Failing of dieting ?
In 2002, the World Health Organization ranked obesity as one of the top 10 risk factors for mortality, thus becoming a contributor to smoking. We are witnessing its worldwide epidemic explosion. The reasons for this are multifactorial.
Why talk about risk factors, even illness?
Obesity can be responsible for the onset of diabetes (type 2) (some authors speak of “diabetes”), high blood pressure, disruption of blood fat metabolism, Uric acid and other factors constituting the “plurimetabolic syndrome” (or “syndrome X”). This is probably the fat overload of the liver, realizing a real poisoning of this organ, and leading to resistance to hormone insulin, responsible.
Obesity may be responsible for the onset of diabetes (type 2) (some authors speak of “diabetes”), hypertension …
This will be reflected in the more frequent and earlier occurrence of myocardial infarction, stroke and kidney failure.
Other diseases are more frequent in the obese, among other calculations of the gallbladder, some cancers, joint destruction of the hips and knees.
Are all obesities equal?
No: “visceral” obesity (ie the fat around the abdominal organs, also called central or orroid obesity, or obesity “apple” Is the most dangerous, as opposed to feminoid obesity, “pear”, preferentially reaching the thighs and buttocks of women.
What are the causes of obesity?
They are multiple. Heredity occurs most often, but exceptional are the affections where it is the predominant factor: these are rare diseases appearing in early childhood, and in which hereditary obesity does not occur, Is that one of the facets of the disease.
Similarly, endocrine diseases can be accompanied by a form of obesity: other symptoms and laboratory tests make it possible to diagnose it.
Usually, if genetics promotes obesity, it is only if the conditions of life are favorable to its expression. It is possible that this genetics allows survival during a famine period: some scientists have called the genes incriminated “genes of survival”.
Compared with the past, the present conditions of life in the part of the world in which we live are characterized mainly by two facts:
- Accessibility to food, often too fatty and / or sweet
- Significant decrease in physical activity.
But these are not the only factors: other parameters intervene, characterizing the overall behavior of each individual, and which only an interrogation and an overall evaluation can reveal.
Can we treat obesity?
Definitely: this treatment must take into account not only the excess weight, but precisely all these parameters. It is not enough to prescribe a “diet”: most of our patients have tried several, with disappointing results in the long term. Just as they have already, for most of them, tried one or the other “perlimpinpin powder” boasted by misleading advertising, or taken risks with “treatments” not scientifically validated seriously ( Let us recall here the case of “Chinese powders”, responsible for cases of renal insufficiency and cancer of the urinary tract).
It is not enough to be on the balance: the distribution of adipose tissue must be evaluated, the weight must be evaluated according to the size (body mass index). A food survey should be carried out as a basis for therapeutic proposals. It will include not only information on food intake, but also other important factors, such as the conditions under which they are ingested.
The treatment is based on interdisciplinary care: this interdisciplinarity is the cornerstone.
To this end, our team includes several disciplines: dietetics, internal medicine / endocrinology, psychology, psychiatry, gastroenterology, digestive surgery, plastic surgery, physiotherapy.
Initially, the most accurate assessment of the health status and the parameters responsible for obesity will be carried out. Initial treatment proposals will be proposed. If progress is insufficient, either drug may be proposed, in compliance with the “good medical practices” adopted in Belgium and internationally. For some patients, the installation of an intragastric balloon or the choice of bariatric surgery should sometimes be considered, always in compliance with “good practices”.
DR Maximilien KUTNOWSKI
Gastroenterologist