As many as 25 percent of Belgians are obese. But although it is very common, there are still many myths and uncertainties about the subject. That is why obesity surgeon Wim Bouckaert and obesity coordinator Leen van Lierop, both affiliated with ZOL, launched the book ‘The kilo too much’. “There are many books about diets and losing weight. But anyone who has ever struggled with being overweight or obese knows that most methods only work for a short time and do not last,” says Dr. Bouckaert. “Leen and I wanted to demonstrate from the perspective of the obesity center that the solution to losing weight does not exist. There is no one successful way for everyone.”
How can we calculate whether we are overweight or obese?
Dr. Bouckaert: “At the moment, obesity is still defined using the Body Mass Index (BMI). Adults can calculate their BMI by dividing their weight in kilograms by the square of their height in meters. We call a BMI score of 20 to 25 healthy. However, if you are over 25, we are talking about overweight and from 30 we are talking about obesity. From a BMI of 40 you even have to deal with morbid obesity, a disease with a very high risk of additional conditions such as diabetes, which can be life-threatening. In addition to this Body Mass Index, the waist circumference also says something about the amount of fat mass in the abdomen. This is too high from 80 centimeters for women and from 95 centimeters for men. A factor that is not taken into account enough is the origin of the individual. For example, a BMI of 40 has a very high health risk for someone of the Caucasian race, while for someone of the Mediterranean type it is BMI 35.”
What is the main cause of obesity?
“Genetics only plays a role in the obesity we see in very few cases. The basis for obesity is mainly the imbalance between what you eat and consume. We live in a society where the majority of adults do not do manual labor and have opportunities to consume nothing. Most have a car that takes them everywhere and products are delivered to their homes. The same applies to children: they are taken to school by car or bus, while previously they cycled for miles. Ideally, we should take at least 10,000 steps per day.”
“If you take in too much food and consume too little, the balance changes”
Wim Bouckaert
Obesity surgeon (ZOL)
“At rest you need at least between 1,500 and 2,000 kilocalories per day. If you have a highly physical job, you can easily reach 3,000 to 4,000 per day. Exactly how many kilocalories you need depends on your physical activity and is different every day. But an average Belgian encounters a food supply of 12,000 to 15,000 kilocalories every day. An example is the vending machines at work. And the food you see is often very refined or processed. The more processed and processed, the unhealthier. If you take in too much food and consume too little, the balance changes. Our body automatically has the reflex to store the surplus in fat tissue. And once this is in, it is difficult to get out. So you have to find a balance between what you consume at rest and what you need on top of that to do an activity.”
“But it is not easy to find healthy food and make the right choices in our society. Unfortunately, the following also applies: the healthier, the more expensive. A Big Mac from McDonald’s costs about five euros, but if you go to a fruit shop with five euros, you won’t be able to buy much. So we live in an obesogenic environment, in which there is too much unhealthy food and too little exercise is stimulated, and it is not easy for people to make the right choice.”
What is the best way to lose weight for obese people?
“All our patients have already tried dozens of diets. I can also prescribe you a diet that will help you lose five kilograms in one month. But that is in the short term, because when we meet again after three months, you will have regained six or even seven kilograms. If you do the soup diet, apple diet or lemon diet for a week, not much will happen. Those one-sided diets are never good. You’re not going to get a balanced diet, so the basics are already wrong. You’re also going to starve yourself. And when you stop taking it, you are hungrier, you start eating again and you gain weight again. The same with Ozempic, you won’t get there with just that injection or pill. Diets and medication only make sense when combined with sufficient exercise and broad support.”
“In our book it doesn’t say ‘this is the solution’ because no one has it. But the best diet is a healthy and balanced diet. If you have an insight into why you are overweight, you need to think carefully about what your diet looks like. Is the distribution between good and bad carbohydrates, proteins and fats okay? Is your diet over-processed? These are working points that we work on with our patients. That doesn’t mean you should never eat unhealthy food. We always say: everyone eats an average of three times a day, that’s 21 meals a week. If you eat eighteen of those 21 meals in a correctly distributed and balanced way, and three of them are a little less, then there is no drama. Too bad, but unfortunately there are people who eat eighteen bad meals and three good ones.”
