Why Your Body Fights Weight Loss | Katherine Saunders | TED

Prevodilac: aleksandra ristic Lektor: Milenka Okuka

I'm going to tell you something that's going to surprise you.

Ispričaću vam nešto što će vas iznenaditi.

It might be upsetting.

Možda i uznemiriti.

And for some of you, it might explain a lot.

A nekima od vas će objasniti štošta.

And maybe I can convince you that it's liberating.

I možda uspem i da vas ubedim da je zapravo oslobađajuće.

Your body is evolutionarily conditioned to gain weight,

Vaše telo je evolucijski uslovljeno da dobija na kilaži,

which means that your body is also evolutionarily conditioned

što ujedno znači da je i evolucijski uslovljeno

not to lose weight —

da ne gubi na kilaži -

and definitely not to keep weight off.

i definitivno da ne održava izgubljene kilograme.

According to one explanation called “the thrifty gene hypothesis,”

Prema “hipotezi štedljivih gena”,

when we were hunter gatherers,

u vreme lovaca-sakupljača

our body's powerful anti-starvation responses helped us survive.

moćni odgovori našeg tela na gladovanje pomogli su nam da preživimo.

We had to find our food and sometimes we couldn't,

Morali smo da tražimo hranu, ali ponekad ne bismo u tome uspeli,

so our bodies stored calories to keep us alive.

pa je naše telo moralo da skladišti kalorije da bismo preživeli.

The better we stored calories, the better our chance of survival.

Što smo bolji u “skladištenju kalorija”, to su nam bile veće šanse da se izvučemo.

So what changed?

Šta se onda promenilo?

Nowadays, if we can afford food,

U naše vreme, ako možemo sebi da priuštimo hranu,

there's plenty of it, everywhere.

imaćemo je dosta i svuda.

We don't have to hunt.

Ne moramo da budemo lovci.

Even the gathering is easy.

Čak je i sakupljački deo olakšan.

We can order food to be delivered directly to our sofa,

Možemo da poručimo hranu da nam je donesu bukvalno do naše sofe,

and portions are huge compared to even 20 years ago.

a i porcije su ogromne u poređenju sa onima od pre 20 godina.

And a lot of food is tasty, but not so great for us.

I mnoga jela su ukusna, ali ne baš zdrava za nas.

We're living in what obesity doctors like me

Živimo u sredini koju doktori za gojaznost poput mene

call an obesogenic environment:

nazivaju “sredina koja podstiče gojaznost”:

limited need for any kind of physical activity,

sa ograničenim potrebama za bilo kojom vrstom fizičke aktivnosti

and easy access to inexpensive,

i lakim pristupom jeftinoj hrani,

calorie-rich, nutrient-poor food

bogatoj kalorijama, siromašnoj hranljivim sastojcima

or food-like substances.

ili kvazihranljivim sastojcima.

Our bodies, primed to keep us alive,

Naša tela, koja su pripremljena da nas održavaju u životu,

have gone into overdrive

preopteretila su se kalorijama

to store all these calories from all of that food,

koje moraju da sačuvaju iz sve te hrane

just in case.

za svaki slučaj.

And this is one of the reasons why we have an obesity epidemic

I ovo je jedan od razloga zašto imamo epidemiju gojaznosti

in the United States,

u SAD-u,

where 42 percent of adults have obesity,

gde je 42% odraslih gojazno,

and when we take a look at overweight and obesity combined,

a kada pogledamo zajedničku statistiku o višku kilograma i gojaznosti,

that number goes up to 74 percent.

taj broj ide do 74%.

Let's go back to the biology part of the equation because it gets worse.

Situacija postaje još gora ako se vratimo na biološki deo teme.

For example,

Na primer,

a high-fat diet damages nerve cells

dijeta bogata mastima oštećuje nervne ćelije

in the area of our brain called the hypothalamus,

koje se nalaze u hipotalamusu,

which is like a thermostat,

koji ima ulogu termostata

regulating how hungry we are

i reguliše glad

and how we use energy.

i to kako koristimo energiju.

When these nerve cells or neurons become inflamed,

Kada u ovim nervnim ćelijama ili neuronima započne upalni proces,

feedback signals from our guts, our digestive system,

povratni signali iz naših creva, našeg sistema za varenje,

and our fat cells

i masnih ćelija

can't get through to our brain

ne mogu da stignu do mozga

to tell us to stop eating when we're full,

da nam kažu da prestanemo da jedemo kada smo siti

and to stop storing calories when we're not at risk of starvation.

i da prestanemo da skladištimo kalorije kada ne preti opasnost od gladi.

