Robert Lustig, MD

Robert H. Lustig, M.D. is Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, and Director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

Dr. Lustig is a neuroendocrinologist, with basic and clinical training relative to hypothalamic development, anatomy, and function. Prior to coming to San Francisco in 2001, he worked at St. Jude Children’s Research Hospital in Memphis, TN. There, he was charged with the endocrine care of many children whose hypothalami had been damaged by brain tumors, or subsequent surgery, radiation, or chemotherapy. Many patients who survived became massively obese. Dr. Lustig theorized that hypothalamic damage led to the inability to sense the hormone leptin, which in turn, led to the starvation response. Since repairing the hypothalamus was not an option, he looked downstream, and noted that these patients had increased activity of the vagus nerve (a manifestation of starvation) which increased insulin secretion. By administering the insulin suppressive agent octreotide, he was able to get them to lose weight; but more remarkably, they started to exercise spontaneously. He then demonstrated the same phenomenon in obese adults without CNS lesions. The universality of these findings has enabled Dr. Lustig to weave these threads together into a novel unifying hypothesis regarding the etiology, prevention, and treatment of the current obesity epidemic. This has led him to explore the specific role of fructose (half of sucrose and high-fructose corn syrup) as a specific mediator of both chronic disease, and continued caloric consumption. His now notorious YouTube video, “Sugar – the bitter truth” continues its popularity with the lay public.

A native of Brooklyn, NY, Dr. Lustig went to Stuyvesant H.S. in Manhattan, graduated from MIT in 1976, and received his M.D. from Cornell University Medical College in 1980. He completed his pediatric residency at St. Louis Children’s Hospital in 1983, and his clinical fellowship at UCSF in 1984. From there, he spent six years as a post-doctoral fellow and research associate in neuroendocrinology at The Rockefeller University. He has been a faculty member at the University of Wisconsin-Madison, and the University of Tennessee, Memphis. Dr. Lustig has authored 85 peer-reviewed articles and 30 reviews. He has mentored 20 pediatric endocrine fellows, and trained numerous other allied health professionals. He provides endocrinologic support to several protocols of the Children’s Oncology Group. He is the former Chairman of the Ad hoc Obesity Task Force of the Lawson Wilkins Pediatric Endocrine Society, a member of the Pediatric Obesity Practice Guidelines Subcommittee of The Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration, and a member of the Steering Committee of the International Endocrine Alliance to Combat Obesity. He also consults for several childhood obesity advocacy groups.

Dr. Lustig lives in San Francisco with his wife and two daughters (ages 10 and 4). Spare time (what little there is) is spent cooking, theater-going, and traveling.
Residency, - School of Medicine, University of California, San Francisco
  1. Corrigendum to "Obesity II: Establishing causal links between chemical exposures and obesity" [Biochem. Pharmacol. 199 (2022) 115015].
  2. Sex-Specific Pathways Lead to Statural Growth Impairment in Children with Crohn's Disease.
  3. Endocrine Outcomes after Limited Surgery and Conformal Photon Radiation Therapy for Pediatric Craniopharyngioma: Long-term Results from the RT1 Protocol.
  4. Obesity I: Overview and molecular and biochemical mechanisms.
  5. Obesity II: Establishing causal links between chemical exposures and obesity.
  6. Effects of Isocaloric Fructose Restriction on Ceramide Levels in Children with Obesity and Cardiometabolic Risk: Relation to Hepatic De Novo Lipogenesis and Insulin Sensitivity.
  7. Childhood Overweight and Obesity and Pubertal Onset Among Mexican American Boys and Girls in the CHAMACOS Longitudinal Study.
  8. A Brief Motivational Intervention Differentially Reduces Sugar-sweetened Beverage (SSB) Consumption.
  9. Longer Leukocyte Telomere Length Predicts Stronger Response to a Workplace Sugar-Sweetened Beverage Sales Ban: An Exploratory Study.
  10. Clinical Variables Associated With Statural Growth in Pediatric Crohn's Disease Differ by Sex (The Growth Study).
  11. Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn's Disease Growth Study.
  12. Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation.
