Obesity and heart health – Associate Professor Aleksandar Kibel
Croatians are the most overweight population in Europe, with 65% of citizens being overweight. We share this unenviable first place with Malta, followed by the Czech Republic and Hungary, each with 60% of the population classified as overweight, according to the latest Eurostat data.
With 35% of children overweight or obese, based on 2022 data from the World Health Organization, Croatia ranks fifth in the WHO European Region. The study covered 33 countries.
Experts have long been warning that obesity is a major public health issue in Croatia.
The Impact of Eating Habits and Social Change on Obesity
Humans evolved in scarcity, as gatherers and hunters, and whether they would find food depended on both their skills and external factors they couldn’t control. In essence, we evolved relatively hungry, with limited calorie intake. With civilization came agricultural production and an abundance of calories. Our bodies, still adapted to scarcity, are genetically predisposed to extract and store high amounts of calories from fats or carbohydrates. Of course, evolution is only part of the story. A wide range of factors influence obesity genetics, psychological, sociological, and economic reasons, as well as dietary habits, including the types of food we eat and how we prepare them, explains Assoc. Prof. Aleksandar Kibel, specialist in internal medicine and subspecialist in cardiology at the International Medical Center Priora in Čepin near Osijek.
When we look at photographs of our citizens between the two World Wars, it’s rare to spot anyone overweight. Even during the 1980s, summer beach scenes were striking for the absence of excess weight. So, did the economic transition of the 1990s in Croatia bring extra kilos?
In lower-income, transitional, or developing countries, a tendency toward weight gain is common, as people often lack access to healthier foods—which are more expensive—and instead rely on highly processed, calorie-dense foods such as fried items and those rich in oils, trans fats, and starch. These economic conditions contribute to obesity. At the same time, a cultural shift has occurred compared to decades or even a century ago, altering not only eating habits but also food availability – explains Dr. Kibel.
Childhood Obesity: Long-Term Consequences and Treatment Challenges
Childhood obesity is especially concerning. Who’s responsible parents or the system?
Likely, many actors play a role. As already mentioned, it involves genetics, eating habits, availability of high calorie foods, fast food, and education, where parents have a key influence over their children’s eating behaviors. In childhood obesity, not only does the size of fat cells (hypertrophy) increase, but the number of fat cells (hyperplasia) grows as well. Once that number increases in childhood, it doesn’t easily decrease in adulthood. Therefore, those who become obese as children find it harder to lose weight later because they have more fat cells – Kibel explains.
Diseases Linked to Obesity and the Importance of Timely Intervention
A wide range of diseases is associated with obesity, from diabetes to various cardiovascular conditions, such as atherosclerotic cardiovascular disease, coronary artery disease which can lead to heart attack cerebrovascular disease which can result in stroke and peripheral arterial disease, which may lead to gangrene.
Obesity is also linked to fatty liver degeneration, liver cirrhosis, gastroesophageal reflux disease, and a wide range of musculoskeletal problems caused by strain on the spine, joints, and hips not to mention sleep apnea. In short, obesity has numerous significant consequences for the body. However, it has been proven that substantial weight loss reduces the risk of developing these diseases and even lowers overall mortality, emphasizes Professor Kibel.
A Cardiological Approach to Treating Obesity: Dr. Kibel’s Perspective
Aleksandar Kibel is an associate professor at the Faculty of Medicine in Osijek and the Faculty of Dental Medicine and Health. He worked at the Department of Internal Medicine at the University Hospital Center Osijek from 2011 to 2024, mainly in the Department of Cardiovascular Diseases.
“I focused on obesity treatment primarily because, as a cardiologist, it’s fascinating that by significantly reducing body weight, we can greatly reduce adverse cardiovascular outcomes, including strokes and heart attacks, coronary artery disease, and peripheral artery disease. We can thus significantly improve patients’ cardiovascular health and reduce mortality. Secondly, many of our cardiology patients are obese. And third, we finally have access to effective and safe medications for treating obesity that also positively impact cardiovascular outcomes. Some of these medications have been included in international cardiology guidelines for treating specific heart conditions,” he says.
Modern Pharmacotherapy: New Medications for Treating Obesity
Previous medications were not very effective and had many side effects. Some were even misused—like amphetamines, which were not medically advised or included herbal remedies without scientific proof. Today, we have medications that are effective and have a favorable safety profile, with few adverse effects and several beneficial impacts, especially on cardiovascular health – he adds.
Three modern drugs are approved in Croatia for obesity treatment. They are administered via subcutaneous injections and are “barely felt by the patient.”
Ideally, the medication should be used long-term because discontinuation can lead to weight regain, and cardiovascular benefits are greatest with long-term use. However, due to cost, many patients can’t afford prolonged treatment, so we tailor the duration individually based on their goals and financial capacity – says Dr. Kibel.
Why Early Intervention is Key in Obesity Treatment
Treatment starts with low doses that are gradually increased, depending on how much weight the patient wants to lose.
“We’re not gurus for treating obesity we approach it medically. As an internist and cardiologist, I emphasize pharmacology, along with dietary counseling,” he underlines.
Ideally, obesity should be addressed in its early stages, when the BMI is around 30, to better prevent cardiovascular disease.
Changing Perspectives: From ‘Healthy and Fat’ to Recognizing Obesity as a Disease
Changing Perspectives: From ‘Healthy and Fat’ to Recognizing Obesity as a Disease
Slimness used to be considered a sign of illness, an unhealthy body type—rooted in historical circumstances. For instance, during the Victorian era, tuberculosis patients often had very low BMI. Malnutrition was common throughout history, which likely gave rise to the idea that a bit more body weight was a sign of health. Today, numerous studies show that overweight individuals tend to have a shorter life expectancy and are more prone to heart disease. Obesity is a disease, with a classification code in the international disease registry. It’s essential to raise awareness about this—not just among patients but even among some healthcare professionals – concludes Prof. Dr. Aleksandar Kibel.
The Croatian Parliament declared March 16th as the “Croatian Obesity Awareness Day” in 2017, a day dedicated to prevention, diagnosis, and treatment of obesity.