It literally becomes harder to tell how full we are after eating,

Bukvalno postaje teže odrediti koliko smo siti nakon obroka

and how much fat our bodies really need

i koliko masti našem telu zaista treba

to keep us alive.

da bi nas održalo u životu.

Without an accurate thermostat sensor,

Bez tačnog termostatskog senzora,

our bodies store more calories as fat,

naše telo skladišti više kalorija u obliku masti,

and we're more prone to what we call food noise

a mi smo podložniji onome što nazivamo “buka u glavi zbog hrane“

or persistent thoughts of food,

ili upornim mislima o hrani,

often leading to maladaptive eating behavior.

što često dovodi do neadekvatnog ponašanja u ishrani.

And this is how weight gain leads to weight gain.

I tako dobijanje na težini vodi ka još većem dobijanju na težini.

It's a vicious cycle.

To je začarani krug.

And there are other factors that compound the situation.

Postoje i drugi faktori koji dodatno pogoršavaju situaciju.

Some people are even more genetically susceptible to obesity

Neki ljudi su čak i genetski osetljiviji na gojaznost

or develop health complications like sleep apnea,

ili razvijaju zdravstvene komplikacije poput apneje u snu,

that can worsen obesity and other health outcomes.

koja može pogoršati gojaznost i druge zdravstvene ishode.

Many people have even less access and ability to afford healthy food,

Mnogi ljudi imaju još manje mogućnosti i sredstava da priušte zdravu hranu,

and medications can be a huge culprit,

a lekovi mogu biti veliki uzročnik,

with so many common prescriptions

jer mnogi uobičajeni lekovi

and over-the-counter drugs that are weight-promoting.

koji se kupuju bez recepta podstiču povećanje telesne težine.

And people with obesity are extremely,

Ljudi sa gojaznošću su izuzetno često u situaciji

extremely likely to experience weight bias, stigma and discrimination,

da budu podvrgnuti predrasudama, stigmi i diskriminaciji,

which can worsen obesity.

što može dodatno pogoršati gojaznost.

And I can go on and on about factors

I mogla bih dugo da govorim o faktorima koji nisu samo prejedanje

other than eating too much and exercising too little

i premalo vežbanja,

that lead to weight gain.

a koji vode do dobijanja na težini.

Oh wait, there's one more thing.

Oh, da, postoji još jedna stvar.

When people with obesity try to lose weight,

Kada ljudi sa gojaznošću pokušavaju da smršaju,

their bodies freak out and think they're starving.

njihovo telo pada u stanje panike misleći da gladuju.

The hunger hormone, ghrelin, increases

Hormon gladi, grelin, raste,

and the fullness hormones decrease.

a hormoni koji izazivaju sitost opadaju.

It's not your imagination.

Nije samo u vašoj glavi –

Every time you diet, your body holds on to calories.

svaki put kada držite dijetu, vaše telo se čvrsto drži kalorija.

Your metabolic rate slows down

Vaš metabolizam se usporava,

and your bodies behave as if you're starving.

a telo se ponaša kao da gladujete.

This metabolic adaptation is fantastic

Ova metabolička adaptacija je fantastična

if, say, you find yourself on a deserted island

ako se, recimo, nađete na pustom ostrvu

with nothing but papaya and tree bark to eat.

sa samo papajom i korom drveta za jelo.

But if your coworker has a bottomless candy bowl,

Ali ako vaš kolega ima činiju sa zalihom slatkiša,

it makes life rough.

to čini život prilično teškim.

So have I convinced you

Dakle, jesam li vas ubedila

that obesity isn't just a lack of willpower?

da gojaznost nije samo pitanje nedostatka volje?

We know all of this from tons of medical research

Sve ovo znamo zahvaljujući gomili medicinskih istraživanja

and rigorously designed scientific studies,

i rigorozno dizajniranih naučnih studija,

but also from the TV show "The Biggest Loser."

ali i zahvaljujući TV emisiji „Najveći gubitnik“

If you haven't watched it,

Ako je niste gledali,

"The Biggest Loser" is a show

„Najveći gubitnik“ je emisija

where people with obesity compete to lose weight.

u kojoj se ljudi sa gojaznošću takmiče u mršavljenju.

