OBESITY: A GROWING EPIDEMIC

Julio Fabian de la Rosa, Marisa Andrea Squizzato, Jéssica Edith Masloski

Dr. Julio C. rose

 

OVERVIEW

Obesity is a chronic disease with a genetic component, and represents the second leading cause of preventable deaths in the world.

It is defined as a (BMI) body mass index > 30 kg/m2, and is the result of a positive energy balance, as a result of ingestion of hiperenergeticas diets, insufficient physical and activity in turn favoured by a genetic predisposition.

It is a chronic disease and risk factor of many others, such as cardiovascular disease, hypertension, diabetes, etc.

The prevalence of obesity in the Argentina in the last decade ranges between 4 to 11%.

The diagnosis of overweight and obesity is performed with a standard medium, called the index of body mass or Quetelet, consisting in divide weight in kg. by the height (in meters) squared.

Non-pharmacological treatment of obesity is based on dietary changes, physical activity, and behavioral intervention and/or psychological. Within the drugs most commonly used are sibutramine and Orlistat.

For morbid obesity (overweight extreme), surgery may be recommended to reduce the size of the stomach. Bariatric Surgery is called and is offered as a treatment to individuals with extreme obesity or those obese with medical complications because of their excess weight.

Key words : Obesity, overweight, Diagnostics, nutrition.

 

SUMARY

Obesity is a chronic illness which has a genetic component and represents the second leading cause of preventable deceases in the whole world.

The Index of Corporal Mass is 30 kg/m2, and it is the result from a positive balance of energy because of the ingestion of hyperenergetic diets, scarcity of physical activities and a genetic predisposition.

It is a chronic illness and could cause many other illnesses, like cardiovascular diseases, hypertension, diabetes, etc.

The prevalence of obesity in Argentina in the last decade is between 4 and 11%.

The diagnostic of overweight and obesity is made by standard way, which is called Index of Corporal Mass or of Quetelet Index, that consists in a quotient from the weight (in kg) with stature (in meters) elevated to the second potency.

The treatment not pharmacological of obesity consists in dietetic amendments, physical activities and a behavioral or psychological intervention. Between the most useful medicines are the sibutramine and Orlistat the.

To the morbid obesity (extreme overweight), it can't be recommended an operation to reduce the stomach completo magnitude. It is called the bariatric surgery and offers treatment to the people that have extreme obesity or to another with obesity and medical complications because of their excess of weight.

 

INTRODUCTION

Obesity is a common problem of increasing prevalence which is defined as a (BMI) body mass index > 30 kg/m2; while being overweight is an increase of 25 to 29 kg/m2.⁽¹⁾

Overweight and obesity is an epidemic that affects individuals of all ages, sexes, races and latitudes, without respecting the socio-economic level. It is the consequence of the existence of a positive energy balance that lasts for a while.⁽²⁾

Obesity is a chronic disease that is treatable and preventable, characterized by the accumulation of excess fat in the body, causing severe adverse effects. Serious damage on health which produces by itself, joins the association with pathologies serious such as type 2 diabetes, hypertension, cardiovascular complications and some types of cancer.⁽³⁾

It is also a risk factor for developing osteoarthritis and sleep apnea.⁽⁴⁾

Obesity deserves special attention, since it is itself is a chronic disease and at the same time a recognized risk factor for many others. Study and approach to obesity can not dissociate from the of other chronic non communicable diseases (CNCDS) for various reasons: 1) that share some common, improper food and sedentary lifestyle causes and underlying factors; (2) because to identify the obese subjects is identifying a high proportion of subjects at risk for other CNCDS; (3) because the majority of CNCDS; are prevented by preventing obesity through promotion of healthy lifestyles and, finally, 4) because by treating the obese diminishes the risk of suffering from complications and also reduces the effect mediator who has obesity in relation to other risk factors.⁽⁵⁾

To maintain a healthy weight, you should perform for life simple changes in lifestyle, how to reduce the size of the rations, avoid fee, eat a healthy diet and exercise regularly.⁽⁶⁾

Objectives. Updated information on obesity by reviewing existing literature.Establish the causes and consequences of obesity, highlighting the complications arising from it.