  13. Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health.
  14. Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model.
  15. Risk of brainstem necrosis in pediatric patients with central nervous system malignancies after pencil beam scanning proton therapy.
  16. Isocaloric Fructose Restriction Reduces Serum d-Lactate Concentration in Children With Obesity and Metabolic Syndrome.
  17. Treatment of Hypothalamic Obesity with Dextroamphetamine: A Case Series.
  18. Conformal Radiation Therapy for Pediatric Ependymoma, Chemotherapy for Incompletely Resected Ependymoma, and Observation for Completely Resected, Supratentorial Ependymoma.
  19. Association of phthalates, parabens and phenols found in personal care products with pubertal timing in girls and boys.
  20. Diet and Exercise in Pediatric Liver Transplant Recipients: Behaviors and Association With Metabolic Syndrome.
  21. Association of Prenatal Urinary Concentrations of Phthalates and Bisphenol A and Pubertal Timing in Boys and Girls.
  22. Thiopurines are negatively associated with anthropometric parameters in pediatric Crohn's disease.
  23. Novel Interventions to Reduce Stress and Overeating in Overweight Pregnant Women: A Feasibility Study.
  24. Subclinical Atherosclerosis in Pediatric Liver Transplant Recipients: Carotid and Aorta Intima-Media Thickness and Their Predictors.
  25. Ethical Considerations for Nutrition Counseling About Processed Food-Reply.
  26. Exercise Type in Dieting Obese Older Adults.
  27. Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model.
  28. Hepatic steatosis after pediatric liver transplant.
  29. Effects of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis, and Insulin Kinetics in Children With Obesity.
  30. Mechanisms, Pathophysiology, and Management of Obesity.
  31. Processed Food-An Experiment That Failed.
  32. Association of prenatal and childhood PBDE exposure with timing of puberty in boys and girls.
  33. Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.
  34. In utero and childhood DDT, DDE, PBDE and PCBs exposure and sex hormones in adolescent boys: The CHAMACOS study.
  35. Fructose and Nonalcoholic Fatty Liver Disease
  36. Short-term isocaloric fructose restriction lowers apoC-III levels and yields less atherogenic lipoprotein profiles in children with obesity and metabolic syndrome.
  37. Sickeningly Sweet: Does Sugar Cause Type 2 Diabetes? Yes.
  38. Metabolic Syndrome Components After Pediatric Liver Transplantation: Prevalence and the Impact of Obesity and Immunosuppression.
  39. Effects of a mindfulness-based weight loss intervention in adults with obesity: A randomized clinical trial.
  40. Added sugar intake and metabolic syndrome in US adolescents: cross-sectional analysis of the National Health and Nutrition Examination Survey 2005-2012.
  41. Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial.
  42. Response to "Metabolic improvement with fructose restriction: Is it the fructose or the weight loss?".
  43. Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial.
  44. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome.
  46. Putting the brakes on the "drive to eat": Pilot effects of naltrexone and reward-based eating on food cravings among obese women.
  47. Acute responses to opioidergic blockade as a biomarker of hedonic eating among obese women enrolled in a mindfulness-based weight loss intervention trial.
  48. Latino children's body mass index at 2-3.5 years predicts sympathetic nervous system activity at 5 years.
  49. Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk.
  50. A new biomarker of hedonic eating? A preliminary investigation of cortisol and nausea responses to acute opioid blockade.
  51. Breast cancer screening for childhood cancer survivors after craniospinal irradiation with protons versus x-rays: a dosimetric analysis and review of the literature.
  52. A conversation with Robert H. Lustig, MD, MSL. Interview by Stanford T Shulman.
  53. Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children: a pilot study.
  54. Dietary treatment of nonalcoholic steatohepatitis.
  55. Fructose: it's "alcohol without the buzz".
  56. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data.
