Dr. Deniz Bakalov graduated from Medical University – Varna in 1996. After his graduation, he started working as a resident in the Internal Department of “MBAL – Isperih”, where he worked for 2 years. From 1998 to 2002, he was a clinical resident in internal medicine at the Department of Internal Medicine, Medical University – Sofia.
Since 2002, Dr. Bakalov has been a resident at the Clinic of Endocrinology of UMBAL “Aleksandrovska”, and since 2011 he has been the chief administrative physician at the same clinic. Since 2008, he has been an assistant at the Department of “Internal Diseases” at the Medical University – Sofia.
There are specialties “Internal diseases”, “Endocrinology and metabolic diseases”. He is a member of the Bulgarian Medical Union, the Bulgarian Society of Endocrinology, the European Association for the Study of Diabetes (EASD), the International Osteoporosis Foundation (IOF), the American Diabetes Association (ADA).
According to data from the European Association for the Study of Obesity (EASO), between 30 and 70% of people over the age of 18 in the countries of the European Union are overweight, and between 10-30% are obese. The latest National Nutrition Survey shows that, on average, about 30 percent of childhood girls and boys are overweight, and 13 percent are obese.
What is pathological obesity and what are the possibilities of medicine to deal with it – these questions are answered by the endocrinologist Dr. Deniz Bakalov.
– Dr. Bakalov, is the Bulgarian obese?
– Yes, he is very obese and the reason for this is complex – lifestyle, high-calorie food, lack of physical activity, irregular food intake, with main meals in the evening hours, many stressful situations. Unfortunately, the result is that around 23-24% of the Bulgarian population is obese. And 40-45% of people in our country are overweight.
– When do we talk about pathological obesity?
– Obesity is classified according to the methodology for calculating the body mass index (BMI) according to a certain formula. A normal BMI is when it is between 18 and 25. Between 25 and 30 body mass index we are already talking about overweight. Between 30 and 35 – for the first degree of obesity, from 35 to 40 – for the second degree, BMI over 40 is already morbid obesity.
Since Aleksandrovsk Hospital is a center that is very active in the treatment of obese patients in a metabolic cardiovascular plan, recently we see people with an extremely high degree of obesity, with a BMI over 50. These are huge, very high body weight people.
– Back in the day, grandmothers advised us: “Eat, grandmothers, to be healthy”, and today we are talking about health problems in overweight children…
– Unfortunately, we are back to the original source – because obesity is increasing not only among adults, but also among children, and this is already based on the culture of nutrition and the lack of physical activity in early childhood. Childhood obesity, which is becoming an increasing problem, will certainly lead to metabolic and cardiovascular changes with advancing age, and if not affected in time, things become irreversible at some point.
What tests should be done in case of overweight?
– What are the most common diseases, Dr. Bakalov, related to obesity?
– I, as an endocrinologist, will start with the metabolic changes that occur
And they are a fact in all types of exchanges, and especially in carbohydrate exchange. Over time, a disorder of the type of pre-diabetic state develops and, if no measures are taken, diabetes mellitus subsequently becomes pronounced.
As they say, an evil does not come alone, other changes in the metabolism of fats – lipids – go hand in hand. There is an increase in the levels of triglycerides, the level of good cholesterol drops, which in turn leads to high blood pressure. Changes also occur in other target organs.
As an end product of protein metabolism, uric acid also increases, fatty liver occurs and the state of hepatic steatosis develops, which in turn can be complicated in the future with steatofibrosis and even steatocirrhosis.
These metabolic changes lead to vessel damage and cardiovascular complications develop – ischemic heart disease, cerebrovascular disease or peripheral arterial disease. The many kilos that are put on begin to weigh on the musculoskeletal system and these people suffer from an arthritic disease – i.e., the joints suffer, there is an inability to move, a limitation in it. And a vicious circle turns.
In addition, obese people suffer more often from tumor diseases. Cancers of the gastrointestinal tract, colon, stomach, and pancreas are more common in obese people. Gallstones can also develop…
– At what point should overweight people seek help from a specialist?
– If you are overweight, God forbid obesity, you should seek help in the early stages, when the BMI is over 30. For an obese person – BMI over 40 (morbid obesity), it is very difficult to expect, that only with diets and sports will achieve permanent weight reduction.
My admiration for anyone who starts to eat sensibly and move actively, but in morbidly obese patients, even if there is progress with weight reduction, the problem is that it will be a permanent trend. We have seen many people who start exercising and dieting show good results for the first few months, then very often that diet regime changes and they quickly start putting the weight back on.
– What is the outcome of this?
– Modern medicine has several approaches that can be applied. According to global qualifications, obesitas (obesity) is a disease and each patient is subject to an adequate evaluation by a number of medical specialists. The treatment of morbidly obese people is not the work of nutritionists alone, but of an interdisciplinary medical team. First of all, morbidly obese patients are usually seen by endocrinologists, because very often it is a metabolic syndrome and usually this condition is accompanied by type 2 diabetes.
It is extremely important that patients who are candidates for treatment, in addition to an endocrinologist, meet with a gastroenterologist, an internal medicine specialist, possibly a cardiologist, to evaluate their general condition.
One approach is to start with lifestyle and dietary changes, plus some medication. In the European Union and, respectively, in Bulgaria, three medications are currently registered as medicinal products, which, however, must be prescribed by a specialist and their intake monitored by him.
However, the method that has a lasting effect on pathological obesity is metabolic (bariatric) surgery, and in recent years it has undergone serious development. Its philosophy, on the one hand, is to reduce the volume of the stomach – that is, a person cannot take a large amount of food. And the other postulate of modern bariatric surgery is that food surrounds a part of the small intestine, thus disrupting its absorption in it.
– Does the health fund pay for this type of intervention?
– At this stage, the Health Fund does not cover the costs of this type of operational intervention. In Bulgaria, this is a serious problem, as it is not affordable for many patients. On the other hand, the problem also lies in the poor awareness of the Bulgarian regarding this option for the treatment of obesity and its accompanying diseases.
10 foods to relieve constipation and excess weight
– We are flooded with all kinds of advertisements for weight loss products that promise a miracle. How much should we trust them?
– You said it yourself – advertisements, and they are related to business. According to Bulgarian law, medicinal preparations are only those that have passed the relevant clinical trials, everything else is food supplements, for most of which there is no scientific evidence that they are effective and safe.
And I will repeat again – in order to regulate weight, the right word should be a healthy lifestyle. This includes eating in moderation, three times a day – to have breakfast, lunch, and the smallest amount of food to be taken at dinner, and no later than 6-7 p.m.
Also, avoid high-calorie foods, generally speaking, these are fast carbohydrates. To consume more vegetables that do not have additional calorie filling. Drinks should not have added sugar or glucose-fructose syrup. Water is preferable in this case, as you should drink at least 2 liters of water per day. It should not be forgotten that alcohol also carries calories.
To have a minimum of about 150 minutes a week of some physical activity and that it is related to aerobic activity, in other words one that involves oxygen in the exchange – this is a running track, swimming, cycling, intensive walking or in the mountains.
Rumi GOOD
