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Obesity Treatment

Obesity - a lifestyle disease

"Fatness is not only a disease itself, it is also an indicator of other diseases."

These words are attributed to the ancient Greek physician Hippocrates, who lived 2400 years ago and who is considered to be the father of medicine.

The latest scientific research shows that obesity is a lifestyle disease. Overweight and obesity are the result of excessive accumulation of body fat and due to their prevalence, they represent a global public health problem. According to the data of the World Health Organization, the incidence (prevalence) of obesity in the world has almost tripled from 1975 to 2016. The European health survey from 2014 shows that in member states of the European Union, 51.6% of people over the age of 18 are overweight and obese (of which 35.7% are overweight and 15.9% are obese). In the Republic of Croatia, 57.4% of people over the age of 18 are overweight and obese (of which 38.7% are overweight and 18.7% are obese). Today in Croatia, according to the results of research from 2015, men are significantly fatter than women, 20.8% of them are obese compared to 16.8% of women. Obesity is not only a problem in adults, but it is becoming an increasing problem in childhood as well. In the Republic of Croatia, overweight and obesity are present in 34.9% of children, more pronounced in boys than in girls - in 38.7% of boys and 31% of girls. The obesity itself is significantly more common in boys compared to girls, 17.2% versus 10.7%.

The proportion of body fat mass is normally 15%-20% in men and 20%-25% in women. Body Mass Index (BMI), which is calculated as the quotient of body mass (in kg) divided by the square of body height (in m), is most often used to estimate body fat. So, BMI = body mass (kg)/height (m)2. Normally nourished people are those with a Body Mass Index between 20 and 24.9 kg/m2.

Classification of nutrition according to the values of Body Mass Index (BMI)

Nutrition Status

Body Mass Index (BMI | kg/m2)

Underweight (Malnutrition)

< 18,5

Normal body weight

18,5 – 24,9

Increased body weight (Overweight)

25 – 29.9

Obesity of the 1st degree

30 – 34.9

Obesity of the 2nd degree

35 – 39.9

Class III obesity (Morbid obesity)

≥ 40

Obesity is characterized by the size and number of fat cells. Hypertrophic is one in which the size of fat cells is increased, while hyperplastic is one in which the number of fat cells is increased. The number of fat cells can only increase during development (intrauterine, up to the first three years of life and during puberty). Extremely obese people usually have a mixed type of obesity (hypertrophic and hyperplastic). There are gender differences in the distribution of adipose tissue. In women, adipose tissue accumulates predominantly in the lower part of the body: on the buttocks and hips ("pear" shape or female, gluteal, gynoid type of obesity), while in men, adipose tissue accumulates in the upper part of the body: in the area of the shoulders, chest and abdomen ("apple" shape or male, visceral, abdominal, android type of obesity). The distribution of adipose tissue is determined by hormones. The distribution of adipose tissue has a crucial effect on the appearance of obesity complications. There are two types of adipose tissue - visceral and subcutaneous - which differ not only by localization, but also by function. The abdominal (visceral) form of obesity is particularly dangerous, accompanied by a stronger disfunction of the secration of adipose tissue hormones and metabolic changes with consequent complications. For this reason, it is important to estimate the amount of visceral adipose tissue, and the simplest measurement of the circumference of the waist, that is, the abdomen, can help us with this. Waist circumference is associated with the risk of metabolic syndrome. Increased waist circumference is an indication for obesity treatment, regardless of Body Mass Index (normal waist circumference for men is ≤94 cm and for women ≤80 cm). The risk of metabolic complications is increased if the waist circumference is >94 cm in men or >80 in women, and significantly increased for waist circumference >102 cm in men or >88 cm in women. An insight into the distribution of adipose tissue can be obtained by calculating the ratio of waist to hip circumference, which should be less than 0.90 in men and less than 0.85 in women. In women after menopause, this ratio increases due to a lack of estrogen.

The cause of obesity is not sufficiently explained, and it is an indisputable fact that obesity is the result of a disproportionate intake of energy from food and its consumption in the body with a harmful predominance of fat deposition in adipose tissue. Two important feelings, hunger and satiety, are complexly regulated through the hunger and satiety centers located in a part of the brain called the hypothalamus. The very act of feeding is controlled from these centers, in which stimuli from higher centers in the brain, stimuli from the digestive system, nutrients in the circulation and some hormones participate. The total mass of adipose tissue can affect these centers in the hypothalamus, which try to keep the existing body weight stable.

