Glitter in the gloom of the chronic obesity disease
Of course, compulsive eating of the wrong foods along with inactivity also breeds simple obesity.
Obesity is associated with precipitating diabetes, hypertension, gastro-esophageal reflux disease (GERD), obstructive sleep apnoea (OSA), fatty liver (now called metabolic dysfunction associated steatohepatitis-MASH), and oeteoarthritis. All or any of these can accentuate the pathology, hurtling the patient into rapid weight gain.
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The accumulation of fat around the middle, with ballooning on the waist circumference, is the classic apple-shaped obesity which is the prime cause of insulin resistance. Insulin hormone which is responsible for sugar metabolism is unable to perform its endocrine action leading to elevated blood sugar levels. This then, over a period of time results in cardiovascular, kidney, eye and other complications.
More than one billion people worldwide are living with obesity and so many more are on the brink.
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The enlightenment to course-correct this abyss of kilogrammes, usually dawns quite late in the obesity curve. Socially cast as prosperity, the plump picture is often construed as a 'healthy' look amidst the humdrum of the uphill economic trudge. This race and rave to go up the wealth and 'success' ladder then often chains you to the chair with improper eating portions of the wrong ingredients at odd hours. Obesity worsens with this bad lifestyle of inadequate sleep with almost negligible exercise and this adds to the honey trap of alcohol, smoking, snacking and other addictions.
It is in this regularly seen scenario that the Humpty Dumpty with couch potato syndrome is born.
When the nickel finally drops and exercise, regimentalisation, diet etc finally kick in, the patient is already too obese.
For the lucky ones, the renaissance works and if sustained in its efforts, obesity turns around. However, quite often, the metabolic mileu within the body refuses to respond and stagnation of weight loss creeps in with a sense of defeat and despair.
This is critical to recognise and imperative to treat, lest the frustrated individual in desperation may snap back and return to his erstwhile habits.
While hand holding and counselling is a must, the introduction of scientifically proven drugs (GLP1 receptor agonists, in isolation like semaglutide and along with GIP agonists (dual) like tirzepatide) could salvage the despondency.
Their use should be strictly under medical supervision with careful monitoring.
Having both central and peripheral mechanisms of action, they are given every week by the injectable route — in India, semaglutide is also available in the daily oral form. They do induce gastric upsets at initiation but most patients get acclimatized. As the weight loss chugs along, the dose needs schematic modulation.
The benefits of the loss of fat body mass (desirable) and not lean body mass, soon translate into better sugar and blood pressure control.
Improvements in heart failure, liver dysfunction, kidney metabolism, sleep quality are "Mota-Moti" visible .Amidst this northward jump in health on the double-chinned horizon of the now encouraged patient, I would like to caution that trigger-happy patients should not take law in their hands and use drugs indiscriminately.
Everything has side effects if improperly used.
The harnessing of these drug's has the 'good servant bad master' philosophy.
Who? How long? More? Etc, should be a clinical decision.
Suffice to realise that now, the diseased metabolism can be beaten with a magic wand and the spectre of the sickness can be dispelled with "Bhool Chuk Maaf"
These drug's mandatorily have to go hand in hand with lifestyle intervention which is the real cavalry in the fight. Samosa and Jalebi have been outlawed so that awareness of healthy eating can kick in.
Natural can never be substituted by 'chemical' and in the tug of war both must be on the same side and not like a seesaw on opposite sides.
That's when you can achieve "Zero Se Restart"
(Dr Hemant Thacker is a Consultant Physician & CardioMetabolic Specialist practicing in Mumbai and is affiliated to TOI. Email:dochpt@gmail.com)
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