Obesity in Poland: How to stop the growing problem? Episode 86

Monika Rachtan
Hi Monika Rachtan. I'd like to welcome you very warmly to another episode of Po Pierwsze Patient. It turns out that obesity, a disease, kills more people in the world every day than the COVID 19 pandemic. And unfortunately, we are still failing to deal with this obesity treatment not only in Poland, but also worldwide. Although these figures in Poland are very alarming, and it is these figures that I will be discussing with my guests today. And they are Professor Małgorzata Gałązka Sobotka. Good afternoon. Welcome, Professor.

Małgorzata Gałązka Sobotka.
Good morning, and welcome to you.

Monika Rachtan
And Mr Alexander Prejbisz. Good morning, Professor.

Alexander Prejbisz
Good morning, Madam Editor.

Monika Rachtan
Perhaps I can start with the professor. Only 30 per cent of Poles have a normal body weight. That makes the rest around 60.

Małgorzata Gałązka Sobotka.
57%.

Monika Rachtan
He has an abnormal body weight, which means he is either overweight or obese. Why do we in our country take such a casual approach to how much we weigh?

Małgorzata Gałązka Sobotka.
It seems. Here we have a great many different studies that point to the key causes of the development of obesity, and we know that they are not only genetic, because there are some patients and some patients in whom this condition is very strong, and we take a completely different approach to treating such people. It has its origin in metabolic changes, but these, in turn, are strongly linked to the environment, to the environment in which we function, to changes in lifestyle. For civilisation has brought us a multitude of wonderful things, from which we draw handfuls every day, but it also foots a very high bill. And that bill is our lifestyle. That we move so little because we use elaborate communication systems. That we eat so much because we are subjected to the enormous, enormous pressure of the all-encompassing food that is available. Let me pose this research question. I haven't looked it up yet, but I will certainly be contacting GuS. Do we have such data? And if not, could we answer such a question for ourselves? How high is the saturation of grocery shops per kilometre of our territory, for example?

Małgorzata Gałązka Sobotka.
Because it seems to me, as we come back from holidays from different parts of the world, there is probably nowhere in the world that has such a huge exposure to the outlets that provide us with food and in such huge quantities. And it's not good at all that there are so many of these temptations. Particularly when we have lacked in this transformation of ours and our journey towards the top developed countries of civilisation to invest in what is proving to be one of the most effective tools for obesity prevention. Because the editor said, why are we failing in treatment. I think that these figures of 57% Poles who are overweight, who are obese, show first and foremost that we are totally helpless when it comes to prevention, to preventing the development of this, this disease. A lot of social conditioning, also a certain acceptance of this perception of overweight as a certain symbol of well-being.

Monika Rachtan
It's getting very dangerous.

Małgorzata Gałązka Sobotka.
When more than one grandmother or aunt praised us, they praised us when we turned up to visit with extra kilos, pointing out that it was an expression of this good life we were probably leading. But this is solely due to the fact that for many, many years we have not been made aware of how serious the danger is when this excess weight starts to build up, and that it can lead to the development of a terribly dangerous and, let's face it, fatal disease that can take our lives prematurely. Yet I think it is the wish of every one of us that this life should last as long as possible, in good quality. Because this is a very important component of the discussion on obesity. Quality of life.

Monika Rachtan
I think it has already been said by the professor that obesity is not an aesthetic defect, that it is not an ugly appearance, that it is not something we do not like in the mirror, but we should absolutely view obesity, but also perhaps overweight, which is already tending towards obesity, as a serious life-threatening disease. Obesity has more than 200 complications that can occur in a patient. Professor, about this aspect of health. Apart from obesity, what are the most common illnesses suffered by patients who come to see your professor?

Alexander Prejbisz
Maybe let's start with that, with obesity, with fat tissue itself. Yes, because we have to take into account that, of course, adipose tissue is a normal tissue of the body. Only, as Professor Kurylowicz says, this adipose tissue in people who have an excess of it, who have an abnormal diet, is depraved, It stops functioning in a normal way. And this is something we must always realise, that it's not just fat. Is it not just a tyre? It is a metabolically active tissue that secretes a number of hormones that simply destroy the body and our goal of treating obesity is. This is also Prof Kurylowicz's term, not mine, but a beautiful one. To resocialise the adipose tissue. Yes. That is, to reduce adipose tissue and return to the correct body weight. That's the resocialisation. So that it has its own back. Those functions that it has, well it warms up the body also the proportion of brown tissue, white tissue. This is all important in our organism and hence prevention is important, because we should never really allow this tissue to deprave and have to resocialise it. On the other hand, the fact is, if we realise that it's not just these extra kilos, it's metabolically active tissue that destroys the body, well it's no wonder there are consequences.

