Obese people don’t need to become thin to be healthier – 04/26/2022

It is the case that we ask ourselves: since when should the treatment of obesity pursue the objective of becoming thin in the name of health? Have you ever stopped to think if this makes sense?

That, however, is everyone’s fixed idea, to launch into a hard-fought competition to win the trophy of a normal BMI (body mass index). Just a warning: among individuals who accumulate a lot of body fat, few make it. And looking at the ones that eventually arrive, many lose this trophy soon after.

The biggest adversary is inside the head, in the brain region of the hypothalamus, which uses some tricks for you to recover all the energy reserve you once had. Read, fat.

Thanks to the commands and abuses of a nonconformist hypothalamus, appetite will increase – and, I’m sorry, it won’t adapt over time – while metabolism will become slow as a turtle so that the calories from meals stay left over and can be stored back in the fat cells, or adipocytes.

Losing weight is really a struggle, anyone who has tried to face it knows that. And yet, because of this almost cowardly physiological strategy, she seems like a piece of cake next to the battle that follows: maintaining that weight, even if it seems only slightly less than in the past.

Holding the scales lower than before is what represents a big win for health — and not necessarily achieving a lean BMI. This concept is now enhanced by a brand new proposal for the classification of obesity, jointly launched by Abeso (Brazilian Association for the Study of Obesity and Metabolic Syndrome) and SBEM (Brazilian Society of Endocrinology and Metabology).

“It is based on the person’s weight trajectory. That is, we first ask what the maximum weight she has reached at some point in her life. And, according to how much she has lost since then, we calculate the percentage that this loss would be in relation to to the maximum weight value”, summarizes endocrinologist Bruno Halpern, newly appointed member of the WOF Clinical Treatment Committee (World Obesity Federation).

It was he who conceived and coordinated the work of the new proposal, which, in the end, points out who has reduced obesity and who has controlled obesity, two concepts that we should have in mind instead of mania — sometimes forced and not healthy — of thinness.

Modest losses already make a difference

It doesn’t take much. So you don’t have to be thin to be healthy. Some studies claim that when someone who is obese loses only 3% of their initial weight, improvements in blood glucose and fertility are already observed. Not to mention a slight increase in the defense response to infections, such as covid-19.

But many of the guidelines out there only recognize the existence of clinical benefits if weight loss is 5% or more. There, in fact, you can already see welcome changes in cholesterol levels and relief from symptoms such as joint pain, which are caused by overloading the body.

If the person manages to lose even more pounds, or 7% of the initial weight, the probability of developing type 2 diabetes drops. Above 10% loss, then, the liver is grateful. That’s because he also gets less fat. At this level, in fact, above 10%, there is still an average decrease of 21% in the risk of cardiovascular diseases.

Just note that the new classification is not based on the initial weight — that of the moment you decide to undergo a weight loss treatment — but on the highest weight achieved over a lifetime.

Halpern’s justification for this is as follows: “It’s to this weight that your hypothalamus will do everything to get you back. So there’s a central piece of information in this whole story. I always repeat that if you go to a doctor trying to lose weight and the doctor doesn’t ask what was the maximum weight he’s ever had in his life, change health professionals, because he doesn’t understand much about obesity treatment”.

So what was the heaviest weight you ever had in your life?

When answering, in the case of women, it is not worth remembering the period of pregnancy, when the scales hit records. Not even from the stage of breastfeeding the baby.

“Just as, for anyone, acute situations are not valid, such as those who gained weight during the holidays, but lost weight when returning to their routine, or those who were hospitalized in an ICU and left there weighing a lot, even because of retention. of liquid”, exemplifies the endocrinologist.

By the criterion of the new classification, the highest weight to be registered is the one that was maintained for at least three months, without the presence of extraordinary factors, such as those mentioned above.

Then comes the question: “But, doctor, I only weighed that many kilos for about twenty years, does that count?”, Halpern never tires of hearing. And, at those times, he argues that it doesn’t matter the interval from there to here. He counts, yes.

How is the new classification

For people with a BMI between 30 and 39.9 kilograms per square meter, a 5% to 10% decrease from their maximum lifetime weight would indicate reduced obesity. Less than that? An unaltered obesity.

As an example, imagine a woman who now weighs 95 kilos, but once weighed 100 kilos. By sustaining a loss of 5 pounds, which is 5% of those 100, she can say that she falls under the classification of reduced obesity.

If she had 89 kilos, the difference would be 11% in relation to the 100 kilos she once weighed. In this case, as the loss would exceed 10%, its classification would be controlled obesity.

“For someone who has a BMI result of 40 or more, that changes a little,” explains Halpern. “Hence, you have to have a loss greater than 10% to classify as someone with reduced obesity and greater than 15% to be considered an individual with controlled obesity.”

There’s more: in principle, all this is only for those who are between 18 and 65 years old and have undergone clinical treatment to lose weight, whether based on lifestyle changes exclusively or with the help of medication.

“This classification of obesity does not work for those who underwent bariatric surgery, because there the weight loss is greater”, explains Halpern. “Just as it was not designed for adolescents who are in the growth phase, nor for the elderly who may have a decrease in lean mass due to age, which interferes in the analysis of weight.”

Despite this, one background concept applies to everyone: any weight loss achieved in the past can never be overlooked. It has a positive impact even if the BMI remains in the obesity range.

Reduced, controlled… What’s the difference?

It is easier to understand the new classification when we think about another chronic disease, hypertension. Someone with high blood pressure who manages to lower it just a little is better off than before, without a doubt. But the pressure values ​​may continue to offer some risk.

“A hypertensive person who takes medication may have a normal pressure of 12 to 8. Has she stopped being hypertensive? No! But her pressure is under control”, explains Halpern. The same thing here: there are subjects who have good clinical parameters because their obesity is under control. However, they are still obese.

This is an important point, by the way. Now, it may happen that someone who has already had grade 1 obesity will one day fall into the overweight range of BMI when losing weight. But, according to the new proposal, he remains an individual with grade 1 obesity, only controlled.

This would be, according to the doctor, the downside of the proposed classification or, come on, hard to face: it doesn’t let us forget that obesity is here to stay. Even if the person is underweight and even apparently thin, he will forever be a controlled case of obesity.

The positive side is bringing out the benefits of small weight loss, smaller than we would often like, but still viable. “Often, the suggestion that the patient needs to lose weight even more to enter the normal BMI range comes from the doctor himself”, laments Bruno Halpern.

This, according to him, can make the person despise the weight loss achieved in the past and give up. It can, worse, lead to weight loss due to very restrictive measures, which favor the safona effect. “One of its problems is that people regain weight faster in fat than in muscle, which is the tissue that would most burn excess energy. Therefore, the difficulty in losing weight will be greater with each attempt”, notes Halpern.

The new classification should complement and not replace others, such as the BMI itself. It’s also not a recipe stating that everyone with obesity should lose more than 10% of their weight from now on. It doesn’t even tell anyone who’s lost that much weight that they better stop trying to lose a few more pounds.

“On the contrary, it arrives precisely to provide a more individualized treatment”, says Halpern. That is to say, a treatment that considers each one’s history on the scale, without imposing a thin BMI on everyone who seeks health.

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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