Especially in today's busy and stressful pace, we may not have the chance to consume healthy foods at every meal. In addition, when we consider the size of the ready-made food industry, we are in a period where it is much easier to access ready-made food than healthy food. Thanks to the applications we install on our phone, we have the opportunity to order the food we want, whenever we want, without any effort. This is another factor that makes it easier to integrate unhealthy eating habits into our lives.

Hazır yemek sektörünün öncüsü Amerika Birleşik Devletleri’nde nüfusun %71’inin kilo fazlası veya obezite problemi olduğu raporlanmıştır¹. This figure is calculated based on people with a body mass index over 25. The situation is not much different in our country, which has rapidly adopted a western lifestyle.

It has been determined by research that refined carbohydrates, which are abundantly available in ready meals, do not only cause problems such as weight problems and obesity, but also cause cardiovascular diseases, diabetes, dementia, psychiatric disorders and cancer.^2,3. Although animal-based foods and fat consumption seem to be at the forefront in cardiovascular diseases, it is now known that refined carbohydrates such as white rice, white bread, sugar and honey contribute to cardiovascular diseases.⁴. In addition to all these, obesity-related hormone imbalances bring problems such as sexual reluctance and fatigue, and seriously reduce the quality of life of the person.

In fact, almost all of us are aware of these facts and we know that the various foods we consume are not suitable for us. However, we are not successful in giving up such foods because we do not suffer any harm in the short term, or even get serious pleasure. The reasons why we cannot give up refined carbohydrates and fatty foods can be summarized as follows:

1- Easy access: The preparation of healthy and nutritious foods has a time cost, but access to ready-made foods is much faster and easier.

2- Cost: Prepared foods and refined carbohydrates are cheaper than the foods that should be consumed for a balanced diet. That's why it has a feature that can appeal to every budget.

3- Learned reward system: Since we were little, we learned that foods such as chocolate, candy, ice cream and pizza are suitable for ourselves as rewards. Even when we went to the doctor and behaved well when we were little, we were given candy as a reward. Now we have a ritual, such as alcohol or ready meals, for a good success, a special day or when we want to pamper ourselves.

4- Brain reward center: Seeing food as a reward is not just a learned habit. Our brain can actually get used to foods with us and can trigger food addiction. Just like drug use, various foods make us feel good, encourage the desire to consume more over time, and can cause a sense of deprivation when we quit.⁵. In addition, our brain can enter into various chemical activities in line with the expectation before consumption, as well as the pleasure it will create after the consumption of such foods.

People with weight problems may try to lose weight by trying many different diets, or they may try to achieve results by trying weight loss medications and teas. Unfortunately, there are no easy short-term solutions to a chronic condition, and it is almost impossible to change habits acquired over a lifetime. Although restrictive diets, unrealistic sports and exercise programs provide only short-term benefits, they are not sustainable in the long run. Therefore, one of the recommendations I give to my patients with weight problems is to introduce sports and exercise into our lives very slowly. Just 5 minutes of walking a day outside of our normal routine is a starting point that won't be difficult for most people. However, if the goal of walking for one hour 5 days a week is set, the person will have difficulty and will get bored very quickly and give up. When small goals are set, many people may find these goals less and tend to exceed them. In this way, they can think that a 5-minute walk is actually less, and they can increase it to 8-10 minutes of their own accord. The important thing here is to motivate the person without compelling goals and to set the goal in a way that suits him/herself. The sense of achieving the goal is also very important. Since small goals can be easily reached, people will be able to motivate themselves more easily because they reach their daily goals.

The weight problem is not a one-size-fits-all problem. It will not be appropriate to show the same approach to every person with weight problems. It is important to go down to the source of people's weight problems and to investigate whether it is a pathophysiological phenomenon. Some people may have weight problems due to unhealthy habits, some due to an eating disorder called binge-eating, and some people due to problems such as insulin resistance and thyroid. If there is a situation caused by a health problem, the correction of this situation will also contribute to the resolution of the weight problem.

Although weight problem is not a uniform problem, people with weight problems have a common feature. Being overweight is a factor that increases the number and function of beta cells in the pancreas.⁶. This is due to the changes created by high intake of sugar and fat. Insulin excess that develops in parallel with these changes may leave its place to insulin resistance after a while.⁷. Both lifestyle changes and pharmacological treatments targeting insulin resistance are important methods both to prevent obesity-related risk factors and to lose weight in a healthy way. With the treatment methods approved by the FDA in the USA recently, both appetite control can be achieved and the goal of losing weight can be achieved in a more permanent way.

