No matter how many times you read that there is almost no disease that is not related to excess weight, obesity is still perceived primarily as an aesthetic issue. It is a metabolic disease that is directly related to more than two hundred different diseases. For years, we have been at the very top of the European charts when it comes to obesity, and our children are increasingly at risk of being obese and sick. Medicines that are sold and guarantee quick weight loss have their advantages, but also disadvantages. Every expert will say that without emotional support and self-understanding, as well as without a serious change in habits, weight loss will not be effective and healthy.
That’s why my guest this week is a top expert, endocrinologist and diabetologist Assoc. Ph.D. Maja Baretić.
There is always something to say about obesity, especially when it comes to diseases related to obesity. Diseases of the circulatory system, diabetes, strokes and heart attacks come to everyone’s mind first, but today we know that a whole series of malignant diseases are linked to excessive body mass, as well as diseases of the spine, the possibility of conception and fertility in general, not to mention mental health and psychological difficulties.
Croatia has an action plan that started in 2024 and continues this year and next, and its goal is to raise awareness of the problem and begin to solve it. But what was actually done there and does it have any effect?
This is a good start, in Croatia more than 30 percent of the population suffers from obesity, and about 65 percent of them are overweight. That’s why these public health actions and awareness of the problem are very important to us.
Weight is a layered problem, because we don’t want to ignore even that aspect of how we feel in our own skin and how we see and experience ourselves.
In addition, those of us who medically deal with obesity had to make an effort to change the paradigm of healthcare workers and to first make them understand that obesity is not a matter of will, or laziness, carelessness and bad character. Furthermore, people who have serious excess weight should be made aware of this, not only to help themselves, but also to be able to raise their children by inculcating healthy habits in them.
What makes the difference between lack of will or character and disease?
The fundamental question is what is the cause of obesity? People often say and really think that it is a hormonal disorder, and hormones are only five percent of the cause of obesity. Most hormonal disorders are the result of obesity. The other 95 percent of the causes of obesity are our everyday environment and the way we live and eat. Children are at particular risk here, statistics show us that 90 percent of children move sufficiently when they enter primary school, and only 20 percent of them move in accordance with their age and needs already at the end of primary school. Civilized, we move less, eat improperly, work two or three jobs and are constantly under some stress. We simply get into that wheel and it is very difficult to become aware, to stop, to see how we eat, how much we move and what is bad about it. That is why public health actions are important to us, because it is not an issue for an individual, but for the whole society.
I was part of a study of 1,500 respondents, where it was shown that 42 percent of students gain weight in their first years of college, and these are the years when the first weight gain begins. The reason for this is a messy life, studying at night, stress, improper diet. The main reason is actually the intake of too many and unhealthy calories and a lack of exercise.
Women are a particularly vulnerable group for gaining weight. Why?
Women have several stages in their lives when they are at risk of gaining weight. There is puberty, then after each birth and finally menopause. Over the years, the metabolism slows down and if we had a few extra kilos in our youth, in menopause this problem only grows. We have to accept that with age we simply have to eat less.
How accurate is the information that if we want to keep our weight off in our fifties, we must permanently remove thirty percent of the food from our plates?
That’s right, I love simple instructions, turn the plate upside down and that plate base is your new meal base. In fact, switch from a large plate to a small one. There is also a formula for a healthy plate: half of the meal must be red or green vegetables, a quarter proteins, i.e. meat that is not breaded, and a quarter remains for carbohydrates and that is integral rice or something similar. Personally, I am not a supporter of diets, I only admit the so-called the Mediterranean diet, which is actually a style of cooking and a diet with less salt. For weight loss, a lower calorie intake and a balanced diet are essential.
I remember that as a young girl I fantasized with my friends about a miraculous pill that we would take and become slim before the summer vacation. We don’t have a pill, but we do have an injection. There is a lot of controversy surrounding GLP-1 weight loss drugs, yet they have found widespread use.
I want to emphasize, there is no medicine that we will take, lose weight and never gain weight again if our habits remain the same. Obesity is not a simple equation: the medicine will reduce my hunger, I will lose weight and that’s it. The cause of obesity is different for each person and this should always be kept in mind. Overeating is not the only cause of obesity. Depression, emotional overeating, inability to move for various reasons, as well as the consumption of various drugs that can make us fat are sometimes in the background.
The medicines you mention are made for diabetes and for that disease they are given in much smaller doses. In the case of obesity, before you start using the medicine, it is important to understand what it means to eat healthy, change your habits, change your plate and do this consistently every day, as well as exercise daily and get eight hours of quality sleep. Only after these changes can medicine be taken. If such a drug is used without changing habits, the feeling of hunger will decrease, the person will reduce protein intake, muscle mass will weaken, which is not good at all.
If you do not continue with healthy habits after taking the medicine, studies show that 0.6 kg is returned per month and you very quickly return to your old or even higher body weight.
In case of serious obesity, can these drugs be taken for the rest of life in small doses, as a prevention of regaining weight?
So far, there are no studies on how to treat people who have lost a lot of weight. There, things still need to be crystallized and questioned. Sometimes even applying healthy habits does not mean that some of the weight will not come back. A weight loss drug is not a cure for the impossible living conditions that have led us to obesity.
What is the role of probiotics in the weight loss process?
The microbiome, the intestinal bacteria in our intestines, has connections with many diseases, including obesity. Today, we still do not know exactly which probiotics and prebiotics, and in what doses should be taken for them to have an effect on weight loss. This is in the phase of speculation and research, but it is certainly good to take care of your microbiome.
What about the myth that it’s harder for men to gain weight than women and easier for them to lose weight?
There is an interesting study that dealt with the perception of one’s own body by region, and it is interesting that men – Mediterraneans estimated their body weight to be significantly less than the actual weight. Sometimes the question of weight gain is actually a question of one’s own self-criticism. With drugs for weight loss, we know that we need estrogen in the body, so that the substance of the drug reaches the brain faster, and that is why a better effect is possible in women. Estrogen decreases with age in women, and in men, testosterone is converted into estrogen in the fatty tissue, and it is possible that those on these drugs lose weight faster because of this.
Our children are getting fatter. What does the profession have to say about that?
As with adults, it is a matter of environment, family habits and ingrained patterns. Today, there is no recreational sport for children anymore, either they are focused on elite sports from a young age or they don’t move at all. We very often show our love with food, especially the generations of grandparents. So it is exaggerated both in quantity and in the way of preparation. Food must not become a substitute for emotions, for human contact, for an antidepressant.
I think that public actions should be aimed at young people and adolescents, because they are much more receptive to changes. I like to say that health is the most important stock in the stock market of life. We have to teach young people that it pays to invest in their own health.
How fat is still a highly taboo topic and a way to disqualify a person?
I advocate that we never address an obese person in the way: you’re fat, let’s lose weight. No one chooses to be fat and everyone would lose weight if they could. Fatness is not only a matter of will and fatness is not the only thing that defines a person. A fat person is interesting, educated, charming and everything else, and if we prioritize fatness and not everything else, we are discriminating against that person. This is an important message for the media as well. Let’s repeat, 30 percent of our population lives with this problem, let’s start by learning how to address these people.
