Obesity - the battle that never ends. Episode 80

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you very warmly to the next episode of Po Pierwsze Pacjent. Obesity is a disease. We have talked about it many times in our programme, and it causes more than 200 complications. It would seem that since it is so serious, it is very difficult to recover from. Well, that's what I'm going to be talking to Ela Brzozowska about today, how to recover from obesity. Hi Ela, a very warm welcome to you.

Ela Brzozowska
Hi, thank you very much for the invitation.

Monika Rachtan
Elu, tell me, how much did you weigh before your bariatric surgery?

Ela Brzozowska
The most I have ever weighed in my life was 120 kg. I later managed to lose weight before the operation. There is a recommendation to reduce, to reduce your weight for the operation, so on the day of the operation I weighed 107kg and my height was 173.

Monika Rachtan
Tell me, when you had to lose those 13 kilos, as it were, to change your lifestyle a little, did you start to like it? Did you start to feel some kind of benefit from the fact that the weight was coming off, or was it such an ordeal, a diet with a piece of paper and just no joy in the fact that you were starting to get healthy?

Ela Brzozowska
I was always happy when I lost weight and unfortunately I was like harmony all my life. I was losing weight and gaining weight, losing weight and gaining weight. However, I am now 5 years post bariatric surgery and this is the first time in my life that I have approached the process in a very conscious way and I know that it is not over. It did not end with the operation or shortly afterwards. It is a lifelong task, because obesity, unfortunately, is a nasty disease that does not tend to heal itself, but instead tends to recur. And knowing that I have such an opponent on the other side, I don't want to use the word fight, but I know that I am on a task. I know that I am in a process and this task is for life. A vigilance, an attentiveness and a motivation that cannot let go and in the past. So what are you asking? Well, yes, I was always happy when the weight came off and then it always came back on. Because this reptile brain of ours has it that we go back to old habits, And I think that the way we cope with different problems through food, well these are disturbed relationships with food and this is something that is very important to meet on your path a wise psychologist, preferably one who deals precisely with arranging relationships with food, who understands the needs, the problems of people suffering from obesity and knows how to work with them.

Monika Rachtan
Have you used a psychologist?

Ela Brzozowska
I benefited from the help of a psychologist. Before the operation I benefited a lot from individual meetings after the operation and I still do. Today only the form of cooperation has changed. We work in a support group for the elderly, because we are called chlorki, that is people who are after surgical treatment for obesity. Hence the name Chlorides, which someone might associate differently. No, no no, nothing like that. And this is the group where I meet fantastic women I've never seen in real life yet, because we meet online. The girls are from all over the country. And what does it turn out to be? We are from very different worlds, from different fairytales, we work in different places, we are of different ages. What we have in common is that we had bariatric surgery a few years ago and it turns out that we are connected by much, much more of these different things that are at the root of this and at the root of the fact that this disease of obesity has just become our disease and our lifelong task to deal with it.

Monika Rachtan
What did you look like when you were a child? Were you rather skinny, or did you already have a tendency to this excessive weight?

Ela Brzozowska
I have struggled with obesity since childhood. I always felt inferior because among my peers I was the fat one. And I remember such an image, I have such a frame from my childhood, that I'm standing on all fours and I see this hanging fat belly, which I don't like And I dream that the time will come when someone will invent a machine that will cut off my belly. And so I think to myself, from the point of view of the thoughts of a child of a few years, that today I would hug this Ela for these thoughts, for the lack of acceptance from an early age.

Monika Rachtan
But tell me, is it really the case that the whole environment, where you grew up, where you grew up encouraged you to eat more? But was your whole family and the people who surrounded you slim, and you were the one sheep who had a problem with that weight?

Ela Brzozowska
I think there is an element of inheritance, but it is also very big and I think significant. Such a problem of habits, family traditions and in my house. We ate a lot of sweets. They were often after basically every meal. And my biggest problem has always been just the over-eating of sweet things and the addiction to sweets. As far as my family is concerned, my grandmother, my aunt, my mother struggle with second-degree diabetes. My father.

Monika Rachtan
That is, a complication of obesity.

