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Obesity is a chronic disease, just like diabetes and high blood pressure. It also leads to serious complications, and the number of patients is growing rapidly. Usually, obesity is not caused by other diseases, but by poor nutrition.

In Europeobesityaffects 10-20 percent men and 10-25 percent. women. As much as 90 percent. casesthe cause of obesityis a long-lasting positive energy balance, in other words - an excess of food in relation to the body's needs. Energy supplied to the body in the form of food in approx. 60 percent. it is used up for the basic metabolism. Daily physical activity (but this is only about ordinary activities, not sports) and thermogenesis, i.e. heat generation, consume approx. 20 percent. supplied to the bodycalories . Excess energy turns into fat. We talk to prof. Barbara Zahorska-Markiewicz, an expert in the field of obesity, i.e. the treatment of obesity, who for many years was the president of the Polish Society for the Study of Obesity.

The prevalence of overweight and obesity has been compared to an epidemic. How many Poles are already sick?

Prof. Barbara Zahorska-Markiewicz: More than half of Poles are overweight, and obesity is about 20 percent. population. It is characteristic that in our country the percentage of obesity among women and men is leveling out. But men are more likely to be overweight than women.

Who gets fat faster - women or men?

B. Z.-M .: It is difficult to answer unequivocally. The research conducted among the inhabitants of Warsaw, which has been repeated every 10 years since 1984, shows that the percentage of obese men is growing faster. There are periods in women's lives when the tendency to gain weight is revealed. For young girls, it is the time of puberty, then pregnancy, and then the years of the climacteric period. My observations show that overweight and obesity can be called an occupational disease of accountants. I have a lot of female patients who practice this profession. In men, overweight or obesity often develops after leaving the military. Later in life, weight gain is influenced by a sedentary lifestyle, business dinners, and shift work. I also have a large professional group among my patientsdrivers.

For which gender is obesity more dangerous?

B. Z.-M .: Gender is not of great importance here. The dangerous consequences of obesity result from the location of adipose tissue and the fact that it promotes metabolic disorders. The accumulation of belly fat is the most dangerous. In women whose fatty tissue accumulates on the hips and thighs, there is no risk of metabolic disorders, but the risk of breast and reproductive organs cancer increases. In men, visceral obesity primarily leads to hypertension and diabetes.

What happens when the body becomes obese?

B. Z.-M .: The subcutaneous tissue is a natural place of accumulation of adipose tissue. The fat deposited in organs - the liver, kidneys, muscles, heart, pancreas - is a foreign body for them, causing damage to them. Fat tissue accumulated in the abdominal cavity is not only an energy store, but also a producer of many protein products, the so-called cytokines that are harmful to he alth. They reduce the body's sensitivity to insulin, promoting the development of diabetes, they have a pro-inflammatory effect on the vascular endothelium, accelerating the development of atherosclerosis. Adipose tissue also produces angiotensinogen and renin, which provoke the development of arterial hypertension. People with obesity are more likely to suffer from diabetes, hypertension, and more often have elevated levels of lipids (fats) in the blood. The only product of adipose tissue that has a beneficial effect on our body - it increases insulin sensitivity and has an anti-inflammatory effect, lowers blood glucose, increases the oxidation of free fatty acids - is adiponectin. Unfortunately, in people with obesity, despite excess body fat, its blood level is low. After losing weight, it rises. Obesity multiplies the risk of diabetes, atherosclerosis and coronary heart disease, leading to circulatory and respiratory failure. It's a metabolic syndrome that is being talked about so much now. The list of obesity complications also includes arthrosis, gout, gallstones, fatty liver, hormonal disorders, ovarian cystic disease, fertility disorders, and neoplastic diseases (cancer of the breast, colon, uterus). Often in the last place there are problems with the psyche, e.g. low self-esteem, depression, social isolation, and this is an extremely important problem, because it reduces not only the quality of life, but also causes problems with employment and the reason for retirement.

Eating less, moving more, doctors say. What to change in your psyche to follow these advice?

B. Z.-M .: That's a good question. Actually a major siteThe disorder in people with obesity is the central nervous system. This is where the decision is made whether we are hungry or satiated. From the gastrointestinal tract, a signal is sent through the nervous and endocrine lines to the central nervous system, which informs the brain about the need for food. When we are hungry, ghrelin is produced in the stomach to stimulate the appetite. Its production decreases after a meal. Food enters the duodenum and other hormones tell the brain that we are saturated. This process is disturbed in people with obesity. They may feel hungry more often or feel less satiated when they eat. Above the centers of hunger and satiety, however, is the cerebral cortex and you can learn to control excessive appetite.

Many people with obesity justify themselves with genetic tendencies. How is it in reality?