Establishing a diagnosis and treatment appropriate in each case.

 

MATERIALS AND METHODS

Bibliography obtained from scientific journals, electronic search engines as the pubmed (Medline) database, web pages and books of medicine, was used for the preparation of this work using keywords such as obesity, overweight, diagnosis and nutrition.

 

DEVELOPMENT

Epidemiology

Increases in the prevalence of obesity begin to become evident already in the first years of life.⁽⁷⁾

The percentage of overweight children has doubled, and the percentage of obese adolescents has tripled in the past 20 years.⁽⁴⁾

The prevalence of obesity in different studies conducted in Argentina, in the last decade ranges between 4 and 11%.⁽⁷⁾

 

Etiology

In children and in adults, obesity is the result of a positive energy balance (eating a diet of higher heating value than the cost of the subject).⁽⁸⁾

High overweight figures found in young people from different countries could be associated with factors that affect the energy balance. Changes in the patterns of physical activity (decreased energy expenditure) and the habits of power (increased energy consumption) are considered most important makers. ⁽⁹⁾

Only in less than 5% is for genetic alterations or endocrine; 95% of the cases is exogenous or nutritional obesity, and is associated with the ingestion of hiperenergeticas diet, low physical activity and it is favored by a genetic predisposition.⁽⁸⁾

The fundamental cause of overweight and obesity is an imbalance between the income and the expenditure of calories. The world-wide increase of overweight and obesity is attributable to several factors, which include:

The global modification of diet, with a tendency to increase the intake of foods rich in fat and sugars but low in vitamins, minerals and other micronutrients, energy.⁽¹⁰⁾

The decline of physical activity due to the nature of increasingly more sedentary of many works, changes in the means of transport and increasing urbanization.⁽¹⁰⁾

Obesity in children and adolescents is significantly associated with changes in tolerance to carbohydrates carbon, values of plasma insulin, lipid, blood pressure and other factors recognised as risk for morbidity associated with obesity in adulthood.⁽¹¹⁾

 

Diagnosis

Currently we have a standard means to determine overweight, obesity or severe (morbid) obesity, based on height and weight, called body mass index, said standard is calculated by dividing weight in kilograms by height (in meters) squared. Is considered overweight a BMI = 25; If it is = 30, obesity, and if it is = 40, morbidly obese.⁽⁶⁾

BMI (BMI) or Quetelet index: Is obtained by dividing the body weight in kg. about the size in metres and elevated to the square.⁽⁸⁾

It is recommended in the diagnosis of obesity, correlates, significantly, total body fat and allows not only to evaluate and compare individuals, but populations or subgroups of these and of different origins. It allows to assess the health risks associated with overweight and can be a useful guide for their treatment.⁽⁸⁾

The classification of BMI in terms of the degree of overweight and obesity is currently widely used since it serves to compare significant weight among populations; identifies individuals and groups at risk with increased morbidity and mortality, and also priorities for intervention in individuals and communities.⁽⁸⁾

The BMI is the most useful of the overweight and obesity population measure, how to calculate it not varies according to sex or age in the adult population. However, it should be considered a rough guide, as it may not correspond to the same degree of fatness in different individuals.⁽¹⁰⁾

Classification of patients according to their BMI:

( to) Normal: when BMI is between 18.5 and 24.9.

b) Overweight: when BMI is between 25 and 29.9.

