"It just doesn't work without a lifestyle change!"

In theory, it couldn't be simpler: if you add fewer calories to your body than you burn, you will have a caloric deficit - the pounds will drop. Yvonne Winhofer-Stöckl's everyday life shows that the practice is different, as is so often the case. As a metabolism expert, she helps overweight people lose weight. Why is this often not easy and how it can still work?

The big WOMAN themed special for your feel-good weight

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A body weight of less than 10 kilograms - this is the average wish of Ms. and Mr. Austrians. They clearly name aesthetics as the main motif. "Younger patients in particular want to feel more comfortable in their bodies," reports internist Yvonne Winhofer-Stöckl. In the mid-30s, the motive changes: "Usually it is the unfulfilled desire to have children that motivates you to lose weight." Only at an advanced age, when health problems such as diabetes or high blood pressure manifest themselves, does the health aspect come into focus. Not surprising for Winhofer-Stöckl: "Many of those affected do not feel sick until then, as the consequences only come to bear later."

She does not see the blame for the lack of awareness of the health consequences of being overweight in her patients. After all, just a few years ago the principle "Round is healthy!" Still applied. And not just in layman's jargon: "Doctors first had to recognize that the increase in BMI is linearly related to health consequences."

A conversation about diet hurdles, obesity as a vicious circle & modern weight loss medicine

Only one in ten diets is actually successful. How can you explain that?

Winhofer-Stoeckl: We live in what is known as an obese environment; in a world that makes us fat - because we are constantly tempted to move as little as possible and to eat high-calorie food. If we ultimately make the decision to want to lose weight, there is, in addition to all the stimuli that surround us, above all one that counteracts it with all its might: our body. If we attack its reserves by using less energy, the need for food increases automatically. If we are confronted with triggering stimuli at every corner, this desire intensifies. The snack that ultimately satisfies these cravings is not the apple with 50 calories, but the filled roll with 500. So the challenge here is to resist and opt for the healthier alternative.

Why is it usually more difficult for overweight people to resist hunger attacks and to implement their plans than for people of normal weight?

Winhofer-Stoeckl: The visceral fat tissue, which is present in large quantities in overweight people, plays a decisive role - medicine knows that this type of belly fat is a real hormonal organ that tirelessly sends metabolic signals. Metabolic signals that play a key role in controlling our appetite-regulating centers in the brain. Strictly speaking, the weight gain is often based on a dysregulation of these appetite-regulating hormones, which are produced partly in the gastrointestinal tract and partly by adipose tissue. This means that the more belly fat there is, the higher the production of these hormones - we don't feel full and we are constantly hungry.

"The more you weigh, the more intense your cravings become - a vicious circle."

Sounds like a kind of vicious circle …

Winhofer-Stoeckl: Exactly, the visceral fat "feeds" itself to a certain extent. Another crucial aspect is our insulin level: If we give in to cravings and grab easily absorbable carbohydrates such as cakes or pizza slices, these let the blood sugar level rise rapidly - as a result, the organism pours large amounts Amounts of insulin. By the time it works after about two hours, most of the short-chain carbohydrates have already been absorbed. The now striking insulin thus promotes a hypoglycemia, which our organism wants to counteract by taking in more quickly absorbable carbohydrates - so we get cravings for sweets. So it hits the vicious circle quite well.

Seems like losing weight is a very complex matter after all. However, very few people seek professional help from a doctor. What advantage do those affected have when they seek advice?

Winhofer-Stoeckl: Medicine has made many advances in the field of obesity research over the past few years - today we know a large number of the pathophysiological mechanisms that contribute to its development and, for the first time, we have therapies that actually work. The big problem in the past was that we doctors were reluctant to use the drugs available to us due to numerous side effects and lack of success. And because there were hardly any options, they often did not look at them any further. However, thanks to modern weight loss medicine and interdisciplinary activity, it is now possible to offer patients targeted concepts - with success.

»90 percent of all diets fail. Responsible for this: the environment in which we live."

What are the advantages of modern weight loss medicine compared to previous options?

Winhofer-Stoeckl: In the past, there were broadly two options: One was preparations that had a direct influence on fat digestion - unpleasant side effects such as uncontrollable diarrhea were the result. The other option was provided by centrally acting drugs that suppressed the feeling of hunger. However, these had fatal side effects: heart problems, severe depression and increased suicide rates - understandably no one would be responsible for four or five kilos less. Modern weight loss medicine takes a different approach and starts with the satiety hormones - the focus is on the so-called GLP-1, which contributes to sustainable weight loss by reducing the feeling of hunger. The big advantage: You already have years of experience with the product, which was originally approved for the treatment of diabetes, and you know its successes as well as the side effects, which are comparatively minor to the benefit of the patients.

Who is this option for?

Winhofer-Stoeckl: Basically, the preparation is approved from a BMI of 27 and is used successfully up to a BMI of 40 - in addition, the medical data shows that the best results are achieved with bariatric surgery. When GLP-1 is used, however, has to be decided on an individual basis.

Sounds like a miracle cure …

Winhofer-Stoeckl: I would rather speak of a game changer - the therapy finally enables the necessary change in lifestyle. It just doesn't work without a lifestyle change. However, the preparation can help those affected to cope with the usually difficult start of losing weight and to overcome critical points at which the weight stagnates. This motivates those affected and helps them lead a healthier life.

The possibilities of weight loss medicine at a glance

Anyone who has already tried it knows that losing weight is anything but a sure-fire success. As individual as the causes of obesity are, individual support is also essential. What are the options:

Nutritional, exercise and behavioral therapy

Whether it is a lack of exercise or unhealthy eating habits that have been learned over many years - successful weight loss often fails due to our habits. This is exactly where nutritional, exercise and behavioral therapy come in: A nutrition plan can help limit excessive calorie intake, and an individual exercise plan can help increase energy expenditure through exercise such as endurance or muscle building.

In addition, behavior therapy support can help to make positive long-term changes to habits that have been learned about eating. Those affected can use these methods regardless of their BMI.

Weight-loss medication on prescription

If you have a BMI of 27 or more, you qualify for weight loss medication on prescription in Austria - so-called anti-obesity medication. They physically counteract appetite, hunger and cravings and ensure fast satiety when eating or influence fat absorption. By acting directly on the body, for example on the hunger-satiation balance, they limit the calorie intake. They can help break stagnation when losing weight, break down hormonally active visceral fat and optimize eating and exercise habits. Over-the-counter medications that are supposed to help you lose weight are not tied to the BMI.

Bariatric surgery

If the BMI is 35 or higher, one qualifies in this country for bariatric surgery, i.e. surgical interventions that reduce calorie intake. Two techniques in particular are used: the so-called gastric bypass surgically reduces the capacity of the remaining stomach. By connecting the middle small intestine directly to the remaining stomach, food and digestive juices are only mixed in the middle small intestine, with the result that food is no longer completely broken down and absorbed. The so-called sleeve stomach, on the other hand, means the surgical removal of 90 percent of the stomach, with the result that the appetite is reduced and a quick satiety is made possible.

The doctor-patient relationship is often decisive for the success of losing weight - the right doctor can be groundbreaking.

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