Several factors are involved in the development and maintenance of obesity: heredity, excessive food intake, insufficient or reduced thermogenesis, altered fat tissue metabolism, insufficient physical activity and some medications. Many studies are trying to answer the questions about connection between genetics and environment. It is generally estimated that 30-40% of the variability in Body Mass Index is caused by heredity, and 60-70% by the environment. The interweaving of genetics and environment is very significant. For example, in a certain population some people are genetically predisposed to develop obesity, but the genotype can be expressed only with specific environmental influence, as it is in the case of a sedentary lifestyle. In about 95% of patients, the cause of obesity is a discrepancy between energy intake and consumption, while less than 15% of obesity cases are the result of some other disease.

Consequences of obesity

Due to increased body weight, various disorders arise: insulin resistance, hyperlipoproteinemia, diabetes, changes in the metabolism of thyroid hormones, increased secretion of cortisol, reduced response of growth hormone to stimuli, hypertension, dyspnea, cardiovascular changes, fatty infiltration of the liver, appearance of gallstones, changes in the locomotor system, chronic kidney disease, varicose veins, occurrence of malignant diseases (especially breast, uterus, ovary, colon, kidney and prostate cancer). Complications of obesity also include polycystic ovary syndrome and infertility. In extremely obese people, shortness of breath is the most common problem, which during sleep, due to the relaxation of the pharynx muscles, leads to reduced patency of the upper respiratory tract and causes drowsiness during the day. If the changes are more pronounced, the so-called Pickwick's syndrome is developing, which is manifested by severe alveolar hypoventilation, hypercapnia, respiratory acidosis, somnolence, cyanosis and lethargy. In more severe and longer duration, polycythemia, pulmonary hypertension and pulmonary heart develop. By increasing body weight, morbidity and mortality from cardiovascular diseases increase. Metabolic disorders and elevated blood pressure are common in obese people (the prevalence of arterial hypertension in the general population is 34%, while in overweight people is 60%, and in obese people it is 70 to 77%).

Obesity itself can damage heart function, because it places increased demands on the heart, resulting in thickening of the left ventricle. So far, the role of chronic inflammation, disorders of the endothelial function of blood vessels, insulin resistance and increased coagulability as factor for the development of atherosclerosis, and consequently, high cardiovascular risk in obese people has been most investigated. Obesity is associated with an increased risk of stroke.

By reducing body weight by only 5% to 10% of the initial body weight, the risk of suffering from a number of obesity-related diseases is reduced. For example, the risk of developing diabetes is reduced by more than 50%, systolic pressure is reduced by 10 mmHg, diastolic by 20 mmHg, total cholesterol is reduced by 10%, LDL cholesterol by 15%, triglycerides by 30%, and "good" HDL cholesterol increases by 8%. Total mortality is reduced by 20% to 25%, diabetes-related mortality is reduced by 30% and obesity-related cancer mortality is reduced by 40 to 50%.

Obesity treatment

The treatment of obesity is very demanding and often unsuccessful, and great persistence and renunciation are required from the patient. The basis of treatment is the reduction of energy intake through food, the so-called reduction diet. There are two phases of weight loss during diet. In the first phase, you lose weight faster due to the loss of water and salt, and in the second phase, it is slower because the body adapts to reduced energy intake and to a decrease in resting metabolism. We favor a balanced low-energy diet consisting of 15% of energy from proteins, 30% from fat and 55% from carbohydrates. In principle, one should not suddenly establish a new diet because it can be repulsive and that is why changes to the previous diet should be made gradually. More precisely, changes in diet should be introduced, but in such a way that the tastes and affinities of the individual are respected. Freedom of food choice should be respected and the development of creativity and personality should be encouraged. The most important thing in this is the acquisition of useful knowledge and skills for creating a personalized menu with fewer calories that is healthier than before. The more realistic the goals, the more lasting the success will be.

Proper nutrition and adequate physical activity are the basis of a healthy life, and are particularly important for reducing body weight and maintaining it. The question of how to ensure healthy lifestyle habits in today's conditions as a lifestyle that is acceptable to an individual should be answered by the team of experts at St. Catherine Specialty Hospital. The question arises - what is a healthy diet? It is undeniably a varied diet that satisfies basic energy needs and provides the body with the necessary nutrients. This is not easy to achieve, because in the rush of everyday life, one does not have time to constantly think about what and when to eat, so one usually eats just to fill its stomach. Another big problem is that our eating habits are bad since childhood. Many school children skip breakfast, which can cause memory and learning difficulties, as well as digestive problems. A healthy breakfast is a good start of the day, especially if it is rich in cereals, and contributes to a good mood and work ethic of all ages. A healthy life should be learned from a young age. If we don't do that, we are surely already heading towards the disease. In the period of maturity, business success and financial carefreeness, it is very important to contribute to the preservation of health with a lower calorie intake and increased physical activity. In contrast, an unhealthy diet, starvation during the working day and then an immoderate meal in the evening, along with sitting for a long time at work and in front of the TV screen, will lead to the accumulation of extra pounds and the development of dissatisfaction with our own appearance. At the same time, the possibility of developing chronic diseases will increase. Excessive nutrition with the consumption of fatty, low-quality food popularized by aggressive advertising is another cause of excess body weight. Neurotic reactions that follow a demanding lifestyle disturb the critical attitude towards excessive nutrition. The result is the wide spread of the metabolic syndrome, which today represents the biggest public health problem and is not without reason bombastically called the "deadly quartet" (obesity, high blood pressure, elevated fats and diabetes). Regular daily exercise reduces the risk of cardiovascular disease, diabetes and osteoporosis, which opens up the possibility of living a long age, consistent with the term "golden age". Exercise significantly contributes to health, as stated by the ancient proverb "a healthy mind in a healthy body", so with the need to preserve the environment (especially water and air) and the catchphrase "Planet without tobacco smoke" and other addictions, we can achieve the goals of a healthy and quality life .

