Stating that obesity is a chronic, progressive and recurrent endocrine disorder characterized by excess fat storage in the body, Endocrinology and Metabolic Diseases Specialist Assoc. Prof. Dr. Hakan Düğer said, “Obesity is not only an imbalance associated with calorie intake, but also hormonal mechanisms, cytokines, lifestyle, etc. It should be seen as a result that occurs with the effect of many factors. Fighting obesity only with calorie reduction method may also result in failure.”
Medical Park Antalya Hospital Complex Endocrinology and Metabolic Diseases Specialist Assoc. Dr. Hakan Düğer made statements about obesity, diabetes and treatment methods.
“Obesity is a hormonal imbalance”
Defining obesity, Assoc. Prof. Dr. Düğer said, “Obesity is a chronic, progressive and recurrent endocrine disorder characterized by excess fat storage in the body. Obesity is actually not a caloric (calorie-related) imbalance, but a hormonal imbalance. Sometimes we come across frequent complaints from our patients such as 'I have reduced what I eat, I have been eating very little for months and I have been really careful, but my weight has not decreased'. In fact, these complaints are an indicator of this situation.”
“It is an erroneous assumption that calories consumed are constant”
Pointing out that some classical formulas for calculating obesity may not give the same results for everyone, Assoc. Prof. Hakan Düğer shared the following information:
“In fact, obesity is explained by a simple formula based on the calorie intake-calorie expenditure calculation. This simple formula may not fully and accurately determine the condition of each patient. Calorie expenditure is not constant. A reduction in caloric intake will also slow down the basal metabolic rate, so the expected weight loss may not be realized. 'Basal metabolic rate is the energy required for internal organs and organ systems to function'.) As a person takes in fewer calories, the body expends fewer calories to maintain the status quo. Fat accumulation is not really a problem of excess energy. It is a problem of energy distribution. Too much energy is directed to producing fat instead of increasing body temperature or building new muscle tissue. This energy expenditure is hormonally controlled”.
“Body weight is determined by a process involving energy intake, hormones and cytokines”
Stating that another false assumption is that weight is consciously regulated, Assoc. Prof. Dr. Düğer said, “However, no system in our body works this way. Thyroid, sympathetic/parasympathetic nervous system, respiratory-circulatory, liver, kidney etc. systems are all controlled by hormones. Body weight and body fat are also tightly regulated by hormones. Thus, body fat is regulated by a hormonal balance that goes beyond what we decide to put in our mouths. In line with the perception that excessive calorie intake is the only factor in the development of obesity, the approach of combating obesity by simply reducing calories may result in failure. In other words, the search for a solution with classical calculations that only formulate obesity or excessive fat storage should not be seen as a correct and sufficient approach.”
“The success of obesity treatment depends on lowering insulin levels”
Stating that if the feeding moment is dominant compared to the fasting period, the resulting insulin dominance can lead to fat accumulation, Assoc. Prof. Dr. Düğer added the following information:
“If high insulin levels persist, the body is constantly signaled to store the excess energy from food intake as body fat. This point is very important because it reveals that successful treatment of obesity depends on lowering insulin levels. By eliminating most 'fattening' carbohydrates, we can prevent weight gain by lowering insulin levels. There is a basic biological principle in the human body. If something changes too much in one direction, the body reacts by changing in the opposite direction to maintain the status quo. This is a normal phenomenon. So, the cause of insulin resistance is insulin itself. In other words, the cause of both insulin resistance and obesity is high levels of the hormone insulin.”
“Some patients may not have diabetes”
Stating that 70 percent of individuals with a body mass index above 40 kilograms/square meter (i.e. 3rd degree obese) do not have diabetes, Assoc. Prof. Dr. Düğer said, “Again, 15 percent of all type 2 diabetes patients are normal weight individuals. In fact, the main factor that determines the development of type 2 diabetes in a person is the suppression of insulin-producing cells (beta cells) in the pancreas by fat cells and the threshold of this suppression varies from person to person. For example, a patient with high insulin resistance and obesity will not develop diabetes if their pancreatic beta cells are not sufficiently affected by excess adipose tissue. On the contrary, in a person with a normal weight and a low threshold for suppression by adipose tissue, loss of function in pancreatic Beta cells and consequently type 2 diabetes may develop with much less adipose tissue accumulation.”
“Diabetes is a preventable disease”
Mentioning that diabetes is a preventable disease, Assoc. Prof. Dr. Düğer said, “In fact, it has been stated for years that Type 2 diabetes is a chronic and progressive metabolic disease. However, bariatric surgery has shown that this definition is erroneous. Even in people over 200 kg who have had diabetes for 20 years, all diabetes medications are stopped and diabetes is completely cured. Therefore, we now know that diabetes is a preventable and curable disease. Despite the success of surgery, it is not possible to recommend surgery to every type 2 diabetic for various reasons. Surgery comes at a heavy cost, both financially and physiologically, due to the many surgical complications. But most importantly, we can achieve all these incredible benefits without surgery. All we need to do is to understand why the surgery was successful and how we can replicate its results.”
“Mediterranean diet may be preferred”
Pointing out the importance of diet in the fight against obesity, Assoc. Prof. Dr. Düğer said, “Certain diets are known to provide superior glycemic control; low carbohydrate diet, low glycemic index diet, Mediterranean diet and high protein diet can be given as examples. A common feature of these 4 diets is the low amount of carbohydrates. Refined grains and sugars are the main sources of carbohydrates and any low-carb diet should restrict them. However, we need to make more distinction between unrefined carbohydrates, such as potatoes and fruit, and refined carbohydrates, such as added sugar and flour, because the higher the intake of refined carbohydrates, the higher the risk of diabetes.”
İHA Haber Kodu: 20241101AW320283