Ela Brzozowska
Although my mother was never obese and very much always looked great. And this diabetes appeared already at her such a mature, very old age. My grandmother, on the other hand, was obese. My father, on the other hand, slimmed down all his life and at the end of his life had already reduced his body weight. On the other hand, he struggled with obesity all his life. And I remember a conversation between my parents where my father warned my mother to pay attention to me, because he had just become obese at the age of six. And that's the moment when I started rounding up. And I have to say that I am today a mother of four children of two generations. I have two adult children and two and two tiny little daughters. And that age of 7 when the children go to first grade and there is definitely a reduction in their activity. The kind of natural childish activity that is more common in kindergarten on the floor playing. This is the point at which all my children are rounding up, and I don't think there is particularly much change in the way they are fed. So I think there is a theme like that.

Ela Brzozowska
Well, I don't know if it's genetic or hereditary, but it's also the patterns, the patterns, our family social patterns, of how obesitogenic an environment we grow up in.

Monika Rachtan
I think what you're saying about this age of just six, seven, and especially seven, is that it's a question of us being planted in these desks, because school is not conducive to us being active either. It's true. Why is a nature lesson at a bench, in front of a blackboard, in front of a book, when nature could be learned in a park? These children in first, second and third grade. They really don't need to know the developmental cycle of a pinecone or whatever they're being taught. Maybe I exaggerated because it's more in high school, but they absolutely don't need to sit in front of a book. Let them fall in love with that nature. Let them be active, Because it is beautiful nature that also mobilises us to be active. Also, I think that this school is putting us on the bench. But on top of that, the children are clashing with other children who are no longer chosen by their parents. It's not a friend who is my friend's daughter and we go to yoga together, it's a child who is just in that class and can also come from that environment.

Monika Rachtan
Where this obesity, where this overweight is prevalent. And all of a sudden our child, who has never had contact with crisps or has had it occasionally, is looking and socialising, He sees that these children are eating a little bit differently than we ate at home and he starts reaching for less healthy food too.

Ela Brzozowska
It certainly is, yet my child, who was born at a very high birth weight, over 4kg weighed and has always been obese. She has this sense of injustice, that why is it that she was born like this. And this is where I have a sense of guilt towards myself, because I was an obese mum when I was pregnant and it certainly had an impact on the way my child was born. And it is Zosia who has this sense of injustice. Why are other children thin and they bring sweets to school and eat them and she can't, because we don't allow her, we don't give her breakfast foods like that. So unfortunately she's also trying to take it out of the kids and she's obese and she's bad about it. And even though I've made a lot of changes, even though I've done away with something that was in our house for years, which was the sweet cupboard, she doesn't have it anymore. And I try very hard to make sure that the food that was, that is in our house is healthy, unprocessed and highly processed. So that our guests don't bring home sweets to our children as gifts.

Ela Brzozowska
Here's the whole battle with grandmothers. She was with her grandmothers. And I have to say that by the end of these mechanisms I probably still don't know or understand all of them myself. But I know a lot more today than I knew when I was a fledgling mum to my older children. And I think a great deal really needs to be done to raise awareness, responsibility and a sense of shared responsibility among us sufferers of obesity for our health and the health of our children. And also a great deal more needs to be done in the health care system, which already somehow supports us adults and very poorly supports children suffering from obesity.

Monika Rachtan
Ela You're talking about Zosia and you're talking about grandmothers who, well, they probably came with chocolate. When you were just putting your daughter in the care of her grandmother, did those sweets come up And you know, I also fight very hard against that environment. I'm also a mum myself and I also see the attitude of grandmothers who say you don't give her chocolate, even though she's going to come to me and she's got this pleasure that she has to have something from life. And when I think about it and I start to explain it, I get the impression that it's simply some kind of battle against windmills, against windmills, because you can't take it out of these people's consciousness. And I even have the impression that people who suffer from obesity are so misunderstood by society, precisely by this society that is slim, that has a normal body weight. And even if someone is an abnormal weight, there's such a pull down that I'm eating and I'm having a problem eating, I'm going to pack you with this food so that you eat too.

