Aleksey Kovalkov: ''One can find healthy vegetable salads in fast food — it's a matter of choice''
The dietitian: about the main causes of obesity in Russia
Russia ranks tenth in the ranking of countries with the highest mortality rate from cardiovascular and other diseases caused by malnutrition. This deserves immediate attention, says Aleksey Kovalkov, a dietitian, leading Russian specialist in the treatment of obesity. Whether fast food is as scary as it is painted, how to fight obesity throughout the country and what it requires from the government — read about this and much more in the interview with the expert of Realnoe Vremya.
''Parents feed their children without thinking about the composition of products''
According to the ministry of healthcare of the Russian Federation, in 2017 the number of obese Russians reached 2 million. Over the year, the share of such citizens increased by 6%. What is the main reason for the increase in the number of obese people in our country?
There are three reasons. First, we have no medical university that would train dietitians. Obesity is a disease, but we do not have a dietitian in polyclinics. Since the state has withdrawn from this problem, then every man and his dog is engaged in treatment of obesity — from healers to people who do not have any medical education, but are psychologists. The share of pseudo-medical clinics is huge. There are a lot of such extremely ineffective medical centres both in Moscow and throughout the country.
The second cause of obesity is the general illiteracy of the population with regard to proper nutrition. On the one hand, ask anyone on the street and he or she will tell you how to eat properly. On the other — the diet cannot be the same for everyone. Nutrition for girls is different from the nutrition for elderly people, the diet of a bodybuilder is different from what's the office worker should eat. Stress, illnesses — all this affects us and our diet. But there is no medical programme, either on television or on the radio, which would tell not about how to eat, but about how to combine products and how they affect the development of certain diseases.
Third, there is a lack of appropriate education at school. I once proposed to introduce dietetics lessons for schoolchildren following the example of Uzbekistan. I was refused, being referred to a lack of funds, opportunities and disinterest. We prefer to teach everything except the vital skills: how to behave in an extreme situation, how to eat, how to choose products in the store.
Nutritionists claim that overweight is in people's minds. How important is it to take into account the psychological state in the fight against obesity?
Psychological state depends on hormonal status. For example, with the disease such as pheochromocytoma (a neuroendocrine tumour of the medulla of the adrenal glands), such a large amount of adrenaline is released that people do crazy things. There were real cases when such people were sent to a mental hospital and treated with heavy drugs. Then doctors found pheochromocytoma, did the necessary surgery, and people came to themselves and became absolutely normal. Psychological status is determined by our hormonal balance as well as our hormonal balance is determined by our psychological status. You feel nervous, adrenaline is secreting. Someone immediately begins to eat everthing, eating his or her feelings, but someone cannot eat at all.
''Nutrition cannot be the same for everyone. The nutrition for girls is different from the nutrition for elderly people, the diet of a bodybuilder is different from what the office worker should eat. Stress, illnesses — all this affects us and our nutrition.'' Photo dietsalute.ru
It is necessary to understand that we are one! Therefore, it is impossible to treat obesity separately: separate psychological and hormonal status. An extremely comprehensive approach is needed! But, in my opinion, endocrinology is still primary.
What should be the first step to begin fight against excess weight for a person suffering from obesity?
Obesity is a medical condition. If the excess weight is 10% higher than normal body weight, it is obesity. Normal body weight is easily calculated using the Brock formula, or make measurement of body composition using bioelectrical impedance analysis. The first thing a person with obesity should do is to consult a doctor!
But, unfortunately, it is impossible to find a dietitian in a public clinic, so you have to go to a private one. You can stick to a diet for as long as you want, but the weight will still return, since the root cause of its appearance has not been eliminated.
''There has been some transformation of the idea of body positive''
In the West, the bodypositive movement is popular, calling to accept your extra weight and love yourself for who you are. Can it have negative consequences for people who are overweight? What is the reason for the emergence of such a movement?
Initially bodypositive is a social movement, which is based on the belief that all people should have a positive idea about their bodies and accept them as well as the bodies of other people. It fights against discrimination on the basis of weight, mental and physical health, appearance. Now there has been some transformation of the idea. Bodypositive calls not to link the appearance with health, but it has long been known that obesity is a chronic recurrent disease that leads to an increase in mortality primarily from cardiovascular diseases and cancer. In this case, ignoring obesity as a problem will lead to an increase in socially significant diseases in society as a whole.