Alexander Prejbisz
Yes, of course there are repercussions due to the sheer weight, because there are more kilograms. Imagine if we simply carried two bags or dumbbells of 17 kilograms each up the stairs. For example, if we are 30 some kilograms overweight. So this is already the first problem. From this problem, the joint problems start. Musculoskeletal problems, yes. So it's not just us talking about cardiovascular or diabetic problems of obesity, but it's a range of other diseases. And, of course, diseases, cardiovascular diseases, metabolic diseases, i.e. diabetes, lipid disorders are also a consequence of obesity. We, curiously enough, do not include obesity in the medical risk scales, the ones we use. This is because the consequences of obesity, such as hypertension, lipid disorders and diabetes, take on this cardiovascular risk. They in our cardiovascular risk. What we assess in a 10-year perspective become a stronger risk factor, But this is a complication of obesity. We are comparing here, I am always comparing, that it is such a snowball effect. That is to say, at the beginning we have a Snowball, such a ball that we have to throw, it can splatter.

Alexander Prejbisz
And it is this fatty tissue that starts to accumulate. It's also important to note that the longer the obesity goes on, the more depraved that tissue becomes, so it's also harder to get it back into a rehabilitated form. Therefore, as these complications of obesity build up, it starts to become such a snowman, and then it becomes a big snowball, and then it turns into an avalanche and we are no longer able to stop the avalanche. We treat the complications of obesity and most often that is the problem of the health service, that we treat them, because we have heart failure, we have kidney failure, we have liver steatosis, we have all the skeletal, musculoskeletal sequelae and we treat those sequelae. Whereas, in fact, we could have prevented both of these earlier. I think the professor was alluding to Where did obesity in Poland come from? I think it occurred to me now that maybe it was a good thing that sugar was on cards, but it rationalised it. Besides, please also remember that food used to be cheap too, but there was not such widespread availability, such high-calorie food.

Alexander Prejbisz
Anyway, such sociological and socio-economic theories of obesity say that it was the 1970s when there was a stratification between the increased availability of high-calorie foods, which started to increase terribly, and at the same time what the professor was saying was going on all the time. A reduction in energy expenditure, because we have more and more, more and more lifts everywhere, escalators everywhere, we can get everywhere. Please take into account that when you stay in a hotel, please 80 90% me, especially modern hotels. You will not find a staircase with which you can go up to the second floor.

Małgorzata Gałązka Sobotka.
The same is true in office buildings. Very many of the people we meet at various meetings say But I would love to walk in my work, walk up the stairs. Only my problem is that in our office building it is even forbidden. The health and safety services consider it only an escape route for those special cases. Also, we need a lot to make a kind of civilisational transition again, because this change that we experienced during the transformation stage, this transition to this mass, cheap and poor quality food should be stopped today. This process should be stopped today, and we are talking about perhaps a new revolution in this transition to civilisation, a return to our roots, a return to the habits that our grandmothers, grandfathers and probably parents still have in their memories and minds - simple, unprocessed food, prepared and giving a certain style of functioning also in social relations. After all, one cooked at home. And it was preparing meals together, eating together. I will constantly recall my cooking lessons from primary school and even later secondary school, how they had a salutary power not only on our cooking skills, but also on building social relationships.

Małgorzata Gałązka Sobotka.
Also, perhaps it is to these basic such habits that we should return.

Monika Rachtan
But don't you have the impression that our generation is being fed a little bit by our mothers and grandmothers, who experienced the lack of what you were talking about, those ration cards, and today this access to food, what the producers give us, but also the big food chains, is a little bit of a response to the fact that it used to be impossible. And I have this feeling that even when I'm talking to my mum and I say But mum, the child really doesn't need to eat so many sweets, please, And my mum tells me But you know, because I think it's like that all the time, that it used to not be. And like you, for example, I couldn't buy everything like that because I just couldn't get it. Whereas now there's such an availability that these grandmothers give to these grandchildren because they love. Yes, they love and nurture and at the same time do harm. And that's what I also wanted to say about these children. Because it used to be that a child who was one in a class at school. Maybe there were two such children in whom there was obvious obesity, or there was overweight.

Monika Rachtan
That usually had the nickname Fatty. And I started talking a little bit to the parents and to the children about how it is now. And the children say that there is no longer a fatty in the class, because half of the people, half of the children have this excessive body weight And it's not such a phenomenon anymore, because here the numbers are already alarming. How many children don't exercise in PE lessons? How is that even possible? What does this augur for us in 20 years' time? What kind of society will we have?

Małgorzata Gałązka Sobotka.
The prognoses are not the best, and that is very much the case. Numerous scientific publications, including those on Poland, make it clear that unless we make some radical changes to the way the state operates today, because the fight against this risk that obesity is developing will unfortunately not come down only to interventions by the Minister for Health or the President of the National Health Fund. Here we need to redefine certain paradigms at the level of state policy, policy on infrastructure, design of space, buildings, school buildings, accessibility to sports facilities, but also accessibility to food, accessibility to advertising which presents this food in particular to children and young people. It is no secret that today the school break does not consist of children running around, meeting and talking, but often running outside the school building to do some shopping in a nearby shop. It certainly requires a great deal of action on a great many levels so that we can address many of these risks that affect us and influence the development of obesity, overweight and obesity. To curb, but to change, I think, Polish schooling in general. I think that today the Ministry of Education, in transforming the core curriculum, also touches on the importance of health education.