What happens in the show, and what we've seen in other studies,

Ono što se dešava u emisiji, a što smo videli i u drugim studijama,

is that the weight comes back eventually for most people.

jeste da se kod većine ljudi težina na kraju vraća.

We know that within two years,

Znamo da se u roku od dve godine

half of the weight is regained,

polovina izgubljene težine vrati,

and within five years, 80 percent can be regained.

a u roku od pet godina može se vratiti čak 80%.

This doesn't mean that "The Biggest Loser" winners are losers.

To ne znači da su pobednici ove emisije gubitnici.

This means that weight loss itself is often a losing battle.

To znači da je mršavljenje često borba osuđena na neuspeh.

In 2017,

Godine 2017.

a patient named Barbara walked into my office.

u moju ordinaciju ušla je pacijentkinja Barbara.

She had given up.

Već se bila predala.

She had a lifetime of struggle with her weight.

Iza sebe je imala životnu borbu sa svojom težinom.

I mean, just some awful, awful treatments and experiences.

Mislim, prošla je kroz neke veoma užasne tretmane i iskustva.

Barbara's pediatrician started her on stimulant medications

Barbarin pedijatar je počeo da joj prepisuje stimulativne lekove

when she was just seven years old,

kada je imala samo sedam godina,

and by the age of ten her parents had enrolled her in Weight Watchers.

a već sa deset godina bila je član Weight Watchers-a.

Throughout her life,

Tokom života,

Barbara would lose 100 pounds,

Barbara je gubila po 45 kilograma,

regain them and lose 100 pounds again.

pa ih vraćala, i tako iznova gubila još 45 kilograma.

And while her weight went up and down,

I dok je njena težina oscilirala,

her shame remained constant.

osećaj stida je ostajao konstantan.

Barbara ultimately underwent a gastric bypass surgery,

Barbara je na kraju prošla kroz operaciju želudačnog bajpasa,

but after the initial weight loss,

ali nakon početnog gubitka težine,

the pounds just crept back.

kilogrami su se polako vraćali.

It felt like Barbara's body was conspiring against her

Imala je osećaj da njeno telo radi protiv nje,

because it was.

jer tako je i bilo.

And this is when Barbara was referred to me.

I upravo tada su je uputili kod mene.

Barbara presented completely hopeless

Barbara je delovala potpuno beznadežno,

and blaming her lack of willpower.

kriveći sebe i svoj nedostatak volje.

What else could it be?

Šta bi drugo moglo biti?

I did two things that day

Tog dana sam uradila dve stvari

that completely transformed Barbara's life.

koje su potpuno promenile Barbarin život.

One, I told her, "This is not your fault,"

Prvo, rekla sam joj: „Ovo nije tvoja krivica,“

and two,

i drugo,

I gave her hope that I knew exactly what was going on with her body,

dala sam joj nadu, objašnjavajući da tačno znam šta se dešava u njenom telu

and we had the tools to treat her disease effectively.

i da imamo alate da efikasno lečimo njenu bolest.

Barbara had been made to feel her whole life

Barbaru su naterali da poveruje

like her weight was her fault,

da je njena težina njena krivica,

when in reality she has a disease.

dok je u stvarnosti imala bolest.

Obesity is a disease,

Gojaznost je bolest,

and for those who have it,

i za one koji je imaju,

for their complex set of individual reasons,

zbog skupa njihovih složenih individualnih razloga,

it can be extremely, extremely hard to treat.

može biti izuzetno teška za lečenje.

Does anyone believe it

Da li iko veruje

when a clothing label reads "one size fits all?"

kada na etiketi odeće piše „jedna veličina za sve“?

No, no, right?

Ne, naravno da ne, zar ne?

Especially when it comes to obesity,

Pogotovo ne kada je reč o gojaznosti –

of course not, one size fits none.

naravno da jedna veličina ne odgovara nikome.

For some fortunate folks, diet and exercise work.

Za one koji imaju sreće, ishrana i vežbanje daju rezultate.

For others, surgery works.

Za druge, tu je operacija.

But for most people with obesity,

Ali za većinu ljudi sa gojaznošću,

effective treatment requires a combination,

efikasno lečenje zahteva kombinaciju,

a personalized combination,

personalizovanu kombinaciju,

of more than one treatment approach

više pristupa lečenju

delivered by a trained care team.

koje sprovodi stručni tim.

