Sunday 21 April 2024

We’re paying too high a price to overcome obesity

This column first appeared in Malta Today

When you have a new health Minister who announces that he wishes to increase the number of gastric bypass and sleeve gastrectomy surgeries that take place in government hospitals, “in order to tackle obesity”, you have to wonder whether he himself is on some form of meds.

To be fair, Minister Jo Etienne Abela also said, “We need an aggressive cross-party national campaign to raise awareness about obesity. We cannot modify our genes but we can change our eating, drinking and exercise habits to avoid unhealthy obesity.”

However, mentioning these major operations as part of this campaign is a questionable and potentially harmful way to tackle the problem. Countless Maltese patients have been travelling to the cheaper option of Turkey to get these operations done, but the Minister believes more should be done locally.

A gastric bypass involves dividing the stomach into a small upper pouch and a much larger ‘lower’ remnant pouch, with the small intestine rearranged to connect to both. Sleeve gastrectomy is a surgical weight-loss procedure where a portion of the stomach is removed, creating a smaller, banana-shaped stomach, which reduces food intake. In both cases, the person is being given what appears to be an “easy” solution to overcome their obesity. These surgeries are often followed by further procedures to remove the excess, sagging skin. In some cases the patient finds they are no longer able to enjoy food, because their stomach has been made so small that eating actually becomes painful.

Granted, I agree that there are extreme cases, especially with morbid obesity, where only surgery will work to get the person back on an even keel until they establish a more healthy lifestyle. There are individuals who would, frankly, die unless they lose their extreme weight – their heart and other organs can no longer take the strain which all those kilos are putting on them. We have all seen those shows where a person cannot even walk or leave their home because they have become too big; so yes, in these cases, surgery will literally save their life.

But we also know that over-eating is linked to our emotions and psychological wellbeing. There is a reason it is called “comfort food” when we reach for carbs and sweets to soothe ourselves because we are depressed, stressed or anxious; we have all been there, done that and it is a very common problem. So I can perfectly understand how surgery could be seen as the answer to all our prayers to look like the women posing in scanty bikinis on beauty magazines (or on Love Island). But as a panacea for a country’s alarming obesity problem, I would think that a Health Minister would be the last person to suggest it as part of a nationwide strategy.

Like all addictions, unless one gets to the root of the problem, it won’t be solved.

Apart from the link between mental health and our relationship with food, there is the undisputed fact that so-called junk food is invariably cheaper and more plentiful than that which is healthy for us. Within walking distance from where I live I can buy pastizzi, meat pies, sausage rolls, burgers and chips, fried chicken, pizza – it’s so easy, so available, so handy. Let us not even get started on how tempting it is to tap on the Bolt app for food delivery, which has also negatively impacted our meal choices. It’s so much quicker and more convenient than buying fresh ingredients and cooking a meal from scratch, so I can appreciate how someone who is in a hurry, stressed out and exhausted from juggling work, home and family after a long day, will opt for the fast, albeit unhealthy, option. Plus, with the high price of fruit, vegetables and lean meat, telling someone to eat “clean” rather than buying processed food won’t really work.

The latest Eurostat obesity statistics reveal that 64.8%, or 2 out of 3 people in Malta are overweight, making us the most overweight people in the EU. This dubious honour is clearly due to the fact that the average Maltese diet relies heavily on stodgy, high calorie food which is exacerbated by a sedentary lifestyle. As we say colloquially “mhux se nmutu bil-guħ” (we’re not going to starve to death). Instead, we are waddling ourselves into an early death through overconsumption. Even more alarming are the statistics for child obesity which are paving the way for a lifelong pattern of food addiction which will be hard to break.

The high price we are paying for obesity can also be seen in the extent of the nation’s prevailing health issues: heart disease, high blood pressure, high cholesterol, diabetes, knee problems which require orthopaedic intervention, certain types of cancer…the list is endless. All these are causing a strain on an already groaning, overwhelmed national healthcare system which could be eased if our bad eating habits were to be properly addressed.

Yet while study after study continues to be churned out about the need for more exercise, daily PE in schools and the importance of an active lifestyle, there is something in the human brain which persists in searching for the magic formula which will give people the body they want without the need for them to exert too much effort or make any sacrifices.

Enter Ozempic.

This injection, originally intended for those who suffer from Type 2 Diabetes to help them control their blood sugar is now being used by people to lose weight. The medication works by sending signals to the appetite centre of the brain to reduce hunger and increase fullness. This has caused a very serious shortage for those who actually need it, but that’s not all. Health care practitioners have warned of the serious gastro-intestinal side effects of this drug and users have reported constant nausea, non-stop vomiting, constipation and diarrhoea.

Health and wellness expert Jillian Michaels (who helped obese people to lose weight in the popular show The Biggest Loser) has warned repeatedly about the dangers of this injection. “There is the possibility of thyroid tumours, gallbladder problems, pancreatitis, kidney issues, vision loss and stomach problems, including stomach paralysis.”

There are also the added negative repercussions on one’s appearance, resulting in what has become known as “Ozempic face”. Every woman knows that when we lose a lot of weight, we do not just lose fat from our “problem areas” but from head to toe. Ozempic face refers to a loss of facial fat that can leave the face sagging, haggard, gaunt and generally looking older. The accelerated facial aging is especially common in middle-aged and older patients.

What happens next is often a vicious circle of wanting to be thin, but then panicking at the sight of an aging face – so cosmetic surgery is the next port of call. Cheek fillers, botox, face lifts, unnaturally arched eyebrows, stretched cat-like eyes, with some collagen-injected lips thrown in for good measure have resulted in hordes of women with stick-like bodies and weirdly contorted, artificial faces. I would love someone to answer a question which continues to mystify me: does any one of the opposite (or same) sex think this alien-like look is actually attractive?

Drastic weight loss using Ozempic can also cause severe muscle loss and lower bone density which can lead to osteoporosis. If your bones have been depleted of essential minerals they will become so brittle that they can snap like a twig even from a slight fall and will take longer to heal. So now you are not only looking older but you have the bones of an elderly person…

In her warnings against Ozempic Jillian Michaels makes one final argument which for me is the clincher: that once one has lost the weight, one will reach a plateau, your body will build a tolerance to the drug, and within a few years it will stop working and you will inevitably gain all the weight back.

As she points out, if this easy way out really worked, she would “get in line and profit like crazy” by recommending the drug through her app.

Her advice on what one should do is not revolutionary but simply the tried and trusted method (which so many continue to resist) of calories in, calories out. “Instead of all the negative side effects through drugs, you will have a list of positive side effects from improved cognitive function, improved heart health, improved hormone balance and so on.”

Like anything in life worth achieving, there are no short cuts to maintaining a healthy weight, but the ultimate long-term benefits will outlive any of the latest weight loss trends.