«The goal that everyone should set? Live healthy for as long as possible. Counteracting the aging of mind and body thanks to the most powerful of antidotes: the food we eat every day.” Franco Berrino, eighty years old today, April 30th, has always been a fervent supporter. After having directed the department of preventive and predictive medicine of the Tumor Institute of Milan for forty years, the Emilian epidemiologist never misses an opportunity to reiterate it. And he warns against shortcuts: «Eating well should be a daily habit. Our psycho-physical well-being is at stake.” And on obesity: «Almost one billion people in the world – approximately one in eight – are affected by it. In Italy, according to the latest data fromItalian Barometer Obesity Report, there are six million obese people, i.e. more or less 12 percent of the adult population. A full-blown emergency, which requires a cultural revolution.”
Doctor, but what exactly is obesity?
«Obesity is a clinical condition characterized by a pathological accumulation of body fat that is so excessive that it has a negative impact on quality of life and health. To determine whether a person is obese or not, body mass index (BMI) is generally used. Body Mass Index): this is a measurement obtained by dividing a person’s weight in kilograms by the square of their height in meters (kg/m²). A BMI of 30 or higher denotes obesity. Warning: obesity is a full-blown pathology which, moreover, increases the risk of developing other important pathologies: I am talking about type 2 diabetes, heart disease in general, stroke and some types of cancer, to name just a few. examples”.
How do you get to be obese?
«Meanwhile, everyone has their own story. Wanting to generalize, let’s say that the factors that can lead to this state are different: from the genetic component to the lack of physical activity, from health problems such as, for example, depression, to environmental and socioeconomic factors. Then of course there are the unruliness and addiction to food. Obesity is a complex disease: treatment requires a holistic approach to address both the physical and psychological causes.”
In this historical moment we talk more and more often about anti-obesity drugs. Are they effective?
«They can be even more dangerous if used improperly. We are faced with a bizarre sociological phenomenon since, especially in the United States, many people resort to it, without there being an actual need. Among these there are also many famous and popular people. People who move the masses, so to speak, without thinking about the consequences.”
Meaning what?
«There is a drug – actually more than one, but this one is the most popular – which is actually an anti-diabetic aimed at reducing blood sugar levels and preventing heart disease. Adults use it to treat type 2 diabetes when diet and exercise are not enough to keep the disease under control. Does it make you lose weight? Yes, but hiring for this purpose is improper. Furthermore, the increase in its demand to solve weight problems has made it inaccessible to many diabetics who need it.”
Why can this drug be so dangerous?
«For science, it is a drug whose active ingredient, semaglutide, is a synthetic analogue of GLP-1, the hormone that causes the pancreas to produce insulin. The active ingredient acts as an “agonist” for the hormone receptor itself, activating it. And by stimulating insulin secretion on the one hand and reducing glucagon secretion on the other when glucose levels are high. During hypoglycemia, however, semaglutide reduces insulin secretion without hindering that of glucagon. Body weight and fat mass are reduced by a general decrease in appetite. Translated, semaglutide mimics the action of the hormone GLP-1, generally released by the intestine after a meal. GLP-1, in turn, suggests to the brain that we are full: in this way it discourages us from eating more or too much. Pay attention to the side effects which are important: among the most common are gastric paralysis, bloating and heartburn, nausea, vomiting, asthenia, gastroesophageal reflux, dizziness, constipation and so on.”
So how do you combat obesity?
«Eating correctly day after day. And carefully distributing meals throughout the day. Or rather, during daylight hours. I give as an example an Israeli study, limited but very significant, conducted on 90 overweight women divided into two groups of 45 people each. For three months each of these women, as part of a low-calorie diet, ate the exact same foods in equal quantities. Except that one group always had a hearty breakfast and a very light dinner, the other the exact opposite. The women in the first group lost the most kilograms, 9 to be exact. The women in the second group, i.e. those who ate a lot in the evening and less at breakfast for all that time, lost only 3 kilograms. This is to say that it’s not just calories that make us fat, but when we eat and how.”
When should we eat?
«Studies suggest that, to lose weight, we should allow at least 14 hours to pass between the last meal of the day and breakfast the following morning. Furthermore, dinner should be very light. Even better if you skipped it. In any case, you shouldn’t eat at night.”
Instead, how should we eat?
«Chewing a lot. I ask a question that always makes us think: do obese people swallow food without chewing because they are fat or are they fat because they don’t chew? The second explanation is probably the most correct one. An experimental study that compared those who chew each bite 15 times with those who chew the same bite 40 times found a different effect on the hormones produced by the digestive tract: chewing for a long time causes the stomach to produce less ghrelin, the hormone that stimulates appetite. The intestine, however, produces more cholecystokinin, the hormone that calms the appetite center, and GLP1 (glucagon-like peptide 1), as already mentioned, the hormone that lowers blood sugar and helps you lose weight. More studies have found that chewing a lot reduces appetite and food cravings.”
Doctor, tell us: what should we usually put on our plates?
«All vegetables, except potatoes: raise blood sugar levels a lot. Then: all whole grains, especially rice which is the poorest in proteins. For wholemeal bread, make sure it is truly wholemeal, and not white flour mixed with bran. The breads are excellent, always wholemeal, with pumpkin, sunflower, flax and sesame seeds: they reduce the glycemic index of the bread itself. Returning to cereals, if you choose to eat them for breakfast, in the form of muesli for example, you must be careful that they do not contain sugars or other sweeteners. It is useful to know, then, that the many fibers contained in them on the one hand are very filling, on the other they nourish the beneficial intestinal microbes (a healthy microbiota helps you not to gain weight). Legumes are also usually on the table. In addition to having a low glycemic index and high fiber content, they have inhibitors of the enzymes that digest starches, therefore slowing down the digestion and absorption of glucose, consequently the overall glycemic impact of the meal. In addition, they inhibit pancreatic lipase, in other words they reduce the absorption of fats. These are all “anti-nutritional” qualities, but in these times of overnutrition they are beneficial. Fruit deserves a separate discussion and should be eaten in moderation if it is sugary like grapes, figs and bananas. Walnuts, hazelnuts, almonds and pistachios, on the other hand, are very caloric, but help you avoid gaining weight. On the table, even small doses of kefir, yogurt and fermented vegetables, for an efficient microbiota.”
More proteins or carbohydrates at the table?
«First of all, let’s dispel a very common place. There are many dieticians who believe that carbohydrates make you gain weight and proteins make you lose weight. It is not so. In our DIANA studies we achieved significant weight reductions — on average 4 kg in 5 months — and metabolic improvements by increasing, not decreasing, carbohydrates, but only whole grains and legumes. Then removing sugars, potatoes and refined flours, and reducing animal proteins. In our society we consume too much protein, especially animal protein: around 16 percent of the calories we eat, double the actual requirement. Not to mention that the more we eat, the fatter we get. Only excessively high-protein diets (with 40-50 percent of calories in the form of proteins) make you lose weight, but because they intoxicate. By intoxicating the appetite center you eat less. Those who follow these diets, as soon as they stop excessive protein consumption, gain more weight than before. Better to eat human food: whole grains, legumes, vegetables, fruit and only occasionally meat.”
Finally, foods to avoid?
«Those “over-processed” by industry. Epidemiologists at Harvard University have drawn up a ranking of the foods that make you fat. In first place are chips, then potatoes, sugary drinks, processed meats (burgers, hot dogs, sausages and cured meats), red meats, unsweetened fruit juices, refined flours, commercial sweets and butter”.