Ela Brzozowska
Yes, I think absolutely bingo! What you say about grandmothers, about this generation of older people. I think they have grown up in a deficit. And now that we have such an oversupply of all these beautiful, colourful, tasty things, these grandmothers want to give their grandchildren heaven. And with us, it was simply hundreds of conversations, already reduced to such arguments. When I say Mum, I'm addicted to food, I'm addicted to sweets. So are our children. If you had an alcoholic in front of you, would you put a bottle of vodka in front of him and watch? Would he drink or not drink? Probably not. Then don't stand in front of me when I come to you. Boxes of sweets cookies and don't give my children chocolate because they don't know how to say no. It is very difficult for them to say no. It's better when they just don't have that temptation around them. But of course, a separate issue is still working on our heads. And this is what Agnieszka Węgiel, who deals with the psychology of weight loss, taught me about how to build a proper relationship with food.

Ela Brzozowska
That it doesn't mean I'll never eat anything sweet again, it's just to consider that I, if I eat something sweet, it's to swamp all my sorrows with this pleasure sweet, to loosen up after a long day. Someone will do it with a glass of wine, someone will do it by going to the gym. And I've done it before by reaching into the sweet cupboard. And what Agnes taught me was to graze the bee. So that's why I especially dressed like a bee today, even though I don't usually walk around dressed like that, and especially just going to you I wore a bee necklace and I want to tell you about the bee, because it's something that helps me very, very much in my life. It's with this food that we satisfy our frustrations, our problems when we lack pleasure. And psychologically it's like we're like flies, the fly flies to the cow pie, we find these pies everywhere and we get preoccupied with the various problems that come upon us. We whine, we complain, and the story of the bee is about feeding your bee every day, feeding it something that causes us to find cool things, pleasures in every day.

Ela Brzozowska
And it can be done if we start to focus on it a little bit. So this is a story about mindfulness. For example, our conversation today is a great pleasure for me and this is my bee grazing today. You just have to be aware of it. No, I just come to the conversation. Okay, I'm already after the talk and I'm going on another some to my activities. Just realising wow. I met a cool woman who is doing super things for people's health. It's just a grazing bee. The fact that we get to talk, that they're going to go somewhere in the world. All the conversations you record with experts, with patients? Yes. For me, it's that I can come and talk about my experience and I'm aware that someone will benefit from it. I fed my bee today. I fed it when my child gave me a hug and said Mum, I wish you a very nice day. It's also feeding the bee that I found during the week when I'm very busy because I have a business, I have two foundations, I have four kids, I have a dog, I have a huge amount of challenges, but I find time to go to tennis.

Ela Brzozowska
I find time to go to the forest with a friend and then I feed my bee.

Monika Rachtan
And don't you feed her sweets?

Ela Brzozowska
I don't feed her and I don't need to. Because if I realise during the day these different moments, even if I go for a walk with the dog for 10 minutes.

Monika Rachtan
I love it too. I put my headphones on and just be with myself for a while.

Ela Brzozowska
For example, I will see how blue the sky is or how beautiful the birch tree is and I will notice it. That it is also just 10 minutes of this walk that Agnieszka Węgiel taught me. 10 minutes is better than zero. I'm not going to collapse, that is, fly like a fly into a cow pie that I haven't been out for a walk in two hours, because then I'd be racking up a lot of steps. Okay, but I've been out three times for 10 minutes each. Well that's half an hour now. Already that's better than nothing.

Monika Rachtan
This is true.

Ela Brzozowska
So I urge everyone to be a little bit like those bees and find like bees the nectar in the meadow, not like flies the cakes in the meadow. And let's not feed on all those things that don't build us up, that are sad. Let's just feed on every good thing we can find and at the end of the day we can sum up for ourselves what nice things happened, but also during the day. Like giving back to myself that wow, I've done something for myself, I've done something enjoyable, I've done something good for someone, that's my grazing bee. And if I can't find anything else during the day like that, for example, I'll just lie in the bath with a ball for 10 minutes without the kids in the tub, that's cool too. But let's just say it's nice to find that kind of time just for myself. It's also my grazing bee that I was those 10 minutes with my thoughts. I met with myself and still in pleasant circumstances.

