Classification of obesity

ACCIDENTALLY OBESE? Causes and classification – not judging – of an overweight human being

After some years of experience with obese patients, I have elaborated in a simplistic way, some dominant categories on the genesis of obesity in a person. There are in fact 8 families of patients for each of which the cause of the overweight is different and for which the treatment will be different.

The first group is that of overweight babies: they are children with high birth weights (macrosomia> of 4 kg of weight), for which already in the intrauterine life the endocrine organs have been troubled by a gestational diabetes, a preclampsia, an important weight gain of the mother (depends on the starting weight). These children have already had an epigenetic imprinting during the crucial phases of their development. They are children who at best will be able to become slightly overweight but will always have to struggle with the weight for life, probably with drugs for type 2 diabetes in childhood. In this case it will be difficult for him to become a teenager with a right weight. Therapeutic stays and low-calorie diets have devastating effects on the child’s self-esteem and metabolism. For many the only solution will be bariatric surgery. I abstain for the moment on expressing my opinion on bariatric surgery in adolescence.

The second group is made up of children in whom the previous stimuli may have been present but not dramatically. They are however to grow in a family in which for economic reasons (poverty, social hardship, attribution to other families), or for organizational reasons (working mother, lack of surveillance, educational laxity, education confided to third parties), meals are relegated to fast food, the snacks are packaged and the juices are sugar with dyes. In these cases the only way to get out of it is a kidney stroke of the family, which is capable of changing and enforcing new healthier and more balanced habits. We should firmly avoid the restriction once the damage is done. Rather, push the child to move and change bad family habits where possible. If the attempt is a failure, once again the only solution remains unfortunately the bariatric surgery.

The third group is made up of teenagers. These children tend to be of normal weight or slightly overweight, who at a delicate moment of their growth experience a major psychological blow. Deaths (often grandparents who have cared for them), separation of parents, domestic violence to themselves or against a parent, irreparably affect this fragile mind that is being forged without having effective tools to counteract the pain. Each fat cell has therefore tattooed the word “LOVE”, but often even if the family becomes aware of it, a chain effect has already started. In these cases it takes the intervention of a good psychiatrist who knows how to frame the problem and above all a family support that aims to increase the esteem and respect of himself.

The fourth group are competitive athletes: boys and girls who have extraordinary talent (and there are many!), Invest the early years of their teenage and adulthood occupied in daily workouts often far from the family. When a trauma occurs for which the young athlete is forced to stop, the inevitable happens: a depressive crisis, a drastic change in metabolic activity, a lack of a goal, and so the still rather immature young person loses herself and finds comfort only with food. In these cases, often, the young man abandons the sport and is therefore even further from the resolution as the weight will aggravate the injury. Self-esteem will suffer a big blow. In these cases, psychological support becomes mandatory and therefore it is essential to encourage the young person to return to training (he will need the endorphins he was used to producing abundantly) or if it is not possible to resume, stimulate him to do a more appropriate activity. Every intervention on weight is essential for psychological work on the young person and his identity.

The fifth group is that of the “married“: young people around twenty years leave his family to build their own, but the life of the couple leads the two to become aware of duties to which until then had not thought: work (shifts of work), shopping, cooking healthily, limiting expenses, finding time for oneself and physical activity, managing children, financial problems; these are some of the things that affect these post-teenagers who suddenly begin to gain weight without even realizing it. I always joking saing to these patients “then you have to change wife / husband”! But the problem goes far beyond that. The patient must understand that it is his interest to restore the balance and regain a hygiene of life. The problem is that this awareness comes between 40 and 50 years old when the first pill of hypertension arrives, cholesterol increases, for women, menopausal symptoms are added and for men the signs of an erectile dysfunction. In such consolidated soil there must be a strong motivation to radically change the lifestyle.

The sixth group is that of the “pregnant“. Women who have passed the normal-term adolescence, begin to churn out babies between the ages of 20 and 30 and to take pounds of pounds, pregnancy after pregnancy without being able to lose them in the interval between one and the other. Often pregnancy is desired and sought but evidently the stress load that pervades the woman’s mind becomes unbearable. It is normal to be afraid of what you do not know and often in the head of the future mother are installed catchphrase as “I will be a good mother,” “what will become my relationship,” “and my work?”, “Will I have a good birth? “,” and if the baby is not healthy? “. These and other questions are the fruit of conscience and we hope to have one; but often the woman does not find reassurance in the consort, the family, the institutions or even the gynecologist or the obstetrician who follows her. Unfortunately I see these women when they have had 3-4 pregnancies and then the excess pounds have become really too many and there is nothing left but the surgery. Instead, I believe that it is the moral duty of every gynecologist impose a check of the weight curve and understand when the patient needs additional psychological support or approach it to relaxation techniques for stress management.

The seventh group are the traumas of adulthood: violence, accidents, attacks, murders, griefs, illnesses of beloveds, become an unbearable and unmanageable pain and the patient first finds comfort in food and then uses it to build a barrier between himself and the world. The help they receive is often medicated (antidepressants) which further implements weight gain. Those who do not pass through an attempted suicide, however, decide to be killed slowly (more or less consciously). Others justify the overweight seen what they have passed, not aware of the fact that they live a difficult and unhappy life. In these cases I understood that the desire to live must start from the patient and in any case weight loss can only improve the quality of life and self-esteem. On the other hand, an excellent psychiatrist or psychotherapist should help to pigeonhole the pain and to dig into the patient’s subconscious to find a lever on which he can pivot to return and live.

The eighth group is composed of the overweight of the third age. In women, a mix of menopause, stop tobacco and retirement interact with problems of children (separations, financial) determined a need for the same to take refuge in food. These patients are the ones that best respond to the restoration of a healthy life. Maybe helped by a gastric balloon and by the study of techniques for managing stress (meditation, yoga, breathing, tai chi), they are women with a lot of time available in which you have to know how to rekindle the fuse of motivation.

In men the mechanisms are similar and I would also add a loss of “purpose”. The mission of man had been throughout his life to provide the family especially economically. Arriving at retirement, if he has not cultivated parallel interests during his life, he is lost. It therefore needs to rediscover a “why” and the right pleasure to persist in this new goal.

This classification aims to be a simplistic view of the causes of obesity and above all an explanation of how we do not find ourselves “accidentally obese “. It is true that modern society does not help us to eat properly, the culture of good food is becoming rather quantitative than qualitative. The poverty of relationships makes us more isolated from each other, preventing the development of a collective solidarity network. Who is alone, remains even more alone. Those with a weight problem are often stigmatized and put on the margins of society labeled as “being without willpower”. As a obesity’s doctor I had to take a personal path of years not to judge the obese patient and to understand his reasons, so I do not blame the neighbor. I only hope that my classification, born from the rather empirical observation of my patients, can help; for those who are overweight to elucidate and better understand their path, for those who are not, to understand and not judge the path of others.

With gratitude,