Trend: It’s All Ozempic, But Research on Transforming White Fat to Brown for Weight Loss Sees Momentum

When Dr. Michael Roizen, chief wellness officer emeritus at Cleveland Clinic, wrote our 2023 trend “The Skinny on Brown Fat and Eliminating Obesity” back in early 2023, even using the term “weight loss” felt a little verboten, after the hard-won body positivity progress achieved in the last few years. What a difference 2023 made! Breakthrough weight loss (GLP-1 plus) drugs like Ozempic, Wegovy and Mounjaro have quickly reframed the fight against obesity and shaken up the old dieting- and willpower-focused weight loss market. These drugs now dominate global headlines as a market set to reach $100 billion by 2035. We know that they work (people lose 12-21% of body weight), but that you basically have to take them forever, and that there is new data on rare, but serious side-effects, including stomach paralysis, pancreatitis and bowel obstruction.

While drugs like Ozempic have owned the weight loss conversation all year, there has actually been interesting new research on Dr. Roizen’s trend: how the transformation of white fat (WAT) into beige or brown fat (BAT) also has the potential to tackle obesity and metabolic health disorders. Most of us know about white and brown fat. In a nutshell:

White fat (the stuff we despise on our thighs and stomach) is metabolically inefficient, doesn’t use much energy, is hard to burn off, and causes all kinds of health problems—from heart disease to chronic inflammation. Brown fat, plentiful in the neck and shoulders of newborns (the reason why kids don’t get as cold or shiver), has an increased density of mitochondria,  is extremely metabolically efficient (producing around 300 times more heat than any tissue in the body), and burns tons of sugar and fat molecules to keep you warm, thanks to a process called thermogenesis. Brown fat is linked with broad health benefits. As we age, we tend to shed fat-burning brown fat: by age six, we only have about 5% of the amount we were born with.

Dr. Roizen’s trend looks at the potential of brown fat’s ability to burn off killer white fat. What are some breakthroughs? How do we activate it? He outlines a few key interventions:

Cold therapy: We may have cold plunge trend fatigue, but numerous studies concur that cold exposure/cryotherapy builds brown fat. While there is no hard-and-fast cold protocol to activate it, Dr. Susanna Søberg, founder of the Soeburg Institute and co-author of studies on the topic, such as how cold swimming enhanced brown fat thermogenesis in winter-swimming young men, developed the least painful recommendation: a minimum of 11 minutes a week of water exposure below 60 degrees to produce browning and activate thermogenesis, and allowing the body to warm naturally after (not in saunas, etc.). While scientists agree cold exposure can play a significant role in metabolic transformations, others will argue that brown fat is not the lone “magic thermogenic bullet,” but likely works in concert with other tissues: muscles, the liver, the cardiovascular system, etc. Cold immersion always comes with serious cautions and needs a doctor’s guidance.

Pluripotent cell transformation: Pluripotent fat cells can turn into either white or brown fat cells. Researchers have induced pluripotent stem cells (iPSCs) and turned them into induced brown fat cells (iBAs) by transducing a gene. The resultant cells produced proteins typically found in brown fat cells, with remarkably high levels of oxygen consumption, characteristic of brown fat thermogenesis. So if researchers can take white fat, regress it to a more pluripotent fat, flip a few epigenetic switches and—voilà!—turn it into brown fat, then they could inject the brown fat into the original owner. This has been done in three animal species and is moving into human trials.

Fasting: Humans used to experience long periods of not eating and studies on rodents show fasting increases brown fat and thermogenesis. This suggests that longer fasting, or fasting mimicking diets, increases thermogenesis in humans, but studies are needed to provide direct evidence.

Food Ingredients: A wide range of food ingredients/supplements improve thermogenesis and assist in weight loss. Ingredients like capsaicin, creatine, cinnamon and trehalose may have those effects because of their ability to brown white fat tissue.

We return to Dr. Roizen’s trend, because despite the near-totalizing focus on the new GLP-1 drugs, research on how to transform white fat to brown remains a hot topic in metabolic research. Below are just a few new studies focused on cracking the brown fat code that have appeared since he wrote the trend. The race to solve for obesity is on, and Ozempic won’t be the only story.

READ the full trend.

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