“Deep Dive into Obesity: A Silent Threat Changes Lives, Risks Health Crisis”

Obesity (Obesity) It's not just body shape issues that affect self-confidence. But it is also a silent threat that affects long-term health. Increased risk of chronic non-communicable diseases (NCDs) For example, diabetes, high blood pressure. Cardiovascular diseases In addition, obesity affects the quality of life. It affects the economy and society, both in terms of increased medical costs and decreased work efficiency.

In an era full of unhealthy food. Facilities People have decreased physical mobility. Obesity has become a common problem at all ages. Teenagers or adults Therefore, it is important to understand obesity so that we can take proper care of our own health and that of our loved ones.

Dr. Tanupol Wirulahakarun or Dr. Amp, Chairman of the Board of Directors of BDMS Wellness Clinic, Bangkok Dusit Medical Public Company Limited and President of the Bangkok Association of Obesity Medicine and Obesity Education Promotion Physicians (BARSO) It will take you to delve into the causes of obesity in various dimensions. Welcome “World Obesity Day (World Obesity Day)” This falls on March 4 every year so that everyone can start to change the system and create a healthy and sustainable society together.

Obesity is expanding to a wide area.

Obesity crisis (Obesity crisis) It is a global public health problem that needs to be addressed urgently. Examples of studies published in journals The Lancets revealed that in 2014, 2022 There are more people. 1 Billions of people around the world are being affected by obesity. 35 The previous year was twice as high in adults and in children and adolescents who were 5-19 The increase has quadrupled. 2022 It also revealed that: 43% of the global adult population is also overweight. In addition, information from World Obesity Atlas 2024 It is also predicted that in 2014, the Olympics will be restored to its original state. 2035 Or in the next ten years. Our world must have people who are overweight and overweight and obese. 54% or railing. 3.3 Billions of people.

For Thailand Reports from the Medical and Health Warehouse System Ministry of Public Health In monitoring obesity and obesity. In 2023, Thai PopulationThere are problems with overweight and obesity. 48.35% The Bangkok metropolitan area has the highest prevalence, accounting for 56.4 cases.% Next is the Northern Region (51.8%) Southern Region (50.8%Central Region (46.9%) and the Northeast (46.6%)

Another demographic group that we should not ignore is the childhood group. According to a report from the Ministry of Public Health in 2024, Thai children under the age of 10 5 The prevalence of obesity was 9.24 years.% In children between the ages of 6-14 The prevalence of obesity and obesity is 13.12% While children who are 15-18 The prevalence is as high as 15.76% The childhood population living in Health Zone 4 is Bangkok, Nonthaburi, Pathum Thani, and Phra Nakhon Si Ayutthaya. Ang Thong, Lopburi, Sing Buri, Saraburi and Nakhon Nayok are the provinces with the highest prevalence of obesity and obesity. This percentage is still higher than in 2023. Also,

Therefore, we should pay more attention to the childhood and adolescent population. Because childhood health conditions can affect health conditions and quality of life as adults. Examples of studies published in the journal Frontiers in Nutrition In 2023, it is estimated that children and adolescents with obesity are 5 times more likely to become obese adults compared to children who are not obese, with 55% of children with obesity from school age developing into obese adolescents, obese adolescents 80% more likely to develop into obese adults and up to 70% more likely to become obese by the age of 30.

Obesity is a chronic condition caused by a combination of many factors. Body Mass Index (BMI) But in fact, BMI It may not be a very accurate tool for assessing obesity. Because it is not possible to assess the composition of the body, such as a person with BMI Equal For example, bodybuilders have more muscle than people who lack exercise, so it is not recommended. BMI For diagnosis alone, it is best to use another tool such as a waist circumference. Measuring body composition with a machine DEXA (Dual-Energy X-ray Absorptiometry) It will help to better assess obesity. In the middle-aged group (20–50 years old). Women should not have a fat proportion of more than 32%, and men should not exceed 25%.

This is mainly due to the fact that it gets more energy from food than it can be metabolized by the body. Therefore, our body accumulates excess energy in the form of fat in different parts.

"In addition, there are other factors such as hormonal imbalances, genetics, as well as supergenetic processes, or Epigenetics Importantly, when obesity occurs, the accumulated fat will further stimulate changes in various systems, making obesity more severe and creating an endless cycle like this," Dr. Amp explained.

Understanding the body through diet/weight maintenance mechanisms

Eating habits and maintaining that body weight It is caused by the collaboration of 3 Mechanism together As follows:

Mechanism One: regulation of the body's appetite balance; (Homeostatic feedback)

This mechanism occurs by the secretion of hormones in the gastrointestinal tract and sends signals to the brain stem (Brainstem) and the hypothalamus (Hypothalamus) Hormones that play an important role in this mechanism are:

o  Leptin (Leptin) – Hormones of satiety

Leptin is a hormone that plays an important role in regulating satiety and maintaining the body's energy balance. By stimulating through neurons. Pro-opiomelanocortin (POMC) and Cocaine-amphetamine regulated transcript (CART) or groups of neurons involved in increasing feelings of fullness.