(c) obesity: when the BMI is greater than or equal to 30. It can be subdivided to obesity class I (BMI of 30-34.9); Class II (BMI of 35 to 39.9) and class III (greater than 40 BMI) also called obesity clinically severe (formerly referred to as morbid obesity).⁽¹²⁾

Obesity rates are defined according to the distribution of fat in the body: type 1: excess fat/weight distributed in all body regions; Type 2: excessive subcutaneous fat in the abdominal region, or adiposity Android; Type 3: excessive deep abdominal fat, and type 4: excess fat in regions of the gluteus and femoral, or fat ginecoide.⁽¹³⁾

The obesity of the upper part of the body (excess fat around the waist and side) is one greater risk to health than the lower part of the body (fat in the thigh and gluteal regions).⁽¹⁾

 

Treatment

The therapeutic approach of obesity, multifactorial nature, should be subject to multiple sectors or members of society. In correspondence with the reality that there are no magic treatments for it it is necessary that doctors, paramedics, teachers, parents, public health officials and other sectors together with formal and informal community leaders join their efforts to achieve the implementation of programmes or measures to avoid the progressive number of cases increase and at the same time to those already affected allows them to reduce excess body fat and even return to their healthy weight.⁽²⁾

Non-pharmacological treatment of obesity involves dietary changes, physical activity, and behavioral intervention and/or psychological.⁽⁸⁾

The negative energy balance, can be reached only effective treatment of obesity, increasing physical activity or reducing total dietary energy intake. For this reason actions running must be addressed to develop healthy lifestyles through accompanied by a proper diet moderate and intense physical activities.⁽²⁾

In the obese patient food planning should be considered a period of reduction of body weight, in which calorie intake should be significantly less than of resting energy expenditure more physical activity, followed by a phase of stabilization of body weight that must be meet the nutritional needs and avoid the further increase of weight. ⁽¹⁴⁾

Physical activity is closely related to the level of energy expenditure, and both the free time and the time spent on physical activity influence on it.⁽¹⁵⁾

Before the global epidemic of obesity and type 2 diabetes mellitus, the highest authorities of public health in the world (who, PAHO and CDC) have declared the promotion of healthy lifestyles as a priority for modern society.⁽¹⁶⁾

Formal use of drugs for weight loss are:

1) Patients with obesity (BMI > 30)

2) Patients with BMI > 27 and high risk by the presence of abdominal obesity.

The drugs currently recommended therapeutic guidelines for the treatment of obesity are sibutramine and Orlistat.⁽¹⁷⁾

Sibutramine both blocks the uptake of serotonin and norepinephrine in the central nervous system.⁽¹⁾

Orlistat reduces the absorption of fat in the gastrointestinal track.⁽¹⁾

For morbid obesity (overweight extreme), a surgical procedure may be recommended to reduce the size of the stomach. Bariatric Surgery is called and is offered as a treatment to individuals with extreme obesity or those obese with medical complications because of their excess weight. Bariatric operations are part of surgery called major and have certain risks as well as benefits.⁽⁶⁾

They are combination procedures that use both restriction and malabsorption to achieve weight loss.⁽⁴⁾

Of all the alternatives of surgical treatment of obesity gastric bypass in and Roux is one of those made in Chile and the world. Its advantages include less postoperative pain, less impact on respiratory mechanics and less hospital, among others, stay to be compared with the open alternative. ⁽¹⁸⁾

 

CONCLUSION

Obesity has increased significantly worldwide and is currently considered one of the most difficult to control public health problems.

This disease increases the risk of developing various diseases including: high blood pressure, type 2 diabetes, cardiovascular disease, stroke, disease of the gallbladder and prostate and colon cancer.

People are sometimes victims of discrimination at work and in other situations, and they are penalized by their condition despite the laws that protect against this type of situation.

On the other hand, it is a serious public health problem that can result in death and the premature disqualification. However, this condition does not receive the attention that deserves Government, the health care profession or industry of health insurance, which is inadequate and limited access to the treatment of obesity.

Campaigns of prevention against the disease would determine very beneficial results and would require a lower cost than the one used in the treatment of various complications that she produces from the economic point of view.

