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And a Disease Called… Obesity

Obesity brings on it’s wings health and psychological disorders as well as serious diseases, and  in itself  can be defined as a disease. With all the severe results of the phenomenon of obesity, the medical professional cannot save the day and cannot be the only address for resolving the problem. "There are solutions, but their implementation requires an overall commitment from  the authorities, food industry, advertisers, Medical Association and by us ourselves”.

Obesity is one of the most significant medical problems of the Western world, which modern medicine has been unable to resolve successfully. There is no doubt that obesity causes, one way or another, a significant decrease in quality of life, whether indirectly by contributing to development of diabetes, hypertension and high blood fats and directly by pulmonary morbidity (such as sleep apnea), it also often leads to various surgical interventions, side effects of slimming drugs and eventual social difficulties and negative psychological effect.

But is obesity a disease in itself or just a risk factor that allows the emergence of diseases, among others, increased morbidity and mortality from the cardiovascular disease? In my opinion, the answer is unequivocally yes! Even without the presence of other risk factors, the obese people not only more prone to the cardiovascular disease, but obesity allows diseases that almost did not exist, at least not in the same severity.

Diabetes Type II

As opposed to juvenile diabetes (Type I), which is not dependent on obesity, more than 85% of cases of adult diabetes (Type II) are directly dependent on significant increase in weight. Diabetes is perhaps the most significant cause of cardiovascular disease - myocardial infarction, angina, peripheral blood vessel disease of the limbs and kidney failure up to dialysis. Furthermore the morbidity and mortality are caused directly as a result of the Invasive activities frequently performed to these patients such as catheterization, open heart surgery, blood vessel surgery, infection following multiple hospitalizations and more. And important to note that diabetes is the most common cause of blindness in older age.

The sad fact is that existing drugs and treatments are not effective enough in reducing high morbidity associated with diabetes. On the other hand, a significant reduction in weight up to the "ideal" weight (and no less than that), can regulate the basic metabolic disturbance of diabetes.

Hypertension

High blood pressure is a phenomenon that exists in 75% of the adult population in the Western world. Blood pressure values are up gradually over the years. Optimum balance of high blood pressure reduces the chances of heart attack, kidney failure, a disease of the arteries in the limbs and especially the chances of stroke of tens of percent.

The high blood pressure of obese patients who have not lost weight, was unchanged or even increased in spite of the drug treatment that they received, whereas blood pressure values of the patients who reduced their weight over 10% were significantly lower in percentage terms. The mechanism responsible for these changes in blood pressure as a result of weight loss is not completely clear. One explanation is that the change in diet toward reduction of the consumption of flours and sugars, the process food with high salt content and at the same time physical activity, often accompanied by changes in lifestyle, is responsible for a decrease in blood pressure.

Blood fats

High blood fats and especially high "bad" cholesterol (LDL), constitute a significant risk factor for myocardial infarction and stroke. High blood fats mostly associated with familial tendency. Decreasing the values to about 70 mg/dl significantly reduces the chances of a first heart attack (primary prevention) or repeat heart attack (secondary prevention).
Many studies also proved the withdrawal of coronary sclerosis after aggressive drug treatment that reduces the LDL values. The effect of weight loss on the bad cholesterol is small and restricted, mainly on the very obese patients, whose diet is based on fatty foods. On the other hand weight reduction causes very significant decrease in the amount of triglycerides whose contribution to cardiovascular disease is also important. Moreover, it has been observed welcome increase in "good" cholesterol (HDL) after weight loss.

Belly obesity

Accumulating fat around the abdominal internal organs and not just in the sub skin tissues is the source of the belly obesity. This situation is typical in patients with "metabolic syndrome" (see below). Belly pathological obesity is defined by waist circumference: men value stands at 102 cm and for women 88 cm and also by the ratio of waist circumference to the belly circumference. The belly being wider than the waist is pathological. It is important to note that this ratio is a risk factor even in people that don’t have high weight.

Metabolic syndrome

Metabolic syndrome is a condition in which a number of risk factors exist in the same person and together they constitute a greater risk factor than all diseases. This is a very common phenomenon. Metabolic syndrome present in a quarter of the U.S. population. Components of metabolic syndrome include:

  • diabetes or "tendency" for diabetes 
  • Insulin resistance 
  • Hypertension 
  • Belly obesity 
  • high blood fats, and particular high triglycerides and "good" cholesterol (HDL) low

Not only medicine

During the past two decades, enormous efforts were invested in the treatment of risk factors, such as different medications reducing blood pressure and cholesterol, for diabetes balance and slimming drugs. This occurred together with a flood of personal programs for weight loss, marking products and other different inventions. Everything to reduce the frequency of vascular disease - the final product which these risk factors are leading to.

Although there were some successes, the general view is that the obesity problem seems to be getting worse simultaneously with diabetes and cardiovascular disease. Admittedly here, modern medicine with variety of treatments that it offers, is not able to provide a complete solution.

It seems, therefore, the main contribution to epidemiological changes that may be will reduce obesity, as well as other risk factors, can not be achieved just with the help of modern medicine alone. Medicine in its current form knows pretty well how to handle the complications of the disease that sometimes appears decades after it began to cause cumulative damage to blood vessels. Thus, we have noted the importance of primary prevention and prevention of obesity altogether . Work should be done by us ourselves, the population, various health authorities and government authorities.

There is no doubt in my mind the great change can occur only by a radical change in the quality and the quantity of food. There are solutions, at least on paper, but implementation must be maintained for a general overall commitment of the authorities through laws and regulations, food industry, advertisers, Medical Association and the population itself that needs to "vote with their feet" in favor of the higher quality food.

Am I optimistic that all of these will occur as soon as possible? Unfortunately not.

Dr. Ilan Kitzis / Healthy to  Know Magazine

A senior cardiologist at Ichilov Hospital, Chairman of the Department of Clinical Cardiology Heart Association community. Program manager for "large" for weight loss.

(Translation by Dr. Izabella Zevin)

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