The most dangerous fat: the main mistakes in the fight against excess weight are revealed

— Konstantin Pavlovich, different people put different concepts into the concept of “excess weight”. At what indicators should we really sound the alarm, and what is a variant of the norm?

— From the point of view of weight standards, everything is quite relative, although, of course, experts turn to a number of anthropometric indicators. Most often we calculate the body mass index. And we always pay attention to visceral (which is much more dangerous) rather than subcutaneous obesity. An important indicator is waist circumference. The norm is considered to be up to 80 cm for women and up to 94 cm for men.

— Nowadays there is a lot of talk about injections that help stars lose weight. Do they help you quickly get into an attractive shape?

— The answer depends on what problem we put at the forefront. The drugs in question “intervene” in carbohydrate metabolism, stabilizing it and reducing sugar levels. Endocrinologists prescribe them, for example, in the case of type 2 diabetes.

They really showed good results in their direct action, moreover, they also gave the effect of significant weight loss by reducing the volume of visceral fat (the most dangerous, since it provokes chronic inflammation in the body, increases sugar levels and is dangerous for blood vessels).

It was these consequences of the accumulation of visceral fat that attracted the attention of cardiologists to initially endocrinological drugs. Therefore, now such active substances as liraglutide, semaglutide are widely used not only by endocrinologists, but also by cardiologists, when obesity can lead to cardiovascular disaster.

These drugs are an analogue of the human hormone glucagon-like peptide (GLP 1). It is a regulator of appetite and food consumption. According to data, GLP 1 is found in a number of parts of the brain and is involved in the process of appetite. Studies of another substance, retarglutide, have recently been completed. It is an agonist of receptors for three hormones at once: GLP 1, GIP and glucagon.

– So, does this mean the drugs still work?

— They work in relation to the diagnoses. But! No endocrinologist or cardiologist will prescribe them to you “to make your jeans fit better.” We are talking strictly about working with a specific disease, the totality of data that the doctor collects about the patient, well-chosen dosages and a calculated course.

I don’t want to scare you, but there is reason to be wary. For example, a study on the side effects of semaglutide (the active ingredient in one of the most advertised injectable weight loss drugs) showed a risk of developing a thyroid tumor, and MedlinePlus (an online health information resource for patients in the United States) posted a warning to patients about the possible risks.

In addition, there is no data on the long-term consequences of these injections. What will happen in 5–10–15–20 years? The effects have been best studied after just 56 weeks. There are also no data on the health effects in patients under 18 years of age. When we talk about targeted weight loss, it is important to control and provide for a number of biochemical processes from an endocrinological point of view.

And it’s not as simple as reading the instructions for the drug yourself. Yes, you may be impressed by the quick results, but you will be very disappointed when the weight comes back with the supplement or unwanted diseases appear. This also applies to sports “fat burners”, which many people resort to.

— Does the weight always come back?

— This phenomenon is often called a rollback. We all want quick and lasting results, but data confirms that the weight after injections often returns and drags new pounds with it. Because advertising, advice from stars, the experience of my mother’s friend’s daughter have nothing to do with the value of your health and evidence-based medicine.

Even if a doctor actually prescribes a drug according to indications, it is still necessary to create a new scenario for your relationship with yourself, the world and food. You can eat and lose weight only if before eating you think about what you are eating, how much, when, what other measures you are taking for your health and condition. The principles of a healthy lifestyle work better than any drugs.

– What to do with excess weight?

— Take responsibility for your weight here and now, start eating right, don’t overeat, be sure to drink enough clean water during the day. And, of course, training is necessary. This can be regular exercise for 15 minutes, including cyclic training, which has proven itself well.

Plus, it is useful to seek help from specialists. Diet therapy in the modern world is, to a large extent, correct psychocorrection. We must accept that this is a long process, but it will bring results. By the way, the help of a psychologist can also be useful at the plateau stage, when the weight went off, and then the numbers on the scale froze.

— By the way, about the plateau. Why does the weight stop coming off, even if you continue to put a lot of effort into it?

— There is a concept of basal metabolism. Metabolic rate decreases as you lose weight and limits your ability to maintain a good rate of weight loss. The key factor in weight gain is in many ways a decrease in the level of basal metabolic rate, which, with the sound approach of a nutritionist, endocrinologist, psychologist and, of course, the patient during complex therapy, increases to a normal level and approaches the values ​​​​characteristic of people with a stable weight.

About 30 years ago, nutritionists had an unequivocal attitude towards the plateau: it was necessary to tighten the diet. But we now know that this does not work as well as a combination of fasting and non-fasting modes. But there is also such a thing as an imaginary weight plateau, which is associated with fluid retention with a continuing decrease in the volume of adipose tissue. There are also unauthorized patient indulgences. Or even refusing therapy in secret from the doctor. In this case, the plateau most often ends with weight gain.

— How do you feel about the so-called “banquet” pills?

— Yes, I often hear from patients that on the occasion of a feast they resort to one-time doses of certain medications (as a rule, these are drugs prescribed for diabetes). My opinion: they should not be on sale without consulting a doctor and issuing a prescription. And if a person is willing to risk his health for the sake of large amounts of unhealthy food, then we are definitely dealing with a problem that needs to be sorted out not only with a nutritionist and endocrinologist, but also with a psychologist.

— Is it possible to gain weight with the help of cosmetic procedures?

— The market now offers a whole range of techniques for reducing fat and rejuvenation. Popular lipolysis is the use of drugs that are injected under the skin and allow you to remove fat deposits on the abdomen, thighs, face, arms, décolleté, get rid of a double chin, very large cheeks, and even to reduce the amount of fat on the back of your hands.

But this technique does not in any way affect that very visceral fat, the most dangerous, through the prism of which we talk about the pandemic of the 21st century – the metabolic syndrome. Lipolitics are, first of all, a story about local fat deposits, which you can immediately try to remove. But they definitely won’t work in a generalized way, and they don’t have any mechanism of action in relation to carbohydrate metabolism. Many clinics offer to supplement lipolysis with LPG massage, mesotherapy, pressotherapy, and thermolifting.

If a person does all this, gives a huge amount of money, then the effect will be one way or another. But! The most important thing to remember is what any good cosmetologist will definitely tell you: all this will work only if at the same time you exercise and eat right.

Now think about it. If you pull yourself together, change your lifestyle, start exercising and update your menu, will you see changes in the field of beauty and health? Of course – yes! But whether this is due to fashionable drugs and procedures or your conscious attitude towards your own health – draw your own conclusions.