Wednesday , March 29 2023

To lose weight, what happens in the head is as important as what is on the plate


This article was co-written by Lélia Bracco, Endocrinologist. He draws heavily from his book, "Obesity beyond Behavior," in the collection "My Brains and Me", directed by Fabien Dworczak (Edp Sciences Publishing House).

Until 10 years ago, infectious diseases, such as tuberculosis, HIV / AIDS and malaria, have been the biggest public health problems in the world. But today there is another threat: non-communicable diseases such as diabetes or cardiovascular disease. These are now an emergency health situation, both in high income and low income countries. However, only 2% of the total funding allocated by international health partners is dedicated to the fight against these diseases.

To combat them, fighting the epidemic of obesity that spreads across the planet is a priority.

Overweight, obesity: a global epidemic

The report is alarming: obesity is increasing throughout the planet, affecting both rich and emerging countries. In particular, childhood obesity is becoming more and more worrisome in 2014, 41 million children under 5 who are overweight or obese. According to Gilles Fumey, professor of geography at ESPE-Paris and author of the book "Géopolitique de l'alimentation"

More than one billion people are overweight worldwide with a body mass index (BMI> 25) and at least 300 million people are obese (BMI> 30). Overweight and obesity cause nearly 3 million deaths each year. "

The repercussions of these weight problems are worrying because they cause many diseases that reduce life expectancy and burden budgets for public health. These are not only metabolic diseases such as diabetes, high blood pressure, high cholesterol, heart disease and atherosclerosis, but also osteo-articular diseases, pulmonary diseases, and certain types of cancer.

Unfortunately, despite its banality, the problem of overweight remains without a real global solution because of its large complexity. Indeed, obesity results from very heterogeneous social factors: overconsumption, junk food, sedentary lifestyle, accelerated rate of urban life, stress, social exclusion … These factors add genetic, neurohormonal and psychological factors, but also phases restrictions. "yoyo effect"), eating disorders and personal history factors.

Causes of overweight are therefore both individual and multifactorial, biological and socio-economic.

The role of pleasure

The brain and the rest of the body communicate and influence each other. The smallest fat cell is bidirectionally connected to the central nervous system. This dialogue is especially reflected in the place of pleasure in food. The pleasure is anticipated by the brain, felt by the senses, in connection with the emotional environment, but also with the memory, as illustrated by the famous anecdote of Proust's Madeleine.

Pleasure also allows for a hormonal modulation of appetite and satiety, which depend for each individual on the sensitivity of the brain areas involved in the reward and self-control system. This neurohormonal cascade, which comes from a complex mix of emotions, stress and diet, is unique to everyone. It is at the intersection of genetic and epigenetic sensitivity, psychological parameters and personal influences on the environment.

Understanding how these different factors affect the self can better help fight obesity, especially by avoiding stigma attached to guilt or negative judgments. Many people who want to lose weight are, in fact, in psychological pain. However, anxiety, like the pleasure of eating, can encourage food without a real physiological need.

To lose weight, everything does not work on the plate

The harmful consequences of obesity health are not limited to "physical" medical issues, which require weight reduction. Another consequence, independent of body level, is mental suffering. The complexity of managing the latter has many causes, multiple (self-esteem disturbances, obsessive thoughts …) as a support. Mental suffering can be paradoxically aggravated by measures taken to lose weight and should therefore be dealt with independently of nutrition issues. In long-term nutrition monitoring, the feeling of failure and guilt is omnipresent …

Managing obesity and overweight requires the disclosure of many current practices in the face of the recognized failure of simple dietary advice. So far, as no approach has demonstrated sustainable efficacy, health authorities need to remain attentive to the individual and provide comprehensive support for the body and mind, taking into account society's contradictions. The latter puts forward consumption, creates needs, desires … And so through the same frustrations and addictions. We are the happy victims of large areas with innumerable rays passing through industrial food, with irresistible packs of calories!

A model that promotes overweight

This industrialization of food has led to the enrichment of fat and sugar, to improve the pleasure of the palace and hence to increase sales. This is the main factor of diseases, such as diabetes. These food changes have led to foods with high levels of low calorie volumes. Our physiological regulatory capacities are defiled by this industrial food. The feeling of fullness is based, in fact, on stomach dilatation, which is interpreted as a signal that food needs have been met.

In addition, excessive food consumption leads to addictive behaviors. In addition, already malnutrited by diet, our physiological balance must also adapt to changes due to modern, more sedentary lifestyle.

It is not at all banal that the emergence of obesity in a country be linked to its level of economic and industrial development. It is favored by urbanization and affects primarily disadvantaged social classes. At an economic level, it is therefore a problem to find a difficult balance between returns on profits in the agro-industrial sector and the mass distribution and losses due to the exponential growth of health costs resulting from obesity and the degradation of nutritional quality.

Find the resources to break the vicious circle

Currently, to lose weight, the most effective solution is stomach surgery (bariatric surgery). Given the intrusive and irreversible nature, it remains reserved for severe or complicated obesity. Dietary changes and lifestyle changes, such as the fight against a sedentary lifestyle, are therefore essential for weight reduction.

Easier to say than after you have followed a multitude of medical, social, or friendly tips and you've been through a long period of hard work, struggle, loss of control and self-confidence, many people end up crackling and lead to growth paradox of food intake and weight. To avoid stalemate, understanding the vicious circles that lead to this resistance to weight loss is essential. This requires exploration of the neurobiological and psychological plan.

The person suffering from obesity has unforeseen resources. New perspectives on the brain's ability to remodel suggest the possibility of changing habits and transformation at any age.

And for those who want to live with overweight, then the problem of free will and room for maneuver, for each one, to live differently.


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