A life active and incorporate a healthy diet helps prevent and maintain a good quality of life.

Mobilization of fatty acids and muscle metabolism

During the year, as well as the AGL mobilized from adipose tissue and transported by albumin, are used on a priority basis as fuel the AGL derivatives TGIM deposits, after stimulation of the muscle LHS. Interior of the myocyte fatty acids are transported by carrier proteins of fatty acids (PTAG) and after activation, the acyl coA through the mitochondrial membrane by carnitine acyl transferase system, after which degrade to acetyl CoA in the process called betaoxidacion. The key enzyme in this process is the betaketotiolasa which is inhibited by its final product, the acetyl CoA.

Si_bien at rest, regulatory mechanisms in the lipolytic metabolism, can be explained by the effect Randle, is the use lipid glucose saving prevalent, because of the following mechanisms: 1) inhibition of the PDH by acetyl coA, 2) inhibition of the fosfofructokinasa (PFK) by citrate and 3) inhibition of the entry of glucose from plasma for glucose-6-p. During the exercise on the other hand, the regulatory mechanism would be mediated by malonyl coA, a derivative of the acetyl coA by the enzyme acetyl CoA Carboxylase (ACC). The accumulation of malonyl coA would lead to an inhibition of the CAT1 and consequently, an inhibition of the entry of fatty acids long-chain (AGCL) to the inside of the mitochondria. At the same time the enzyme ACC is stimulated by glucose and insulin, and inhibited by adrenaline. The availability of carbohydrates may therefore be an important factor that determines the use of AG. During exercise increases levels of malonyl coA in skeletal muscle. The flow increased by higher exercise intensities, glucolítico cause a greater formation of malonyl coA, with greater inhibition of CAT 1 and therefore lower income of AGCL and lower beta oxidation.

On the other hand, malonyl CoA via reverse can become again acetyl CoA by the action of the enzyme malonyl CoA decarboxylase (MCD). Both processes are regulated by an important modulator, whose concentration increases during and after exercise: the protein kinase 5´Adenosin Monofostato activated (AMPK). This modulator acts as a sensor of energy depletion and stimulates the via of the MCD and inhibits the ACC, so it encourages the formation of acetyl CoA and prevents the formation of malonyl CoA favoring the use of AGCL which are incorporated into the mitochondrion by action of CAT1. At the same time the AMPK is able to register the level of cellular energy depletion being stimulated by AMP and the AMP/ATP ratio increased and is inhibited by ATP. The AMPK also has the possibility to register the cellular energy level by the variation of the redox potential, being stimulated by NAD or the increase of the NAD/NADH ratio, and inhibited by NADH.

The AMPK plays an important role in the expression of genes that encode for the synthesis of several key enzymes in the muscle during exercise metabolism and in the process of adaptation to training.

Metabolism of fats during rest and exercise

Body fat is stored as triglycerides (TG) in the adipose tissue, the fat cells and some cells inside and abdominal viscera. Adipocyte has two enzymatic systems of control of metabolism, influenced by the neuroendocrine system, conditions of intake and physical activity. The enzyme lipase hormone sensitive (LHS) catalyzes the degradation of the TG to free fatty acids (AGL) and glycerol (Gl), this last is released into the plasma and is used as a measure of the magnitude of lipolysis, and can also be a gluconeogenico in the liver substrate; Meanwhile the enzyme endothelial lipase lipoprotein (LPL) which is optimally active at acidic ph, catalyzes the synthesis of TG from AGL and Gl. Insulin stimulates the LPL as contrainsulares hormones stimulate the reverse pathway (LHS): glucagon, adrenaline, VIVO norepinephrine and cortisol, growth hormone, the antidiuretic, the melanocitoestimulante, the adrenocorticotrophin, the parathormone (PTH) and vitro thyroid hormone have a permissive effect. On the other hand (by stimulation of Phosphodiesterase) insulin, lactate and ketone bodies inhibit the LHS.

