Andreea Ciudin
Endocrinologist and coordinator of the Obesity Unit at Vall d'Hebron Hospital.
Obesity is a group of chronic neuroendocrine diseases characterised by alterations in appetite regulation and metabolism, resulting in excess and dysfunction of adipose tissue that negatively impacts health. This definition alone shows that it is not a matter of willpower or weight. Although excess fat is more visible in larger bodies with many extra pounds, there are also body mass indexes (BMI) of 25 with excess fat that are considered obese, not overweight. We need to shift the focus from weight to body composition and its impact on health.
Example 1: bodybuilder, 120 kg, BMI 35, 80% muscle: NOT obese, does not need to lose weight.
Example 2: person weighing 80 kg, BMI 25, 40% fat: obese, but needs to lose fat, not weight, as weight can also include muscle and bone, without distinction.
Keeping the focus on losing weight causes and perpetuates the craze for miracle strategies, body image and aesthetics, and the inappropriate use of treatments that are hormone-based drugs, with clear mechanisms and indications, which have recently been trivialised for this reason and are being misused.
It can even be dangerous if the goal is to lose weight at all costs, seeking different methods without considering that significant muscle mass can be lost. And this is harmful rather than beneficial.
This encourages frustration and stigma, because comparisons are made between people in the same household, neighbours, friends... Weight loss is measured, when treatment goals should be individualised in each case.
The goal should be to improve health. If there are no complications due to obesity, the goal is to reduce fat and prevent non-fat organ dysfunction. If there are complications, the goal is to reverse the dysfunction in these organs. And it is not always necessary to lose a certain number of kilos to do this.
Example: a person who loses 10 kg of fat and gains 8 kg of muscle. If you look at the fact that they have lost 2 kg, it is a disaster, but in reality it is a huge success, because they have lost the fat that was making them ill and gained muscle that is making them healthy.