Today, overweight and obesity are rightly considered diseases and, unfortunately, their prevalence in all age groups not only does not stabilize, but also increases with time. The World Health Organization has estimated that by 2035 more than 50% of humanity will be overweight and obese, which means that we will have more than 4 billion people on the planet with serious diseases that will worsen and progressively increase with age. Given that more than a third of children and adolescents in developed and developing countries today are overweight or obese, and knowing that the incidence of obesity is increasing, especially when it begins in childhood and adolescence, we expect not only early morbidity, which occurs even in children, but also increased incidence at any age. Thus, this forecast is both reasonable and very disappointing.

If the above data based on body mass index (BMI) is extremely alarming, the reality is that already today, in 2023, the epidemiological situation with human health is much worse than predicted for 2035, while chronic morbidity affects possibly two people. -thirds of the population, i.e. about 6 billion people. Of course, this includes today’s overweight/obese people with their morbidity, as well as many other people with normal or even reduced BMI and increased morbidity. Thus, while the presence and extent of overweight/obesity is an excellent biomarker of emerging morbidity, it actually underestimates the true prevalence of chronic total morbidity in humanity.

In fact, overweight and obesity and their incidence are only a large subset of the widespread primary “chronic stress and inflammation syndrome” or CCS that underlies almost all modern pathology. Indeed, the well-known cluster of pathologies accompanying overweight/obesity and especially the “abdominal” or “visceral” form, i.e. blood hypercoagulability, chronic systemic inflammation, as well as cardiovascular diseases, are also a subgroup of morbidity, and this is due to the fact that that the range of pathological manifestations of the population – regardless of BMI – is much wider, with frequent pathological manifestations, which include cardiometabolic syndrome, but also many additional, psychological and physical ones.

Together they correspond to the so-called “chronic non-communicable diseases”, including anxiety, depression, overweight/obesity, cardiometabolic syndrome, allergic and autoimmune diseases, psychosomatic disorders, chronic obstructive pulmonary disease, sleep disorders, cancer, etc., and in is primarily the result of the chronic psycho-socio-economic stress that we are subjected to in our time, coupled, of course, with poor diet, lack of exercise, insufficient sleep and an irregular daily schedule.

Chronic stress, characterized by abnormal circadian secretion of stress hormones and inflammation, causes the aforementioned “Chronic Stress and Inflammation Syndrome” (CSSI), which is far more common than overweight/obesity and its incidence, including causal and its morbidity. Chronic stress has the ability to bring out genetic, epigenetic and behavioral weaknesses in individuals that make them vulnerable to various diseases. For example, if someone has a problem with a gene, or genes, or gene expression that makes them vulnerable to anxiety, then the person suffers from anxiety, if they have the equivalent of depression, they experience depression, if they have obesity, they accumulates body fat if it develops dementia due to neurodegeneration, etc. Thus, chronic stress causes chronic non-communicable diseases in predisposed patients, while at the same time reducing the body’s defense against cancer and infections (for example, COVID-19) . Thus, CKD is today the leading cause of disability and death.

If people were not subjected to chronic psychosocial economic stress and other adverse conditions of modern life, or if they coped better with stress and led a proper lifestyle, they would be and remain slim, healthy, with much less mental, psychosomatic and psychiatric disorders. physical morbidity, with greater healthy life expectancy and less need for psychological, psychiatric, medical and pharmaceutical support. Of course, some people are innately able to withstand stress and do it “on the machine”. Unfortunately, most people do not have such a gift, to be able to control their stress and not be negatively influenced. But, fortunately, stress management as a catalyst is taught and taught. Let me add that basic knowledge and practical wisdom are the key to making decisions regarding both prevention and treatment of all chronic non-communicable as well as communicable diseases.

What then is needed to prevent and treat CFS and the often accompanying obesity or overweight? In principle, educating all of us about healthy lifestyles and the prevention of CKD and its manifestations, including obesity, is essential. Today, unfortunately, the treatment of CFS, especially with co-morbid obesity, is of particular complexity and requires treatment by a team of specialists, such as an endocrinologist, nutritionist, psychologist and occupational physiologist, as well as methods of monitoring treatment, in addition to physical examination and calculation of BMI. . The presence of symptoms of chronic stress and inflammation (so-called “functional” or “non-specific symptoms” or “medically unexplained symptoms”, MUS), such as chronic fatigue and various chronic pains and knowledge of body composition – especially the presence of reduced muscle mass (sarcopenia ), an increase in visceral fat (visceral or abdominal obesity) and a decrease in bone mineral density (osteopenia or osteoporosis), systemic inflammation, a decrease in blood pressure and cortisol circadian rhythm, and a decrease in heart rate diversity. indicates a chronic morbidity and signals the urgent need for a drastic lifestyle change: proper nutrition, moderate exercise, adequate sleep, regularity of daily activity, food intake and sleep, and, of course, stress management.

Fortunately, medical science has given us knowledge and medicines that have increased life expectancy, despite the unfavorable modern lifestyle and ever-increasing obesity. Interestingly, all proven life extension drugs counteract mediators of stress and inflammation, such as catecholamine and angiotensin-2 antagonists, insulin sensitizers, antidepressants, anticoagulants, unsaturated fats, omega-3 lipids, and others. Fortunately, the recent discovery of hormonal drugs, including The gastrointestinal hormones GLIP-1, GIP and PYY have given us another powerful additional weapon against overweight/obesity and its complications. However, given that “prevention is better than cure”, our best weapon remains the use of logic in the proper management of our lives. Hence the need for a high level and ubiquitous education.

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