Medicosnext
When I was in Florida, U.S.A., some years ago, I was appalled to see hordes of really fat people, which prompted me to write an article on the subject, some lines of which go like this: “After a months’ stay here, I have come to the conclusion that in proportion to what Americans earn, costs, especially those to do with basic necessities, aren’t really all that bad…No wonder the locals seem to be so well fed. Well fed? Well-fed indeed, and grossly overweight in most cases. My first visit to a Wal-Mart Supercenter I’ll always remember as a grand spectacle of America’s heaviest…There is a rapid evolution in progress here. Truly, people are evolving into whale-like beings…surgery to cut out one’s intestines (bariatric surgery) to stop oneself from eating more is the new fad around here.”
Bariatric surgery, which includes gastric bypass and other weight-loss surgeries (sleeve gastrectomy, adjustable gastric banding), makes changes to the digestive system to help one lose weight. Desperate measures, no doubt, for desperate people, because unlike for other ailments, one cannot just rest and recuperate and get better. It is a fact that obesity is a disease like any other plaguing the human race, and it’s on a global scale. A common refrain is that it is a disease of rich countries, but that is not really the case. According to WHO, overweight and obesity are on the rise in low- and middle-income countries, especially in urban areas. In 2019, almost half of the children under five who were overweight or obese lived in Asia.
Liposuction is another surgical procedure that uses a suction technique to remove fat from specific areas, such as the abdomen, hips, thighs, buttocks, arms, or neck. However, liposuction is generally not considered to be an overall weight-loss method. For those with a body mass index (BMI) between 25 and 29, liposuction may be of use, but those with BMI between 30 and 34 or above (morbidly obese) should understand that there is a limit on how much fat can be removed. (BMI, (weight in kilograms divided by the square of height in meters) is a simple way to classify overweight and obesity in adults. Overweight is a BMI greater than or equal to 25; and obesity is a BMI greater than or equal to 30)
In most cases, surgical intervention is the last resort, in case other methods to shed those unwanted kilos are to no avail. Which, actually, is generally the case in many instances. Why is it so hard to lose weight? In his book, Burn: The Misunderstood Science of Metabolism, evolutionary biologist Herman Pontzer writes about a study he did of a very active Tanzanian tribe with a hunter-gatherer lifestyle. He was surprised to find that they did not spend a greater amount of energy than that spent by an average American in a week. It seems that no matter the lifestyle, our bodies seem to maintain daily energy expenditure within set limits. This means that there’s not much that can be done to change the amount of calories we burn.
This new understanding of metabolism has been supported by a number of other studies, and it has great implications on how the growing obesity epidemic is tackled. Pontzer writes that if a typical 150 lb adult walks 10,000 steps daily, he will burn only about 250 kcal (a large hamburger contains double that amount). In the same way, climbing one flight of stairs burns only about 3.5 kcal. He states that while exercise is good for all-round health and well-being, it won’t make you thinner, and says, “Just don’t expect any meaningful weight change in the long term from exercise alone.” However, exercise does help, and experts are of the view that high-intensity workouts that result in heavier breathing and increase the heart rate is the quickest way to increase metabolism and reduce fat.
Pontzer concludes that diet seems to be the culprit for obesity, and that eating a diet that doesn’t have processed foods is the main reason why the above-mentioned Tanzanians stay thin. People tend to consume larger quantities of unhealthy food because, as such, they provide less nourishment. Stress also influences eating habits, so reducing stress could help control the tendency to overeat. This is of course a big call, since stress can be emotional, psychological, or physical, and a routine part of the modern lifestyle.
Weight gain has also been linked to alterations in gut bacteria due to antibiotic use, with some researchers postulating that changes to gut bacteria composition could increase insulin resistance, inflammation, and fat storage, thereby resulting in overweight and obesity. One study suggests that probiotics, which are present naturally in some foods, besides being available as supplements, may be a potential treatment for overweight and obesity. A 2019 meta-analysis of about 6.000 participants found reductions in body fat, waist circumference, and BMI in those who had probiotic treatment, and other studies have found that weight gain could be controlled through the use of probiotics.
A study in Australia, where 75 percent of men and 60 percent of women are overweight or obese, suggests that two in five thyroid cancers in men, and one in 10 thyroid cancers in women, are attributable to overweight or obesity. In the U.S.A., where 40 percent of Americans are overweight or obese, scientists at the University of Virginia have identified 14 genes that can cause obesity, as well as three that can prevent it. This finding may makes clearer the intricate connection between obesity, diet, and an individual’s DNA. In another recent study in the U.S., researchers have developed a specific gene silencing therapy against a fatty acid metabolism gene using CRISPR technology. In their study, mice were given a high-fat diet leading to obesity and insulin resistance, and after six weeks of treatment, a 20% reduction of body weight and improved insulin resistance was seen.
Currently, the US FDA has approved five weight-management drugs for long-term use, namely, orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, and semaglutide. It has also approved some weight management medications that curb appetite, namely, diethylpropion, phendimetrazine, benzphetamine, and phentermine, for short-term use (8-12 weeks). Most of these drugs work by decreasing appetite and/or increasing feelings of fullness. Orlistat, however, works by interfering with absorption of fat, while both liraglutide and semaglutide are anti-diabetics that mimic the glucagon-like peptide-1hormone, which targets areas of the brain regulating appetite and food intake.
Semaglutide is the newest drug to be approved for obesity. A 2019 double-blind trial involving 1,961 adults with a BMI of 30 or higher found it to have “unprecedented results” for patients with obesity, with the semaglutide group losing more than 2% of body weight in the first four weeks, and with weight loss continuing throughout the 68-week trial period. Novo Nordisk’s semaglutide (Wegovy) was approved this year for chronic weight management in obese/overweight adults with at least one weight-related condition, such as type 2 diabetes, high blood pressure, or high cholesterol. It is given percutaneously at a dose of 2.4 mg once weekly, unlike liraglutide, which has to be injected daily.
Obesity has nearly tripled since 1975 and has reached epidemic proportions in many countries. OECD (Organization for Economic Cooperation and Development) data shows that 60% of adults were overweight or obese, on average, across 20 developed countries in 2019, with men more likely than women to be overweight or obese. But, like mentioned before, the problem is not limited to only rich nations, with 20 percent of adults in every country in the world now thought to be overweight or obese. It is well known that obesity is a high-risk factor for developing diseases like diabetes, heart failure, strokes, and certain types of cancer. Now, a study has found that if obese people contract COVID-19, they are twice as likely to be hospitalized as those of healthy weight, 78 percent more likely to be admitted to intensive care, and 50 percent more likely to die. Considering all this, it is to be expected that a lot of research is going on all over the world to find better cures for what is now, undoubtedly, a global pandemic.
