What are the reasons leading to obesity and how to tackle it successfully? – an interview with Dr. Maya Hristosova – endocrinologist at Vita Hospital.

- Dr. Hristosova, what constitutes obesity?
Obesity is a chronical condition, in which there is an increased accumulation of fat in the body of the patient. It’s a metabolic disease with an epidemic character and is one of the leading causes for death worldwide, due to all of the accompanying diseases and complications.

- What are the main causes that lead to obesity?
The causes are many and diverse, for most people it’s a combination of multiple factors that contribute to the person being overweight or obese – overeating, low or none physical activity, genetic and physiological factors, infractions in the hypothalamus that respond to the sense of satiety. Sometimes psychological factors lead to stress and overeating is a coping mechanism to deal with it.

- How do you determine the degree of obesity?
There are different degrees to obesity:

* According to the Body Mass Index:
- from 30 to 35 kg/m2 is first degree of obesity,
- from 35 to 40 kg/m2 is the second degree of obesity, and
-  over 40 kg/m2 is  the third degree.
From 25 to 30 kg/m2 it is accepted as overweight, and from 18.5 to 25 kg/m2  - as normal weight.

* There are various types of obesity depending on  the reasons:

This is the most common case of obesity and comes as a consequences to a genetic predisposition for gaining weight, as the result of overeating and low physical exercise.

Obesity, caused by an endocrinological or other disease, leading to a decreased functionality of the thyroid, gonads, reduced reproduction of the growth hormone (GH), insulin resistance and etc.

Obesity syndrome:
This type of obesity occurs within various generic syndromes like Prader-Willi syndrome, Angleman’s syndrome, etc. It is discovered in early childhood and is related to a number of malformations – neurological, renal, ophthalmic, etc.

* Obesity is defined also as hyperplastic and hypertrophic one:
Hypertrophic obesity is characterized by increased volume of adipose cells.
Most often it develops in adults and depends on external factors like intake of calories and physical inactivity. Usually it is not severe by degree.

Hyperplastic obesity is typically related to an increase of the quantity and size of fat tissue. This type of obesity is most distinguishable in early childhood. The genetic predisposition of the mother and subsequently her fetus in combination with an unstable diet and eating in surplus, lead to the enlargement of the fat tissues of the fetus, which cannot be broken down, creating the constant feeling of appetite, thus creating a vicious cycle.

* According to its clinical symptoms, obesity may be:
Gynoid obesity or also known as pear-type obesity. It is characterized, with the accumulation of fat around the waist and hips, causing a variety of mechanical problems for the patient, such as arthrosis and varicosis. Sadly this type of obesity is hypertrophic in nature and doesn’t respond effectively to treatment.

Android obesity – or also known as apple-type obesity or central obesity. It is characterized, with the accumulation of fat tissues over the waist and around all of the vital internal organs of the patient. It is often associated with an increased risk of metabolic syndrome – type 2 diabetes, arterial hypertension, dyslipidemia, hyperuricemia.  In its nature it is hypertrophic obesity and with a suitable diet and physical activity it yields to medical treatment.

Obesity nowadays is typically incorrectly depicted as an aesthetic issue, but it is important to make lucid, that obesity bears a number of health risks with it. People with obesity suffer more often from type 2 diabetes, arterial hypertension, dyslipidemia, some types of carcinoma, gall bladder diseases, obstructive sleep apnea, disturbed fertility, strokes, psycho-sociological problems etc. In the midst of this ongoing pandemic patients with obesity are also at risk of a severe course of the virus.
Most of the diseases common to patients with obesity are chronic ones and they necessitate long-term treatment and often lead to irreversible consequences. Therefore it is necessary to diagnose and start treatment for obesity to start as early as possible, prior to the development of some of its complications.

- How do you diagnose obesity?
Firstly, we look at the patient’s medical record so far, in order to determine if there is a genetic predisposition to his condition, as well as any accompanying diseases or eating disorders. Then based on his BMI as well as his day to day routine we determine his condition.

In order for us to intervene meaningfully, we take the patients opinion into consideration. What does he hope to achieve and what could get in the way of his goal.

The physical examination includes the calculation of BMI, measurements of height and body weight, measurement of arterial pressure. Laboratory tests and examinations are carried out like lipid profile, blood sugar at fasting or glucose tolerance test and IRI, hormonal tests, etc., depending on the patient.

- How do you treat obesity at Vita Hospital?
Obesity as a status with many health consequences is necessary to be monitored and treated by multidisciplinary team, including GP, endocrinologists, psychotherapists, nutritionists, surgeons with specialty in bariatric surgery, gastroenterologists, cardiologists, psychologist, etc.

In my opinion the patient is the most important piece of this big team. Without his/hers active participation, motivation and engagement to the cause, even the best therapy will not achieve long-term results. Therefore the aims, placed before each unit of the team, are individualized to deal with the peculiarities of every individual patient and his/hers accompanying diseases.
Predominantly the goal is to reduce the health risk, i.e. namely the accompanying diseases are to be treated. The aims of the team should be focused on the long-term and they should be realistic. Namely – the idea is not only to reduce the body weight, but also the patient to establish the necessary healthy nutrition and motor habits, which are to be preserved till the end of his/her life so that he/she can remain as healthy as possible.

Obesity treatment methods are:
* Suitable dietary regimen;
* Appropriate physical activity;
* Drug therapy;
* Bariatric surgery.

All of these stages of treatment of obesity are relevant to a different degree to every individual patient. Our multidisciplinary team will devise a personal treatment plan for every separate patient, designed according to his condition and aiming to improve his health in the long-term and help him reach his goal. Sometimes the treatment of obesity can take months, but every time the end result, justifies the long wait – helping a patient lead a normal life and saving him from severe lesions.