When friends say you're fat, what do you do?

An eternal promise

And us? We promised to diet and to exercise after the holidays—an annual promise, as always. A big tummy, he said, quoting a Facebook ad, could be a symptom of a liver problem, or a sugar overload.

Are we overweight? At home, while facing the mirror, we asked: But do we really look like we have feasted on so much? For so long? With so little restraint?

Getting in shape can sometimes be depressing, more so if you have a friend who looks good and seems to look even better over time.

‘We tried everything'

Unknown to our compadre, we have tried probably all available means—all conceivable and all affordable means, if you please—to keep in shape.

Less sugar at the outset, we tried that as much, then eventually no sugar, which meant black, bitter coffee. Every cup, every day? Couldn’t really get used to it. We felt violated. Diet, which meant smaller food portions, then eventually fasting, six hours, then eight hours to 10 hours. Exercises, biking, walking, going to the gym. And all that jazz.

We tried all that privately. We don’t look that bad, do we?

Mirror has two faces

It is easy to dismiss other people’s views. But nothing beats a mirror when that mirror is one of your closest friends.

Is that body shaming? He meant well, especially when he reminded us that some of our contemporaries have died or have suffered a stroke at the height of the COVID-19 pandemic.

He only wanted us to stay healthy.

The pandemic ushered us into our senior years, but it provided no big-bang transition, health-wise, or even vanity-wise. We couldn’t care less.

But we survived. Is there something wrong with that? With him? Or with me? The lockdown left us with some additional pounds so uneasy to shed off in one’s senior years. But if you don’t want to be shamed, get back in shape.

That simple? No, it is not, according to Dr. Luz Katigbak, a psychiatrist working at Makati Medical Center, among other hospitals.

When fat becomes chronic

“Obesity is a serious disease,” said Katigbak, president of the Philippine Society for the Study of Overweight and Obesity.

One is considered obese if their Body Mass Index is 30 or higher, calculated from their height and weight, indicating excessive body fat and health risk.

Waistline says something

What is your waistline? Check with your doctor if you are a male and your waistline is more than 35.5 inches, if you are a female and your waistline reaches 31.5 inches. If you are, you are an obesity candidate.

It's always best to consult a doctor for an accurate assessment before starting a health plan. Some doctors say there are women and men below the measurements who could still be overweight, especially those who always feel tired, or with a chronic energy deficiency of 7.2%.

Who's fat? Be careful

Obesity is a complex, chronic disease, recognized by major health organizations, characterized by excess body fat and driven by genetic, environmental, metabolic, and behavioral factors.

It remains “underrecognized and undertreated,” said Katigbak in an interview.

Why? All these criticisms about another man's shape, especially if he is obviously obese, the most visible proof that one is not exactly in the pink of health, can make one feel depressed and lose hope.

Is the use of the term fluffy to describe obese patients more polite than the word "fat"? Whatever, calling them names doesn’t help.

An emerging crisis

“Stigma continues to delay care and discourage patients from seeking help,” said Katigbak.

But the delay in medical treatment makes one sink further: You get fat, you get obese, you get sick.

Obesity attracts all kinds of ailments involving practically all body organs, according to Dr. Elaine Cunanan, an endocrinologist at UST Hospital.

It leads to serious health risks, she said, such as Type 2 diabetes, heart disease, certain cancers, fatty liver disease, and reduced quality of life, all of which require long-term, multidisciplinary management beyond just diet and exercise.

4 out of 10 Pinoys are overweight/obese

Cunanan is the vice president of the Philippine College of Endocrinology, Diabetes, and Metabolism, and listening to her during our conversation took us back to a time when we were young and reckless, unmindful that youth was only transitory. Youth does not make one invincible.

Cunanan said obesity and diabetes, more commonly termed as “Diabesity,” are fast becoming a national crisis.

“The numbers are staggering,” she said. “Nearly four in 10 Filipino adults are now overweight or obese. They can be our neighbors, friends, and even family members.”

Obesity hits more women

Obesity is more common in adult women living in urban areas. Cases are expected to climb sharply in the coming years. At present, the number has reached 4.7 million.

“These are people whose lives are being cut short,” said Cunanan.

So, what are they doing about it? “We are moving away from shaming,” she said.

The situation is already alarming, said Katigbak and Cunanan, but it is unfortunate that the government has not given adequate support to fight obesity.

Genetics, lifestyle

We remember the time when our mother died in September 2021. At her wake, older relatives from both sides of the family shared stories about their blood sugar levels.

Many of those who perished during the pandemic had comorbidities, the diabetics among them.

We wonder if we would have a similar problem further into our senior years. To date, three of my siblings are now diabetic and are taking maintenance drugs. One of them was hospitalized because of a diabetic wound on his right leg, less than a year after our mother’s funeral.

But genetics is one thing, lifestyle is another.

Katigbak said diabesity is getting worse globally, especially in the Philippines, in the age of social media.

The Philippines is a poor country, but it has a dynamic gastronomic society.

