Obesity - A Problem And A Threat

The modern way of life in developed and developing countries is the main reason for the drastic changes in medical statistics in recent decades. Overweight is a risk factor in a number of socially significant diseases today, diseases that occupy the first place among the causes of death in much of the world, including in our country.

Obesity is not just the accumulation of excess fat. A few extra pounds will not affect our health at first, but we must be careful not to gain more. When we talk about obesity, we mean a chronic multifactorial disease that affects the whole body and leads to a number of complications.

According to data from the Ministry of Health, 2.2 million people in Bulgaria are overweight and 1.045 million are already obese - 21% for men, 17% for women (2004 data). Among children (under 18), 13.9% are overweight and 4.9% are obese.

 

In general, it is the result of energy intake in excess of energy expenditure. The body's natural response, genetically determined, is to store this excess energy in the form of fat.
Eating regularly , especially with the high-fat and carbohydrate-rich products that abound on the market today, is the main cause of energy imbalances. Another mistake that is extremely common today issingle meal - late in the evening after work. You can find more about harmful eating habits leading to overweight HERE .

A particularly important factor in obesity is early childhood nutrition . Being overweight in children is associated with permanent obesity. This stems from the fact that the number of adipocytes increases in early childhood, which cannot be reduced later. In adults, the accumulation of excess fat is the result of "enlargement" of existing fat, but not an increase in the number of fat cells.

Another aspect of the energy balance available for control is movement. Physical activity not only burns calories, but also tones the body, increases its reactivity to various pathogens. However, the fight against overweight and obesity often proves to be much more complicated than just following our diet and exercise.

The role of the genetic component in obesity is not small . We know that for some of us every cake we can afford affects the scales, while for others the regular "trampling" in fast food restaurants is not a problem. Our genes are the ones that control the rate of metabolism, the hormonal connection between the brain and eating behavior, the distribution of adipose tissue and more. Therefore, in many cases, but not always, overweight is hereditary.

Adipose tissue produces hormone -leptin , which plays a key role in energy balance. Based on the percentage of adipose tissue in the body, it limits food intake through signals to the satiety center in the hypothalamus and increases energy expenditure. It has been found that due to a genetic defect, the body does not respond to leptin, and the hypothalamus perceives the situation as "lack of adipose tissue in the body." This leads to excessive accumulation.

Age also contributes, as the intensity of metabolic activity decreases with age. Gender is another factor that affects her - in women it is slower than in men.

Some diseasescan alter metabolism - hypothyroidism, Cushing's syndrome, Polycystic Ovarian Syndrome, Prader-Willi syndrome, Lawrence-Moon syndrome, adipose-genital dystrophy, hypothalamic damage in trauma, tumor (in the mouth) are located and others.

Changes in our body during puberty, during pregnancy, after menopause can lead to the deposition of excess fat.

Medicationscan also alter metabolism. Among the most widely used are beta-blockers in the treatment of cardiovascular disease, contraceptives, anti-diabetic drugs - insulin and oral antidiabetic drugs (sulfonylureas). Other examples are tricyclic antidepressants, valproates (antiepileptics). A serious side effect of corticosteroids is weight gain.

Often psychological factors affect our eating habits. These are often people with an unbalanced nervous system, often depressed, unable to cope with stress.

Not infrequently smokers they refuse to stop smoking because they are afraid of gaining weight. It occurs for many reasons. On the one hand, there is no nicotine, which has so far stimulated the metabolism, on the other hand, each changes the taste perception, and not to be neglected is the factor of cigarette substitute eating.

 

To unify the classification of body weight in the world is introduced index The body mass index (Body Mass Index) - the ratio of the weight in kilograms and height in meters squared - kg / m2. Normal values ​​for BMI - 18.5, - 24.9. We are talking about overweight with a BMI of 25.0 to 29.9. Above BMI> 30, obesity is already present.

Adipose tissue can be divided into two types:
- Of the female type (pear-shaped) - in the area of ​​the hips and thighs
- Of the male type (apple- shaped) or also called android - in the area around the abdomen, both subcutaneously and intra-abdominally among the intra-abdominal organs - viscerally.

Android-type obesity is a dangerous and correlated with dyslipidemia (high triglycerides and LDL and low HDL), high blood sugar and high levels of insulin to insulin resistance (prediabetno condition or type 2 diabetes), atherosclerosis, arterial hypertension, - components of the metabolic syndrome.

To assess the type of distribution of adipose tissue, both the waist circumference itself (up to 94 for men and up to 80 for women) and its ratio to that of the hips - up to 0.95 for men and up to 0.80 for women - are used.

