— Videnskab —

Må man godt spise is, når man er fed?

maj 13, 2017

Jeg er opdraget til at være forholdsvis fordomsfri. Især min far har lært mig, at man ikke skal danne sig en mening om nogen eller noget, før man har hørt alle sider af sagen. Derfor prøver jeg, at møde folk med et åbent sind uanset om det er indvandrere, Jehovas vidner eller gadesælgere. Og har jeg ikke tid til at høre på dem, ja, så prøver jeg, at lade være med at have en holdning til dem.

Men ak! Jeg er også bare et menneske og jeg har i mange år haft et svagt punkt. Nemlig tykke mennesker.

Selv prøver jeg at leve forholdsvis sundt, altså spise sund og varieret kost (hvilket jeg langt hen ad vejen kan takke min kære mand for) og dyrke regelmæssig motion. Men jeg har en svaghed for chokolade, chokoladeis, chokoladekage, chokoladepålæg og alt hvad der ellers har med chokolade at gøre. Desuden er jeg så heldig at have en såkaldt dessert-mave, så selvom jeg er stopmæt efter hovedretten, så er der altid plads til dessert (og ekstra meget, hvis der indgår chokolade). Heldigvis er jeg også velsignet med et stofskifte, der tillader mig at gå amok i dessert og chokolade, uden at jeg tager på. Min vægt har, siden jeg stoppede med at vokse, højst ændret sig med et par kilo og med en BMI i den lave ende af middel-kategorien, har jeg aldrig prøvet at være på slankekur.

Derfor er det svært for mig, at forstå hvordan man kan blive overvægtig. Og hvis man først når der til, hvor man ikke længere kan lukke sine bukser, hvorfor gør man så ikke bare noget ved det (altså ud over at gå ud og købe et par nye og større bukser)? Når jeg ser familien fed på gaden med en is eller cola i hånden, er det svært ikke at tænke, at det er deres egen skyld. Når det står aller værst til, så har jeg endog tænkt, at tykke mennesker må være mindre begavede, for hvordan kan det ikke være gået op dem, at deres høje vægt med stor sandsynlighed fører til en række andre alvorlige sygdomme f.eks. type 2 diabetes, kræft, eller depression?

Jeg er bestemt ikke stolt over disse fordomme om tykke mennesker, men jeg kan se, at jeg ikke er alene med dem. I en ny megafonundersøgelse for TV2 og Politiken svarer 82% at de mener, at overvægt først og fremmest er den enkeltes ansvar.

Men er det nu også det? Eller er det bare en stor, fed fordom, som vi går og bilder hinanden ind er sandheden? Min kloge far, har mere end én gang lært mig, at fordomme skal bekæmpes med viden og information. Så det prøver jeg nu. Kolde facts og videnskabelige resultater, der kan komme min og mange andres fordomme om tykke mennesker til livs.

Langt de fleste eksperter på området påstår nemlig, at man ikke udelukkende kan skyde skylden på de tykke mennesker. Der findes en række andre årsager, der i mange tilfælde har større betydning for om en person bliver overvægtig, end ens egen indsats.

Årsager til overvægt

Op mod 30% af de personer, der søger hjælp mod overvægt lider rent faktisk af en spiseforstyrrelse. Binge Eating Disorder (BED) også kaldet overspisning er den hyppigst forekommende spiseforstyrrelse og det siger sig selv, at en bivirkning af denne lidelse er en vægtøgning. Man kan lige så lidt give folk, der lider af BED skylden for at være overvægtig, som man kan give anoretikere skylden for at være undervægtige.

Andre kan være så uheldige at have en fejl i deres gener, der i nogle tilfælde gør det nærmest umuligt ikke at blive overvægt. Overvægt er en kompliceret størrelse og skyldes en god blanding af gener og miljø, men generne spiller formegentlig en meget større rolle end de fleste af os går og tror.

Nogle gener har en meget stor betydning for, om man bliver overvægtig. Et eksempel er genet LEPR. Genet koder for leptin receptoren, der sidder i hypothalamus, det område i hjernen, der blandt andet er ansvarlig for at regulere vores appetit. Når vi har spist produceres hormonet leptin i vores fedtceller, herefter transporteres det til hjernen og binder til leptin receptoren. Dermed for hypothalamus besked om at “nu har du spist nok” og man bliver belønnet med at føle sig mæt. Hvis man er så uheldig, at have en fejl i LEPR genet, kan hypothalamus altså ikke modtage denne besked og man føler sig derfor aldrig mæt. Der findes forfærdelige historier om børn med denne genetiske fejl, hvor forældre har måtte sætte lås på køleskabet, og hvor børnene i stedet har spist råt kød direkte fra fryseren, rester fra skraldespanden eller ligefrem slået sig selv til blods i et forsøg på at komme ind i køleskabet. Heldigvis er denne genetiske fejl ekstremt sjælden.