Food everywhere

From Greenbelt to BGC, from Ortigas to Morato to Maginhawa, from Intramuros to Cubao to Pampanga, to the hills of Angono, Antipolo, and Tanay, from Batangas to Quezon to Bicol, to Bacolod, Bohol, and Cebu, to Zamboanga and Sulu, and elsewhere, there are cafés, carinderia, and fine restaurants that serve food, glorious food. You will never go hungry on this side of the universe, for as long as you have the means, of course.

And they’re all there—listed, documented, photographed, shown live in living colors in various platforms on social media that nobody can ever say that at one point, at some time of the year, he doesn’t have too much, with little restraint. Too much of anything is bad for everyone.

This has created an infectious culture of engagement: One feels left out if one has not tried what others have posted.

Self-help drugs everywhere

Too bad, all these provide a platform for excessive indulgence, which can lead to physical and mental harm.

But overindulgence is not the only problem, Cunanan said.

Social media has promoted a culture of self-medication, given the proliferation of drugs, among others.

All conceivable slimming creams, pills, and surgeries, a cure for all or any ailment, and all body enhancements are readily promoted in social media, some of them even AI-generated, and obtained with ease through the delivery apps, all without consulting a doctor.

If you can afford it, you can get it.

This is dangerous, Cunanan said.

It is always good to obtain an FDA-approved drug. And it is always best to consult a doctor who can check a patient’s health, can give the right dosage, advise the patient of its side effects, the length of medication, and possible complications with other medicines. 

Wanted: Government help

Even snake oil and other fake drugs are readily available, she said, and the government is not doing anything yet about it.

We met Katigbak and Cunanan in response to our own curiosity about our own senior issues, which led us to discover their advocacy with other doctors in private and public facilities, including Zuellig Pharma.

Katigbak, Cunanan, Dr. Fatma Tiu, of Diabetes Philippines; Dr. Araceli Panelo, of the Institute for Study on Diabetes Foundation; Dr. Walid Amil, of the Philippine Heart Association; Dr. Maria Leonora Capellan, of the Alliance of Clinical Endocrinologists, and Zuellig’s Dr. Gyneth Lourdes Bibera, Ninia Torres, and Pinky Ferrer have joined forces by signing a memorandum of agreement to reverse the rising cases of obesity and diabetes in the Philippines.

Called “UNIFIED: A Collaborative Commitment to Excellence in Obesity and Diabetes Care,” the group is the first of its kind. Members decided to bond because of the alarming rise in cases.

“This partnership sends a clear message,” said Katigbak. “Obesity deserves the same urgency as any chronic disease,” 

About time we called government attention to the emerging crisis, said Cunanan.

For instance, why not regulate the proliferation of unauthorized drugs on social media? Why not provide sufficient PhilHealth financial coverage for obesity, where most major chronic ailments begin?

Why not spearhead, promote, and support research for a cure?

“We cannot do this alone,” said Cunanan. “We need the help of (everyone).”

They want the public to know that diabesity is treatable, manageable, and preventable.

Drugs and doctors

Katigbak said the formation of the group was a milestone in the fight against obesity.

“We should look at obesity in a holistic perspective. And as we come together as a group, we come together because obesity is everyone's business.”

Indeed, we probably tried everything, except slimming drugs, despite some “success stories” told on social media involving some celebrities. We think some of them could be fake news. What is good for an individual may not be good for another. What is good for one body organ may harm another. Who knows if a drug can induce dependence?

Family’s medicine cabinet

But because there are diabetics in the family, some drugs are often part of dinner conversations. 

There are some medications made available to the market known by their generic names: GIP and GLP-1 (otherwise called Tirzepatide), a dual mechanism that reportedly enhances both appetite regulation and glucose control.

It was developed by Eli Lilly, an American multinational pharmaceutical company behind the first polio vaccine in 1955.

Approved by the FDA under two different brand names, Tirzepatide is distributed by Zuellig Pharma in the Philippines.

But then again, go consult your doctor and find out what suits you best.

The best of me 

“Though there are, of course, biological, pharmacological interventions, the psychological, social aspects should not be neglected,” said Katigbak.

One finds from Zuellig Pharma website a program called “First Move to My Best Me,” a patient-focused digital platform designed to increase awareness of obesity as a chronic disease.

The microsite provides medically sound advice as it motivates patients to consult a doctor.

Best mirror

Over the weekend, we got a piece of bad news that another college friend, a diabetic, was rushed to the hospital at midnight. He has been overweight, and we never really stopped reminding him, but maybe our kind reminders never helped. He has not seen a doctor for a long time.

Getting old is like having a time bomb in one’s body. Obesity can trigger an explosion. To stop it, see a doctor. One's best mirror is the doctor who can give you the best advice.

One finds pleasure in knowing one is healthy. Over coffee early this month, our friend-critic and I talked about our passing blood tests. Somehow, there’s some kind of pleasure in knowing that we look good because we feel good.

So, when friends say you’re fat, what do you do? Just say thank you, say you appreciate it. No need to look for a physical mirror. Get even, see your doctor to get back in shape.

In time, your buddy will be the first to ask: “Ang sexy mo! Anong sekreto mo?” Smile, then give him your doctor’s business card.