The World Health Organization (WHO) recognizes obesity as a chronic disease, as does hypertension, type 2 diabetes and chronic respiratory diseases. This disease requires great awareness on the part of the patient, and its treatment should be interdisciplinary.
Obesity is a disease that evokes many emotions and is an object stigmatization. Is it always the result of the patient’s laziness, weak will?
Of course not! The vast majority of obesity is caused by an inappropriate lifestyle with a positive energy balance, and then even a small disproportion (<0,5%) between the energy supplied from food and the energy consumed causes weight gain. All obesity-inducing secondary causes should be kept in mind, such as environmental, genetic, endocrine, psychological, and iatrogenic factors, including medications. However, people suffering from obesity often face negative reception from their surroundings and a lack of tolerance in the work environment, school or even family. The worst thing is when such stigmatization, followed by discrimination, affects the patient in health care facilities, because it is us who should understand the essence of obesity and the need for its treatment. Many patients try various diets and physical activity for years, unsuccessfully trying to reduce their body weight. As a result, they feel powerless, have low self-esteem, and this can demotivate them in seeking help and making decisions about treatment. Many people treat it not as a disease but as an aesthetic defect.
Is this perception correct? Why obesity should be treated?
Obesity is always a disease, although for years it has been seen only as an aesthetic defect, it is a serious, chronic and dangerous disease. And it is dangerous because it causes chronic complications, often imperceptibly for a human being, which at the time of disclosure may be irreversible.
How is obesity diagnosed? And what kind of doctor can do that?
Obesity can be diagnosed visually, but for the objectivity of nutritional status, the body mass index (BMI) is still recommended by the WHO, calculated as the quotient of body weight in kilograms and the square of height in centimeters. It is a simple, repeatable test, regardless of gender and age. The cut-off point of BMI> 30 kg / m2 as a diagnosis of obesity is characterized by high specificity (94–96% in men and 98–100% in women), but low sensitivity (35–37% in men and 48–50% in women ). However, it should be remembered that BMI does not reflect the location of adipose tissue and therefore it should be used as a screening measure or to monitor therapeutic effects during obesity treatment.
Another parameter of nutritional status that has been known for years, but is more focused on the distribution of adipose tissue, is waist circumference measurement as an indirect indicator of visceral adipose tissue and the risk of metabolic complications. A waist circumference of ≥ 94 cm in a man or ≥ 80 cm in a woman allows for the diagnosis of abdominal obesity. It is measured halfway between the lower edge of the ribs and the upper edge of the iliac crest. A more advanced method to evaluate the content
body fat is a non-invasive bioelectroimpedance method for the patient, which defines obesity as a body fat content> 25% in men and> 30% in women. On the other hand, the most accurate method, but used mainly for scientific purposes, is the magnetic resonance method. Due to the fact that in the Polish health care system we still do not have specialized structures or therapeutic teams for the treatment of obesity, diagnostics and treatment are within the competence of both family doctors and other specialists, especially endocrinologists.
Does the timing of treatment initiation make a difference in its effectiveness? When is the best time to start therapy?
As early as possible, before complications appear, because they are often irreversible and may in themselves limit the choice of treatment methods, such as heart attack or unstable arterial hypertension limit the patient’s physical activity.
How is obesity treated today? What is the site of pharmacotherapy and who can benefit from it?
Effective obesity treatment should be comprehensive, based on a multidisciplinary therapeutic team consisting of a physician, dietitian / nutritional educator, psychologist, physiotherapist and bariatric surgeon. The basis for the treatment of overweight and obesity is to obtain a negative energy balance by changing eating habits and increasing physical activity, individually tailored to each patient. On the other hand, pharmacotherapy can be added as an element supporting the modification of nutritional treatment and help in adhering to the principles of a healthy lifestyle. According to the characteristics of medicinal products registered for the treatment of obesity, they are intended mainly for patients with BMI ≥30 kg / m2, but also when BMI ≥27 kg / m2 to <30 kg / m2 (overweight) and there is one or more obesity-related diseases (e.g. type 2 diabetes, dyslipidemia or compensated hypertension).
