VANESSA FELIPPE - GZH
In this interview, Dr. Andrea Pereira talks about various aspects of obesity on World Obesity Day.
How did you let it get to that point? If you're a person with obesity or live with someone who is, you've probably heard someone asking questions like this. In addition to revealing misinformation, the questioning is full of prejudice. On World Obesity Day, March 4, health professionals say that the combination of these two factors greatly hinders the fight against the disease. In 2023, the campaign of the Brazilian Society of Endocrinology and Metabolism (SBEM) in conjunction with the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso) and with the support of the World Federation of Obesity (WOF) has as its theme “Another way of looking". The goal is to make people understand that obesity is a multifactorial chronic disease and change the stigma that being overweight is the result of bad habits. According to Clinical Nutrition Physician Andrea Pereira, from the NGO Obesidade Brasil, it is not just a matter of willpower: — Many people do not believe that obesity is a disease, they think that it is the fault of the person who cannot control himself. Nobody tells a person with diabetes that they have diabetes because they want to. But they say that all the time to people with obesity. It's not a simple matter. It's not just closing your mouth. And, in fact, it is not. The doctor points out that there is not always a direct relationship between obesity and the over-consumption of food.
— Everyone knows someone very skinny who eats a lot and doesn't get fat. And there are people who don't eat as much but get fat very easily. Being a disease, obesity makes the patient gain weight much more easily. Even the response to physical activity is lower. Overeating and under-exercise is a combination that won't necessarily make everyone fat. But, for those with a tendency and predisposition, it ends up being an aggravating factor - explains Andrea. It is important to understand that obesity is a chronic disease characterized by excess body fat. The body mass index (BMI) is the reference that doctors use to classify whether or not a person has a disease. In general (there are particularities involving age and differences between men and women), the calculation divides a person's weight by height squared. When the BMI is equal to or above 30, obesity is considered, which can be grade 1 (BMI between 30 and 34.9), 2 (BMI between 35.0 and 39.9), or 3 (BMI greater than 40,0). A BMI between 25 and 29.9 means overweight, which is a kind of pre-obesity. The higher it is, the greater the chance of other diseases appearing, which are comorbidities. Andrea warns: — People with obesity are at high risk of high blood pressure, diabetes, high cholesterol, joint, bone, and lung problems, liver damage due to excess fat, and at least 13 types of cancer that are associated with obesity. There are also a number of mental health issues, such as depression. So, when we treat obesity, we prevent a series of other illnesses. The most serious is a cardiovascular risk, which can even lead to death.
A reality that only grows The number of overweight and obese individuals has grown in recent years and has generated great concern in public health. According to the Obesity Atlas 2023, released on Thursday by the World Obesity Foundation (WOF), 41% of Brazilian adults will be obese by 2035. This number is classified by the entity as a “very high alert level”. It is the same classification for the projection of the annual growth of children with obesity in the country: 4.4%. The atlas also predicts that, worldwide, one in four people (almost 2 billion) will be obese by 2035. And more than half of the population (51%, or 4 billion) will live overweight. The economic impact of overweight and obesity will reach US$ 4.32 trillion by 2035, which represents almost 3% of global GDP, being comparable to the effect of covid-19 in 2020.
Back in Brazil, one of the most recent surveys was presented in 2022, carried out by the Ministry of Health, through a telephone survey. The Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) shows how overweight and obesity have evolved, in the 27 Brazilian capitals, in the adult population, over 18 years of age, between 2006 and 2020. Among men, the percentage of overweight individuals (BMI equal to or greater than 25) increased from 47.5% in 2006 to 58.9% in 2020. In the case of women, in the same period, the index increased from 38 .5% to 56.2%. Regarding obesity (BMI equal to or greater than 30), the percentage of men increased from 11.4% in 2006 to 20.3% in 2020. Among women, in the same period, the index increased from 12.1% to 22.6%. Considering only Porto Alegre, the percentage of overweight individuals, taking into account men and women over 18 years of age, increased from 48.3% in 2006 to 58.8% in 2020. Regarding obesity, considering the same public and the same period, the index increased from 12.7% to 19.7%.
How to treat obesity? To avoid complications and health risks, doctors say: obesity needs treatment. For Jaqueline Rizzoli, endocrinologist and member of the Brazilian Society of Endocrinology and Metabology (SBEM), there are currently many effective options that can help, but it is essential to seek a doctor or a nutritionist: — Be very careful with miraculous promises. There's a lot of hacking. Outlandish recipes that do not bring benefits, but risks. It is very common for patients to arrive at the office only after they have already made several attempts on their own. The person with obesity needs professional follow-up. We have to evaluate and carry out tests to find out what the real situation is if it is more or less serious, what health problems she has, what her eating habits are if she does physical exercise, and if she is able to do it, how we can intervene to improve the routine, in short, are many factors to be considered.
