The well-known slope of January this year – in terms of shedding kilos – joined the challenge of facing the third wave of the pandemic. The reason is threefold: obesity increases the probability of being infected by Covid-19 by almost 50%, doubles the probability of being admitted to a hospital and increases mortality by 48%. With these data, it seems indisputable that it has never been more necessary than now to protect yourself and return to a healthy weight.
The serious thing about it is that the number of obese people in the world has increased from about 100 million in 1975 to 700 million today. As we tell in the book «WHAT DO YOU EAT? Science and conscience to resist »(Planet, 2020), the coronavirus pandemic will go down in history, but it will disappear; obesity seems to be here to stay.
The best evaluation of the damage that excess weight does is provided by the “Global Burden of Disease” (GBD-2017). In this study, they assessed 68.5 million children and adults in 195 countries between 1980 and 2015, and quantified the burden of disease related to a high body mass index (BMI). They concluded that nothing less than 4 million deaths annually in the world were due to high BMI.
Although the BMI is not a perfect indicator, since it can rise in people with a lot of muscle mass, it is the most used and practical. It is calculated by dividing the weight (in kilos) by the height (in meters) squared. Thus, a person who weighs 80 kg and measures 1.70 m will have a BMI of 27.68 (because 80 divided by 1.7 squared is equal to 27.68).
Ideally, your BMI should be around 22. Overweight is defined as a BMI greater than 25 and obesity, 30. In the GBD-2017 study, almost 40% of excess deaths occurred in people who were overweight or obese.
We could continue for decades talking about genes and molecules – looking for the culprits of obesity – while realizing how badly the most basic prevention and public health actions are being exercised. The paradox is that no other country has investigated as much in these genes and molecules as in the US, which is where morbid obesity rates rise the most. One in 12 Americans is already a candidate for bariatric surgery – popularly known as “stomach reduction.”
Do not be fooled by blaming genes and molecules. The branch cannot cover the forest. What you have to do is eat less (the message that no food industry cares). It takes willpower. Endeavor. Free decision. Control. But this seems increasingly difficult in a culture dominated by atrocious materialism and where citizens are little more than minions or puppets in the hands of powerful business interests of those big corporations that sell junk food and drink.
The challenge of overcoming obesity is not only physiological, but also psychological and cultural. A consumerist and hedonistic culture leaves the citizen defenseless and encourages obesogenic behaviors. Perhaps decision, courage and radicalism are lacking to confront a deep cultural deficit at its roots.
Obviously we are referring to situations in which obesity is not a consequence of an organic pathology (eg a hypothalamic disorder) or a psychiatric illness (eg bulimia nervosa or binge eating disorder). Here it is not only the exercise of the will, but it will be necessary to remedy the disease to solve obesity.
Another exception is when there are depressive disorders, and above all, anxiety disorders, which lead to overeating or even binge eating that leads to a state of obesity. In these cases, the resolution of anxiety will be the only way to tackle obesity. Obviously, these are situations that explain only a small percentage of cases obesity.
Report without stigmatizing
But to say that in the 21st century Homo sapiens has stopped feeding wisely and that excesses are paid for, could be interpreted as an exercise in cruelty equivalent to blaming the victims. Are obese people being stigmatized by telling them that shedding that excess weight belongs to their free will? Stigma is harmful. It can create a vicious cycle by increasing anxiety and depression, which in turn may be accompanied by bingeing.
Stigma must be distinguished – which would be any derogatory, derogatory or incriminating representation or comment – from the right to be able to tell the scientific truth. Fear of stigma cannot be invoked to silence scientifically proven truth. You can always tell the truth with respect, empathy, and affection. Nutrition education could not be done if it was not admitted that human beings are free and that we have the reins of our conduct in our will.
It is necessary to confront economic, social and cultural determinants that have created obesogenic environments. Sure. Not everything is education to change personal behaviors. But not everything is structure and economism either. It is necessary to act at both levels (personal education and social advocacy action). Always with respect, tact, empathy, synergy and providing the appropriate psychological support.
Miguel A. Martínez González. Professor of Public Health, University of Navarra.
Francisca Lahortiga Ramos. Clinical Consultant, University of Navarra.
This article was originally published on The Converstion.See them