Currently, we have 3 drugs registered for the treatment of obesity in Poland, with various mechanisms of action. The first one is Orlistat, which inhibits the activity of pancreatic lipase and stops the hydrolysis of triglycerides, which reduces the absorption of fats from the gastrointestinal tract by about 30%. It is recommended mainly for patients who consume food 2-3 times a day, but high in calories / high in fat and do not have problems with hunger. Another is the combination drug Naltrexone / Bupropion (naltrexone is an antagonist of the opioid receptor, and bupropion is an inhibitor of neuronal dopamine and noradrenaline reuptake), which stimulates the satiety center in the arcuate nucleus of the hypothalamus and gives a feeling of satiety and reduces appetite. In addition, it stimulates the reward system in the limbic system, which leads to pleasure and improves mood through dopamine. The effect of taking the drug is to reduce appetite and snacking between meals, which is especially important for people who eat under the influence of emotions. The last drug is the glucagon-like peptide-1 (GLP-1) agonist, liraglutide at a dose of 3,0 mg, is homologous with the gut hormone GLP-1 and suppresses appetite by 2 mechanisms. In the central mechanism, it stimulates the satiety center and inhibits the hunger center, but additionally important in the peripheral mechanism, it slows down gastric emptying, so the food stays in the stomach for a longer time, giving a feeling of fullness. In addition, it has a number of benefits, in addition to weight reduction, such as glucose-dependent insulin secretion from pancreatic β cells, inhibits glucagon secretion in normoglycemia and causes many systemic effects, especially valuable for patients with obesity and coexisting metabolic diseases (type 2 diabetes or pre-diabetes, hypertension). , obstructive sleep apnea or polycystic ovary syndrome).
Is obesity treatment safe?
Obesity disease treatment is a long-term, but safe process under the control of a therapeutic team and not the Internet, friends or neighbors. It is the disease itself, and its complications are dangerous to health and life, therefore it must and can be treated, but it is best prevented.
Obesity should not be taboo
The lack of social knowledge about obesity as a disease underlies the stigmatization of patients. That is why educational campaigns that will reliably and from scratch present the topic of obesity are so important and necessary.
Despite your active lifestyle, you heard the diagnosis of “obesity”. Do you remember that breakthrough moment when you decided to fight for your health and life?
I remember that moment very well. In my case, obesity was caused by hormonal disorders that I had been struggling with since 2004 and I was still looking for a complete diagnosis. Until finally, 2 years ago, a diagnosis was made indicating that it was obesity, which was caused by disorders on two hormonal axes, thyroid and insulin.
Did you treat obesity as a disease before?
I was aware that obesity is a disease, but until you experience it on your own, you are not fully aware of what obesity is associated with.
Obesity is known to be a risk factor for other diseases.
Do you also have other health problems due to obesity and is obesity worth treating?
Obesity in Poland is very rarely diagnosed and even less often treated. Therefore, if the doctor himself does not start a dialogue with us about the necessity of treatment, it is worth proactively addressing this topic. It is a manifestation of responsibility for our health. Obesity causes about 200 complications, increases the risk of developing diseases such as diabetes, hypertension and many others. In my case, the diagnosis was Hashimoto’s with a tendency to hypothyroidism and insulin resistance, hyperinsulinemia and reactive hypoglycemia.
Still a large part of the society believes that a good diet or supplements supporting weight reduction will solve the problem of “extra kilograms”. On the other hand, obesity is a disease that needs to be treated, and treatment should be managed by an experienced physician. How does this process look like in your case? Can you count on a doctor’s support?
Of course, I am under a doctor’s care all the time. Extra pounds are a pain – that’s true. However, in order to deal with them, you need to approach the subject comprehensively and professionally. Diagnosis, proper treatment, diet and exercise are key.
Is the subject of obesity a taboo subject for you? Or rather, talking about it out loud encourages you in the therapeutic process of the disease?
This is absolutely not a taboo subject for me, I keep telling myself that if my story inspires someone to act and fight for themselves, they have to be shared. Unfortunately, in the case of obesity, stigmatization occurs very often – people struggling with this disease are discriminated against and even blamed for their disease.
Have you experienced such behavior on the part of the environment? How important is the support of the closest environment and social acceptance in making a decision about treatment and the treatment itself?
Of course there have been some nasty comments about my weight gain. Often times, commentators did not even consider that there might be some serious reason for this situation. It is hard to imagine any other disease that would be as stigmatized and stigmatized as obesity. The sick are blamed for the development of obesity, they are accused of laziness, weak will, and lack of care for their health. Consequently, they are excluded from social and professional life, depriving them of hope and strength to act. Each obese patient is a different story, often full of sadness and loneliness. We do not know how much a person does, how many sacrifices are behind him. We only judge the appearance by jumping to conclusions. Are we aware that every negative comment, every irony can cause the patient to close in on himself and give up treatment? The lack of social knowledge about obesity as a disease underlies the stigmatization of patients. That is why educational campaigns that will reliably and from scratch present the topic of obesity are so important and necessary. The voice of experts and patients is also important. Such a campaign is “Let’s talk honestly about obesity”, which aims to educate and change the social perception of obesity.
Is there anything you find most difficult in the overall obesity treatment process?
The biggest difficulty is that you can’t let go. If we lose a certain amount of kg, you have to remember that it is not given forever and you have to be vigilant all the time. It cannot be done without changing your lifestyle, without the support of loved ones, without XNUMX% convincing that it makes sense and I am doing it for myself.
What advice do you have for other obese patients?
Don’t get sick – I always say that a known enemy is better because you know how to defeat him. Obesity is treated and it’s safe to talk to your doctor about it. Also remember that this is a process and nothing happens immediately, however if you start you already won! Good luck!
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