Monika Rachtan
But do you just think that the reason it occurs. One of the reasons obesity occurs is because of this sadness that is within us?

Ela Brzozowska
I think so, that food is our way of sticking to problems that we don't want to reach out to, or that we become aware of but don't have the resources within us to reach out to a therapist for help, or to resolve these problems in some way, to break some toxin that is rolling over us somewhere, whether at work or at home. And we eat up various sorrows, various frustrations and problems. And it's good to see a psychologist who can help us discover what the real reason is for our reaching for food. This is then known as emotional eating. But I also don't want to exaggerate and say that only a psychologist will help us, because there are also medical tools to reach for and I think very much so. I myself am an example of this, that the help of a doctor is essential, because obesity is a disease and it is such a disease that can be treated in different ways. And I also, thanks to the paediatric surgery I had five years ago, finally understood what it meant that I couldn't eat any more. I never felt or understood how my friends were in restaurants.

Ela Brzozowska
They ate something and said, and left, and said I can't eat any more. I could always, I could have a starter, soup, main course. I was already very full, but a separate stomach for dessert. There was always room, and after the paediatric operation I only realised that there was this point of satiety, this point of fullness, and that you can't have any more. And I love that feeling that I can't eat any more, that it's not like I have to eat. Like my mum used to tell me that you have to eat everything to the point of fullness, because in India children are starving. And one time I just shot this wisdom towards a friend's child. How I was totally such a young girl in my twenties and this child was smarter than me and told me yes, pack it up and send it to these children.

Ela Brzozowska
And it was only then that I realised that this is stupidity. You have to reach a point of satiety to get to the end, and not everything disappears from the plate. In the kindergarten my children were told there was even a sign hanging in the hall. No, it doesn't have to all disappear from the plate, it has to disappear as much as we need and the operation is just that. But also modern medicines make us start to control how much we eat and when we feel satiated. Because it was only then that I learnt about the fact that there are two hormones that some people, like us obese people, unfortunately have too much of and others have in the normal range and that's why maybe sometimes a slim person won't understand an obese person, because ghrelin is the kind of hormone that screams give to eat, give to eat and you have to give. Yes, you can.

Monika Rachtan
And so he can sing all day, can't he?

Ela Brzozowska
And leptin says I still can, I still can. I don't feel full. And I can see that it was through the operation that I only just understood that, even the professor explained that too. It's not just about shrinking the stomach, that the aim is precisely to deprive us of that nasty ghrelin, which unfortunately after two years starts to rebuild itself and screams let's eat again! But we are given precious time to just work with a nutritionist, to work with a psychologist, with ourselves, to take co-responsibility for our health. Because it is not just the responsibility of the doctor who does the operation. The responsibility of the doctor who prescribes the medicine. It is our responsibility for it. The doctor is just a tool. The doctor is our ally, he is our help. The psychologist will also help us to form a relationship with food.

Monika Rachtan
But it won't lock our fridge.

Ela Brzozowska
Well that's exactly what it won't do to help us make choices every day. And that's why I need to be in this support group, to keep up the motivation, to talk things through. Why do we sometimes stray from this path? After all, it's not like I've just become perfect and always eat the right way either.

Monika Rachtan
But you look very good.

Ela Brzozowska
Thank you very much. But it's also my day job. And also it turned out that I started gaining weight just last year. I mean this year, but when I saw that the scale was already showing 84 kilos, I said no, this can't be. I have to do something about it. And I also don't know if our viewers know this, that it's possible to ask your GP for a referral to a hospital endocrinology department. I actually had a referral from my GP to a diabetologist and the doctor said I have so much hypoglycaemia. There's a lot of different problems with me that I'd better be on the ward and there I was examined for a few days on all sides. And I was put on different medications, because it turned out that I had all sorts of hormonal problems. And from June to November I lost 13 kilos. My problems with concentration and memory ended. I was already convinced that I must have a brain tumour, because I actually had a very high prolactin. It turned out that I had hyper prolactin.

