I’ve struggled with my weight all my life. I don’t need an alarm clock because my stomach will wake me up for breakfast. It infuriates me when skinny friends tell me that they “forgot to eat.” I have always suspected that anyone who forgets to eat has some kind of brain damage. It turns out they do have a different brain biochemistry from mine. I just saw this article about brain pathways and obesity. Apparently, there are two pathways in their brain that (at least in part) determine whether a person is obese: the proopiomelanocortin (POMC) pathway tells people to eat less and store less food and the Agouti-related protein (AgRP) pathway tells people to eat more and store more food. Apparently, people with obesity have an active AgRP pathway. There is no way to get around the reality that in order to lose weight, a person has to increase their physical activity and manage their food intake. However, these pathways are the reason that certain obesity drugs can help by upregulating the POMC pathway.

Why am I paying attention to this? Because a huge percentage of our patients with chronic non-healing wounds are obese – morbidly obese. It contributes to the development of diabetes which contributes to the development of wounds, and to sleep apnea and heart failure which contribute to uncontrollable edema. There just isn’t a way to manage patients with chronic wounds without addressing morbid obesity. I started putting marketing materials for my hospital’s bariatric surgery program in the wound center weighting room and, at least before COVID, trying to get them to attend the regular, free informational seminars. I am not ready to start prescribing weight loss drugs, but we’ve got to figure out how to be more proactive than we have been with regard to morbid obesity (as well as heart failure). We see these patients more often than their primary care doctors, and that gives us a rare opportunity to listen to them and for them to listen to us. I don’t have the answer – but anytime I can speak more knowledgably to patients about the problem, it helps.