Małgorzata Gałązka Sobotka.
We rejoice and look forward to this famous lesson in health. At the same time, however, I try to appeal every time I get the chance to make a plea for us not to reduce this, this new transition to civilisation, to just this one lesson. Because please note that parents often talk about the fact that at my school, there is no more unhealthy food in the canteen, at my school, the shop no longer sells this, those sugary snacks.

Monika Rachtan
That is, not just the lesson, but the whole school has to be changed to make it work.

Małgorzata Gałązka Sobotka.
This is probably the moment when we should say to ourselves that a healthy school is not just some kind of campaign for the keenest, most ambitious and most aware headmasters, teachers and parents, but that we should define a new standard for a healthy school. So that every Polish child, when he or she enters this stage of education, because it is not only school, it is kindergarten, so that they are health-secure. We should understand the concept of health security not only in terms of getting to a doctor when we need medical intervention, but also in terms of reducing the risk of this happening without a single environment. This can be done, for example, by specifying what a Polish school or kindergarten could look like. The example of Japan has recently been often cited, that is, a qualitative change, that is, a reduction in the risk of obesity developing in Japanese children. Because, indeed, in the adult population there this dynamic is very high, but in the child population this problem is being contained. Among other things, there is the fact that children do not bring their meals to school. They are guaranteed at school and this ensures that every child, regardless of their social status, where they come from and the locality in which they live, is guaranteed a healthy meal for their second breakfast.

Małgorzata Gałązka Sobotka.
And I think that we in Poland are in for such a wide-ranging discussion about changes in very many areas and levels of our daily lives, of our children and young people, in order to really reduce all these risks that are lurking around. Their awareness is already a great potential and resource for us, but awareness alone is not enough. Concrete, very concrete action is simply needed here.

Monika Rachtan
Systemic action. Professor, does it happen that in 20-year-olds you are already diagnosing complications of obesity? For example, do 24-year-olds come to your professor with hypertension?

Alexander Prejbisz
Yes. And before I even answer your question, Madam Editor, I will refer to what the Professor said, because it is very important. As part of the National Cardiovascular Disease Programme, we did a very huge amount of work, 10,000 questionnaires. Professor Dobrowolski was the coordinator of this project. I participated together with him in this project. We surveyed 10,000 18-year-olds, that is, school leavers. And this is also a procedure that seems to be very important, that first we research and then we act. Because also our actions must be supported by knowledge. And for example, what came out of this survey. One observation is that young women in particular were affected. Eighteen-year-olds are young women. I can't call girls or girls anymore. Yes, young women. It turns out that the difference in physical activity between summer and winter is double. That is, it follows that we need to put more emphasis on physical activity in winter, because in Poland the majority and we see this later. Patients are not physically active in winter because it is dark, because it is cold, because it is unpleasant.

Alexander Prejbisz
So access to not just building a gymnasium, but organising activities that would be, that would be attractive and that would attract in the winter. The second issue is school food. This is also very important and there is a very huge way to improve there too. I have children at school, so I know what it looks like in different schools. For example, it was the case that in my son's primary school, the teacher was the first second class, she organised a class breakfast together, which was very important, and the teacher, in a way, checked what was on that breakfast. You couldn't bring a chocolate bar, you couldn't bring chocolate. It was kind of her business, also her own business, because she knew that if a child eats a chocolate bar for his second breakfast, his concentration goes down. It's terrible. So it was policed. Yes. The children were learning in some way. The other issue is the daughter, who is in high school. Okay, it's very cool, she can choose her meals Vegetarian. Normal. Only one problem is. She has a less than 15 minute meal break where there is a queue to pick up that meal and a queue to eat that meal.

Alexander Prejbisz
There are not enough places and I think this is also a problem that then transfers to my patients, to society, that we are not used to this lunch break. Please see that in the Mediterranean diet there is a lunch break, but it is a one-hour break. Firstly, it gives us a break at work, which is also important, but on the other hand it gives us free time for a meal, which, by the way, is not eaten alone. It is also an opportunity to meet, to socialise, to do some business. But there is time. Yes, we can't. Even the healthiest meal eaten in 10 minutes is an unhealthy meal. First of all, this is also such a habit we have and many people have. He doesn't have time to eat at work, and this is wrong. He doesn't have time, he has to have time. This is also what we tell patients who come to us. That it's not that I don't have time. I have to manage my life in such a way that there is time for everything, especially for myself.

Alexander Prejbisz
And that's really the first thing we say to patients who come in with obesity or any other problem. In our clinic you have to have time for yourself, you have to have time to go for a walk, to have physical activity, because you have to take care of yourself. I always say that in medicine there is no prodigal son effect. You can't come in 10 years from now and say This is me now I'm going to start getting better and I'm going to start treating myself, I'm going to change my lifestyle. No. These 10 years, that body fat is depraved. Hypertension has caused left ventricular muscle hypertrophy and. Going back to the question, we have patients in their twenties, even transferred from the Children's Health Centre, that is, patients who have already developed hypertension within being a teenager and very good weight loss results. I have patients who came to me on three drugs, four drugs. Sometimes a weight reduction of 30 kilos puts a patient on half a tablet of one drug and they have well-controlled good blood pressure levels. It is possible, you just have to approach that patient and offer them something.

