[LifeStyle] How to combat obesity, a disease that is already an epidemic

[Inkriql]

 

Studies are multiplying around the world and the alert does not stop sounding: excess weight and obesity –with their multiple impacts on the human body– are already considered a serious health and even social and economic problem at a global level.

While all kinds of measures are being debated – legal, educational, fiscal, among others – the disease continues to advance until it reaches epidemic levels, and health professionals struggle daily to provide help to their patients.

"This type of disease requires a transdisciplinary treatment, specialized doctors and a health system that takes into account the needs of patients," says Juliana Mociulsky, endocrinologist, Head of Nutrition at the Buenos Aires Cardiovascular Institute (ICBA) and member head of the Argentine Society of Diabetes.

How is obesity defined?
-Through the body mass index (BMI) that serves to categorize health risks. The value to define it is kg/m2. The higher that number, the greater the chances of having cancer, osteoarthritis, sleep apnea, to which must be added the limitations in daily functionality, depression and confinement.

What factors determine obesity?
-The causes are multiple: the genetic component, the family way of eating, work, the obesogenic environment favored by the food industry and a sedentary lifestyle. On the other hand, there is a circuit in the body that regulates food intake, a circuit that obese people have unbalanced and one of the consequences of which is not receiving the satiety signal properly. When someone loses weight, hormones that increase appetite rise, because the body always regulates up and that is the reason why it is so difficult for them to maintain the appropriate weight.

 

care that meets the needs of patients
-What are the most important diseases to which obesity is associated?
-The most important are hypertension, diabetes and high cholesterol, all diseases that involve cardiovascular risk. There are different kinds of obesity: the one found in the belly generates these risks because the fat operates as a kind of laboratory for toxic substances; the one located in the hip is associated with problems such as osteoarthritis or varicose veins. Each type of obesity –phenotype– causes different diseases, so when a patient arrives at the office, we already know where to start. Other associated diseases are cancer of the colon, breast, uterus and, to a lesser extent, pancreas.

-Are there less serious diseases derived from excess weight?
-Yes, of course. There are referrals that cause alterations in people's lives, such as sleep apnea that prevents the patient from sleeping well (because he is startled, although he does not realize it, due to lack of air) and increases the chances of cardiovascular disease . Other common consequences are, among others, gallstones, skin problems and difficulty in hygiene.

-What impact does obesity have on a psychological level?
-The common characteristic is depression and denial. The obese person goes through different stages. One of them is the denial of the problem that translates into inaction; At this stage it is usual that they do not take photos from the neck down or do not look at themselves in the mirror. Then a stage of rebellion can come, a kind of anger with reality that also causes inertia. Then the internal negotiation stage begins, at which time the person begins to consider doing something and tries to limit himself in everyday life. Accepting is the first step to make any changes.

-How does someone who is not yet aware of his problem get to the office?
-Because they bring him, or refer him to his cardiologist or clinician, because he is tired of the comments or because he wants to change and he doesn't realize it. The attitude is essential to be able to generate changes and we also define it with stages: precontemplation, when the patient is not willing to do anything; contemplation, when he begins to contemplate the idea; acceptance and action. This process is what would lead a person to lose weight. Maintenance is difficult and there will surely be relapses, but these serve as learning and as a starting point to resume changing habits.

Accepting is the first step to make any changes
-In general, do they manage to maintain what has been achieved?
-No more than 10% make it. But another factor must be taken into account, which is accepting the possible weight that will allow the person to maintain it over time. This is related to expectations, and it is necessary not to neglect this aspect to avoid frustration.

-There are many medications for weight loss. Are they effective in the fight against obesity?
-Until now, the ideal medicine to treat obesity has not been developed. There were some that were to a certain extent effective because they acted on brain circuits, but they were taken off the market because they generated cardiovascular risk in elderly people. There are some drugs, not approved in Argentina, that act on the satiety and reward circuit, but they must be rigorously evaluated due to possible side effects. Where there have been important advances is in the treatment of type 2 diabetes with obesity, since there are drugs that are used in our country and that have proven results in weight loss and also in cardiovascular benefits. These are liraglutide, which has an effect on the control of satiety, among other things, and empagliflozin, which acts on the renal elimination of glucose and sodium. Another key issue is related to mood: a depressed patient is not going to lose weight, does not go to the doctor, does not take care of himself, etc. There is an obesity-depression relationship: it is a vicious circle that constantly feeds on itself and that also deserves a diagnostic and therapeutic approach.

-There is much insistence on the need to avoid a sedentary lifestyle and it is common to hear professionals say that less than forty minutes of physical activity does not serve to burn fat. Do you agree?
-No. Very few people have that time and the important thing is to set possible short-term goals. This statement, far from encouraging daily movement, makes people do nothing because it is a very ambitious, improbable and discouraging goal. The World Health Organization speaks of performing 30 minutes of cumulative physical activity daily. You have to work for what is possible, because short goals stimulate self-esteem and are motivating.

 

https://www.infobae.com/def/desarrollo/2018/04/17/como-combatir-la-obesidad-una-enfermedad-que-ya-es-epidemia/