Adipose tissue possesses both receptors stimulating adrenergic beta of lipolysis (via stimulation of Adenylate Cyclase) whose action prevails during the exercise, as also inhibitory Alpha receptors whose action modulates lipolysis during rest, regulating metabolism. There are also receptors beta 3 whose stimulation causes release of leptin from the Adipocyte, which mediates satiety response to hypothalamic level. Adiposity in the intra-abdominal area related with different clinical entities is the most active area from the point of view lipolytic and relates to the prevalence of receivers adrenergic beta. Despite mobilize a significant amount of AGL, not contribute largely to the energy used for physical activity. Most of AG that would contribute to muscle activity would be derived from abdominal subcutaneous adipose tissue and to some extent of intramuscular triglycerides (TGIM).

The AGL can be reesterificados in the Adipocyte, to form new TG in a process known as "fatty acid triglyceride cycle-". But the muscle activity in most uses as fuel rather than for the re-esterification processes. Although the available evidence points out that reesterificarse in muscles not involved can directly in the exercise or into motor units inactive muscles involved in submaximal exercise.

TG of adipose tissue sources are various: glucose, amino acids, the chylomicrons TG and lipoproteins of low density (LDL) from the diet and from liver lipoproteins of very low density (LMBD).

As the provision of skeletal muscle activity in power comes from the AG related to plasma albumin, the TG to LMBD, possibly the FA released by fat cells attached to myocytes and also the TGIM.

Some studies evidenced a contribution of up to 10% of the total energy supplied during the exercise in conditions of fasting in males, although it may be higher in women.

Adipocyte is metabolically very active, considering the cytoplasmic mass isolated content of TG constituting about 90%. Similarly the TG stored far from being metabolically inert, they experience a continuous replacement.

The AGL (in fact the more accurate term would be to call them acids not esterified fatty: AGNE) freed from the adipose tissue are transported to their destinations, mostly attached to albumin, are not truly free except in a very small amount. You can go to the liver and reesterificarse forming again TG or esterified cholesterol, rust forming carbon dioxide (CO2), forming phospholipids, or rust forming incompletely ketone bodies. They can also go to the muscle and used for the formation of ATP in the Krebs cycle in the presence of oxygen.

Bioenergetics and metabolism during physical activity.

Power supply systems:

Metabolism is the totality of biochemical reactions of the organism mediated by biological catalysts or enzymes.

Depending on the magnitude of the stimulus: volume and intensity, the body can turn to different sources of energy for metabolic processes, during physical activity.

There are roughly three systems of provision of energy and ATP resynthesis:

1) System of the phosphagen system ATC-CP, called also historically anaerobic (although it is not strictly in the absence of oxygen) alactacid (although it is not strictly in the absence of lactate). Characterized by physical efforts of very high intensity and short duration.

2) The glucolítico, also called anaerobic lactacid system. Characterized by physical efforts of high intensity and intermediate duration, with production of lactate. Studies Nuclear magnetic resonance (NMR) oxygenation of human muscle Myoglobin in exercise showed that the levels of oxygen in muscles in exercise decreases with the charge, but even at maximum consumption of oxygen it is well above the mitochondrial needs. This rules out the hypothesis that the accumulation of lactate is due to a lack of oxygen. Due to the intensity of work, accumulation exceeds removal and produced the "shuttle" or exchange of lactate to other places where it can be reused, or oxidized.

(3) The oxidative aerobic system. Characterized by low intensity and long-term efforts.

Classically expressed the specific characteristics of each system as set forth in the following table, although most modern studies tend to relativize these aspects.

 

System/Caract	Sources	It take to intervene	Maximum intervention	Important intervention
Phosphorous	ATP - CP intracellular	Null	2 a5 sec	0 to15 sec.
Glucolítico	Glucose and glycogen	10 sec.	30 a40 sec.	30 sec to 2 min.
Oxidative	Carbohydrates, lipids and Prot.	1-3 min	2 a5 min.	2-3 min to hours.

