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Obesity: a growing and life threatening burden

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Obesity has become a pandemic owing to an obesogenic environment.

According to the World Health Organisation, Obesity is a chronic relapsing disease that needs lifelong treatment. In 2016, more than 1.9 billion adults aged 18 years and older (39 per cent) were overweight. Of these over 650 million adults (13 per cent) were obese. World Obesity Federation, predicts that one billion people globally, including 1 in 5 women and 1 in 7 men, will be living with obesity by 2030.

“Being overweight and obesity are major risk factors for a number of chronic diseases, including cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide. Being overweight can also lead to diabetes and its associated conditions, including blindness, limb amputations, and the need for dialysis. Rates of diabetes have quadrupled since around the world since 1980. Carrying excess weight can lead to musculoskeletal disorders including osteoarthritis. Obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon. The risk of these noncommunicable diseases increases even when a person is only slightly overweight and grows more serious as the body mass index (BMI) climbs,” according to WHO.

Obesity and being overweight has a major impact on Quality of life (QOL). Weight loss causes a significant improvement in different domains of QOL such as physical, psychological, social, and sexual. Recently an international consortium (SQOT) validated these patient related outcome measurements (PROMs) for clinical and research purposes.

According to WHO, over 4 million people dying each year as a result of being overweight or obese in 2017 according to the global burden of disease.

As many chronic diseases are somehow perceived as having an external cause – and we feel compassion for the people suffering from it - for obesity it’s different. People living with obesity and those around them, including medical professionals, quite often assume it’s their own fault, and being overweight or obese is due to a lack of willpower and poor lifestyle choices.

However, obesity is much more complex. Of course, initial weight gain originates from a disbalance between energy intake and energy expenditure, but here ends most of the individual’s influence.

For example, we all know of those who can consume large volumes of food, without gaining weight while others struggle with quick weight gain even though they consume normal or even less amounts of food. We don’t have all the answers, but metabolism plays a big role, and the way we respond to food and energy intake - differs per individual, stage of life and age.

Next there is genetic predisposition accounting for approximately 70 per cent of our phenotype, and what about our obesogenic environment? Walking in a mall or supermarket is extremely difficult without being attracted by fast food, sweets, or unhealthy snacks. Most of our food is processed which does not help either. Our daily exercise is also reduced due to ongoing automation and digitalisation. Unfortunately, our bodies are programmed to fight starvation so that explains why diets are not successful on the long term and patient regain weight after initial and limited weight loss.

Two main approaches are needed to stop this obesity pandemic. First being prevention and second treatment of current cases. All stakeholders – Governments, healthcare professionals and educators, payers like insurance companies and patients are responsible. In the last few years prevention is slowly picking up by governments in the form of sugar taxes and developing and implementing lifestyle interventions at schools and communities. However, in many areas Obesity is still considered as a cosmetic condition and treatment is not covered by insurance companies.

The definition of being overweight is a body mass index (BMI) between 25 and 30 kg/m2 and for Obesity a BMI more than 30 kg/m2. In general, treatment is based on the BMI criteria and occurrence of co-morbidities. For a BMI between 27 and 35 medical treatment or endoscopic procedures (i.e. gastric balloon or gastric plication) will be advised. For surgical treatment a BMI more than 40 or a BMI between 35 and 40 in combination with one or more co-morbidities is advised.

It is crucial that treatment of Overweight and Obese patients occurs in a multidisciplinary setting of doctors, dieticians and coaches experienced in the treatment of Overweight/Obesity and its related diseases. There are very clear international guidelines for treatment of overweight and Obesity jointly developed and endorsed by surgeons and non-surgeons, like endocrinologists, cardiologists and diabetologists, and these guidelines are adopted by many national governments, payers and professional societies. Only in the right multidisciplinary setting with the right lifestyle support this pandemic can be turned around, saving the lives of many people and for many more significantly improving quality of life.

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