The constant rush and lack of time characterize the unhealthy lifestyle of a large part of the population, which makes it difficult to change the diet. The imposition of strict dietary rules in real life has proven to be ineffective in the long term, so today preference is given to a change in lifestyle, which is greatly contributed to by better organization of everyday life and the adoption of healthy eating habits. Physical activity should be worked out individually, because obese people cannot carry out more strenuous programs, and the load should be gradually increased because cardiovascular incidents may develop in untrained people with heavier loads. 30 to 60 minutes of exercise daily, mostly aerobic as walking and brisk walking, is generally recommended. Anaerobic exercises can also be added to this: push-ups, weight lifting, resistance exercises on machines. Each exercise program should be individually adapted, depending on age, health and physical condition, and comorbidities.

Changing the lifestyle is a basic step in the treatment of obesity, and it is based on the fact that the lifestyle is a product of the individual's personality, genes and environment, and developed habits. Sudden lifestyle changes easily end in failure. In order to avoid this, after a detailed analysis of an individual's lifestyle, gradual changes in the micro-environment and organization of time are made, which should lead to permanent deviations from an unhealthy lifestyle. It is necessary for the patient to plan changes in the organization of time and daily schedule in agreement with family members, and the doctor should have an advisory role. The goal is to reduce the body weight by 10% during 6 months and after that try to maintain the body weight. If the patient is successful in this, he can cyclically try gradual weight loss again. It is recommended to lose 2-4 kg per month. By reducing energy intake by 500 kcal/day and increasing its consumption by 500 kcal/day, a daily energy deficit of 1000 kcal is achieved, which leads to a loss of 3 kg of body mass per month. The main problem of losing weight in obese people is not the act of losing weight itself, but maintaining the achieved reduced body mass. Unfortunately, obese people rarely keep their reduced body weight, but soon gain weight again. These people need strong motivation. Losing body weight and especially maintaining the achieved body weight, is an extremely difficult task that for a large number of people requires professional psychological support, i.e. the application of a behavioral-cognitive approach to weight loss, which is based on overcoming one's own psychological obstacles in the adoption of behavior, which will ultimately lead to the goal.

Behavioral changes include acquiring knowledge about proper nutrition. A person should learn to independently reduce unacceptably large amounts of food with the help of tables with the caloric value of food. The rule is that there are no prohibited foods and that everything can be consumed, but in the right amount. In order to facilitate the adoption of new eating habits, behavioral techniques related to the way of chewing food, speed of eating, quantity and serving of food are applied (putting down cutlery between bites, etc.). Keeping a food diary is an important tool for successfull management of your own behavior, which helps to change eating patterns and replace old eating habits with new ones.

If a change in lifestyle does not achieve a reduction in body weight, drug support can be included, and in some cases, restrictive endoscopic procedures are also considered. For example, by placing a balloon in the stomach, which can be the last method of treatment or transition to a bariatric surgical method of treatment.

Obesity is a chronic disease. Obesity is a lifestyle disease and it is caused by the interaction of genes and the environment. The prognosis of obesity, if it is not treated, is bad because there will be numerous complications that shorten life expectancy. Treatment results are better if treatment is started as early as possible. Our experts (endocrinologist, nutritionist and physiotherapist) will help you to change your lifestyle, diet, physical activity, sleep and other lifestyle habits with the help of the principles of personalized medicine. In case of sleep-disordered breathing, additional treatment will be recommended. The goal should not be a large loss of body weight in a short period, but gradually over a longer period, which ensures the stability of the results and the improvement of the quality of life and, ultimately, the extension of the life span.

At St. Catherine Specialty Hospital we offer a complete and personalized approach to diagnostics, treatment and education. Contact us with confidence and make an appointment.

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