 

System/Caract	Recovery	Limiting factors	Maximum power	Capacity	Examples
Phosphorous	50%: 45seg 100 ci95%:1.16 - 3 min	Exhaustion CP	90 kcal/min	Up to 30 sec.	Games, jumping, lanz.
Glucolítico	ENTR:60 - 90 min No Entr:120 - a180min	Metabolic acidosis	30 kcal/min	Up to 3-4 min	100 mts bigest. plain 400mts
Oxidative	Permanent	Agot.glucog. VO2.Dream	10 kcal/min	HS - days	Marathon, triathlon

Both the muscular contraction and the neuronal processes occur in a matter of milliseconds, therefore the energy process must occur in those units of time. Using NMR techniques with ³¹P (phosphate 31), for the measurement of metabolites phosphates with a time resolution of 1 millisecond (ms) with a 1 herz (Hz) stimulation, it was established that in this model, the glycogen decreases not oxidativamente in a matter of milliseconds to fill the pool of ATP/PC while it is resynthesizing oxidativamente in periods of ~ 1 second between contractions. A fraction of lactate is oxidized, between contractions to restore the PC and glycogen deposits. In the light of these new investigations, both glycogenolysis and muscle contraction is activated in milliseconds by action of the ca ++ (calcium), and glycogenolysis provides the necessary ATP during the milliseconds of contraction, for the filling of PC.

The use of fats as a substrate is only done in the realization of physical work in the oxidative system. Within this system, there are also numerous subsystems some of which use this fuel as prevalent. During a period of increased intensity occurs increasingly increased use of carbohydrates as a source of energy and the use of lipids is reduced. The degradation of glucose according to the speed of energy requirements can take a fast track (fast glycolytic) via the enzyme lactate dehydrogase (LDH), with conversion of Pyruvate to lactate and progressive accumulation of this; or a slow pathway (Glycolysis slow) via the enzyme pyruvate dehydrogenase, entering the mitochondria to pyruvic acid and starting the series of reactions of the Krebs cycle or the tricarboxylic acids (CATC), for utilization of oxygen to generate ATP

Physiological principles. Organic systems during physical activity

For the effective realization of a motor task involving muscle action, coordinated attendance of different organic systems is required: mechanical work produced by the muscle contraction is possible thanks to the splitting of the energy sources for muscle stored in the form of high energy phosphates: adenosine triphosphate (ATP). Replacement of these energy sources, over time, is possible thanks to the power of the chemical bonds in the reserves of molecules stored in the muscle itself and others provided by the delivery system mediated by blood transportation, which allows also the Elimination of the waste products from the reactions metabolic intramuscular. The resynthesis of ATP is made from various possible sources: high energy phosphates: Creatina-Fosfato (CP) intramuscular glycogen and intramuscular glucose, lipids and proteins.

The blood circulation is ensured by the function of the heart muscle pump and the passage through vessels of different calibre which distributed selectively, the blood towards the territories metabolically active and restrict it at retail sites demand. This is done by opening and closing controlled arterioles that supply sectors, contracting or dilating the smooth muscle that surrounds them. This control is mediated by local factors such as the temperature and the presence of certain metabolites and neuroendocrine factors.

Cellular biochemical reactions waste products are eliminated in the blood for transport to the emuntorios organs: liver, kidney, intestine, sweat glands.

Many chemical reactions occur in the presence of oxygen, whose provision is secured through the respiratory system, which also contributes to the Elimination of carbon dioxide (CO2) product of intracellular biochemical reactions for the provision of energy. Cell oxygen (VO2) consumption and production (VCO2) carbon dioxide depends on the blood supply or volume min cardiac (VMC), influenced in part by the contents of blood hemoglobin; and the difference arteriovenous oxygen in the territories of metabolically active. Transport and the intracellular utilization of oxygen depend on turn of the intracellular Myoglobin content, the number of mitochondria and the amount of intermediate metabolism enzymes.

