Recently, the World Health Organization estimated that, unless some drastic measures are taken in the next few years to prevent and treat overweight and obesity, by 2035 more than 50% of humanity will be overweight and obese. The degree of obesity is determined on the basis of a person’s body mass index (BMI). Adults weighing over 25 kg/sq. m of body surface area, up to 30 are considered overweight, from 30 to 35 – obese and over 35 – with “pathological” obesity. We know that the pathogenicity of obesity increases with BMI, starting at 25 in Europeans and 23 in Asians, and depends on the length of time the body remains overweight/obese. The incidence of overweight/obesity increases significantly when it begins in childhood and adolescence. In general, the incidence of overweight/obesity is characterized by comorbid health problems that increase progressively with age, which now, due to early onset, appear relatively early in late adolescence and early adulthood. Quite ominous is the fact that the upward trend in the prevalence of overweight and obesity in all age groups has not only not stabilized, but has worsened over time.

The presence and degree of overweight/obesity is an excellent biomarker of current and underlying comorbidity, which is known to progress over time. American and other epidemiological studies, including Greek, show that the pathology that accompanies overweight/obesity, predominantly abdominal or visceral form, is the so-called “cardiometabolic syndrome”, which includes insulin resistance, dyslipidemia, arterial hypertension, type 2 diabetes . , hypercoagulability, chronic systemic inflammation, cardiovascular disease, non-alcoholic fatty liver disease and sleep apnea, making it a serious chronic disease. It has many other psychological and physical comorbidities such as anxiety and depression, cancer, dementia, and increased vulnerability to infections. All pathological manifestations of overweight/obesity are primarily the result of a rapid and radical change in lifestyle over the past 50 years, including an increase in chronic psychosocial and economic stress, which we clearly experience constantly in the modern era, combined, of course, with low-quality but plentiful food, lack of exercise, insufficient sleep, and an irregular daily schedule that is disconnected from the natural biological circadian clock. The human organism, that is, found itself in an unprecedented environment, to which its genes did not have the necessary time of several generations to adapt. This maladjustment has transformed a known but very rare condition in the past into a common, classic, severe chronic disease that has strongly resisted our many prevention and treatment efforts. Let me add here that to a large extent there is a high correlation of overweight/obesity with the educational and socio-economic level of people’s society, which means that a thorough education is the key to the solution, especially in terms of preventing this chronic disease.

Its treatment requires a team of specialists such as an endocrinologist, a nutritionist, a psychologist and an ergophysiologist.

Unfortunately, to date, the treatment of overweight/obesity has been particularly difficult or completely unsuccessful, especially in individuals with a high BMI, with difficulty commensurate with this measure of disease severity. In addition, attempts with new drugs in most cases have not been successful. Overall, the worst outcome was an initial loss of adequate weight, i.e. simultaneous loss of fat and muscle mass, followed by a relapse, with the return of fat but not muscle mass, which meant a worsening metabolic pathology. The treatment of overweight/obesity requires a team of experts such as an endocrinologist, nutritionist, psychologist and physiologist, as well as treatment monitoring methods, in addition to physical examination and calculation of BMI. Measurement and monitoring of muscle mass, visceral fat and bone mineral density, assessment of systemic inflammation, circadian rhythms of blood pressure and cortisol, heart rate variability are indicators of chronic morbidity and signal the urgent need for a drastic lifestyle change: proper nutrition, moderate exercise. activity, adequate sleep, regularity of daily activities, nutrition and sleep, and stress management.

More recently pharmacological treatment of weight loss and maintenance of tolerable weight loss with specific gastrointestinal hormonal agents such as weekly subcutaneous semaglutide (Ozenpic, Wegovy) for up to 15% body weight loss or tirzepatide (Mounjaro) for up to 25% body weight has been used successfully in overweight and obese adults with relatively few side effects and an effective reduction in the incidence of overweight/obesity. Some of the initial side effects were nausea and gastrointestinal disturbances (constipation, diarrhea, abdominal pain), which can be avoided by starting at low doses and allowing the body to develop a tolerance to them. Very rarely, acute pancreatitis, a serious condition, has occurred, so the presence of gallstones may be a contraindication for the above treatment. Interestingly, the above drugs may also affect specific thyroid cells that cause rare medullary thyroid carcinoma. The adage “there are no drugs without side effects” applies here as well. While we cannot predict other side effects in the long term, we cannot say with certainty that they will not occur in the future. Research into the medical treatment of obesity is advancing rapidly and we hope that “medical bariatric treatment” will take the place of “bariatric surgery”. It is clear that the prescription of pharmacotherapy must be prescribed and supervised by specialists, while patients must be aware that there are certain, relatively rare, contraindications and side effects and that they are likely to receive the drug for life, even with lower maintenance therapy. dose. There are patients, fortunately few in number, who do not respond to treatment for as yet unknown reasons. However, for most responding patients, it is important that weight loss occurs primarily through fat rather than muscle mass, meaning that parallel exercise is needed to strengthen muscle and protect against the development of sarcopenia. Finally, everyone should be aware that pharmacotherapy is used as an accompaniment, as an aid in reducing and maintaining a lower body weight. It should be emphasized that the main therapeutic approach to overweight/obesity remains the improvement of lifestyle and the proper management of stresses, which are generative causes.

Mr. Georgios P. Chroussos is Professor Emeritus of Pediatrics and Endocrinology, Director of the Institute of Maternity, Childhood and Precision Medicine of the Research University, Head of the UNESCO Center for Adolescent Health and Medicine.