''Ignoring obesity as a problem will lead to an increase in socially significant diseases in society as a whole.'' Photo: hudey.net
One of the frightening trends in Russia is the growing number of obese teenagers. What is the reason for this and how does excess weight affect the development of a teenager in general? How should parents instil the proper food culture in children?
According to the World Health Organization, the number of overweight infants and young children (0 to 5 years) worldwide increased from 32 million in 1990 to 41 million in 2016. These are frightening statistics. A child with obesity is a 90% adult with all manifestations of metabolic syndrome — diabetes, arterial hypertension, insulin resistance. The latter is already in adolescence and young age is a risk factor for infertility in both men and women. This trend is associated with improper high-carbohydrate nutrition, the formation of a reflex from early childhood ''did something good — get a sweet'', ''tired, crying, brawling — it is necessary to give a sweet''. But the excess sugar-rich and gluten-rich products only worsens brain function and reduces progress in studies.
Health is affected by the lack of sports, poor eating habits in the family, not always proper nutrition in schools and kindergartens, reducing natural feeding. It is necessary to start to teach parents the principles of healthy eating, including healthy snacks, to introduce in schools and kindergartens talks about proper nutrition and the dangers of excess weight, to develop the availability of children's sports, to teach children to enjoy, celebrate and get positive emotions not only with pizza and sweets.
''In Spain I have not met a single slender child''
According to a study by Friedrich Schiller University of Jena, the first 10 positions in the ranking of countries with the highest mortality rate from cardiovascular and other diseases caused by malnutrition are occupied by the countries of the former USSR. Russia is the 10th (first — Uzbekistan, Ukraine — 4, Belarus — 7). How much are cardiovascular diseases related to nutrition?
Indeed, cardiovascular diseases caused by the development of atherosclerosis take the fisrt place as the reasons of deaths. But how does this disease develop? First, the blood sugar level increases, and the high concentration of sugar in the blood turns it into a real acid for blood vessels.
Our skin is a multi-layered epithelium, and any damage is quickly overgrown. Vessels consist of a single-layer endothelium. If people eat fast carbs in large amounts, the sugar level immediately becomes higher than the normal indicator and erodes the vessels. Liquid blood plasma begins to sweat inside the vessel, the muscle wall gets compacted, the vessel narrows, and platelets and high-density lipoproteins occupy this place. This is how atherosclerosis develops.
Therefore, all complications of diabetes occur due to damaged blood vessels, that is, microcapillaries on the legs are destroyed, a diabetic foot develops, which leads to amputation. You can spend as much money as you want on the construction of cardiac centres, but until we solve the problem with nutrition we will not eliminate the growth of cardiovascular diseases.
''Our skin is a multi-layered epithelium, and any damage is quickly overgrown. Vessels also consist of a single-layer endothelium. If people eat fast carbs in large amounts, the sugar level immediately becomes higher than the normal indicator and erodes the vessels.'' Photo: diabetsunveseliba.lv
Also, scientists have found that people in Spain, Israel and France have the most healthy diet. What contributes to this state of affairs: the policy of the state, especially the national cuisine or something else?
I wouldn't agree about Spain. I visit this county quite often and see many children with excess weight. I will tell more — I have not met a single slender child in Spain. The French (''true'' French) are more fortunate — they are genetically programmed to assimilate the national cuisine and not to gain weight.
In our cities, new fast food outlets are constantly opening, advertising of harmful food can be found literally everywhere. Should the government regulate the proportion of food with harmful components?
The state should regulate the promotion of healthy food and education of food culture. In the same fast food you can find useful vegetable salads, and it is a matter of choice.The mother is a ''broiler'', father – a ''broiler'', and son — a ''broiler'' — such fattened ''cells of the society'' are often found in large supermarkets with an excessive number of packages. In such families there usually reigns a kind of cult of food. The house is always full of delicious, well-prepared and beautifully served food. There are constantly overeating adults and, of course, a child accustomed to this. So what does the fast food advertising on TV have to do with it? It is necessary to explain from childhood why sugar and white bread are harmful, how to make a diet properly, what cereals are the most useful, and what should be refused, why it is necessary to drink water.