Monika Rachtan
I also think about the fact that if we got rid of the problem of obesity and overweight, you would be a bit out of your depth. In most cases. Some specialities could cease to exist at all. Because when I think of cancer, for example, many people don't realise that such Obesity can contribute to the development of breast cancer, that it can contribute to the development of head and neck cancer. These are such distant poles for us today that absolutely no one connects these two points with each other, that they just interact. When I look at the problems of patients who come to see primary care doctors, where it is mainly hypertension, cholesterol and some heart problems, if the patient only had their obesity treated, they would very rarely visit their primary care doctor's surgery.

Alexander Prejbisz
I mean I wish we were all sports medicine doctors. That's how it would be.

Małgorzata Gałązka Sobotka.
Or just a journey of good style, of good living.

Alexander Prejbisz
So it means in a good lifestyle, in taking care of body weight, but also all the other elements. Hence the introduction of 10 For the Heart as part of the National Cardiovascular Disease Programme, which means showing that we can't just focus on one factor, we have 10 factors that we need to take care of. These are blood pressure, glucose, cholesterol, body weight, physical activity, healthy eating, not smoking, not drinking alcohol, not stressing and healthy sleep. If we take care of these 10 areas, we will live a long and happy life.

Monika Rachtan
Well, it's just that this is very difficult for many people these days.

Alexander Prejbisz
But you can see the editor's immediate approach is that difficult.

Małgorzata Gałązka Sobotka.
But yet we have examples of many people who have decided yes, I can't go on, I'm not able to. I want to fight for myself, for my life. And they embarked on this path, this change. They were probably also lucky enough to find doctors who were competent to guide them through this long process. It has to be said to ourselves straightforwardly that this is not a treatment like a knee injury. We lay down the treatment. It takes time. Hospitalization lasts 2 3 days. Then, yes, you have to rehabilitate, but within three to six months we can be back to our previous fitness. It's a process that requires patience, it requires a multidisciplinary team, it requires commitment, but it also requires the kind of determination, which of course it's not, of support.

Monika Rachtan
Just favourable conditions.

Małgorzata Gałązka Sobotka.
Of course, it is not easy, but everyone who has embarked on this path and experienced this recovery from illness and obesity today bears witness as to how important this moment is, how important this decision is, which gives renewed hope. It is not that these 9 million patients today, because 57% of Poles are overweight and obese, but we must tell ourselves straightforwardly that 9 million patients in Poland are already suffering from obesity, a disease that leads to the development of many complications. It is no coincidence that obesity is called the mother disease, is it? A somewhat forgotten kind of mother, just as the professor said. But, but we are getting more and more tools when it comes to treating obesity. I think that advances in medicine here are giving us more and more hope of managing this disease well. But before we talk about the treatment itself, we need to create awareness in all of us today to prevent it from developing. Here, a great deal depends on us, on our awareness, including in the Patient First programme.

Małgorzata Gałązka Sobotka.
We should ask ourselves directly what am I doing for my health to reduce the risk of developing obesity? To what extent am I supporting my loved ones? Well, because the question is whether love always has to be shown through a box of chocolates.

Monika Rachtan
How about a walk, right?

Małgorzata Gałązka Sobotka.
That's right. This could definitely be better. How about making a salad together and bringing that person you love just something they can't make. It's not a habit to prepare such food for ourselves. I, when I always invite my parents or in-laws for Sunday dinners or holidays, each time I cook exactly something different from what we ate in our family home, showing them how the same ingredients can be used to make completely different things, which they say are wonderful, tasty and open up a kind of new thinking about what our kitchen could look like, what our diet could look like and that after this meal together, instead of sitting in front of the TV and watching some soap opera. That just going for a walk together is also perhaps something for many. In many homes, many families, something new. But everyone who experiences it admits that it is very pleasant. So we should probably also show each other this support.

Alexander Prejbisz
Precisely the most important thing is to have this meal together, because it is also a question of that healing. Of course, this word diet is a very bad word, because in Poland diet is a pejorative. It is a kind of punishment. So we say more healthy eating, healthy nutrition. But it's also a change in eating habits. So having that lunch, having that so it's keeping an eye on those meals, making them longer, but also the issue of not eating alone. It's also important that a meal eaten with someone is also part of the modification. Remember what the Mediterranean diet looks like. We model ourselves very much on the Mediterranean diet. As cardiologists, we like it a lot because we have evidence that it reduces the incidence of heart attacks, prolongs life. But the Mediterranean diet is not a question of us eating more tomatoes. It is a question of everything. First of all, it is a diet that is very optimal. There is no deficiency of any product or excess there. There is even a bit of butter, a bit of cream, There are cookies? Yes? Not the bans themselves. But notice how important all the elements are there.

