I'm going to push you

and I'm going to push your body
to make me this size."

It's like I'm fighting
this constant battle.

- Yeah. Yeah, wow.
- Yeah.

It might seem unfair,

but Sharon's regime is doing wonders
for her fitness,

cardiovascular and mental health,

along with many other benefits
to her wellbeing.

She's proof you don't need to be
stick-thin to be healthy.

A recent study found losing just 3kg

can reduce health problems
related to being overweight.

I always knew that obesity
was bad for the body,

but I never realised that
the body could actually

stop the ability to change weight.

And now that I know that,
it's really exciting,

because it changes the expectations
of people who are losing weight.

It changes the way that we approach
losing weight,

and hopefully with all the research,

it could change the treatments
we offer in the future.

So far, we've learned
healthy eating habits when we're young

are the best protector against
adult obesity.

And while putting weight back on after
you've lost it may not be your fault,

a crash diet is no substitute for
healthy eating and regular exercise.

But is there anything in the pipeline
to help people like Sharon?

As a stem cell biologist,
you probably think I'm a bit of a nerd.

And that'd be fair.

But hey, I'm pretty good at karaoke.

And as a researcher, I'm naturally curious
about the latest developments in science.

Apparently there's a way to burn calories
without moving a muscle.

I'm on my way to Melbourne's
Monash University

to be a lab rat
in a world-first experiment.

It's part of cutting-edge research
into something called brown fat

that could fundamentally change
the way we treat obesity.

And it's spearheaded by
Professor Brian Oldfield.

He also likes... sailing?

- Michael.
- Hi, Brian.

- Can I introduce you to Dr Shalin?
- Hi, Michael, how are you?

- I'm good, thank you. How are you?
- Very well.

So, Michael's going to be
running the experiment today.

I'm going to leave you here
in his very competent hands,

and I'll be back this afternoon

and we can talk about the results.
- Alright.

Running the experiment is
neuroscientist Dr Michael Farrell.

He'll give us a quirky demonstration
of the MRI

that will look inside my brain and body

using radio waves
and an extremely powerful magnet.

Ooh, sciencey!

I have no metal limbs.
Is that an important question?

Yes, that's one of the questions that
Richard the radiographer will be asking.

- OK. I am not the Terminator.
- OK.

That's a good thing.
Have you been fasting?

Yep, I haven't eaten anything
since dinner last night.

I haven't had my coffee, I'm struggling,
but in the name of science,

- I'm food and drink-free.
- OK.

In this experiment,

we're hoping to see
some sort of connection

between the brain and the brown fat,

because one of our end goals is to
determine how we can turn brown fat on

through activation of different parts
of the nervous system.

So what is this brown fat
we're talking about? Glad you asked.

We're born with brown fat,
which actually burns energy.

It's nature's back-up generator
for keeping helpless babies warm.

But excitingly, brown fat was
recently discovered in adults.

Although it only makes up 1%
of our body fat,

because it burns energy or calories,

it could well be the key
to tackling our obesity epidemic.

So, the brown fat, the good fat,
brown fat's the burning fat.

Exactly.

And then there's the white man
and the brown man,

and the brown man does it
better than the white man.

I mean... it's just life, right?

Sorry.

But it's dawning on me that
what I've signed up for is no joke.

It's an endurance test,
because brown fat is activated by cold.

My ordeal kicks off with cannulas
being stuck into my arms

so they can monitor my blood sugar level

and inject me with radioactive glucose

that will light up
if my brown fat activates.

So, my left arm gets
the radioactive sugar,

my right arm gets the blood samples
taken from it.

Exactly.

Now I'm shoving myself
into a suit riddled with tubes

that will circulate litres of icy water
around my body,

and hopefully be cold enough
to activate my brown fat.

The suit's alright. It's...

It's a nice blue.

The cannulas are
a little bit uncomfortable.

There's lots of hoses
coming out of my rear end,

but apart from that,
it's pretty comfortable.

Could have a good afternoon
watching a movie on the couch.

We've got no popcorn, though,
unfortunately.

- No popcorn?
- Yeah.

What kind of an MRI facility is this?

For the next hour and a half,
I'll be entombed in this MRI.

