Obesity is a disease condition in which the body mass index is 30 or higher. Obesity is the result of an imbalance between energy intake through food and energy expenditure of the individual. A common cause of this condition is overeating, i.e. intake of more energy than necessary for basic metabolism and motor activity. How to deal with it… Lieutenant Colonel Dr. Vessela Mikhneva, part of the team of the Clinic of Endocrinology and Metabolic Diseases of the Military Medical Academy, spoke to FACTI.
- Dr. Mikhneva, how big a problem is overweight nowadays?
- In our country, over 45% of Bulgarians have a body mass index over 25 kg/m2, which is defined as overweight or obesity. Of these, approximately 23% have grade I obesity, 8-10% - with grade II, and 3% - with grade III or excessive obesity. According to research, 49% of people in Bulgaria have been overweight for more than 6 years, and 12% - over 20 years. If we talk about children - 200,000 are overweight, and 67,000 of them - with obesity. In the last 50 years, the number of people with obesity has tripled.
- Why is obesity a chronic condition? What happens in our body to make us start accumulating fat in our body?
- For years, we have been talking about many hormones that lead to appetite regulation, and this has been the basis of modern trends in understanding overweight and obesity. Adipose tissue is a hormonal organ, and therefore, when it quickly loses weight due to starvation, the adipose tissue has a “memory” and after stopping the diet, we have a new increase in body weight. This is precisely why a balanced lifestyle and diet are important, and not falling into extreme dieting regimes. Due to the complex regulation of appetite and multiple systems responsible for the metabolic systems in the human body, the development of morbid obesity leads to the onset of a chronic disease process.
- It is estimated that worldwide, about 1 billion. people suffer from obesity. Is this a new modern disease?
- 813 million people worldwide are obese, and
their number will reach 1.5 billion by 2035.
Almost 60% of adults in the EU and one in three school-age children are overweight or obese. For some countries, obesity may replace smoking as the main risk factor for cancer in the coming decades. Obesity is a complex multifactorial disease that represents excessive fat deposition and has a negative impact on health. It has increased dramatically in the last 50 years, leading to an unprecedented pandemic, with its incidence increasing by 100% since 1980. WHO epidemiological data from 2016 indicate that more than 1.9 billion people over 18 years old were overweight – 39% of the adult population. Of these, more than 650 million were obese (13%).
Obesity and overweight are the fifth leading risk for mortality, with at least 2.8 million people dying annually as a result of being overweight or obese.
44% of cases of diabetes mellitus, 23% of cases of ischemic heart disease and between 7 and 41% of cases of some cancers are associated with obesity. This is why obesity is defined as the new pandemic of the century.
- Overweight in children. Why are more and more children overweight. What is not being done at school and in the family to make it so?
- We are one of the world's leading countries in overweight and obesity in children. These problems begin in early childhood and we already have 10-12 year old children with type 2 diabetes, which until recently was considered adult-onset diabetes and is a consequence of insulin resistance and overweight. Of course, genes and family history also play a role when it comes to obesity, but immobility and lack of exercise in children, consumption of high-calorie food and fast food, combined with the lack of fresh vegetables and fruits in the diet, are the main factors in the development of overweight and obesity.
- Tell us more about the term “Longevity”…
- “Longevity” is a field of medicine that tells us how to live longer, but also healthily. Here, it is important not only to ensure a long life, but also to be active, healthy and able to work until a later age. How can the term “longevity“ or “health“ be defined?
The goal is:
1. Increasing individual life expectancy.
2. Long life without diseases.
3. Controlling and improving the distinctive signs of old age.
There are three main factors that influence “health“.
1. GENETIC - health is largely influenced by genes, 25% is due to genetic factors. Genes are responsible for maintaining telomeres (the ends of chromosomes), repairing DNA and protecting cells from oxidative stress.
2. ENVIRONMENT - the environment around us plays a critical role in our health. It has been proven that people who live at higher altitudes live longer. There are geographical areas – so-called “Blue Zones“, where people live longer and have a reduced risk of chronic diseases. These Zones are Okinawa (Japan), Ikaria (Greece); Sardinia (Italy); Loma Linda (California) and Nicoya (Costa Rica) and the new “blue zone“ - Singapore.
3. OBESITY AND LIFESTYLE - obesity is associated with reduced life expectancy. It has been known for many years that there are no obese long-livers. Also important are good sleep, a full social life and daily physical exercise or at least 10,000 steps a day.
- Obesity and genetic factors - is there a connection?
- Obesity is a complex disease that develops as a result of the interaction between environmental and genetic factors. Undoubtedly, lifestyle plays a fundamental role in its development - overeating and lack of physical activity. At the same time, various endocrine diseases are often identified as the root causes of weight gain - for example, the thyroid, adrenal or pituitary gland.
A serious problem with obesity is that about 65% of sufferers have a genetic predisposition that contributes to its development. A large group of genes influence this complex disease and ultimately make its treatment significantly more complicated and challenging. By 2023, mutations in over 189 genes have been identified that lead to the possibility of overweight and obesity. Of course, this is not the only reason and we are talking about the so-called “sleeping genes“ that wake up against the background of the life we lead. People should not be reassured that only genetic factors are the cause of overweight, but also various environmental factors that interact in a complex way are important, and so the incidence of this disease is increasing significantly worldwide.
- Why do people who live at higher altitudes live longer and do not suffer from obesity as much?
- According to German scientists, higher altitudes have a beneficial effect on people's weight loss. After staying in the mountains, volunteers have reduced weight, reduced their appetite, and blood pressure has improved significantly.
Scientists believe that weight loss is due to improved metabolism and reduced calorie intake.
Loss of appetite is very typical for people who are not used to high altitudes.
- What is the factor of food? What can we do to be in better shape?
- Especially in developed countries, there is an oversatisfaction with various high-calorie foods and drinks. Separately, high-calorie food often appears “tastier“ - such are fried, breaded and sweet products, which “seduce“ the human eye. In addition, children today often sit in front of computers and eat mainly chips and “fast food“. People in the office do not have time to eat and eat fast, harmful and high-calorie food. The oversatisfaction with high-calorie food on our continent increases the risk of obesity and cardiovascular diseases.
The kitchen may be the key to a better life.
Many studies have linked evidence that consumption of fruits and vegetables reduces the risk of metabolic syndrome, obesity, cancer, cardiovascular disease, and brain disorders. This protective role of plant foods may be related to the antioxidants found in them - including polyphenols, carotenoids, folates, vitamin C, and others.