Alexander Prejbisz
There is an after-meal coffee. It is known to be very important from a physiological point of view. Extra insulin secretion, help for digestion. Yes, but there are other elements as well. For example, the fact that we eat the meal together and share the meal. Look at Spain or Greece. Less Italy, because Italy doesn't have such a tradition. But Spain, Greece. They eat dishes that are in the middle of the table, that they share. Yes. That is also part of the Mediterranean diet. Socialising there is also part of the Mediterranean diet, so that is also part of the change. We always say, when an obese patient, a patient comes to us, that your new self is to be happier and to say that your new self never wants to go back to your old self. Yes, because that's what our changes are about. It's such a bit of a psychological connection too Please remember that also obesity is a multifactorial problem. In a large proportion of people it's also psychological problems of stress eating, sugar addiction, because that's also a kind of addiction. Therefore, it has to be multifaceted.

Alexander Prejbisz
It is said that we did not notice obesity, we noticed obesity, we just did not have the means to help patients. Because, of course, on the one hand, there are now drugs available to help us treat obesity, but because of this we also know more and more how to treat obesity. We know more that we have to have a nutritionist. How this nutritionist must help our patient. This is also difficult because there are a lot of myths, superstitions precisely. The diet, the style, the menus, the menus, so that there has to be a strict calorie restriction and a patient comes in on a 1000 calorie diet who has an energy requirement of 3000 calories.

Monika Rachtan
And that will certainly always have a bad connotation. Therefore, I do not want to say that it is impossible or that it is very difficult. All I am saying is that a lot of things have to come together when it comes to the patient for this to work, because it is often the case that there is a desire, but it is the environment that is unfavourable. The professor described beautifully what it looks like in Mediterranean countries, whereas in Poland I associate cheesecake with a grandmother who says: "But you won't eat it at my place, but you must have some more, so that's it.

Małgorzata Gałązka Sobotka.
But I will give a good example, because I think that nothing builds us up more than when we manage to do things differently from and better than before. Here I would like to mention two local authorities in Rybnik and Leżajsk, which decided to change the face of school nutrition under the supervision of local authorities and with the help of experts, allocating appropriate resources of course. School canteens were rebuilt, changing their model from one in which the meal is served to the child to one in which children put the food on their own plates. This has changed, as statistics were presented, how the feeding pattern of children in these schools has changed in general, and it has changed the attitude of the child to the meal in general, which has become a certain ritual of the school. The layout of breaks was changed so that children had the space to consume this meal in a conscious manner, but at the same time consume it in such a really comfortable way, in a comfortable environment. It turns out that the fact that I can put it on myself by watching my peers, and we know how important and influential this peer acceptance is, has systematically increased the amount of fruit and vegetables consumed.

Małgorzata Gałązka Sobotka.
Making independent choices. How many children were starting to be interested in eating a meal at school? And we know that this is a problem in many schools, that children are saying absolutely Mum, I don't want to eat these horrible, unpalatable lunches. Therefore, we already have wonderful examples in Poland today of how leaders can change the approach to nutrition, how the culture of eating at school can be changed and thus, through the experience of this, this, this new model of approach to food at school, really convince young people that it is not necessarily cookie bars that they like, that we can really develop and expand our plate here systematically.

Alexander Prejbisz
And let's also remember that the fact that, for example, children don't eat something and don't like it is also sometimes the case that their parents simply don't eat them.

Monika Rachtan
I have never even tried it.

Alexander Prejbisz
This was, incidentally, a study carried out several years ago. I think it is still relevant. It turned out that children coming to kindergarten, and it was a large percentage, it was about 30%, did not know what a cucumber was. And that's why they don't eat vegetables and fruit, for example, because it was a punishment for them, because they were the only ones at home who ate. For example, like this. Because the parents didn't eat cucumber, Then why should it eat cucumber if the parents don't eat cucumber? Because it's also important, that's what I always say, because there was always obesity in my family. Yes? Of course, these genetic factors are there somewhere, but on the other hand, please remember that it is often impossible to separate what is in the genes and what is, as it were, a common background. These are families that often eat a lot and move little, so from an early age such a pro-development environment for obesity is created.

Monika Rachtan
It seems to me that what you are talking about, this whole systemic change that needs to take place, is very important here. And we have already given a great many of these examples, so it would already be possible to create some new solutions from this which should be introduced. But I would like to ask about one more aspect today. Professor, you just said that we have tools to help doctors treat obesity. But precisely, do they cure? Do they help? Can they be present on their own? Do they also require a change of environment, a change of lifestyle to make it work and to make sense?

Alexander Prejbisz
Do I think that the entry into the availability of drugs that significantly help to reduce body weight. Is quite a big revolution in medicine. Firstly, from my kind of empirical point of view, they show, they prove in the patients we use them, that even small changes in body weight result in enormous benefits, for example, in controlling blood pressure, which is what we have always done. We used to think that obesity was such a contributory factor to high blood pressure. Now we see the enormous impact here of increased body weight on the development of, for example, hypertension, elevated triglycerides, the development of metabolic disorders. So we see that by reducing body weight, we are affecting these risk factors. Of course, these drugs that have entered the market in the last few years are a breakthrough. That's what we need to be aware of. It is, as I would compare it, like the entry of serotonin reuptake inhibitors in the treatment of depression. When drugs first came onto the market that are well tolerated, effective treatments for depressive-anxiety disorders, that improve quality of life.

