Obesity Is Not a Choice: A Q&A With Ania Jastreboff

Ania Jastreboff, MD, PhD, associate professor of medicine (endocrinology), is director of the Yale Obesity Research Center (Y-Weight) and co-director of the Yale Center for Weight Management. She is an international leader in research and clinical application of anti-obesity pharmacotherapeutics.

Recently, Jastreboff received the 2023 Clinician of the Year Award from the Obesity Society, which recognizes excellence in the practice of obesity medicine and a high level of competency in obesity care.

In a Q&A, Jastreboff discusses barriers to treating obesity, benefits of clinical trials, and the new era of obesity medicine.

There are many barriers to treating obesity, including access, cost, and the stigma, bias, shame, and blame that our patients unfairly face. By treating obesity as we treat any other chronic complex disease, we can begin to break down these barriers.

Obesity is a disease, not a behavioral choice. Two-thirds of us did not wake up one morning and decide to have obesity or to be overweight. If we understand this, then we can target the biology underlying the disease.

If a patient has diabetes or hypertension, we provide them with treatment options, including medications, and recommend lifestyle changes. But for individuals with obesity, for years we’ve been saying to eat less and exercise more, without giving patients the tools to target the pathophysiology of their disease.

We need to treat patients with obesity the same way we treat patients with diabetes, hypertension, or any other chronic disease; we need to provide patients with options and treatment tools that target the biology of obesity while serving as guides on their health journey.

Some of my studies involve using anti-obesity medications to probe the physiology of obesity. I also conduct clinical trials looking at new anti-obesity medications in development. Currently, I focus on nutrient-stimulated hormone-based medications, such as tirzepatide and semaglutide. Nutrient-stimulated hormones are released when we eat food, and they signal to our brain whether we’re hungry or full, and our overall energy state. Nutrient-stimulated hormone-based medications target the same receptors in the brain as these hormones do to help reregulate energy homeostasis, or how much fuel—in this case fat—our body wants to carry.

We can engage our patients in this type of clinical research and offer them the opportunity to have access to these potential novel tools. By sharing the research and science of obesity with our patients, we can help expand their understanding that having obesity is not a choice that they made, that a complex underlying biology exists, and that we are working to find the right tools to help treat that biology and their disease.

The new anti-obesity medications are highly effective, and they’re transforming the way that we can care for our patients. By treating obesity, we are mitigating, treating, and preventing obesity-related conditions such as cardiovascular disease, diabetes, hyperlipidemia, and hypertension.

We are entering a new era of obesity treatment. Many developments are underway, including medications that can decrease fat mass while preserving or maybe even increasing lean mass. Soon we’ll have more tools to help our patients optimize their health. As the field grows, we’ll continue to improve health outcomes and shift the way people think about this disease. By treating one disease, obesity, we can treat or prevent 200 others, and, in so doing, transform the health and lives of our patients.

Yale School of Medicine’s Section of Endocrinology & Metabolism works to improve the health of individuals with endocrine and metabolic diseases by advancing scientific knowledge; applying new information to patient care; and training the next generation of physicians and scientists to become leaders in the field. To learn more about their work, visit Endocrinology & Metabolism.