But if the experiment works,
it will be the first time in the world

where the interaction between brain
and brown fat is recorded in real time.

And the end game is
to try and find a chemical

that is specific within those
nerve pathways

for turning on brown fat.

In other words,

the long-term goal is a pill
that will activate brown fat

a method that, if successful,

could bring hope to the overweight
and obese.

So, you're going to be here
for 90 minutes.

- Alright.
- It's very important,

any little bit of niggle now
will be agony in 90 minutes.

So I can't scratch my nose?

Um, well, you can, but you have to
remember to keep your head still.

- To keep my head still. OK.
- OK? Yep.

Now all I can think of
is scratching my nose.

OK, two thumbs up.

This isn't as easy as it looks.

I'm feeling a bit claustrophobic

and I'll be trapped in here
for an hour and a half.

But if it helps science to one day
find a pill to treat obesity,

then I'm going to grit my teeth
and bear it.

Could you switch to the ice water,
please, Emma?

OK. Here we go.

Now the ice water
is circulating around my body,

I'm feeling it in places
I've never had ice before.

Hi, Shalin.

We're just checking in
to see how you're getting on.

Well, my head can't move.

There's things all around my eyes.

It's pretty tight in here.
I feel like I'm trapped.

Ah, but I guess I'll just try to stay calm
and keep going.

So, when you do burn calories,

where does the fat actually go?

The human body is
a genuine biological wonder.

The pinnacle of millions of years
of evolution through natural selection.

But sadly, very few of us look like this.

Most of us look more like Gary.

In fact, at 37.8 years of age,

175.6cm tall

and hauling a few extra kilos,

Gary's about as average as you can get.

And like most people most of the time,
he'd rather be somewhere else.

Gary! Not so fast!

Gary, you're doing exercise!

Well, good for you, because we know
we all should be doing a little bit more.

But have you ever wondered
where fat actually goes

once you've done enough exercise
to tap into it?

It's a common misconception that the atoms
in so-called burned fat

are converted to heat and energy.

But that's physically impossible,

because the only way atoms
can turn directly into energy

is in a nuclear reaction...

...and obviously this isn't happening
every time someone jumps on a bike.

Let's take it from the top.

Now, you might have noticed
that all this pedalling

has got Gary breathing pretty hard.

That's because the key ingredient
his body needs

to turn fat into energy
is oxygen.

So let's see what's required
for Gary to burn 10kg of fat.

For a start, he'll need to get extra busy
on that bike,

because he'll need to breathe in
roughly 29kg of oxygen.

That's around 406 cubic metres of air.

The resulting chemical reaction
powers his muscles,

but also produces waste,

around 28kg of carbon dioxide,
and 11kg of water.

Which means, in simple terms,
most of the fat Gary burns off exercising

will exit his body through his mouth
as CO2,

a little bit each time he breathes out.

As for the water, some of it
will leave his body as sweat,

and if you're wondering
how he gets rid of the rest,

same way as everybody else.

How would you tackle
our obesity epidemic?

I'm trapped in this MRI
for the longest hour of my life so far,

and there's still another 30 minutes
to go.

I'm taking part in
a world-first experiment

to record what parts of the brain
activate brown fat.

Researchers hope they can develop a pill

that could burn calories
without moving a muscle.

The end game is to try and find a chemical

that is specific within
those nerve pathways

for turning on brown fat.

Hello, Shalin.

Hello, Michael.
Can I have a coffee?

OK, I'll just talk to
the group's barista for you.

Thank you.

Tell me how you're feeling,
temperature-wise?

- Yeah, feelin'... feelin' cold.
- OK.

I'm glad I went to pee
before I came in here.

So far,
Shalin's skin temperature

has dropped down a few degrees
to 32 degrees Celsius,

but we'll want it to get as low as 26,

'cause at that temperature,
the brown fat will activate.

We're certainly going to have to get him
a bit cooler than he is at the moment.

While I'm lying here,

let me tell you why
brown fat burns calories.

Unlike potentially harmful white fat,

which stores energy
and makes us, well, fat,

brown fat contains brown mitochondria,
the energy powerhouses of the cell

that burn calories when activated
without us having to move a muscle.

