Over the past years, my interest in this field of research has been solicited by the fascinating complexity of interactions between homeostatic mechanisms underlying energy metabolism and body weight regulation, and environmental pressures, making our evolutionary biology a challenge in the contemporary scenario characterized by profound lifestyle modifications and excess energy availability. Currently, I am based in Rome, Italy, where I work as associate professor at the Food Science and Human Nutrition Research Unit, Sapienza University. I started working in the field of obesity during medical school, when I prepared a thesis for my defense concerning ghrelin in children with obesity. I graduated as a Doctor of Medicine, and I concluded a residency program in Food Science and Clinical Nutrition, at the High Specialization Center for Obesity Care, Sapienza University (Rome), which is part of the EASO (European Association for the Study of Obesity) COM Network. Mentored by Dr. Eric Ravussin, I was a visiting research scholar at the Pennington Biomedical Research Center, USA. I prepared my PhD thesis at the “Centre de Recherche en Nutrition Humaine”, Clermont Auvergne University, France, under the supervision of Dr. Yves Boirie, and I obtained my PhD degree in Endocrinological Sciences with the additional mention of Doctor Europaeus. I participated in research projects exploring the metabolic, hormonal, and functional characteristics of obesity and its different body composition phenotypes, mainly sarcopenic obesity, in humans and rodents. Furthermore, I worked on eating disorders, and on time-restricted feeding as a novel approach based on chronobiology to improve metabolic flexibility. In 2016 I received the EASO New Investigator Award- Clinical Research.
In the last decade accumulating evidence on the mechanisms underlying obesity development and eating behavior regulation prompted multiple advances and responses in different fields, from national policies aiming at reducing excess calorie and nutrient intakes (we have plenty of examples at the global level, e.g. sugar taxes and fat taxes), to drug and novel food development. The major change elicited from research on obesity is the acknowledgment of nutrition as a tool to be implemented in conventional medical approaches for disease management.
This initiative is very relevant in acknowledging obesity as having analogous dignity compared to other clinical conditions and diseases; in addition, promoting a sense of community among researchers dealing with obesity is pivotal in favoring a sense of belonging and identification, turning individual and personal investment into a larger commitment for the entire social group. In the future, this approach can provide increased strength to the scientific community in terms of influence and audit for international policy development to tackle obesity worldwide.
I really appreciate G. Rose’s article titled “Sick individuals and sick populations”, published in 1985. Rose distinguishes the causes of cases from the causes of incidence, and this paradigm perfectly aligns with a comprehensive vision on the determinism of obesity and development of primary prevention strategies.
When we focus on body weight management mainly through energy deficit (based on dietary restrictions, obesity medications, bariatric surgery), we may overlook the causes of incidence, encompassing several factors not related to nutrition, nor energy balance and metabolic derangements, such as level of education, low income, social isolation, and stress and emotion regulation. Multiple actions are required at the individual and social levels to provide prevention strategies to be effective over time.
I appreciate the emphasis put on body weight stigma, but we should be cautious with the risk for responsibility avoidance. The myths of the "gluttony theory" and "set point theory" are the most relevant, in my opinion: overcoming them, we expand the power of behavioral and pharmacological treatments, with patients and clinicians taking over a central scene in the obesity narrative.
On the one hand, economic barriers related to patient income represent one of the most significant, well-known disparities in access to treatment. On the other hand, as the scientific community, we should acknowledge that disparities stem from differences in healthcare services, not only in terms of funding for obesity care, but in cultural limitations behind it: at the global level, only a minority of medical schools include nutritional education in their curricula. Awareness has its roots in the scientific community, and raising obesity and nutrition awareness among clinical professionals is crucial for a paradigm shift in the types and quality of healthcare services delivered.
This indeed scales down the potential of novel anti-obesity medications. The pressure to thinness in our modern society is so marked that misuse of incretin-mimetics represents a serious concern for both the risks related to their use beyond the recommended indications, exposing those users to serious health risks, and for the reinforcement of weight stigma. In this era of popularity through social media, with the scientific community not warranting a proper communication outside of niche channels used by science, it is frequent that the audience is reached out by non-scientific players without a robust clinical knowledge but mastering communication abilities, making their messages more accountable than the ones delivered by institutional and scientific counterparts.
My perspective includes mainly drug discovery and the recognition of different obesity phenotypes, clustering patients with obesity in different subtypes based on somatic and behavioral features, refining personalized interventions. Moreover, I foresee weight gain prevention, rather than weight loss, as a crucial objective of future research avenues in obesity.
Drug discovery to be coupled with a campaign on personal responsibility and active policies: the availability of medications should not be an excuse for avoiding behavioral and political responsibilities.
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