FDA approved for the first time as weight control semaglutideIt acts as a human glucagon-like peptide-1 analog. This increases the body's insulin secretion and accelerates the sugar metabolism in the body. However, it has also been observed that it increases the activity of beta cells in the pancreas.⁸. In other words, it can be said that while increasing insulin secretion, it also increases the population of cells that will increase insulin secretion.

Semaglutide also inhibits glucagon production. Glucagon is the hormone that triggers sugar production in the body. In this way, the sugar level becomes more balanced. All these are very important factors for individuals with insulin resistance. However, semaglutide can be used only for weight control in people without insulin resistance. As a result of trials with Semaglutide, it has been reported that the use of the drug reduces appetite, decreases the desire to eat junk food, and decreases the desire for fatty and high-calorie foods.⁹. However, it means that the food increases the transit time from the stomach to the intestine, the drug prolongs the feeling of fullness, reduces the amount of food and the number of daily meals.¹⁰. Semaglutide ile tedavi edilen kişilerde ortalama olarak vücut ağırlığının %15’i kadar kilo verdikleri gözlemlenmiştir¹¹. More importantly, it has been found that a significant proportion of the weight lost is from body fat.⁹.

It should be known that the weight problem is not only related to the physical appearance of the people. It is also very important to detect other risk factors that occur with weight problems. Although losing weight is very important for living a healthier life, early detection and normalization of health problems caused by weight is at least as important as weight control. Therefore, it is important to control insulin resistance, cholesterol level, thyroid functions and imbalances in certain vitamins before treatment.

I wish you healthy days,

Dr. Ahmet Ozyigit

Tel: 0392 444 3548 / 0548 887 8787

E-mail: dr.ahmet@elitenicosia.com

References:

1. National Center for Health Statistics. 2017. Health, United states, 2016: with chartbook on long-term trends in health. [online] Available at: [Accessed 24 July 2021].

2. Sommerfield, A., Deary, I. and Frier, B., 2004. Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes. Diabetes Care, 27(10), pp.2335-2340.

3. Sánchez-Villegas, A., Toledo, E., de Irala, J., Ruiz-Canela, M., Pla-Vidal, J. and Martínez-González, M., 2011. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutrition, 15(3), pp.424-432.

4. Fan, J., Song, Y., Wang, Y., Hui, R. and Zhang, W., 2012. Dietary Glycemic Index, Glycemic Load, and Risk of Coronary Heart Disease, Stroke, and Stroke Mortality: A Systematic Review with Meta-Analysis. PLoS ONE, 7(12), p.e52182.

5. Alonso-Alonso, M., Woods, S., Pelchat, M., Grigson, P., Stice, E., Farooqi, S., Khoo, C., Mattes, R. and Beauchamp, G., 2015. Food reward system: current perspectives and future research needs. Nutrition Reviews, 73(5), pp.296-307.

6. Ye, J., 2007. Role of Insulin in the Pathogenesis of Free Fatty Acid-Induced Insulin Resistance in Skeletal Muscle. Endocrine, Metabolic & Immune Disorders-Drug Targets, 7(1), pp.65-74.

7. Gray, S., Donald, C., Jetha, A., Covey, S. and Kieffer, T., 2010. Hyperinsulinemia Precedes Insulin Resistance in Mice Lacking Pancreatic β-Cell Leptin Signaling. endocrinology, 151(9), pp.4178-4186.

8. Goldenberg, R. and Steen, O., 2019. Semaglutide: Review and Place in Therapy for Adults With Type 2 Diabetes. Canadian Journal of Diabetes, 43(2), pp.136-145.

9. Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T. and Hjerpsted, J., 2017. Effects of once‐weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes, Obesity and Metabolism, 19(9), pp.1242-1251.

10. Doggrell, S., 2018. Sgemaglutide in type 2 diabetes – is it the best glucagon-like peptide 1 receptor agonist (GLP-1R agonist)?. Expert Opinion on Drug Metabolism & Toxicology, 14(3), pp.371-377.

11. Wilding, J., Batterham, R., Calanna, S., Davies, M., Van Gaal, L., Lingvay, I., McGowan, B., Rosenstock, J., Tran, M., Wadden, T., Wharton, S., Yokote, K., Zeuthen, N. and Kushner Overweight Obesity in Adults-Overweights with 2021. New England Journal of Medicine, 384(11), pp.989-1002.