OK, I think we've got your
skin temperature where we want it,

at the optimal level.
- Alright.

I will rule my fat to activate.
It'll be fat-tivated.

OK.

This is like water torture.

I only hope they can cool me down
enough to activate my brown fat.

But we won't know that
until we analyse the results.

OK, Shalin, that's it.

We're going to come
and get you out of there.

Alright, come and get me.

And now we'll get you to
sit up for us.

Oh, core strength.

And swing around.
Well done. Well done.

I feel like I've been
in hibernation or something.

- Oh, really? Had a good sleep?
- It was alright. Bit cold.

- Pants off, please.
- Pants off Friday.

- Pants off.
- Whoa.

And we'll move out to the chair
and we'll take those needles out.

- Alright, let's do that.
- Well done.

Oh, you got the double latte!
Oh! You champion.

- You've been a very good participant.
- Oh...

- You deserve every bit of that.
- I've never been so happy to see a coffee.

Well done. We'll get those lines out.

Thanks.

It was pretty challenging in there,
and I'm still feeling pretty cold.

But I'm really pumped to go in
and see what the results look like,

and hopefully it was all worth it.

- Hi, Shalin.
- Hi, Michael, how are you?

I'm good. Have you thawed out yet?

Yeah, I'm back to room temperature.

Excellent. Have a seat.

Thank you.
Alright, what have we got here?

This is it. The moment of truth.

Did they get me cold enough
to activate my brown fat?

And will we be able to tell
how my brain and brown fat

are talking to each other in real time?

So what you can see, Shalin,
is that this is at a point

where you're being perfused with water
that's about your body temperature.

- OK.
- So it's quite comfortable.

But things changed, of course.

We cooled you down,
your skin temperature dropped.

- I remember that.
- Yes, indeed, and things began to happen.

You can see it specifically
in these areas

that are just above your collarbone,

and all of this is brown fat.

Right, so I've got little patches of
brown fat just either side of my neck.

That's right.

And they're extending up the side,
and they're all...

they're lighting up
because they're working?

Absolutely.

It's amazing to see
my brown fat activating.

I'm dying to know how may calories
I burned without moving a muscle.

In this sort of experience where you were
in the scanner for about 90 minutes,

that you burnt about 250 calories.

What's that equivalent to?

Say you were walking
for about an hour and a half,

you would expend about
that same number of calories,

just by lying in that cold suit.

So I could either lie down
and be cold for an hour and a half,

or go for a walk for an hour and a half,

and I would have expended
the same amount of energy.

In this situation,
theoretically that's true.

OK.

I don't know about you,
but after what I've just been through,

I'd rather take the walk,

which would also give me cardio
and mental health benefits.

But was the experiment a success?

Does it show how the brain and brown fat
actually talk to each other in real time?

This is a very preliminary analysis that
Michael's done since you've had the scan.

But he's started to identify
areas of the brain that light up

in conjunction with the activation
of your brown fat.

So this is critically important.

Wow, they've done it!

The experiment worked!

This is a small but significant step
towards developing a pill

that may one day replicate this process.

What you're saying is, I don't have to
sit on a couch with a cold suit

for an hour and a half a day
to lose weight.

In the future, there might be something
that could mimic that event.

- Mmm.
- And help me lose weight.

Couldn't have said it better myself.

Cool.

The idea that fat could actually help us
stay thin is truly fascinating.

I hope my small
and rather chilly contribution

could one day help those
struggling with obesity.

It's early days yet, but these results
are an exciting indication

of what could be possible in the future.

So what I've learned is that
we need to tackle obesity from all angles,

and I'm optimistic.

Incredibly, if our kids develop
the right eating habits,

we could cut obesity
in a single generation.

And I feel maybe we carry
too much guilt

when it turns out our biology
could be playing a big part.

But whatever your size,
if you eat well and exercise,

you will live better
and maybe even longer.

Take it from someone who knows.

No, not you, Gary.

If you're trying to lose weight,
just don't give up.

Be stubborn. Be strong.
Like, push through it.

It's going to be hard,
but you've got to keep trying.

You still here, Gary?
You can go now.