Ela Brzozowska
But an MRI scan showed that there was no tumour. On the other hand, there were terrible symptoms of forgetfulness and lack of concentration. And it turned out that the cause was not these symptoms. And the cause of that was multiple hypoglycaemia, which I detected thanks to a sensor that I also have here on my arm, which shows me for the two weeks that I wear it. What does my glycaemia look like? Well, and what did it turn out to be? It turned out that after I've eaten the sort of thing that doesn't seem innocuous-two pieces of mango, and then a big spike in glucose, the sensor squeaks and shows 230 and 240 and everything in there lights up in colour. And the rapid drop and the hypoglycaemia and in red. And when I have hypoglycaemia, I want something sweet. And that's why I just, before June, I still had this urge to reach for carbohydrates again, for something sweet that will balance me out again quickly. And it's all about being in the normal glycaemic range. And that's what these modern GLP1 analogues help with, and that's what the sensor helps with, to control after what food my glycaemia looks like, what happens when I'm at tennis, what happens when I'm out for a walk, and even if I eat a more hearty meal but go out for a walk, it turns out that it's nicely normalised, that it doesn't spike upwards at all and it doesn't suddenly go downwards.

Ela Brzozowska
This is the kind of teacher I have on my shoulder, who also helps me to make good choices and get off whatever Lousy road I'm going to get on. If I eat the wrong things, I already know I have a signal. Well I have it, I can't. I don't know if it will work the same way for other people, because I think it's also individual.

Ela Brzozowska
That's just the way it is with me, but it's also well known that dried fruit has a lot of sugar, so it will probably affect everyone quite similarly. But I used to love mangoes, and since Libra just showed it to me, I've stopped buying them at all because it just turned me off. No well I can't do that to myself. And I think it's very important to combine the possibilities given to us by the doctor, who already has these modern tools in the form of medicines, who will check for deficiencies, because deficiencies also make us want certain things, our body calls out for something sweet, when we have a magnesium deficiency. I'm a vegetarian, so it turns out I'm also deficient in vitamin B12, which I supplement. But I also had to increase the dose of this supplementation. I had a vitamin D deficiency, so it's also good to put yourself in the hands of a specialist, because I don't want to be the good advice auntie who's going to say now do this, this and this. No. Let the doctor check what you are lacking and a good setting of just the right supplements. If you need them and are not able to keep them up from food, good treatment will make such unpleasant symptoms disappear, which also just cause you to start entering that circle of food again, which then leads to weight gain.

Monika Rachtan
When you said sensor, I was very happy, because I think there should be a sensor at all. It is reimbursed in some extreme cases. However, it is a tool that every person needs in order to learn about their body, because we often have some kind of ailment and, as you said, it doesn't have to be the kind of ailment that you immediately look at in the mirror. I'm 20kg bigger. No. It could be a problem with concentration. It could be, for example, sleepiness after meals.

Ela Brzozowska
I lack the strength to be active. I'm very active. And just when I was having 13 hypoglycaemics a day, I was feeling like a flak. I wasn't able to function normally.

Monika Rachtan
This is a huge effort.

Ela Brzozowska
And that is definitely what you are saying is. Everyone should have the chance to bear at least those 2 weeks. And it would be especially wonderful if people who are pre-paediatric could have such a sensor reimbursed, for example, or to have people who are starting to gain weight back, because it's a capital teaching. I'll say more I had gestational diabetes during pregnancy and thanks to the sensor I didn't have insulin, because it's also interesting that when I was under the care of the hospital outpatient clinic, I was treated so from below the line. Your pregnancy blood glucose. High. So insulin. And I went to see a professor. Diabetologist who deals with. She took a very individual approach to me. She gave me a sensor to lift for a fortnight. I fell in love with it. He just showed me what was going on.

Monika Rachtan
I think he's so guarded talking about Ela.

