Obesity and by extension overweight are a hot topic. Not a day goes by without it being discussed in the press or social media, but also in conversations among ourselves. About 50% of Belgians are overweight and as much as 20% obese if we define it by BMI. A few years ago, the Obesity Clinic AZ Groeninge was born: a group of enthusiastic doctors, paramedics and nurses who share a common mission.
After all, besides caring for the patient, our task is to change the way obesity/overweight is perceived. Still too often, patients are blamed as the ‘culprit’ for their condition. People even often talk about wrong life choices those people would make.
As an endocrinologist, I have been treating patients with diabetes for more than 20 years, together with a wonderful team. In the group of type 2 diabetes patients, obesity is very often present. For years, I myself have succumbed to the traditional and well-meaning advice: ‘eat less and move more’. Too often, however, I saw patients who did not succeed in this battle and became despondent after years of fruitless attempts and passages to various healthcare providers. Personally, my views around this issue have changed over the years through discussions with our obesity surgeon but also through the effects we saw from GLP-1 analogues first in diabetes patients and later in the treatment of obesity.
Meanwhile, it has become clear to me: Obesity is an illness, a chronic disease. In other words, in people suffering from it, something is going wrong. Science and knowledge about this is increasing exponentially in recent years and more and more
explanations are emerging: Our weight is determined by neurohormonal signals that are either orexigenic (make us eat) or anorexic (make us eat less). The cooperation between these signals determines whether people gain weight. Humans are one of the most successful ‘species’ in evolution and thus need to guard against shortages in energy supply (e.g. in famines or wars). Those that can stockpile energy better are better armed against shortages and will eventually be thrive. We know that as soon as someone reaches a higher weight, the body will do anything (use less energy, be more hungry, absorb more, have less satiety) to maintain this higher weight. This phenomenon even has a name : the ponderostat. This explains why losing weight can be so difficult once you reach a certain weight. In obese people, therefore, this ponderostat is slightly higher and they strive for a higher weight.
It is clear: Obesity is a biological phenomenon, so there is absolutely no point in making people feel guilty about it. Guilt will lead to shame after which patients feel even worse and often dare not seek further help for their problem. The advice :‘ eat less’ can often lead to frustration among patients because that is precisely what they are unable to do.
Unfortunately, this realisation has not yet dawned on many healthcare providers, let alone the government. It is our job as Obesity Clinic to keep emphasising this. I would therefore like to refer to the work of the BASO (Belgian Association of the Study of Obesity) and the BESOMS (Belgian Section of Obesity and Metabolic Surgery). Both associations try to spread this message to healthcare providers but also to the government. In light of this, a very nice podcast series was published highlighting this story : The Big Truth Podcast - The Belgian Association for the Study of Obesity (easo.org)
Gerd Vanhaverbeke
Endocrinologist AZ Groeninge
Member of the Obesity Clinic AZ Groeninge
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