Obesity is an excessive accumulation of fat in adipose tissue that leads to weight gain and morphotype changes with the appearance of metabolic and mechanical complications.
The Body Mass Index (BMI), which is the result of dividing weight in kilograms by height in meters squared, is currently used to assess overweight and the different degrees of obesity. A normal BMI ranges from 18.5 to 24.9. Grade I overweight is between 25 and 26.9; grade II overweight is between 27 and 29.9. Grade I obesity is between 30 and 34.9; grade II obesity between 35 and 39.9 and grade III or morbid obesity between 40 and 49.9. Lastly, superobesity is considered to be over 50.
Regarding the metabolic complications caused by obesity, the most frequent are type 2 diabetes mellitus, dyslipidemia and arterial hypertension. Of the mechanical complications, osteoarthritis and venous insufficiency are the ones to be taken most into account.
The influence of hormones on obesity
Hormonal alterations are frequent and multiple, and in turn can be a cause or a consequence. Obesity can be primary or secondary. Primary obesity is the consequence of genetic mutations that induce obesity associated with environmental alterations, especially sedentary lifestyles. Secondary obesity can be due to hormonal alterations such as excess of corticoids, androgenic hormones, insulin, lack of thyroid hormones, hypogonadism, empty sella, etc., among others.
Therefore, the act of the Endocrinology specialist before an obese patient begins with a thorough clinical history that helps to know what type of obesity the patient is facing, if he/she needs complementary explorations and of what type.
It can often be observed that obese patients go to clinics where, not being supported by an endocrinologist, the existence of this pathology, which can be the cause of obesity, is unknown.
Treatment for obesity
It should be assumed that there is no treatment that is 100% recommendable and/or effective. It depends on the degree of obesity and the clinical phenomena surrounding the obese person. Thus, for morbid obesity, nowadays bariatric surgery is recommended as a first step, and within this, the gastric BY PASS.
However, if a person does not want to undergo surgery, it is possible to resort to a treatment with very low calorie diets, which is what used to be called protein fasting. These people will ingest between 600 and 800 calories a day, but not with typical foods, but with synthetic diets that offer the proteins, vitamins and minerals that the body needs daily. It is advisable that the patient spends one month with these diets, then 15 days with a 1200 calorie “typically” hypocaloric balanced diet, to repeat this cycle as many times as necessary. With this treatment some patients have lost 100 kg in approximately 1 year.
Balanced hypocaloric diets are still as useful as they were 40 years ago and a loss of 3 or 4 kilos per month means an average loss of 30 kg per year. Anyone who loses 30 kg has either solved their problem or improved it quite drastically. It should be remembered that a 10% weight loss is a great improvement at all levels.
The ideal drug to treat obesity would be the one that calms the appetite, which is the main problem, and does not induce side effects. All of the above should be accompanied by an increase in physical exercise; walking for half an hour to an hour a day may be sufficient, since we must seek, more than energy consumption (which with exercise is much lower than one might think), to promote changes in pathophysiological alterations in the obese, such as insulin resistance and its corresponding poor tolerance of sugars, all of which improves with weight loss.
Treating appetite and satiety
What suppresses appetite the most is bariatric surgery, the loss of a stomach hormone, ghrelin, is its cause. With the diet it is important to eat the total calories in 5 times, as well as to have a water intake of 2 to 3 liters per day. Also chew well what you eat and do it slowly.
Recently a drug has been marketed in Spain which is a mixture of two other drugs in an extended release form. Both substances are approved by the American FDA and the European Medicines Agency. But it has its contraindications and side effects. It must be strictly used by an expert physician, an endocrinologist. Its most common adverse reactions are: nausea or vomiting, constipation or diarrhea, headache, dizziness, insomnia and dry mouth.
Obesity treatment results and follow-up
The first days of starting an obesity treatment are hard for the patient, but more psychically than physically. The need to eat or “snack” can become unbearable in some people, so the physician must explain to the patient what he/she is going to notice and the benefits he/she is going to obtain.
The doctor must provide the means and teach how to use them, although it must be the patient who uses them. It is like when one quits smoking, the first 15 or 20 days are the worst, after that, things start to improve. In this phase the doctor must stimulate the patient and show him that his effort is being useful.
For the woman the best reward is, in general, to lose a few sizes; the man is looking more for the acquisition of a new energy that will help him in his day to day life. But both get a lot of benefits in the functioning of their bodies.