"Is 'let's lose weight' really all there is to it?"

Hello!

Well then... today, I'd like to talk about "obesity" that I've been thinking about for a long time.

"Obesity"I'd like to talk about the topic of.

Honestly, I'm not exactly stoic about managing my own body shape either.
I'm not exactly stoic about managing my own body shape either.

I eat ramen after a night shift, I go to the convenience store in the middle of the night, and when I'm busy, I stop exercising for a while... sweat

While saying "Let's lose some weight" in the outpatient clinic,

"No, I'm not doing it at all either..."

I often think that.

So lately, I've been studying obesity quite a bit, thinking that at least I should have the knowledge.
I've been studying obesity quite a bit, thinking that at least I should have the knowledge.

At first,

"In the end, isn't it just diet and exercise?"

That was about the extent of my feeling.

Of course, even now, that hasn't changed as being important.
Of course, even now, that hasn't changed as being important.

But, the more I studied,

"The human body isn't that simple..."

I started to think that.

For example, when you lose weight, your body actually tries to "return to its original state."

Hunger becomes stronger, and energy expenditure decreases.

The fact that so-called "rebound" is easy to occur is, in a sense, a very natural reaction.

Moreover, adipose tissue isn't just where fat is stored.
Moreover, adipose tissue isn't just where fat is stored.

Inflammation, insulin resistance, hypertension, HFpEF, CKD——

It is a quite “systemic” organ that is involved in various pathological conditions.

Recently,

“Obesity is a disease that cannot be explained by ‘overeating’ alone.”

I have come to think this more often.

Today,
I would like to talk a little about that.

Are we stopping at “let's lose weight”?

When working in outpatient clinics,
“weight loss” comes up in so many different situations.

Diabetes.

Hypertension.

Dyslipidemia.

Sleep apnea.

Knee pain.

Fatty liver.

HFpEF.

“Shall we try losing some weight first?”

The phrase itself,
is probably not wrong.

In fact,
there are truly many diseases that improve with weight loss.

Even just a 5% drop in body weight,
can significantly change blood sugar and blood pressure.

But recently,
there is something that concerns me a little.

That is,
the fact that the word “weight loss”,
is being used too easily.

Of course,
diet and exercise are important.

There is no doubt about that.

However,
actual clinical practice is
not that simple.

For example,

“I worked hard and lost 5kg, but it came back.”

There are really many patients who say that.

Moreover,
the person themselves is putting in quite a bit of effort.

Cutting down on dinner,
refraining from snacks,
and going to the gym.

But it comes back.

And,
with a fairly high probability.

In the past,
somewhere along the line,I used to think,

“Maybe they just couldn't keep it up.”

I thought something like that.

But,
as I studied the pathology,
my perspective changed a little.

The human body
tries to “return to its original state” more than you would imagine.

When you lose weight,
feelings of hunger become stronger.

Conversely,
energy expenditure decreases.

In other words, from the body's perspective,

“Danger! This might be a state of starvation!”

a reaction like that is occurring.

Therefore,
rebounding is,
not just a "failure",
but in a sense, quite a physiological reaction.

Since learning this,

“Let's lose weight”

I have started to think a little bit about the weight of that casual phrase.

Adipose tissue was not "just fat"

While studying obesity,
this was personally the most surprising thing.

Adipose tissue is,
not just a "warehouse" that stores calories.

Rather,
it functions as a quite active "endocrine organ."

When I first learned this,

“Wait, fat does that?”

I thought.

From adipose tissue,
various substances are released.

Cytokines involved in inflammation.

Leptin.

Adiponectin.

Even substances involved in RAAS.

In other words,
as fat increases,

• insulin resistance

• chronic inflammation

• hypertension

• Arteriosclerosis

• Na retention

• HFpEF

• CKD

Pathological conditions like these
gradually progress throughout the entire body.

This also connects significantly to the concept of
"cardio-renal-metabolic"
which is often discussed recently.

Therefore,
obesity is not just a "state of having high body weight,"

it is actually more natural to view it as a
.

And what makes it troublesome is that
all of these are interconnected.

Insulin resistance progresses.

Then, high TG levels occur.

Blood pressure also rises.

Sleep apnea also worsens.

Nocturnal hypoxia further increases sympathetic nerve activity.

Na retention progresses.

HFpEF worsens.

...and so on,
the pathological conditions connect like a single river.

Recently,
when seeing patients with obesity in the outpatient clinic,

"How many kilograms does this person weigh?"

Rather than that,

“I wonder which pathological condition is active right now”

I have come to think about this more often.

Perhaps,
that is the interesting part of viewing “lifestyle-related diseases” not as separate entities,
but as a single flow.

“That’s why it’s not just about ‘losing weight’”

So, obesity is not a story that ends simply with “let’s lose weight,”
but rather,

• which pathological condition is active

• what should be prioritized

• how much weight should be lost

• what should be protected

thinking about these things,
it is quite a general internal medicine-like disease.

Recently,
diabetes,
hypertension,
CKD,
HFpEF,
and dyslipidemia,

rather than seeing them as separate diseases,

“looking at the downstream of the same river”

I have come to think of them with a feeling like that.

I am still learning,
but since I started studying obesity,
I feel that the way I see lifestyle-related diseases has changed significantly.

Obesity is not so simple that it ends with
“overeating”
or
“lack of exercise.”

But conversely,
once you understand the pathology,
it is quite interesting.

• why do people rebound

• why does it lead to HFpEF

• Why does CKD progress?

• Why does high TG occur?

• Why does OSA worsen?

Everything
is connected, little by little.

Recently,
I have been studying obesity quite a bit,

and I find myself thinking,

“I see, so that’s why this happens...” quite often.

I am still in the process of learning,
but I will continue to share
interesting things and information
that might be useful in clinical practice, little by little.