68% of women and 31% of men in the country are overweight or obese¹.

Obesity, defined as someone with a Body Mass Index (BMI) of over 30, generally peaks towards middle and older age but is becoming more common amongst younger people. In South Africa, there is a concerning high prevalence of both overweight and obese younger females aged between 18 and 24².

Being overweight is categorised as someone with a BMI of over 25². BMI is calculated as weight in kilograms divided by the square of the person’s height in metres (kg/m²)³.

A survey conducted amongst South African female university students found that 64 % of them had attempted to lose weight in the past 12 months^2. The most common way they were trying to lose weight was through changing their diets and increasing their exercise².

The mental and physical health consequences of being overweight and obese are well known. They include depression, anxiety, asthma, non-alcoholic fatty liver disease (NAFLD), gall bladder disease, certain cancers, osteoarthritis, sleep apnoea, cardiovascular disease, chronic back pain and type 2 diabetes⁴.

The good news from the survey was that many of the university students were trying to lose weight and lower their BMI². Even a 5-10% weight loss has significant health benefits. These include  improved respiratory function and mental wellbeing, reduced risk of certain cancers and joint disease, and improved quality of life. In women, weight loss also improves fertility⁵.

There are many factors at play when it comes to appetite regulation and suppression, including the role played by certain hormones. These include leptin which suppresses appetite and ghrelin which stimulates appetite^6,7.

When it comes to the physiology of weight gain, the body will always try to maintain its energy balance and protect the body’s existing body weight⁷.

People who have been overweight or obese for a long time will often have an excess of leptin due to an excess of adipose tissue. This can then dysregulate the body’s hunger system which may affect a person’s ability to control food intake and to lose weight⁶.

The reason for this is that the brain gets to a stage where it no longer recognises the appetite suppressing hormone leptin, which can result in increased hunger and a reduced ability control food intake⁶.

What this means is that despite a person’s best efforts to exercise, make dietary changes and include portion control, their weight loss efforts may not be successful^6,8.

To add to the complicated nature of losing weight is the fact that weight regain after weight loss is not simply because of a person returning to their former lifestyle habits. This too has a strong physiological basis^6,8.  Unfortunately, it is estimated that 90 percent of people who lose a lot of weight eventually regain most, if not all, of it⁹.

When losing weight, the satiety hormones such as leptin decrease as does energy expenditure, whilst hunger hormones such as ghrelin increase which results in an increase in energy intake. This is the body’s way of getting a person’s weight back to the heaviest weight, which is known as the metabolic set-point^10;11.

Appetite control can be affected for up to a year^7,10, which makes the use of a clinically proven appetite suppressant helpful to assist patients to lose weight and most importantly, to keep it off¹².

A study has shown that 70% of obese patients would welcome their doctor starting a conversation about their weight¹³.  Eating a balanced diet and maintaining an active lifestyle are proven to help with weight management¹¹ but patients may require help to control their appetite¹². Pharmacotherapy can play an important part to assist patients who struggle with lifestyle modification alone⁷.

DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. This editorial has content that includes independent comments and opinions from independent healthcare providers and are the opinions and experiences of that particular healthcare provider which are not necessarily that of iNova Pharmaceuticals.

Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. IN4657/22

References:

1. SA Heart and Stroke Foundation. Healthy Weight (2020) at https://www.heartfoundation.co.za/healthy-weight/ (website accessed 30 June 2022)
2. Senekal M, Lasker GL, van Velden L, et al. Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters. BMC Public Health 2016;16:918. DOI 10.1186/s12889-016-3576-x.
3. World Health Organisation. Body Mass Index (2017) (https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle—who-recommendations)
4. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health 2009;9:88.
5. Haslam D, Sattar N, Lean M. ABC of obesity. Obesity-time to wake up. BMJ 2006;333:640-642
6. Crujeiras AB, Carreira MC, Cabia B, et al. Leptin resistance in obesity: An epigenetic landscape. Life Sci 2015;140:57-63.
7. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia, 2013.
8. Mendieta-Zerón H, López M, Diéguez C. Gastrointestinal peptides controlling body weight homeostasis. Gen Comp Endocrinol 2008;155(3):481-495. 33. Sumithran P, Prendergast LA, Delbridge E, et al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. N Engl J Med 2011;365(17):1597-604.
9. University of Michigan. Weighing The Facts – The Tough Truth about Weigh t Loss (2017) at https://healthblog.uofmhealth.org/health-management/weighing-facts-tough-truth-about-weight-loss#  (website accessed on 30 June 2022)
10. Sumithran P, Prendergast LA, Delbridge E, et al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. N Engl J Med 2011;365(17):1597-604.
11. Healthline. What You Need to Know about Set-Point Theory (2020) at https://www.healthline.com/health/set-point-theory (Website accessed on 30 June 2022)
12. Rosenbaum M, Kissileff HR, Mayer LES, et al. Energy Intake in Weight-Reduced Humans. Brain Res 2010;1350:95-102.
13. Caterson ID, Alfadda AA, Auerbach P, et al. Gaps to bridge: Misalignment between perception, reality and actions in obesity. Diabetes Obes Metab. 2019;21:1914–1924.