Multiple hormones act in concert to regulate blood sugar and food intake. The idea has already led to a new diabetes therapy; will it also yield new strategies for obesity?
By Christian Weyer
Stepping on the scale each day and diligently recording their caloric intake and body weight in a little booklet, my patients marked the progress and failures of their dieting efforts. It was the mid-1990s and I was working as a medical fellow in endocrinology and metabolism at the University of Düsseldorf Medical Center in Germany. During the day, we optimized insulin therapy in patients with Type 1 or Type 2 diabetes, using modern tools such as new insulin analogs, glucose meters, and insulin pumps. In the evening, I supervised an outpatient obesity clinic. Our department was internationally renowned as an accredited World Health Organization collaborating center, and patients came from far and wide to seek care for their diabetes, and a variety of obesity-related conditions.
…I was drawn to endocrinology because I was intrigued by the complexity and elegance with which hormonal signaling systems govern whole-body metabolism and many other vital functions. Most hormones have multiple actions that are well coordinated, and naturally integrated with other hormonal systems. It is, in many respects, the equivalent of individual musicians playing together in a philharmonic orchestra producing the most melodic, beautiful symphonies. Some hormones, such as insulin, thyroid hormone, or cortisol, are “major players,” and their deficiency or excess can result in life-threatening metabolic derangements. Others, such as calcitonin, pancreatic polypeptide, or amylin can be viewed as complementary signals that enhance, or “fine-tune,” a tightly regulated metabolic process. In many cases, the central nervous system (CNS) orchestrates and balances these hormonal interactions, serving as the role of conductor….