  57. Prenatal and postnatal bisphenol A exposure and body mass index in childhood in the CHAMACOS cohort.
  58. What is metabolic syndrome, and why are children getting it?
  59. Associations between perinatal factors and adiponectin and leptin in 9-year-old Mexican-American children.
  60. Determination of bone age in pediatric patients with Crohn's disease should become part of routine care.
  61. Cranial irradiation increases risk of stroke in pediatric brain tumor survivors.
  62. Menarche in pediatric patients with Crohn's disease.
  63. Hypothalamic obesity in children.
  64. Leptin concentrations in response to acute stress predict subsequent intake of comfort foods.
  65. Diabetes and dietary fibre: directive or distraction?
  66. Toward a unifying hypothesis of metabolic syndrome.
  67. Public health: The toxic truth about sugar.
  68. Health-related quality of life in adolescents with or at risk for type 2 diabetes mellitus.
  69. Effects of sugar-sweetened beverages on children.
  70. Postoperative radiation therapy for low-grade glioma: patterns of care between 1998 and 2006.
  71. Hypothalamic obesity after craniopharyngioma: mechanisms, diagnosis, and treatment.
  72. Growth hormone secretion after conformal radiation therapy in pediatric patients with localized brain tumors.
  73. Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study.
  74. Is fast food addictive?
  75. Infant formula, tea, and water supplementation of latino infants at 4-6 weeks postpartum.
  76. Identifying metabolic syndrome in African American children using fasting HOMA-IR in place of glucose.
  77. Risk factors for obesity and high blood pressure in Chinese American children: maternal acculturation and children's food choices.
  78. The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (Web ABC study).
  79. Chronic maternal depression is associated with reduced weight gain in latino infants from birth to 2 years of age.
  80. Sex differences in statural growth impairment in Crohn's disease: role of IGF-1.
  81. Just a spoonful of sugar helps the blood pressure go up.
  82. Fructose: metabolic, hedonic, and societal parallels with ethanol.
  83. Bariatric surgery in a patient with complete MC4R deficiency.
  84. The Active Balance Childhood program for improving coping and quality of life in Chinese American children.
  85. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome.
  86. Carbohydrate intake and cardiometabolic risk factors in high BMI African American children.
  87. Metformin extended release treatment of adolescent obesity: a 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up.
  88. Insulin resistance is improved in overweight African American boys but not in girls following a one-year multidisciplinary community intervention program.
  89. Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study.
  90. Macronutrient intakes and cardio metabolic risk factors in high BMI African American children.
  91. A clinic-based lifestyle intervention for pediatric obesity: efficacy and behavioral and biochemical predictors of response.
  92. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.
  93. Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation of cognitive, endocrine, and hearing deficits.
  94. Accuracy of self-assessed Tanner staging against hormonal assessment of sexual maturation in overweight African-American children.
  95. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents.
  96. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young;
  97. Socioeconomic status in relation to early menarche among black and white girls.
  98. Hypothalamic obesity: causes, consequences, treatment.
  99. Patient guide to the prevention and management of pediatric obesity.
  100. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion.
  101. Baseline correlates of insulin resistance in inner city high-BMI African-American children.
  102. Pilot study of an individually tailored educational program by mail to promote healthy weight in Chinese American children.
  103. Which comes first? The obesity or the insulin? The behavior or the biochemistry?
  104. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal.
  105. Outpatient transition of an infant with permanent neonatal diabetes due to a KCNJ11 activating mutation from subcutaneous insulin to oral glyburide.
  106. Racial disparity in glucagon-like peptide 1 and inflammation markers among severely obese adolescents.
  107. Adolescent obesity and puberty: the "perfect storm".
  108. Childhood obesity: adrift in the "limbic triangle".
  109. Television viewing and hypertension in obese children.
  110. Patterns and levels of hypoxia in head and neck squamous cell carcinomas and their relationship to patient outcome.
  111. GliaSite brachytherapy boost as part of initial treatment of glioblastoma multiforme: a retrospective multi-institutional pilot study.
  112. Feasibility of a dance videogame to promote weight loss among overweight children and adolescents.
  113. Pituitary development and physiology.
  114. The 'skinny' on childhood obesity: how our western environment starves kids' brains.
  115. Childhood obesity: behavioral aberration or biochemical drive? Reinterpreting the First Law of Thermodynamics.
  116. A multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a long-acting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecretion.
  117. Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children.