Leptin is produced and secreted by fat cells in white adipose tissue (White Adipose Tissue, WAT) The level of leptin in the body increases with the amount of fat cells accumulated. The more fat there are, the more fat is accumulated. The more leptin the body produces, the more leptin it produces. In obese people, the body is resistant to leptin (Leptin Resistance) Despite having very high levels of leptin (Hyperleptinemia) But it cannot reduce appetite. This is why some people overeat. Even if the body has received enough energy.

o  Ghrelin hormone (Ghrelin) – Hunger hormones

Ghrelin is a hormone that plays a role in regulating hunger. Stimulation through neurons Agouti-related peptide (AgRP) and Neuropeptide Y (NPY) It also inhibits the work of POMC It helps us get hungrier, and it also affects the brain's reward system. Recognize and make decisions to eat with

Ghrelin is secreted by the auxin glands in the stomach, where it is secreted a lot before meals and when I finish eating. But in obese people, ghrelin will stop secreting. The level of this hormone does not decrease. Foods that cause ghrelin to malfunction include soft drinks or foods that contain sugar. High Fructose Cron Syrup (HFCS) causing obesity.

In addition, there are other hormones secreted to help control weight and treat obesity, including:

o  Clocystokinin hormone (Cholecystokinin, CCK) - Hormones that help regulate satiety

CCK It is a hormone that acts as a ‘Intermediates’ The link between the brain and the intestines helps the body to balance energy properly. When we eat fatty foods, we eat fatty foods. CCK It sends signals to the digestive tract to secrete gastric juices and enzymes that help digest food, as well as send a signal to the brain that the body has received enough food and a feeling of fullness.

o  Hormones Peptide Y (PYY) - hormones that reduce appetite;

PYY Hormonalsecreted from the peripheral duodenum and large intestine. works well when eating foods that contain short-chain fatty acids such as in vegetables, fruits, nuts and whole grains. GLP-1. In regulating sugar levels and slowing down the movement of food from the stomach to the small intestine. Helps to keep you full for longer. The more there are, the more PYY and GLP-1 The more you work together, the faster you feel full and the less you can eat.

 o  Hormones Glucagon-like Peptide-1 (GLP-1) - Hormones help regulate sugar and satiety.

GLP-1 It is a hormone secreted by the distal and large intestine, which is stimulated when food enters the small intestine to start the metabolic process and stimulate the secretion of insulin from the pancreas. Inhibits the activity of the hormone glucagon. As a result, food moves from the stomach to the small intestine more slowly, resulting in satiety.

It can be seen that the mechanism regulates the balance of appetite and energy balance of the body. It is caused by the connection between the digestive tract and the hypothalamus brain to make you full or hungry. But in people who are obese, Satiety hormones and hunger hormones work in relation to each other. This causes more appetite than usual, resulting in eating large quantities (Overeating) And they get more energy than their body needs, accumulating until they become obese.

Second mechanism: Eating Control for Pleasure (Hedonic feedback)

In addition to the appetite control mechanisms from various hormones, the body also has a system that allows us to eat for satisfaction. which is controlled by the Mesolimbic system (Mesolimbic System) Or the brain's reward system. This system is made up of parts, including the hippocampus (Hippocampus), Amygdala (Amygdala), Frontal lobe of the brain (Prefrontal Cortex) and the central brain (Midbrain)

The brain responds to food properties such as shape, taste, and smell. Stimulated through neurotransmitters, including dopamine (Dopamine) that stimulates the motivation to eat., Serotonin (Serotonin) that regulates mood and appetite., and endocannabinoids (Endocannabinoid) With opioids (Opioid) that increases the preference for eating, but in obese people. Once these neurotransmitters work simultaneously with the hormones mentioned above, they are already active. This will allow them to continue eating. Even if you feel full.

Third mechanism: Cognitive Response Mechanism (Cognitive feedback)

Sometimes, there are certain factors that encourage us to have bad lifestyle habits and become obese, including:

Self-control (Self-regulation) is the ability to manage our eating habits. Both consciously and unconsciously. In the part that is conscious. We may try to modify our diet to control our weight, such as limiting our food intake or choosing low-energy foods. The unconscious part comes from stress or emotions.

Social Response (Social feedback) Our eating and exercise habits are often influenced by those around us. Social networks can be either a force for positive change or an obstacle to improving behavior, depending on the social norms we perceive.

An environment conducive to obesity (Obesogenic environment) They include a sedentary lifestyle and decreased physical activity. There is increased stress. Access to high-energy food, etc.

Dietary control in people with obesity is associated with an imbalance of three main mechanisms: the body's appetite balance mechanism, which is an important factor; The imbalance of these mechanisms causes the body to control hunger poorly. There is a tendency to choose to eat to meet more satisfaction and reduce self-control. As a result, they eat more than necessary, leading to weight gain, and eventually leading to obesity.