Alexander Prejbisz
And I think that's an important element, that these drugs improve the patient's quality of life. But very often they have the effect of helping us to break down a certain barrier in the patient. That is, a patient who has struggled with obesity for years, as we say, there have been numerous diets, the yo-yo effect of 10 this way, 15 that way and so on. Suddenly he gets a tool that allows him to reduce his body weight. Often this is the first 3 kilos in 20 years.

Monika Rachtan
This mobilises.

Alexander Prejbisz
It's kind of like a pebble, like dominoes. Yes, he reduces four kilos, he starts to move more, He looks at the diet. Yes, patients, because these drugs work by increasing the feeling of satiety. They eat less, as a result they suddenly see that you can eat less and you can survive. That's how I live, I live on, despite eating less. Yes, and this is also important, because what we should be fighting against at the moment are portion sizes. Portions in restaurants of many are like that. Sure. Me and the professor could split in half and we'd still have left over. Yes, but they are such that someone eats it. That being said, there is also the issue here that they help to change lifestyles, because treating obesity is not just about reducing pounds, it's about re-evaluating your world a bit, looking at your lifestyle in a completely different way. It's sometimes patients who really have such a warped outlook. I remember a patient who barely opened the door, he immediately says just nothing on steam, just nothing on steam.

Alexander Prejbisz
Yes, because his fear was that he would get a spread diet where all the foods would be. Just boiled carrots, nothing fried, nothing and this. That's not what it's about. We are supposed to change slowly. It's also a question of motivation, because firstly we have to find motivation for the patient, and secondly we have to give achievable goals. Achievable targets. It's not 20 kilos in six months. It's three kilos by the next visit in 2 3 months. Sometimes these are just really small things. Finding a target? Yes. For everyone it will be a different goal. For one patient it will be getting ready for her wedding in 2 3 years, for another person it will be looking after her own health. For one patient it was the birth of a child, so we have to get every element out of the patient somewhere. We talked before the programme with the professor about a quality healthcare system, where it is very important to talk to the patient. As long as we don't get to know the patient, even 5 minutes is sometimes enough to find somewhere with the patient a kind of this understanding. Yes. Finding where to hit the patient's quotidian, which tender point to motivate him.

Alexander Prejbisz
Because this is very important, this motivation. Please remember that we work within diseases. If a patient comes to us with obesity, with slight hypertension, whom nothing hurts basically, who is actually functioning well, and we give him a lot of drugs, start treating him and tell him that he is ill with several diseases at least. Yes, it's very important to motivate him, to show him the goal, because our goal is an elusive goal for him as well. He will not get a heart attack, he will not get a stroke, he will not get kidney failure. That is to say, our treatment goal will not materialise. For him, it will. He will live a long and happy life. Time perspective is also important. We look sometimes because you will live to be eighty. Well, talking about a person who is 22 years old, believe me, is not going to motivate. We were talking recently at a conference about what the perspective of cardiovascular risk assessment should be. Our cards are 10 years old. It sometimes seems like 10 years is too little, but on the other hand, more than 20 can't be either. This is an abstraction. A 30 year old patient I once told him that you will live to see your granddaughter in primary school, and he says I don't care anymore, yet.

Monika Rachtan
Not my children.

Alexander Prejbisz
So it's like it's important that we look at an aspect, such a short-term patient. I laugh that the risk card should be as long as there is a patient has a mortgage, that's the perspective.

Monika Rachtan
That the children are not left with a problem. But from what I gather, as we're talking now about just creating that environment, because I think that's what I would like to talk about, and through the right treatment, and through the right system, that we're starting to look at all of this in such a positive way, and so we're starting to talk about this obesity treatment in general in terms of pleasant and positive things, because we used to be frightened by the dietician's 1000 calorie diet, the treadmill for two hours a day, and the fact that they're going to padlock our fridge. And now it's like it's all centred around the patient, the person, their lifestyle, their capabilities and it's de facto down to them, what they're ready for. We want to adapt these tools that you have at your disposal, and you, Professor, are also helping to introduce, so that the patient feels good and that no one tells us now, quickly, in a month, in two, but tells us look at ourselves, take a deep breath, exhale and only then do we act. And we don't have to achieve the goal today.

Małgorzata Gałązka Sobotka.
I think life has a way of not liking a vacuum. And where we don't have systemic solutions that refer to hard scientific evidence of the effectiveness of the interventions undertaken. And here we are not only talking about strictly medical interventions, those oriented towards prevention or diagnosis and treatment, but also those interventions of a social or economic nature. As long as we do not apply systemic solutions and do not build a kind of ecosystem whose main objective is to keep the population healthy, the reality is that we very often push society towards methods which are, unfortunately, only a kind of utopian outcome, which very often generates even greater risks and escalates health problems, or we make risk factors such as access to highly processed and very unhealthy food only grow. So I think there is a deep awareness today that the scale of the phenomenon we are talking about today, which is obesity, is already so huge. I do not think any of us can say that there is anyone in our immediate environment who is not suffering from this disease. Nine million of us now know that one in four Poles is suffering from obesity, and we are aware that this is the moment to stop.