Ela Brzozowska
But it is precisely me and the guardian, and such a friend, and such a teacher precisely. I would even say yes, who prompts and prompts me and prompts the doctor. And what turned out? I had high blood glucose in the morning, when I woke up there 112, 100 something, and hence the idea was to switch me to insulin. And the professor said Mrs Elu, please eat one slice of rye bread at 11pm. And so I started doing that before going to bed. So supposedly against the recommendations, such for all such under the line. This slice of bread at 11 p.m. meant that I didn't have nocturnal hypoglycaemia and I didn't have high sugars in the morning. And I didn't need insulin for the rest of my pregnancy. But. Well, exactly. This sensor also showed me how my body behaves after eating specific things and after some activity like walking. And this is such a nice motivator. Well, because if I see that after a walk it regulates itself nicely, it's a nice level, then I want to repeat it, right? Or if I start to freak out incredibly after eating something inappropriate, sweet. I don't know, I had a pudding phase.

Ela Brzozowska
I just don't know. Such a childish sort of pregnant just pudding. Pudding. As I saw after that pudding too, unfortunately, but I had high glycaemia. So I stopped eating it thinking about myself and the baby. So it's very, very nice to teach, as long as we're exemplifying ourselves. Because it's an app on the phone that shows us and we can see what's happening to us and after. There's an option to take notes there, so then you can write down for yourself what I ate.

Ela Brzozowska
After which it blew me away like that. What was I doing, what activity was I doing, was I under a lot of stress? We underestimate stress and I think it's also a very big hormonal factor in our various changes. And just ghrelin, leptin, a lot of hormones play a part in whether we gain weight, whether we lose weight, whether we keep it off. And it's also not about us being like harmony like I was before. I, too, have this dream of never weighing more than 80 kilograms again. I leave myself such a margin somewhere. I now weigh 72 kilograms and I feel best with this weight. But I know that this is a terrible disease and that.

Monika Rachtan
It can always come back.

Ela Brzozowska
She can come back, and it's my job not to let her.

Monika Rachtan
When you think of the new me five years ago you were old and now you are new. I've been me for five years now. How has your quality of life changed? How have your relationships with people in general changed? Do you have more mirrors in your home now?

Ela Brzozowska
There's something about it. Maybe not so many mirrors, but now I like to look at myself in photos and I definitely take more of them. I couldn't look at myself when I weighed 120 kilos and maybe I didn't have as many problems with such some kind of social ostracism. Although I know that a lot of obese people face such reluctance from people. I have always had this mask. The warm, smiling Ela, which always helped me to feel rather liked by people. But that has changed. And you coolly said the old me and the new me. I have a scale that also shows all these parameters, not just weight, and shows my metabolic age. I love it for that. Me, when I was 37 was 56 according to my scale. Today I'm 47, but my scale says what I want to see. I am 32 years old. And that's the version I'll stick to.

Monika Rachtan
So you're younger than me? Hahaha.

Ela Brzozowska
So what changed? What changed was that I started to be able to do things that I couldn't do because, unfortunately, the weight of 120 kilos meant that I was, in a sense, a person with a disability. I had such horrendous pains in my knees, my hips, my spine, that there was no way I could somehow be very active. My children, on the other hand, play tennis and once my coach or my children's coach really urged me to try at least one lesson and if I liked it, I would stay, if not, no. But that I would promise to come for one lesson. But how do you run around the court weighing 120kg, having gigantic breasts and a big belly, HUGE thighs? Well it's not difficult. And one of the things I owe to the bariatric surgery, which allowed me to reduce my body weight so much, is that I fell in love with tennis. Of course, I'll never be Iga Świątek and I'll never be successful on the court, but I take great pleasure in the fact that I coach tennis and that I've also found a coach who doesn't want to make me into a player, who doesn't turn the screws on me because he knows.

Ela Brzozowska
I do it for pleasure. Sam says you are a cep away from the computer keyboard. I have always led a sedentary lifestyle. I have been exempt from P.E. all my life. I don't have that kind of muscle memory I've never exercised particularly intensively. And the fact that I now happily run four times a week to these training sessions, where I have fantastic girls I train with, where I have a great trainer who understands that this is not the way to make me into Iga Świątek, but to give me the pleasure of bouncing the ball with effort. Of course, that's one of the things I discovered for myself after the operation and the weight reduction. The fact that I can play differently with my children. For me to pick myself up off the floor when I weighed 120kg was difficult. Today I just jump up. I'm with the kids in some kind of play that involves squatting, sitting down, standing up and that's not a problem for me at all. Above all, health issues too. And that's something I see a lot. How my insulin resistance has withdrawn, And it's nicely called insulin resistance today.