Much of the body, approximately 60% in adults, is made up of water, and that is the middle where most of the biochemical reactions occur. The balance of water in the body is regulated through the participation of control mechanisms in the hypothalamus, several components of the endocrine system, kidney, liver, lungs and adrenal glands.

The dynamic equilibrium of the body which could be called "homeocinetica" as opposed to homeostasis or static balance, is ensured through a complex system of regulation of neural short-term and long-term endocrine responses.

Transient "acute" changes, in physiological conditions of the body during physical activity, can be called "answers", as for example the increase in heart rate; on the other hand more permanent changes products of systematic training such as muscle hypertrophy due to overload, are called "adaptations".

All physiological systems are capable of manifesting acute responses to a situation of exercise and chronic adaptations to systematic stimuli repeated, able to surpass a certain threshold. The stimulus of little intensity or some frequent, are not capable of producing adaptations and those of great magnitude of load can cause damage.

These physical stimuli possess certain characteristics in addition to the intensity, such as the total volume of the load, the density or compactes (relationship between load and recovery), and the frequency of application. The cyclic alternation of load dynamics is governed by complex biological laws of adaptation, which is necessary to set the appropriate stimuli and cause desired changes, both populations sports and active people whose primary objective is health. The correct application of these aspects, even though it is based on physiological and methodological principles is not based only on "Science", also constitutes an "art".

"Exercise prescription" correctly and individualized, you learn by studying, but mainly by the experience.

 

 

 

OBESITY AND PHYSICAL ACTIVITY

The Global strategy on diet, physical activity and health of the World Health Organization, ratified during the General Assembly in May 2004, emphasized the fact that physical inactivity is one major public health problem in countries both developed and developing. Physical activity reduces the risk of many illnesses and chronic conditions, is associated with low morbidity and mortality and improves the functional status and quality of life. In order to contribute to this global strategy creates the physical activity of the Americas (RAFA) network / The Physical Activity Network of the Americas (PANA), to build a "network of networks" that integrates members of public and private institutions both national and international, to promote health and quality of life through physical activity. RAFA/PANA work with members to develop, share and coordinate strategies that strengthen efforts and increase knowledge, benefits and levels of physical activity among the populations in the Americas. In this sense have been developed programs focused on physical activity as a basis for the improvement of the quality of life, such as the case of "Wave San Pablo" and other similar programs in countries of America. In Argentina were diverse experiences in communities, as for example in Balcarce province of Buenos Aires, promoted by the program of prevention of infarct in the (own) Argentina, dependent of the Faculty of Medicine of the Universidad Nacional de La Plata. At the local level, we are currently developing in the center of physical education N ° 2de the city of La Plata, the programme "Quality of life", taking systematic physical activity and preventive check-ups, as cornerstones for the modification of lifestyle and the fight against the disease risk factors.

On the other hand the exponential growth, in our environment, of the factors related to the care of the health and quality of life of the population and their promotion through the mass media also encouraged by economic and commercial factors: companies of nutrition, clothing, health, fitness, etc. have contributed to the growing awareness of the importance of physical activity. So both at a personal and institutional level is installed the theme and there is a progressive increase in the space it occupies. Some companies encourage the systematic realization of physical activity of their employees and promote participation in sporting or recreational events on behalf of the same, there is sustained growth of mass events such as racing aerobic and mega events of outdoor fitness, sponsored by municipalities or organised by sports apparel companies. Where previously only seen "training" competitive athletes (sports facilities, promenades, squares, parks), today can be observed the growing participation of common people of all ages who have decided to change their style of life, incorporating physical activity as a habit.

It also changed the attitude of the professionals of health with respect to physical activity; an amount growing of any specialty physicians, even not related directly, they practice and recommend or prescribe physical activity to their patients.