“We live in an obesogenic environment, in which there is too much unhealthy food and too little exercise is stimulated”
Wim Bouckaert
Obesity surgeon (ZOL)
“But in addition to nutrition, exercise is also important. Everyone has a smartphone on which you can put a free pedometer. My patients rarely exceed 3,000 steps, while on average you should take 10,000 per day. If you have a sedentary job, you should also stand up every half hour. We would have come a long way if everyone in the workplace would hang up the nutrition triangle, exercise triangle and happiness triangle and everyone would look at it once every week. So you can do a lot yourself by knowing where things go wrong. Instead of watching Netflix on the couch at the weekend, go for a walk or swim with your family every other week. If you drink twenty pints every weekend, and you stop doing that for a year by reducing it to two pints, you will have lost eight kilos after that year without having to do much.”
What if you can’t lose weight yourself?
“If you really cannot lose weight yourself, ask a doctor for help or go to an obesity clinic. In our clinic, the least serious cases receive advice from dieticians, psychologists, exercise coaches and physiotherapists. But in the most severe cases – a BMI of 40 or higher, or 35 if there are serious health problems – surgery is often suggested. But even if you undergo surgery, you must realize that there must be a lifelong commitment to nutrition, exercise and also follow-up because there is a whole schedule behind it. Consultations with a nutritionist, physiotherapist and psychologist, for example. Surgery is also not the ultimate solution. Without proper follow-up, you even run the risk of weighing more after your stomach reduction than before. I have never cured anyone, because the disease still remains in the background.”
(Read more below the photo)
Dr. Bouckaert: “There is a huge stigma attached to people with obesity.” — © Serge Minten
You also talk about an obesity epidemic?
“A quarter of the world will be obese by 2035. That ratio also increases in children. In the United States they now see a ceiling, while in Europe it is still rising. If we look at our country, currently 25 percent are obese, but this will increase to 33 percent in 2035. Every year we increase by 1.8 percent in Belgium. The word epidemic is therefore certainly appropriate. Life expectancy and quality also deteriorate, because we know that someone with morbid obesity has their lifespan shortened by several years. Because of the weight you can no longer mobilize properly, you have to take pills, take a lot of blood tests and much more.”
Can society intervene?
“Raising awareness has proven to be very difficult, because how long have we been trying to ban smoking from society? You are no longer allowed to smoke in buildings or hospitals, but many people still do it. In the early 1970s, malnutrition was the major challenge. Now there are as many undernourished as overnourished people in the world, so two major problems. Prevention must become a priority, but we are already too late to avoid the 2035 epidemic. The problem is more prevalent than ever. The government, but also employers, families and individuals play an important role here: including what food they provide and to what extent they motivate exercise.”
“The problem is that we are now missing the net by treating diseases such as diabetes and cardiovascular disease, while these are all diseases in which obesity plays an important role.”
Wim Bouckaert
Obesity surgeon (ZOL)
“But the people who are now obese need to be treated. As a society we have to allocate money for this. There is now little provision for reimbursement. The surgery is somewhat reimbursed. But someone who undergoes surgery not only pays for the procedure, but also for the preliminary phase with paramedics, the costs of consultations and two years of supervision. For a patient with a regular health insurance fund, this costs 2,800 euros out of pocket. That’s a lot of money for a lot of people. The problem is that we are now missing the net by treating diseases such as diabetes and cardiovascular disease, while these are all diseases in which obesity plays an important role. Little or almost no budget is given to obesity itself, not to prevention and not to solutions. Our society will therefore have to provide a good plan.”
“The problem is that we are now missing the net by treating diseases such as diabetes and cardiovascular disease, while these are all diseases in which obesity plays an important role.” — © Serge Minten
The book ‘The kilo too much’ by Wim Bouckaert and Leen van Lierop, published by Borgerhoff & Lamberigts, is for sale for 24.99 euros.