Ela Brzozowska
It used to be called simply pre-diabetes. And I know that since my mum, my mother, my sister, my grandmother had diabetes, I also had it twice in pregnancy. And also there's a statistic that says that women who have had gestational diabetes in pregnancy, there's an 80% chance that they will develop diabetes later in adulthood. So I have to do everything I can to escape diabetes and not let it get to me. The fact that it's a completely different way that this skeletal and joint system functions. I no longer have the pains I used to have. I'm not saying completely, because unfortunately the obesity has caused very big degenerative changes in my knees, hip and spine. But I don't suffer anymore. Every morning, getting out of bed, I don't have to spread my spurs, which have also stopped bothering me anymore. So these are the kind of inflammatory changes that obesity causes.

Ela Brzozowska
A life of suffering, every day with pain. Today I fortunately no longer have that and I am very, very happy about it.

Monika Rachtan
I wonder about one more point, because you professionally also deal with communication, among other things. In health. When you had such significant obesity, when you talked to people about health, did you have this kind of imposter syndrome, that you nevertheless sit there and say Well this is healthy, this is unhealthy. And that someone would eventually tell you? Ela and have you thought about your health? What do you look like? Were you afraid that someone would ask such a question?

Ela Brzozowska
I don't think I was afraid of that, but I also think that I have been working in the field of health for many, many years and. See, we started talking about obesity very recently. And yet in the context that obesity is a disease and that it is bad for our health. We've also only recently started talking about it, because I think that up until now, there's a perception in society that obesity is an aesthetic issue, and so a lot of people were probably also uncomfortable pointing out my obesity, because. well, because it wasn't appropriate. And I also think it's that area of communication. It's a big topic, because how do you speak in a way that motivates and doesn't offend?

Monika Rachtan
This is very difficult.

Ela Brzozowska
It's difficult. It's also very individual because, for example, I don't have a problem saying about myself that I was fat, but I know that the word fat hurts a lot of people, so certainly in relation to someone we shouldn't say respectfully and we shouldn't. And it's better to say that this is a person who suffers from obesity than to say that they are fat.

Monika Rachtan
You know what, I've written down this sentence to myself that just in society someone will say but he's fat and they should say but he's sick and that absolutely here you can't use the word fat some kind of evaluative word when communicating. You just have to say all the time that you are sick. Because when you think about it, once you've managed to come out of that obesity, like you said, how fundamental things like that change, like the fact that suddenly your knees stop hurting. That's sort of what I often say when someone tells me about their condition and says you know, I've got this back pain and this knee pain. And I look at him and say listen, I get it, but you're sick. And the first step like that, in my opinion, is not to inject something in your knees, because that's only temporary, that's only for pain relief. But think about what you could do to put less strain on those knees, to walk less.

Ela Brzozowska
See also The issue of being able to get pregnant. There are many people suffering from obesity who have difficulty getting pregnant. As a result, they also turn to IVF. And in turn, I see, because I run, I also moderate such a group for people before and after operations, and after geriatric operations, and I see a lot of people talking about how they have a kinder surprise, because when they have reduced their body weight, they get pregnant much more easily. What's more, not much is said about this either, but geriatric patients absorb food a little bit differently, but they also absorb drugs differently. And contraceptive drugs, hormonal pills don't quite work effectively. And hence a lot of kinder surprises. So I also attended such a panel where Professor Bomba Oponka, Oponka, who deals with, is a gynaecologist, an obstetrician. She talks about how important it is to first support the patient to reduce her weight and not immediately suggest an IVF method, because maybe if she reduces her weight, she can get pregnant.

Monika Rachtan
I also have such an example and such a case of a girl who reduced her weight and it turned out that all those worries about there being a problem, about something needing to be treated, disappeared. She simply cured herself of her obesity and managed to get pregnant.