  118. Pediatric endocrine disorders of energy balance.
  119. ACTH deficiency in childhood cancer survivors.
  120. Fast food, central nervous system insulin resistance, and obesity.
  121. Nephrogenic syndrome of inappropriate antidiuresis.
  122. Racial and etiopathologic dichotomies in insulin hypersecretion and resistance in obese children.
  123. Childhood obesity.
  124. Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol.
  125. Obesity, leptin resistance, and the effects of insulin reduction.
  126. Treatment of pediatric intracranial arteriovenous malformations with linear-accelerator-based stereotactic radiosurgery: the University of Pennsylvania experience.
  127. Preliminary results from a phase II trial of conformal radiation therapy and evaluation of radiation-related CNS effects for pediatric patients with localized ependymoma.
  128. Pilot study of postoperative reirradiation, chemotherapy, and amifostine after surgical salvage for recurrent head-and-neck cancer.
  129. A critical review of the clinical effects of therapeutic irradiation damage to the brain: the roots of controversy.
  130. Race affects insulin and GLP-1 secretion and response to a long-acting somatostatin analogue in obese adults.
  131. Hypothalamic dysfunction after chemotherapy.
  132. Optimizing growth hormone efficacy: an evidence-based analysis.
  133. Racial differences in glucagon-like peptide-1 (GLP-1) concentrations and insulin dynamics during oral glucose tolerance test in obese subjects.
  134. Octreotide therapy of pediatric hypothalamic obesity: a double-blind, placebo-controlled trial.
  135. Autonomic dysfunction of the beta-cell and the pathogenesis of obesity.
  136. Risk factors for the development of obesity in children surviving brain tumors.
  137. Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults.
  138. Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function.
  139. Craniopharyngioma: the St. Jude Children's Research Hospital experience 1984-2001.
  140. Outcomes of growth hormone replacement therapy in survivors of childhood acute lymphoblastic leukemia.
  141. Use of somatostatin receptor ligands in obesity and diabetic complications.
  142. Radiation dose-volume effects on growth hormone secretion.
  143. The neuroendocrinology of obesity.
  144. The neuroendocrinology of childhood obesity.
  145. Bone mineral decrements in survivors of childhood acute lymphoblastic leukemia: frequency of occurrence and risk factors for their development.
  146. Bone mineral status during and after therapy of childhood cancer: an increasing population with multiple risk factors for impaired bone health.
  147. Diagnosis of hidden central hypothyroidism in survivors of childhood cancer.
  148. Hypothalamic obesity caused by cranial insult in children: altered glucose and insulin dynamics and reversal by a somatostatin agonist.
  149. Diagnosis of ACTH deficiency. Comparison of overnight metyrapone test to either low-dose or high-dose ACTH test.
  150. Differential induction of Th1 versus Th2 cytokines by group A streptococcal toxic shock syndrome isolates.
  151. Papillary thyroid carcinoma: demographics, treatment, and outcome in eleven pediatric patients treated at a single institution.
  152. In vitro models for the effects of sex hormones on neurons.
  153. Testicular degeneration in three patients with the persistent müllerian duct syndrome.
  154. Pentoxifylline in the treatment of children with new-onset type I diabetes mellitus.
  155. Estrogenic regulation and sex dimorphism of growth-associated protein 43 kDa (GAP-43) messenger RNA in the rat.
  156. Temporal actions of 16 alpha-hydroxyestrone in the rat: comparisons of lordosis dynamics with other estrogen metabolites and between sexes.
  157. Considerations in the quantitative analysis of autoradiograms from 2-dimensional gels.
  158. Induction of LH hypersecretion in cyclic rats during the afternoon of oestrus by oestrogen in conjunction with progesterone antagonism or opioidergic blockade.
  159. Opioidergic modulation of the oestradiol-induced LH surge in the rat: roles of ovarian steroids.
  160. Effect of growth hormone (GH)-releasing hormone (GRH) on plasma GH in relation to magnitude and duration of GH deficiency in 26 children and adults with isolated GH deficiency or multiple pituitary hormone deficiencies: evidence for hypothalamic GRH defic