Andre gener har en mindre drastisk effekt, men ses meget hyppigere i befolkningen. Fejl i MCR4 genet (som koder for en anden receptor, der også findes i hypothalamus og også har en vigtig betydning for vores appetitregulering) er de mest udbredte. Det anslås at op mod 1% af alle svært overvægtige har en fejl i dette gen.

I et stort internationalt studie publiceret i det anerkendte tidskrift Nature har en lang række forskere sammenlignet mere end 300.000 personers gener med deres BMI, for at bliver klogere på genetikken bag fedme. I alt fandt de 147 forskellige gener (inklusiv de to beskrevet ovenfor), der, hvis man har en fejl i et eller flere af dem, medvirker til et øget BMI.

Yderligere har bl.a. rygestop og en meget lang række farmaka (bl.a. flere typer af antidepressiver, betablokkere mod forhøjet blodtryk og flere former for almindelige præventionsmidler) vægtøgning som bivirkning.

Der kan altså være rigtig mange medvirkende årsager til, at man bliver overvægtig i første omgang og mange af dem, er man ikke selv skyld i. Men derfor kan man som overvægtig vel godt tage sig lidt sammen og få gjort noget ved det, eller hvad?

Rygrad som en regnorm

Og ja, det kan man godt. Altså tage sig sammen og gøre noget ved det. På dette punkt er biologien er bare så ubarmhjertig indrettett, at hvis man allerede er overvægtig, så kræver det for de fleste en ualmindelig stor indsats at gøre noget ved det og i særdeleshed at bibeholde vægttabet.

Rigtig mange overvægtige lider i større eller mindre grad af leptin resistens. Hormonet, der som beskrevet ovenfor, gør at vi føler os mætte. I den periode hvor man øger sin vægt, vil fedtvævet frigive en øget mængde leptin og når det står på over en længere periode, så holder hypothalamus op med at lytte efter. Det er lidt det samme, som når stofmisbrugere langsomt bliver nødt til at sætte deres misbrug op for at opnå samme fix. Mange overvægtige har altså brug for en større mængde mad, for at føle sig mætte.

Derudover er vores evolution ikke fulgt med vores evne til at skaffe føde. I fortiden var det en stor fordel, hvis kroppen var god til at holde på vægten og hurtigt øge vægten igen, hvis man havde været ude for en sulteperiode. Derfor udviklede vores krop over tid en række snedige systemer til at opnå netop dette. F.eks. bruger kroppen mindre energi på temperaturregulering og forplantningsevnen nedsættes, ja det går sågar ud over immunsystemet, der også bliver nedprioriteret, når vi begynder at tabe os.

At tabe sig er altså en benhård kamp mod kroppen, som gør alt hvad den kan for at modarbejde et vægttab. For til fulde at ophæve min fordom om, at de overvægtige vel bare kan tage sig lidt sammen, så må jeg lige vende blikket indad for en kort stund. For kunne jeg mon selv lægge min elskede chokolade og desserter helt på hylden, hvis det var mig, der skulle tabe nogle overflødige kilo? Det tvivler jeg faktisk på, for jeg har ærligt talt en rygrad som en regnorm, når det kommer til stykket.

Hvad skal der så til?

Men hvad skal vi så gøre? For vi skal vel ikke bare give op på forhånd? Nej, det mener jeg bestemt ikke.

Med den nuværende holding om at man som overvægtig bare skal tage sig sammen, er der alt for mange, der oplever gentagne fiaskoer i forsøget på at tabe sig. For at undgå at dele disse mulige fiaskoer med omverdenen, bliver det ofte en ensom kamp mod de ekstra kilo. Derfor tror jeg, at vi skal have nedbrudt fordommen om, at overvægt er noget man kan og bør klare selv. Som overvægtig skal man kunne stå frem og bede om hjælp til at tabe sig fra både venner, familie og samfundet. Og både venner, familie og samfundet skal forstå og acceptere, at et varigt vægttab er en lang og sej kamp, der kræver en åben dialog og støtte og opbakning hele vejen igennem.

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