Managing obesity…

From festive season indulgences to lockdowns, increased stress and a general trend towards less healthy eating and behaviour, obesity is on the rise and it is dangerous. Ballito specialist physician and endocrinologist Dr Tanya van der Made offers some guidance on this very complex, chronic disease.

While many people struggle with weight fluctuations, dealing with obesity and weight loss can be complicated and multiple factors can leave you feeling hopeless in your weight loss journey.
According to Tanya, who has special interests in thyroid disorders, obesity, diabetes and pituitary disorders, it’s important to remember that no two people are completely alike, and an individualised approach is essential.

“Obesity is defined as a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications and reduces lifespan. It results from complex interaction between genetic, metabolic, behavioural and environmental factors.”

Guidelines and focus have shifted somewhat over the years, says Tanya, with more focus on the patient as an individual and searching for the root cause of obesity. Managing obesity is no different to managing diabetes, high blood pressure or hypercholesterolaemia and, in fact, she says they usually all coincide under the umbrella of metabolic syndrome.
“Each patient must be looked at holistically and then evidence medicine applied. Not everyone with a raised BMI will have obesity-related problems, but these discussions need to be brought up in a gentle manner so that there is a full understanding as to why achieving a healthy weight is important. Our aim in endocrinology is often about prevention of worsening disease and suffering and that is why I am so passionate about it.”

Tanya says there is also a shift in management of patients where diet, exercise and pharmacotherapy are started from the first appointment. “We have some newer medications that have been extensively studied in the context of diabetes that benefit even non-diabetic patients. But patients require long-term support as there is no magic bullet or medication. It requires input, effort and support from all those involved in the patient’s care.”

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She emphasises the importance of an individualised approach because, even people who ‘hate exercise’ will benefit from some form of regular physical activity. “A healthy, well-balanced diet and eating pattern is important as this, with exercise, is what will maintain the weight loss in the long term as well as maintain muscle tone and strength (important in patients with osteoporosis and osteoarthritis) and mental well-being.” Exercise or physical activity needs to be 30 to 60 minutes of moderate intensity for most days of the week.
Pharmacotherapy is used in patients that with certain BMI’s and there are also medications that can help to assist with weight loss as well as reduce weight regain after healthy lifestyle-based weight loss.

“In my practice. I aim to see 5% to 10% of the body weight lost in the first three months once the patient is put onto individualised evidence-based pharmocotheraphy and lifestyle modification. If this does not occur, then the patient is reassessed to determine which root cause of their obesity is not being addressed.” Tanya says some patients still do require Bariatric surgery. “My hope is that patients seek help earlier and realise there are options and there is hope. This requires a team of professionals and time but every improvement is a step forward even if its literally the first step into the office.”

Dr Tanya van der Made practices at The Well Ballito and Netcare Alberlito Hospital in Ballito, as well as Umhlanga Gateway Medical Centre. She has a well organised team including her personal and clinical assistant Joanne Sutherland and she works closely with a diabetic nurse educator and dietician to provide a holistic approach to treating chronic conditions. Tanya’s interests include thyroid disorders, obesity, diabetes and pituitary disorders as well as osteoporosis.
DETAILS: [email protected],, 066 397 0875.

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