Genetics and transgenetic processes: Underlying factors that can cause obesity

As mentioned at the beginning, in addition to the energy balance factor, Hormonal balance Social factors and environmental factors. Genetic factors can also be one of the causes of developing obesity. Many of you may have noticed that if a family member is obese, their children and grandchildren are also likely to be obese. The genetic code is associated with obesity, such as:

1)  MC4R (Melanocortin-4 receptor)

2)  POMC (Proopiomelanocortin)

3)  FTO (Fat Mass and Obesity-Associated Gene)

4)  LEPR (Leptin receptor)

5)  LEP (Leptin) and

6)  ADIPOQ (Adipocyte-, C1q-, and collagen domain-containing) etc.

In addition to genes or genetic codes, transheritous processes (Epigenetics) Or the science of regulating gene expression, which is not caused by gene sequence changes, but is stimulated by our own living habits, which plays an important role in the occurrence of obesity in many aspects. For example:

o Eating a high-fat diet - Reduced functionality PPARγ or genes involved in mitochondrial function in cells. Affects the body's metabolism

o Exercise - Increase gene expression PGC1α In regulating energy metabolism and mitochondrial formation.

o Insufficient rest. - Reduced gene activity Cry1 and BMAL1, which is related to cortisol levels (Cortisol) in the blood increases. Appetite It increases blood sugar levels, and also affects genes. SCD1 that plays an important role in the process of forming and breaking down body fat.

However, Dr. Amp continues to emphasize that the key to this is lifestyle habits (Lifestyle) For example, eating large and large quantities of food, including the type and characteristics of the food we choose to eat, such as foods that are high in energy, high in sugar, and high in fat, processed foods, etc. If we modify our lifestyle habits, we can inhibit or increase the expression of genes associated with obesity through transgenetic processes, both of which help us understand our health blueprint and encourage more targeted health care. 

Modify the system from the inside out.

First System Fix: The body mechanism system to restore balance.

Currently, the approach to managing obesity is Lifestyle Habit Modification (Lifestyle modification) It is still a priority because it can be started immediately and is as sustainable as possible so that everyone can apply it more easily. Dr. Amp has recommended 7 Here are some simple health care guidelines:

1)  Choose to eat 50% vegetables in one dish, 25% good quality proteins such as fish, tofu, nuts, and grains, and the last 25% are whole flour rice such as brown rice.

2)  Avoid foods that are high in fat or low in consumption, especially trans fats and saturated fats such as lean meats. Animal skins, offal, cakes Fast Food Bubble tea Processed meat (Processed meat) Such as bacon, sausage, ham, jam, sausage, sausage, pork slices, pork sausages, meatballs, etc.

3)  Avoid foods and drinks high in sugar, especially those containing High Fructose Corn Syrup (HFCS) Such as nectar, soft drinks, syrups. Juices, jams, candies, cookies, ice cream, cakes, pies, etc.

4)  Exercise regularly for at least 150 minutes per week, or at least 30 minutes 5 days a week.

5)  Get enough sleep at least 8-9 hours every day and go to bed before 4 p.m. so that the body can secrete hormones normally.

6)  Avoid harmful substances such as alcoholic beverages, smoking, and especially things that cannot be talked about at all, such as toxic dust. PM2.5

7)  Relieve stress by meditating, walking, or doing activities that calm your brain.

Modify the second system.: Social Support

Good social support is associated with sustainable weight loss. Participating in the health care of people in the community. There are activities such as educational training or clubs that make everyone aware of health. The important thing is to have a good support system that promotes good relationships and creates a balance between society. Environment and personal life

Third System Fix: Policy support

Improvement of structural problems and social processes affecting the institution. Laws, the economy, infrastructure, and industry are important to solve the obesity crisis, such as taxing high-sugar drinks. Processed food tax, fat tax, etc. Healthy Product Support Modernizing laws and disseminating knowledge through television media Social media to raise awareness for everyone in society.

Improving problems from the near example of individual daily life behavior to systemic and policy solutions is like solving problems from upstream to downstream. It will help reduce the environment conducive to obesity. It indirectly promotes the awareness of each person and will help drive a new way of life. Everyone is interested in good, quality, and ultimately sustainable healthcare.

On the occasion of this year's World Obesity Day, Under the concept of ‘Changing Systems Healthier Lives’ It focuses on all of us to raise awareness in solving the problem of obesity seriously. Transform systems and create an environment that promotes healthy choices and improves well-being.MoreFor everyone

“This matter is not just about one person, but it is consideredIt is a matter for everyone in society, including all departments from the government. From the private sector to international missions.Let's work together. Let's get startedImprove the system to suppress and prevent this obesity crisis. Together, to create a healthy and sustainable future for our children.” Dr. Amp left it at the end.

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