People with obesity should be treated like individuals with any other disease,

Ljude sa gojaznošću treba lečiti kao i ljude sa bilo kojom drugom bolešću,

any other complex chronic disease.

bilo kojom drugom složenom hroničnom bolešću.

An empathetic, reasonable, thoughtful,

Empatičan, razuman, promišljen

trained provider assesses each individual patient one by one,

i obučen stručnjak procenjuje svakog pacijenta pojedinačno,

understands their version of the disease

razume njihovu verziju bolesti

and comes up with a very personalized,

i osmišljava veoma personalizovan,

long-term treatment approach.

dugoročan pristup lečenju.

Obesity medications have absolutely transformed our field.

Lekovi za gojaznost apsolutno su transformisali naše područje medicine.

When I started practicing obesity medicine,

Kada sam počela da se bavim lečenjem gojaznosti,

the most effective medications we had

najefikasniji lekovi koje smo imali

were associated with five to 10 percent total body weight loss,

davali su gubitak 5-10% ukupne telesne mase,

which was still a lot.

što je svejedno značajan rezultat.

But now we can help our patients lose even more weight

Ali sada možemo pomoći našim pacijentima da izgube još više kilograma,

and more importantly,

i što je još važnije,

much, much more importantly,

mnogo važnije,

keep that weight off long-term.

da dugoročno održe tu težinu.

This new frontier is absolutely astonishing

Ovo novo umeće medicine je apsolutno zapanjujuće

and transformative to our field and to our patients' lives.

i transformisalo je našu oblast i živote naših pacijenata.

But we don't want to fall into a pharmacologic craze

Ali ne želimo da upadnemo u farmakološku euforiju

and think that the only way to treat obesity is with medication.

i pomislimo da su lekovi jedini način lečenja gojaznosti.

We have an entire armamentarium of lifestyle interventions,

Imamo čitav arsenal intervencija u stilovima života,

other medications, and other treatment approaches.

druge lekove i druge pristupe lečenju.

Treatment, in fact, in whatever form it takes,

Lečenje, zapravo, u kojem god obliku bilo,

should be the last step in the process.

treba da bude poslednji korak u procesu.

The first, and maybe the most critical

Prvo, i možda najvažnije,

is to finally put an end to the stigma

jeste da se konačno okonča stigma,

and the shame and the blame

sramota, optuživanje

and the judgment surrounding obesity.

i osuđivanje vezano za gojaznost.

Understanding obesity as the complex chronic disease that it is,

Razumevanje gojaznosti kao složene hronične bolesti kakva jeste

is essential to liberate individuals

od suštinskog je značaja da bi se ljudima dala sloboda

and to help them actually get the care that they need.

i da bi im se omogućilo da dobiju negu koja im je zaista potrebna.

Plus, when we accurately appreciate the reality of obesity,

Pored toga, kada tačno shvatimo stvarnost gojaznosti,

this will lead to more innovation and to more treatments.

to će dovesti do više inovacija i do razvoja novih tretmana.

We're not hunter-gatherers anymore.

Nismo više lovci-sakupljači.

Well, except we are.

Pa, samo što jesmo.

Think about the buffet line.

Setite se redova oko švedskog stola.

Think about the "all you can eat" food,

Razmislite o ponudama „koliko god možete pojesti“,

all the "grab and go" food at your grocery store.

o brzoj hrani „za poneti“ u vašoj prodavnici.

Think about the endless snacks in office environments.

Razmislite o beskonačnim grickalicama po kancelarijama.

Our biology drives our brain, our bodies

Naša biologija pokreće naš mozak, naše telo

and our behavior to act as if we're still gathering

i naše ponašanje da delaju kao da se i dalje nalazimo

in a feast or famine environment.

u okruženju “gozbe ili gladi”.

Medications are not a quick fix,

Lekovi nisu brzo rešenje,

nor are they the easy way out.

niti su lak izlaz.

Medications are a tool

Lekovi su alat

to help our bodies adapt

koji pomaže našem telu da se prilagodi

to our 21st century obesogenic environment.

ovom okruženju 21. veka u kome se podstiče gojaznost.

They help quiet the food noise

Oni pomažu da se utišaju „misli o hrani“

so we can make better food choices,

kako bismo mogli donositi bolje izbore u ishrani,

and they give us a fighting chance

i daju nam šansu

to take on this terrible adversary once and for all.

da se konačno suočimo s ovim strašnim protivnikom jednom zauvek.

Thank you.

Hvala vam.

(Applause)

(Aplauz)