Ela Brzozowska
It also makes the baby healthier. Because I think the fact that my daughter today is suffering from obesity is me feeling guilty that I made a conscious decision to get pregnant by weighing so much and did her some harm. And when. How to talk to your child about. And to teach mindfulness about food, but also to show that we want to help with her disease of obesity. Do you know that when I told her that she was suffering from obesity, she cried? I said Mum, I'm not ill with anything. So for us adults, no one told us we had obesity. It's a disease entity that has emerged quite recently and fortunately it already has its E66 symbol. But also see that people end up in hospital because of stroke, heart attack, cancer. Obesity is not entered as a leading disease.

Monika Rachtan
He doesn't talk to them about it. This is precisely the worst thing that a doctor sees. The doctor is in general. It is. Obesity is the only disease that you can. Maybe not the only one, but one of the few diseases that.

Ela Brzozowska
It can be seen, and it is invisible.

Monika Rachtan
That's how you can diagnose it at first glance. I, if you sat here having this 120 kg, I would be able to diagnose immediately, without being a doctor, that you have obesity. So it's amazing.

Ela Brzozowska
I think it is very important to teach doctors how to communicate motivatingly with a patient with obesity. Because some people have empathy, sensitivity, that kind of communication competence, and others need to be taught that. And I think many patients feel offended when a doctor brings up the subject of obesity treatment. And in turn, many doctors are uncomfortable talking about this topic. And this is where I also really like how doctors, professors who are teaching about obesity today, say well, but should it be awkward for a doctor to talk about hypertension and how to treat it, or other diseases? And I just think it is very good that obesity today is already considered a disease and we have the tools to treat it. The problem is unfortunately with the availability of medicines, because the medicines are very effective, but they are very expensive and they are not reimbursed. And I think somewhere here is also a challenge for the system, because the system will fall over because of the treatment of obesity complications. If we already have 9 million people suffering from obesity, there are millions of people among them who have multiple complications.

Monika Rachtan
And that is hypertension, that is diabetes, cancer. These conditions are very many. And just finishing our conversation in one of the last episodes of the programme, I said that doctors, if there was no obesity, would have half as much work and I think we would have half as much disease in society and.

Ela Brzozowska
The system would spend less money. That's why I decided to start speaking out about the fact that obesity is a disease that needs to be treated in children and adults. And everything must also be done to ensure that our environment in which we function is no longer so obesitogenic. A beautiful phrase by Marta Pawłowska, which I buy in its entirety, because I believe that indeed our environment, what we are surrounded by, the language of advertising, what is shown in films, theatre plays, habits in schools, images or content in school textbooks. It is simply everything. It makes us think how cool it is to eat a cookie, not how cool it is to go for a walk. So let's do everything we can to make this environment as least optogenic as possible. And it's not just the health system. Just all ministries in general to put their hands on deck to prevent and treat obesity. And in turn, I decided to act socially as well. And that's why, at our Health and Education Foundation ad meritum, we campaign on the importance of health. Because it is health that is so very, very important, and obesity is a disease and needs to be treated.

Ela Brzozowska
And we also joined the Obesity Prevention and Treatment Partnership. Stop Obesity, so that there are as many such voices as possible and that we all speak with a common voice and unite, because you act by reaching out to many people. There are many foundations, organisations, activists, social activists. Let's join forces, let's be a common voice and let's reduce obesity and not let our children get fat.

Monika Rachtan
Ella, thank you very much for this frank conversation, because you showed us your path here, but you also said a lot of important things that unfortunately are not talked about in the context of just obesity, Those feelings and those difficult situations that you were in. Also, thank you very, very much.

Ela Brzozowska
I also thank you sincerely that I had the opportunity to tell you about this and that thanks to you, this story might change someone, maybe it will make someone realise something if they listen and find their way to put their relationship with food in order and reach out for professional, professional help from a doctor.

Monika Rachtan
Ela used the slogan Stop obesity. And I say stop obesity, because obesity destroys our health. My guest, but above all your guest, was Ela Brzozowska, a patient who struggled with obesity for many years and managed to reduce her body weight in the process. If you enjoyed today's episode of the programme, I invite you to subscribe to my channel. We are also on social media, on Instagram, Facebook. Thank you so much for your attention today. This was the programme. First of all. Patient. My name is Monika Rachtan. See you later.