B. Z.-M .: Many genes have been tested in this respect. It turned out that the most common cause of obesity is not a single gene, but a mutation affecting many of them. Gene mutations are in 25-40 percent. responsible for the predisposition to obesity. There are many genes responsible for insulin sensitivity, the activity of enzymes regulating fat metabolism and oxidation, influencing taste preferences and maintaining a stable level of body weight. If we want to understand the difficulties that many people have in losing weight, we must take this factor into account. Let's not forget that obesity can be provoked by, for example, the increasingly frequent endocrine disorders, hypothalamic diseases and drugs - antidepressants, epilepsy, sedatives, glucocorticosteroids, etc.


Did you know that … cancer likes obese patients

People with obesity suffer more often from:
»breast cancer by 17 percent.
»endometrium by 50 percent.
»gallbladder by 20 percent.
»esophagus by 35 percent.
»large intestine by 10 percent
» kidneys by 25 percent
»pancreas by 25 percent


What to follow to choose an effective and safe obesity treatment?

B. Z.-M .: Treatment of obese patients should focus not only on weight loss, but mainly on the improvement of metabolic disorders and obesity complications - arterial hypertension, diabetes, respiratory and cardiovascular disorders. The improvement of the mental and social condition should also be taken into account. Treatment of obesity must be adapted to the age, gender, severity and type of obesity, metabolic risk factors and comorbidities. The immediate goal should be a reduction by 5-15 percent. current body weight within 3-6 months. Anyone who is losing weight must understand that it is a long-term, demanding processsacrifices and perseverance.

What if we lose weight faster?

B. Z.-M .: Quick weight loss is often associated with rapid weight gain, even to a level exceeding the baseline. And this is a very unfavorable phenomenon. Why? Well, although the reduction of body weight takes place mainly at the expense of burning fat reserves, the loss of lean body mass, e.g. muscles, which are responsible for the proper metabolism, is also decreasing. When we gain weight again, only adipose tissue grows, which is bad for the body.

What rules should we follow to successfully fight excess kilos?

B. Z.-M .: The basis must be limiting the caloric content of meals and drinking unsweetened liquids, preferably mineral water. We have to eat regularly, 3-4 times a day, in small portions and not eat enough. We do not leave the house without breakfast and limit the evening food. It is important to eat at your leisure while chewing on your bites. If someone wants to count the calories eaten, he must also remember about the hidden ones, eg in the form of butter added to vegetables, mayonnaise for lettuce, etc. Better slimming results are obtained by people who give up or minimize animal fats. The rationale behind this is that fats provide more calories than proteins and carbohydrates. After eating fatty foods, we don't feel overly saturated. If we reach for carbohydrates, choose those with a low glycemic index. High-index foods, such as potatoes, sweetened beverages, raise blood sugar quickly, which increases the tendency to put on weight. More similar advice could be given. The method of losing weight must be adapted to age, gender, work, accompanying diseases, etc. Therefore, I believe that it is best to lose weight under the supervision of a doctor.

According to an expertprof. Barbara Zahorska-Markiewicz, president of the Polish Society for the Study of Obesity

Many fashionable and advertised weight loss diets allow you to lose weight without much risk to he alth, but often do not achieve a permanent effect. And the longer use of some of the fad diets can be harmful. One-ingredient diets, e.g. milk, rice, cabbage, do not provide the body with many of the nutrients it needs - vitamins and minerals. Fat diet, the so-called Kwaśniewski's optimal diet, which recommends eating large amounts of animal fats, accelerates the development of atherosclerosis, provides too much cholesterol, retinol and iron. However, it lacks vitamin C, potassium, calcium and magnesium, which has a negative effect on the heart. The Montignac diet divides products according to the glycemic index and recommends counting it, which is much more troublesome than counting calories, eliminatessugar, potatoes, white bread, it is forbidden to combine carbohydrates with a high glycemic index with fats. The Copenhagen diet recommends large amounts of black coffee and eggs, which is not he althy for the digestive tract or the heart. I am opposed to starvation, because in many people it slows down the metabolism, leads to acidosis and deficiencies of minerals and vitamins. I consider the South Beach diet to be sensible, in which carbohydrates and fats are divided into good and bad. Replace bad fats with good fats, derived from olives, nuts, seeds and fish. We eliminate bad carbohydrates by choosing those found in grains, fruits and vegetables. The most fashionable nowadays is the protein diet, the so-called protein or Dukan. It facilitates rapid weight reduction, allows you to eat without restricting certain meats, fish and dairy products, but the excess protein strains the liver and kidneys.

Important supports safe treatment and a dignified life of people suffering from obesity.
This article does not contain discriminatory and stigmatizing content for people suffering from obesity.

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