Hellenic Australian doctors of the HMSA meet to discuss the health problem of obesity
By Mary Hett-Stavropoulos (HMSA Board Member, GP)
The doctors of the HMSA gathered to hear the latest research and treatments on areas of medical importance to the Hellenic community in Australia, this time on obesity, which has reached alarming levels in Australia and the Western world.
Genes, conditions in the womb and the first few years of life play an important role in people’s weight trajectory in life, including factors in their adult life such as: physical activity (both exercise and incidental activity levels versus sedentary living such as high screen time at work or for leisure), diet (including the presence of endocrine disruptors in food), sleep patterns, pregnancy and menopause, etc.
Professor John Dixon, Head of Clinical Obesity research of the Alfred’s Baker Institute revealed that obesity is a chronic disease which predisposes the sufferer to among other things, diabetes, high blood pressure, abnormal blood lipids, stroke, heart disease, arthritis, obstructive sleep apnoea and asthma, liver disease, impaired fertility, obstetric complications, foetal abnormalities, and even cancers.
Like high blood pressure and diabetes, obesity needs to be managed by doctors and dietitians with a special interest, training and expertise in the area, when diet and exercise alone have not been effective.
However, it is estimated that only five percent of obese people receive adequate treatment as people mistakenly believe only willpower is needed to make lifestyle changes to dietary and exercise habits.
Research however has shown that as the body’s set point for satiety and weight is higher for obese people due to hormonal and other biological factors, will power alone in matters of lifestyle is rarely enough for sustained weight loss.
It should be noted that while exercise has not been shown to contribute to significant weight loss, it is essential as it decreases the risk of stroke, heart disease, frailty and cognitive decline or dementia.
There are three currently proven methods of obesity management that can be used in various combinations tailored to each patient’s unique circumstances as per the Australian and New Zealand Obesity Society management guidelines:
Medically supervised Very Low Calorie Diet (meal replacement )
Proven to be safe and effective when done under medical supervision for patients where there are no contraindications, the nutritionally balanced very low calorie diet has been shown to be effective long term with weight loss and maintenance as it resets the satiety set point.
An evening meal of lean fish / poultry / meat and non starchy vegetables with some olive oil is permitted.
(In contrast, the ketogenic diet is high fat and has not been shown as yet to be safe long term and other diet work by caloric restriction alone).
A trial of three months of one or more prescription medicines under medical supervision can be used.
Medications rivalling the efficacy of bariatric surgery should hopefully be available in Australia in approximately five years.
Mr George Kalogeropoulos, Bariatric and Oesophagogastric Fellow who has trained at Oxford University discussed the various bariatric surgical procedures, effectiveness and risks.
Bariatric surgery has been shown to reduce the risk of both cardiovascular disease and cancer by 50% each.
Patients with diabetes less than 6 years not requiring insulin often go into remission with VLCD or bariatric surgery.
As they are higher risk, surgery is reserved for patients who have not responded adequately to lifestyle,VLCD and medication.
In particular, patients who smoke, suffer from untreated anxiety or depression or indulge in comfort eating are not suitable for surgery.
Those aged seventy or above are also more suited to exercise and a healthy diet such as the Mediterranean, rather than higher risk interventions.
Unfortunately the stress, poor sleep patterns, sedentary lifestyle, and high sugar, carbohydrate and fat diet of the modern Western world has not served us/the Hellenic community well.
Indeed, the time honoured inherent value of the traditional Hellenic diet and physically active lifestyle in preventing obesity and promoting health has much to commend it.
Once obesity has occurred and becomes resistant to lifestyle measures, it needs to be treated seriously and adequately like any other chronic medical condition and not blamed on the patient suffering from it.