In Poland, as much as 25% of the population is obese, and about 53% of women and 68% of men are overweight. Among children and adolescents, the percentage of obesity is still lower than, for example, in the United States, but the rate of growth in the incidence is deceptively similar to that of the 70s in the USA. In a few years’ time, we may have a similar or greater problem than the Americans. Currently, we are no longer talking about the obesity epidemic, but about a real tsunami that is flooding both highly developed and less developed countries. We took patronage over the project «Obesity – epidemic XXI. How to overcome it? », Prepared by the Medical Media Solutions publishing house and available today with Gazeta Wyborcza. In the publication you will find statements by eminent experts. We present an interview with prof. Paweł Bogdański, Head of the Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics at the Medical University of Poznań. In addition, you will also find an interview with Tomasz Sekielski.
Beata Kaczmarek: What are the differences between being overweight and obese? Can both conditions be treated?
Prof. Paweł Bogdański, Head of the Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics at the Medical University of Poznań: Overweight and obesity are characterized by excessively accumulated fatty tissue in the body. The difference between being overweight and obese is mainly in how much this tissue accumulates. Both states can be recognized and differentiated using a simple BMI (body mass index). This indicator analyzes the relationship between body weight and height. The BMI in overweight patients ranges from 25 to 29.9 kg / m2. We talk about obesity when the BMI is 30 kg / m2 or more. In fact, it is more complicated because the BMI-based definition of overweight and obesity does not include information on the composition of individual body tissues and the presence of comorbidities. Often, complications typical of obesity occur when overweight. Undoubtedly, both of these conditions are pathological, which means that they should be treated appropriately.
Is the obesity problem really that widespread?
Prof. Paweł Bogdański: According to WHO data, in 2016 1,9 billion people in the world were overweight, and among them 650 million suffered from obesity. We observe similar trends in Poland, where as much as 25% of the population is obese, and about 53% of women and 68% of men are overweight. Unfavorable trends are also observed among children and adolescents. Although the percentage of obesity in this group is still lower than, for example, in the United States, the dynamics of the incidence increase is deceptively similar to that of the 70s in the USA. This means that in a few years’ time we may have a similar or greater problem than the Americans. Currently, we are no longer talking about the obesity epidemic, but about a real tsunami that is flooding both highly developed and less developed countries.
What are the most common health consequences of obesity?
Prof. Paweł Bogdański: I don’t know of any other chronic disease with so many potential complications. Obesity dramatically increases the risk of developing type 2 diabetes. In women with a BMI> 35 kg / m2, the risk of developing diabetes increases 90 times! Excess body weight leads to the development of arterial hypertension, lipid metabolism disorders, and accelerates the development of atherosclerosis. Obesity is an independent risk factor for myocardial infarction and stroke. It leads to the development of fatty liver disease, chronic kidney disease, sleep apnea syndrome, and fertility disorders. Obesity promotes the development of neoplastic diseases – incl. breast cancer, colorectal cancer, kidney cancer, esophagus cancer. Obesity has been proven to shorten life and reduce its quality. Remember that health is not only the absence of disease, but overall physical, mental and social well-being. It can be clearly stated that obese patients do not experience such well-being.
How necessary is multidisciplinary care for the best obesity treatment results and cost optimization?
Prof. Paweł Bogdański: According to the data published by the McKinsey Global Institute, the global expenditure related to obesity can be compared to that incurred by the world in mitigating armed conflicts or smoking. The direct and indirect costs of obesity in Poland reach about 3 percent. GDP. This is a serious social and economic problem. It has been known for years that obesity should be treated by a multidisciplinary team consisting of a doctor, dietitian, psychologist and physiotherapist. Unfortunately, in Poland there are still no systemic solutions enabling comprehensive treatment of this group of patients.
Patients spend a lot of money on ineffective supplements. What effective and safe possibilities does modern medicine offer? What medications to ask your doctor about?
Prof. Paweł Bogdański: As in the case of any other chronic disease, such as hypertension, diabetes or ischemic heart disease, the criteria that must be met by a product that can be registered and used in the treatment of obesity as effective and safe have been clearly defined. Currently, only three preparations in Europe have obtained this status – orlistat, a drug consisting of naltrexone and bupropion, and liraglutide. The results of clinical trials in which these three preparations were used confirmed their effectiveness in reducing body weight. Liraglutide is the newest, long-awaited drug that has already been approved in a lower dose for the treatment of diabetes. The list of observed benefits in obese patients taking liraglutide is truly impressive. These include, among others: a protective effect against the development of diabetes, improvement of cholesterol and triglycerides, lowering blood pressure, reducing the number of sleep apnea, antiatherosclerotic effect and improving the quality of life.
Is the patient’s access to obesity treatment at an appropriate level – what are the reimbursement issues and how important is the patient’s access to a wide range of therapeutic options?
Prof. Paweł Bogdański: The increase in the incidence of obesity on a scale unprecedented in human history, clear evidence indicating a significant risk of developing a number of complications, social and economic costs constitute the starting point for discussion on the search for optimal systemic solutions increasing the chances of improving the effectiveness of obesity prevention and treatment. Unfortunately, we still have a lot to do in this regard. None of the drugs for the treatment of obesity are reimbursed, and the availability of places where patients can receive comprehensive assistance is definitely insufficient. Meanwhile, disregarding the effects of excessive body weight, despite undeniable evidence of its impact on morbidity and mortality, passive observation of the next classic obesity complications, despite the clear rules of conduct contained in the current guidelines of many medical societies, may lead to serious health consequences.