Other methods more commonly used, although applicable in some centers only due to lack of necessary equipment, are capilometry - measuring the thickness of the skin fold in certain parts of the body; Measurement of the bioelectrical impedance - by means of electrodes placed in certain places on the hands and feet, or by stepping barefoot on a special device, based on the passed electric current, the percentage of adipose tissue in the body is estimated. If in men it is over 25%, and in women - over 30% - then we are talking about obesity.

 

Obesity is associated with many pathological changes in the body, affecting many systems at the morphological and physiological level. They are extremely interconnected and manifest together - for example, the components of the said metabolic syndrome.

For greater clarity, they will be mentioned separately.
- Cardiovascular system - arterial hypertension; ischemic heart disease with risk of myocardial infarction, atherosclerotic changes in cerebral vessels with risk of stroke; varicose veins, thrombophlebitis.
- Metabolic changes - dyslipidemia - with high triglycerides and LDL- and low HDL-cholesterol. Tissue resistance to insulin and impaired carbohydrate tolerance to type 2 diabetes.
- Fatty infiltration of the liver -steatosis (even if the patient does not abuse alcohol, which is the most common cause). Obesity is usually accompanied by a suitable terrain for the formation of gallstones .
- The role of obesity in malignant diseases is not small . The connection with cancer of the colon and rectum and the esophagus has been proven. There is evidence that obesity increases the risk of postmenopausal breast cancer, due to the persistently high level of estrogen (a stage of their metabolism takes place in adipose tissue). For the same reason, the risk of cancer of the endometrium - the lining of the uterus - is increased. Chronic cholelithiasis is a risk factor for the development of bile duct cancer.
- In connection with the increased weight increases the pressure on the joints, and this predisposes to osteoarthritis
- A dangerous complication is sleep apnea - in obesity it is due to airway obstruction during sleep, interrupting breathing for short periods of time. This leads to frequent waking at night, poor sleep quality and drowsiness during the day.
- Picwick - the syndrome(obesity, reddening of the face, breathing disorders and easy fatigue to drowsiness) is a consequence of high-grade obesity. It also has a genetic component. Impaired ventilation is severe, to an extent that the level of carbon dioxide increases and the number of erythrocytes is usually increased - an attempt to compensate for hypoventilation (erythrocytes contain hemoglobin, which carries oxygen).
- Obesity can be a cause of menstrual disorders, infertility in both women and men.
Obesity causes physical discomfort. It is often the cause of social and emotional problems.

 

The treatment of obesity is complex. It requires both limiting energy imports and increasing costs. This is achieved in different ways.

Fasting is not a good way to lose weight, as it involves a number of complications and the effect is not lasting. More suitable are prepared by specialists low-calorie diets according to gender, age and physical activity of each individual. What is important for the long-term effect of such a diet, however, is a complete change in eating habits. It is necessary to learn to choose products with the appropriate composition in terms of fats, carbohydrates, proteins, to learn to comply with the caloric content, to reduce portions and increase the number of meals per day. Liquids are a good helper in the fight against obesity, but alcohol and carbonated beverages will need to be minimized.

Increasing energy consumption can be achieved in a different, convenient way. Walking, running in the park, hiking in the mountains, visits to gyms are just some examples of how to improve our appearance and overall reactivity of the body. Motor activity has also been shown to lower blood sugar and increase insulin sensitivity, improve lipid status and lower blood pressure. Regular physical activity also ensures the development of a good collateral blood supply to the myocardium and reduces the risk of heart attack.
If these measures are not enough to fight weight gain, we can resort to medication. In principle, recombinant leptin has been developed, which has achieved quite good results in clinical trials.

In clinical practice more important however, anti-obesity agents find two types of medications. Some suppress gastric and pancreatic lipase - an enzyme that breaks down fats and helps absorb them. One such preparation is Orlistat (Xenical) - it suppresses the absorption of fats, which reduces adipose tissue on the one hand, and on the other hand improves lipid status.

The other type of preparations excite the center of satiety and suppress appetite. One such drug is Silbutramine. It is used in patients with BMI> 30 or BMI> 27, combined with other diseases. It also has a good effect on serum lipids and insulin sensitivity.

 

 

It is a method of aesthetic surgery, applicable to persons with accumulation of adipose tissue in certain areas, but otherwise a stable body weight. It can be done in different areas - abdomen, buttocks, hips, arms, neck and more. by removing a small amount of adipose tissue - up to 5 kg.

As we can see, obesity is a complex disease with a high frequency in modern society. His treatment is also multifactorial, difficult and long. Knowing the risks associated with it, it is imperative to strive for prevention against its occurrence. It is more accessible, more cost-effective and minimizes the encounter with the listed socially significant diseases.