Małgorzata Gałązka Sobotka.
That is to say, we need to reach for methods that are much more structured, structured, available not only to a few, available not only to those who have a high level of feeling, a high level of health competence, a high level of awareness, but also the ability to make use of available and effective methods of diagnosis or prevention or treatment, but for these solutions to become a permanent element of a health-oriented system. The professor said that the development of this disease and many other diseases of civilisation is the aftermath of a lack of solutions in which health services are oriented towards quality and not quantity. Today we have an economy of health services and not an economy of health, because all these years, when building the system, we aspired to make it modern. But we didn't make sure that we were really looking not only at the short-term effects of medical interventions, but also at the long-term ones. And we have that optimism that you. Which you, the editor, said he was sounding off a bit about. It probably does for us and many others. It has its source. At least I see it as our Polish successes, because we have the example of the disease that killed heart attacks.

Małgorzata Gałązka Sobotka.
This is a disease which has, in fact, been characterised in Poland by a very high percentage of hospital mortality, up to 30 days. And indeed, Poles, Poland held this palm of primacy for many, many years, but this infamous primacy. And we introduced in 2017 a programme of comprehensive specialist treatment of myocardial infarction, in which the patient is covered not only by specialist supervision after the incident, but also by this rehabilitation support, and we managed to achieve spectacular results in a very short time. The probability of survival after a myocardial infarction, and not only in this short term, but 12 months increases significantly for us only if we approach the problem more comprehensively and more holistically. Because I think that the success of having a myocardial infarction is what you are pointing out, which is to look at and illuminate the many perspectives of this patient, that it is not just going to be just staying in hospital, that it is not just going to be taking medication, but it is going to be such a deeper change in their lifestyle, that this success from a myocardial infarction in my opinion lies in the fact that here is an opportunity for medical professionals to talk and make the patient aware of how many different factors will affect the final therapeutic outcome.

Małgorzata Gałązka Sobotka.
It will be the same with obesity. We need to realise that we need to stop for a moment, stopping to think about whether I get to work and into my office, whether I take the lift, whether I climb the stairs, whether there is something to eat on my breakfast table, or whether I will only eat when I get home from work or eat somewhere on the run? That is, we today need to rethink our choices for a moment And these are choices at the level of the individual, of our family, of our company. That is to say, when we meet at board meetings, that in addition to biscuits there should actually be fruit and vegetables, because Poland stands on agriculture, it is the pride of our economy. We have somewhere to get these ingredients in our diet, which are important and valuable, but at the same time we have to think at the level of state policy about what we could do differently in order to really take care of this risk of developing civilisation-related diseases. And when we take care of obesity, then, as the editor said, doctors will have a little less work to do on diseases. And that's what we should generally wish for. Of course.

Alexander Prejbisz
I think, Madam Editor, that the concept of which I have spoken to you dozens of times for the heart is an optimistic concept and, beyond that, a causal concept. We must not frighten the patient. I recently saw such a Croatian campaign during one of the congresses on or another country not to stigmatise concerning hypertension, where half of the advertisement was a silent enemy, a silent killer. We cannot do that. We show. Anyway, Ten for the Heart will also be available in the form of a risk card that can be filled in at the clinic, in the doctor's waiting room.

Małgorzata Gałązka Sobotka.
And at IKP?

Alexander Prejbisz
There will also be a health calculator in IKP, where we will also 10 be able to assess, but show what we can change. So that we have, we have it wrong, but we can change it. Yes, because I tell it to patients that even the worst gene. the biggest risk factor. We are a good procedure to break through. Yes. You don't get the gene out, but you are able to improve it. Lifestyle quality.

Małgorzata Gałązka Sobotka.
As evidenced by the revision of Lalond's famous risk factors, which in 1973 attributed genetic factors to 16% as an important determinant influencing health, and today this influence is no longer there, this genetic determinant significantly less so. That is, the gene will not be scooped out, but we can modify the gene.

Monika Rachtan
It is this gene that we very often confuse with the environment in which we grow up, in which we are brought up. What the professor said, that we tend to get fat in our family, we tend to get fat because we eat very badly and we don't move. Again, I think that coming back, stopping for a moment and not blaming everything on genes, on the world, that it's impossible, but just analysing your life, what it looked like when you were a child, what it looked like when you were 20 and what it looks like now, when you're 40. Well, it allows you to rationally decide that you have to start acting and, in fact, no system, no minister of health, no doctor is going to do it for us if we don't sit down one Friday, Saturday, Monday or the first of May and say ok, I'm starting to take care of myself, and in order to take care of myself, I need to eat healthily and eat, which is also important, and just have that movement and have my body and my health under control.

Małgorzata Gałązka Sobotka.
But I would not relieve this minister and prime minister of their duties so completely.

Małgorzata Gałązka Sobotka.
Because absolutely studies show that overweight and obesity is correlated with household income, with financial capability, with education. Research shows that obese girls will only be 38% less likely to graduate from university as boys. This risk of having a completely different life course is even higher at 58%.

Monika Rachtan
And this is understandable.

