Faced with obesity, act on all fronts

Faced with obesity, act on all fronts

#Faced #obesity #act #fronts

38% of men over the age of 15 are overweight.

22% of women over 15 years of age are overweight.

30 to 40% of people with obesity have associated diseases.

200 to 300 Genes are involved in obesity.

Qualified as a global epidemic by the World Health Organization, obesity does not spare Switzerland since it affects 12% of men and 10% of women. Long perceived as an aesthetic problem, obesity is now considered “a chronic, progressive and recurrent disease, with significant complications,” says Pr Zoltan Pataky, head of the Therapeutic Patient Education Unit at Geneva University Hospitals (HUG ), co-director of the new Center for Obesity and Bariatric Surgery at HUG and Vice President of the Swiss Association for the Study of Metabolism and Obesity.

The Covid-19 pandemic has not improved the situation. In the last two years, Swiss men and women have shown an average of four to five extra kilos on the scale, which is equivalent to one point of body mass index (BMI)1. However, “research indicates that even a modest weight gain can already lead to the appearance of metabolic complications such as prediabetes or diabetes, high blood pressure or excess cholesterol in the blood,” says the specialist.

After gaining weight, many have the reflex of wanting to (quickly) lose weight. However, it is scientifically proven that diets, whatever they are, are counterproductive, confirms Aude Daccord, dietitian at the HUG Therapeutic Patient Education Unit: “Certainly they can cause weight loss, but in the very short term. People often get back more than they lost, with a yo-yo effect.” Diets can be evil in more ways than one, altering body composition, causing metabolic damage, and often eating disorders.

A fight on all fronts

Úrsula, 68 years old: “My life has changed 360 degrees”

“I followed every possible diet. Six years ago, I followed a program at HUG during which I learned the basics of a balanced diet. It helped me a lot, but I still had binge eating, eating too much during meals and therefore gaining weight. I left with a heavy stomach and great guilt. I was always moving around a lot, but I had this tendency to eat too much, not being able to stop. Since Pr. Zoltan Pataky prescribed me medications that help me feel full, my life has changed 360 degrees. I’m someone who likes to be in control… the only thing I couldn’t control was food. For the first time in my life, I can now stop when I am no longer hungry. Food was an obsession, I kept thinking about what I was going to eat. Now I have a serene relationship with food. I don’t go on a diet anymore, I don’t forbid myself any food, I cook a lot. I am very active and good on my body.

Faced with weight gain, the idea is still to react, but on different fronts. Thank you for a multidisciplinary charge, the new Center for Obesity and Bariatric Surgery proposes individualized suivis reposant to the plusieurs piliers: food, physical activity and food behavior, voire for medical care and bariatric surgery selon the cases. The programs are aimed at people who are overweight (BMI between 25 and 30) or obese (BMI over 30). During the first medical evaluation, waist circumference, an important indicator related to body composition, is also taken into account: “Abdominal obesity is a reflection of visceral obesity, which is often associated with cardiovascular complications,” explains Professor Pataky. Because studies show it, an obese person will sooner or later present at least one disease related to being overweight. “Oh, it’s a matter of time,” emphasizes the specialist.

The consequences of obesity on health are numerous: metabolic syndrome (hypertension, diabetes, excess cholesterol), cardiovascular diseases, cancers (uterus, stomach, esophagus), sleep apnea, osteoarthritis, orthopedic problems, mental disorders (anxiety, depression ), etc. Despite these risks, “insisting on weight loss is not effective. We must first understand the origin of weight gain in order to promote a change of course”, says Professor Pataky.

The dark side of obesity

Obesity doctors, dieticians, physical activity specialists, psychologists and art therapists combine their skills to support adults and children who consult in the context of an interrogation. Behind a diagnosis of obesity, there is certainly always an imbalance between energy intake (quality and quantity of food eaten) and expenditure, but we must go further and focus on the conditions of food intake and the life context of the person. “As long as we don’t put our finger on the cause of the problem, changes are not possible,” testifies the specialist.

The first consultation thus makes it possible to take stock and guide the treatment. Then, therapeutic education workshops are offered according to the problem of each one (diet, physical activity, eating disorder). They are carried out in groups, are interactive and are built jointly with patients and educators. The topics covered are specific and the advice is practical: fundamentals of a balanced diet, hidden fats, digestive sensations (hunger, satiety), etc. “Often, people know the theory, but they can’t apply it on a daily basis. We help them to implement new life habits so that these changes are acceptable and sustainable over time”, says the dietician.

If, despite this multidisciplinary management and lifestyle changes, weight loss does not occur, other options can be considered. New drugs are now enriching the therapeutic arsenal, which represents additional help. These molecules (analogues of GLP-1) cause a reduction in appetite and especially in the urgent need to eat. They facilitate weight loss and reduce the complications of obesity, such as blood pressure. More importantly, they also showed cardiovascular protection in high-risk patients (type 2 diabetes and obesity) and renal improvement. This treatment is administered daily as a subcutaneous injection. A new molecule of GLP-1 (weekly injection), available in Switzerland in the coming months, will represent a real breakthrough with a weight loss of between 15 and 20% “provided that the person benefits from a multidisciplinary follow-up”, emphasizes Prof. Pataky.

When it comes to bariatric surgery, which HUGs are experts at, it’s a last-resort solution.

Whatever the path, losing weight is still a struggle: “Obesity is not an option. If the people who suffer from it had been able to do something else, they probably would have done it”, concludes Lydia Lanza, psychologist at the Therapeutic Patient Education Unit.

Intermittent fasting: a promising approach

Limiting food intake to certain hours, certain days of the week or month, restricting calorie intake and ensuring a balanced diet during these cyclical periods: this is the principle of intermittent fasting. This approach arouses great interest from the perspective of weight loss and the reduction of metabolic risks (hypertension, cholesterol, diabetes). “The data in animals and humans are encouraging. The narrower the window in which subjects eat, the more effective it is for weight loss. On the other hand, we lack hindsight for the control of metabolic diseases in humans”, comments Dr. Tinh-Hai Collet, assistant physician in the Nutrition Unit of the Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education of the University Hospitals of Geneva ( HUG). Larger, longer-term studies are needed to confirm these effects. Dr. Collet is also currently conducting research to determine if eating at set times allows “early birds” to lose fat mass and improve their health through their internal biological rhythms.

More information to participate in the study: https://recherche.hug.ch/etudes/lcc


1 BMI calculation: weight (in kg)/height (in meters) squared. Overweight: BMI between 25 and 30. Obese: BMI greater than 30.

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