According to the statistics and according to your patients, how has obesity impacted people during Covid? If I look at my patients, I can identify 50% who have gained weight by being more sedentary, developing bad food habits related to anxiety, and engaging in more comfort eating in the home office.
The other 50% improved the quality of their diet, lost weight and increased their physical activity, especially those who used to travel a lot.
What are the latest treatments that are available to treat obesity?
Treating obesity by diet and treatment, we suggest:
- The Keto diet, which enables us to lose 80% of our excess of weight and gradually reintroduce good carbs in small quantities in order to obtain a healthy and well balanced diet (for example, the Pronokal diet).
- Intermittent fasting (as mentioned in the Revue Medicale Suisse of 13.01.21) which can include various forms such as caloric restriction (including low fat and low carbs), intermittent fasting or periodic fasting or fasting-mimicking diet or time restricted eating such as 18/6 (fasting for 18 hours and eating during 6 hours) or 16/8 or 14/10.
- Medical treatment: treatment available for obesity is Glucagon-like peptide 1 analog (GLP1 analog) named Liraglutide (Saxenda), subcutaneous injections on a daily basis with progressive dose; these are natural enzymes in the digestive system that can be reduced in cases of obesity and overweight or in diabetes type 2 leading to hunger, overeating and gaining weight.
Introducing these injections could help to reduce ghrelin, which is the hunger enzyme, and to increase leptin, which is the satiety enzyme. We therefore eat less and are immediately full. On the other hand, it could help to reduce metabolic syndrome by reducing glycogenesis in the liver, lipolysis, increasing insulin and reducing the glucagon secretion of the pancreas. This reduces gastric emptying; that is why we feel full. These injections, especially in some people, are very effective and very helpful indeed in reducing weight without any of the psychological frustrations.
Last option is bariatric surgery.
How do you see the role of technology through the available apps? Are they complementary to a treatment? Or are they more of an immediate solution that doesn’t work in the long term.
Technology apps, especially for calculating carbs, fat, calories, or the one used to calculate physical activity, are useful. I think they can only help to motivate you. However, we know that in some people they can have a negative impact, as not everyone can function by being over-controlled. I think it therefore a very personal decision whether or not to use technological apps. Personally, I like the continuous blood-sugar measuring device known as “Free-style Libre,” which can be very useful in evaluating your diet in a personalized manner.
What is the approach towards obesity that Clinique de Genolier takes, in comparison with other clinics?
I treat and follow up on my patients individually and use the amazing platform facilities of the clinic in all aspects (cardiologist, nutritionist, endocrinologist, radiology service and all other domains). This ensures that the follow-up is optimal and complete.