Małgorzata Gałązka Sobotka.
Poland is characterised by the fact that we consume one of the smallest quantities of fruit and vegetables per adult, as well as per child and per young person. So we are today, at the level of state policy, fiscal policy, for example, indirect taxation, VAT. We are in a position to mobilise, to mobilise and to increase the opportunities, especially for those with the lowest incomes, so that their diet can be as well balanced as those who are not only more aware but also have the financial capacity. I think all of us, when we go to the shops and compare the prices of different products, can see that, unfortunately, those products that are healthy and should be in our basket, they are often not available because of the price, and we need to talk about that too. As an economist, I try to combine this world of medicine with the world of economics. We cannot get away from the fact that, still in most shops, the healthy food segment is only a fraction of the space in which the products we put in our shopping basket are offered, and those that are really healthy are, unfortunately, very often unavailable precisely for reasons of price.

Małgorzata Gałązka Sobotka.
Inflation has compounded the risk of reducing the availability of products that are particularly valuable in our diet. And this is precisely the role of cross-sectoral state policy. Here, it is necessary to meet at the same table. The Minister of Health with the Minister of Agriculture, the Minister of Finance, the Minister of Sport, Education and Culture, so that, through a number of parallel interventions, we can really create a kind of ecosystem that will not only reduce the risk, but increase the chances of a long healthy life.

Alexander Prejbisz
This is a tough one. I've also been looking at what's on the health food shelf in the supermarket recently. I wouldn't class half of it as healthy food. Or maybe we shouldn't be sticking healthy food, but unhealthy, health food. Let's also remember that the fruit in those accessible shops you mentioned is somewhere on the side, and there are no fruit or vegetables at the checkout. Then again, in these shops we are also talking about, generally the quality or availability of fruit and vegetables is negligible, unlike other products that are. Let us also remember that you said that Poland is an agricultural country, but this sector is also a very strong lobbying sector, but because of processing, not because we are going to cut up this carrot into strips, because no one is going to make money from selling it. I am sorry to say that, you will probably agree with me economically.

Małgorzata Gałązka Sobotka.
But here we might have supporters on the side of the farmers, because they often argue that the price they get from selling the fruit and vegetables they produce is very low, and that all these margins are earned by the intermediaries who process them. Here we need a very balanced action indeed, because let us remember that we are touching many interest groups, very subtle nuances of economic policy. We probably need this balance very much, but as a consolation, or perhaps as an inconsolation, and just underlining the fact that we need to be mobilised, also perhaps such an international exchange. It needs to be said quite clearly that the problem of obesity and the peculiar tsunami of development of this disease does not concern Poland alone. In fact, all highly developed countries today are confronted with this great challenge and are looking for methods to ensure that, indeed, and at the level of these local environments, for we have not yet drawn attention to this here today, how great is the importance of this local community, this local environment in which we live, and what a great role and enormous tools are in the hands of our local authorities. At the level of local authorities, municipalities, cities and counties, we could take many initiatives that would make use of this local potential, for example that of suppliers, farmers who are located somewhere in the area, who could interact directly with schools, kindergartens and employers in order to increase the availability of these valuable products.

Małgorzata Gałązka Sobotka.
Here, too, there is indeed a great need for action on many levels today.

Monika Rachtan
I would encourage those who are involved in introducing these solutions to go to the supermarket and try to do some healthy shopping, to fill up a basket with lots of vegetables, with healthy cereals and with high-quality animal products. And for them to stand at the checkout and say whether this is a basket that the average Pole can afford. Because, as the professor has explained to us here, here every element matters, and for many people, unfortunately, the price at the checkout is the determinant of whether they choose a healthy product or an unhealthy one. So if we're talking about politicians, they're often a bit out of touch with reality, because they don't all go shopping at the market. But if they went and saw how much it costs, what it looks like, I think you would immediately have a kind of different field of conversation, because the theory and what we are talking about here today, and seeing it in practice, well there it is.

Małgorzata Gałązka Sobotka.
They often pass each other by.

Monika Rachtan
Yes, they often pass each other by.

Małgorzata Gałązka Sobotka.
But we often emphasise the importance of health education. Economic education and consumer education are equally important. And I think that if we combine these three strands of building our civic competence, because building a civic society is how I feel it should be understood, that we are building a citizen who, from an early age, is able to combine elements of Economics with health, but also with the awareness of choice, that even if indeed this tomato is more expensive, we do not necessarily have to buy a kilo of tomatoes straight away, because we also have to learn to make this choice, not only in terms of quality, but this has already been said many times, today also in terms of quantity.

Monika Rachtan
Ladies and gentlemen, we could talk for so long, but unfortunately we are running out of time. Our viewers have been with us for more than 60 minutes. I would therefore like to thank you very much for our conversation. My guest, but above all your guest, was Professor Małgorzata Gałązka Sobotka. Thank you very much Professor Aleksander Brejbisz. Thank you very much. Thank you very much, Professor. This was the programme first of all. Patient. My name is Monika Rachtan and I invite you to subscribe to my channel on YouTube and I also invite you to our social media. We are on Instagram, on Facebook. See you there!