The endocrinologist states that the basis of treatment is always dietary re-education and physical activity, even when using medication or undergoing bariatric surgery (check the requirements in the table below). — Currently, we have several drug options to help control obesity, but unfortunately, none of them are available through the SUS. They are not part of the list of the National Health Agency (ANS), despite several attempts to incorporate these treatments by entities and health professionals. Through the Unified Health System (SUS), bariatric surgery can be performed, but the number of surgeries is much lower than the demand. Here in Rio Grande do Sul, it has taken 6 to 7 years from entering the UBS to performing the surgery — says, Jaqueline. The Clinical Nutrition Physician Andrea Pereira also explains that the treatments cannot abandon the simplest care:
— Both the use of medication and the performance of bariatric surgery need to be accompanied by a change in lifestyle: nutritional education and physical activity are possible for each person. Currently, we have new drugs, with very important weight loss. It is the GLP1 analogs (liraglutide and semaglutide), which are the most modern. And they are emerging more and more, there are many studies outside Brazil. But it is important to emphasize that we are talking about a chronic disease, that is, it has no cure. You have control. It's no use for you to do the treatment, lose weight and abandon the healthy routine, because the tendency is for you to gain weight again. It is a treatment for life. The psychologist and president of the NGO Obesidade Brasil, Andrea Levy, highlights an important point that is not always addressed: treating obesity is not synonymous with getting thin. — The expectation has to be within the reality of each person. It is a very individual treatment, which needs to have feasible goals. The patient needs to accept and understand that he doesn't need to stay thin. Frustration is very possible if he is not well accompanied. It's important to focus on achievements, not what's still missing. If the patient needs to lose 40 kilos and, so far, he has lost 20, he will already have a gain in locomotion, day-to-day activities, and in mental health. Mental health treatment is part of obesity treatment - points out Andrea.
Who is bariatric surgery recommended for? It is indicated, according to endocrinologist Jaqueline Rizzoli, in specific, more serious cases: * grade 2 obesity, with BMI equal to or above 35 and with some comorbidity; * grade 1 obesity, with a BMI between 30 and 34.9, for some patients who also have diabetes; * grade 3 obesity, with BMI equal to or above 40.
CAUSES OF OBESITY Obesity can have several causes, so it is classified as a multifactorial disease. Endocrinologist Jaqueline Rizzoli says that, normally, there is a combination of genetics and environment. — We can say that 40% of people develop the disease due to genetic propensity and 60% due to what we call an obesogenic environment. These are lifestyle traits. Is a person sedentary because they don't like to exercise or because they work too much and don't have time? Is there a safe and lighted place to walk near the house? What is the quality, not just the quantity, of the food? Is the routine low or high-stress? How is the sleep quality? We often say that genetics loads the gun, but the environment pulls the trigger. The environment can enhance or soften genetics - exemplifies Jaqueline. Therefore, prevention is also closely linked to lifestyle, as explained by Clinical Nutrition Physician Andrea, from the NGO Obesidade Brasil. It does not mean that the person will not develop the disease, but it can reduce the chances:
— There are many works showing that the regular practice of physical activity reduces the chances of a person being obese because they will have a greater caloric expenditure. Another point is a balanced diet. What is a healthy dish? Half greens and vegetables, quarter carbohydrates, quarter protein. It's best if possible. As well as avoiding empty calories, like sweets, for example. They are very tasty, but they are not nutritionally rich. Highly processed and industrialized foods are very caloric. So the way is really to try to eat more natural food, prepared at home. And the ideal thing is for this care to start from childhood, especially in families with a tendency to obesity. The Risks of Prejudice The professionals heard by the report are adamant: prejudice is enormous and harmful. Says Andrea Levy, psychologist, and president of the NGO Obesidade Brasil: “It's everywhere, all the time. The lack of accessibility is one of the things that most represents prejudice. Appropriate furniture is lacking, from cinema and airplane seats to coffins and stretchers. When armchairs for people with obesity appeared, we heard a lot: "What do you mean? Instead of losing weight, she gets a better chair? She can control herself!". Women don't go to the gynecologist because they don't fit on the stretcher, so they don't do the preventive exams. They can have cancer and not find out. This is very serious. It makes many people not even seek professional help. The biggest damage is that prejudice can kill.
The Clinical Nutrition Physician Andrea reinforces: — Prejudice extends even among health professionals, who often deny adequate treatment. They say that the patient doesn't need medication and that it's just a matter of willpower, dieting, and working out. The dissemination of information is very important because people need to understand that we are talking about chronic disease.
LINK:
https://gauchazh.clicrbs.com.br/saude/vida/noticia/2023/03/quatro-a-cada-10-pessoas-serao-obesas-em-2035-indice-coloca-o-pais-em-um-alerta-muito-alto-clepmbu5s001k016mzdmxulm
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