But despite this progress, there is a great battle to wage against the sedentary lifestyle, obesity and other non-communicable diseases, whose increasing prevalence is favored by various socio-cultural and economic factors, lack of nutrition education and physical culture, the unfair fight against the computer, television, and video games used especially by children and certain ingrained habits that reduce the quality of life of the people.

The systematic and controlled realization of physical activity, moderate and individually adapted to the structural and functional capacities of persons, not only contributes to the fight against the epidemic of overweight and obesity; It brings a number of benefits, according to several studies, among which we can mention:

-An increase in the sense of physical and psychological well-being

-A better perception of body image

-An improvement of the conditions of dream

-An elevation of cardiorespiratory fitness with greater tolerance to effort and reduced levels of fatigue

-Improvement of the levels of muscular strength

-An improvement in the levels of flexibility and mobility to articulate

-One body availability for motor tasks of daily living, work or sports activities

-A change in the shape and body composition with decreased fat and increased lean mass

-A positive change in the metabolic conditions

-Improvement of immune function.

-The acquisition of a healthy skeleton in young and the postponement of the loss of bone mass in older adults.

-The postponement of sarcopenia (physiological loss of muscle mass in older people)

-Discharge of environmental or occupational stress levels

-A lower incidence of labor absenteeism by disease and a reduction of costs and health services utilization

-The contribution together with other factors to longevity with quality of life.

In people with any pathology physical activity also contributes, according to different studies, in the following aspects:

-Improvement of blood pressure

-Reduction of the sensitivity to Catecholamines myocardial

-Increase of fibrinolysis and alteration of platelet function (minor thrombogenesis)

-Resistance decrease in insulin and glucose intolerance

-Increase bone mineral density

-Improvement of hepatic function

-Correction or improvement of the lipid profile

-Improvement of chronic respiratory disorders

-Improvement of sleep disorders

-Improvement of emotional disorders

These are just a few of the reasons that must commit to people, health professionals and private and governmental institutions

to promote physical activity in the community, since childhood.

Some of the aspects to take into account for the implementation of physical activity programs in a community are:

-Plan and inform the program

-Engage the participants and promote adherence

-Focus the evaluation

-Collect irrefutable evidence

-Exchange information

The epidemic ofChildhood obesity

Childhood obesity is growing in the region of Murcia at a rate of 1% a year for 15 years and currently affects 16 percent of the children, a percentage that exceeds the national average at one point. (According to the endocrinologist Juan Madrid),

 

Childhood obesity has tripled in the Region in the last two decades

15 of every 100 children suffer from this problem, and two of every three Murcia have a weight greater than levels considered healthy by the doctors

 

In the Region of Murcia the obese children national average is exceeded by more than four points . While the national average is obese 14 for every 100 boys, in Murcia is 18, also the growth of childhood obesity grows currently twice what did in the Decade of the eighties.

Only the Canary Islands and Andalusia beat Murcia in the percentages of obesity.

 

According to data of the Ministry of health and consumption of Spain, only 7.5% of children Spanish takes a balanced breakfast, i.e. the compound by milk, fruit or juice, and carbohydrate. Approximately 20% of the child and juvenile population only takes a glass of milk, while 56% only accompanies it of any carbohydrate. Half of those children spent less than 10 minutes for breakfast. In short, Spanish children eat poorly, according to experts in nutrition, which implies an increase in obesity in the majority of cases.
Damages causing excess weight for health.

 

Childhood obesity of nutritional type can generate Orthopedic, respiratory and skin complications.Overweight children are at the risk for diabetes, cholesterol and high blood pressure. In short, all of them lead to suffering of cardiovascular diseases

 

Most frequent causes of childhood obesity

A) incorrect nutrition

 

The abandonment of traditional food, excessive consumption of fast food and high calorie, as industrial pastries and sweets, and sedentary lifestyle and lack of exercise. (According to the endocrine Dr Madrid)

 

One hundred grams of industrial bakery, drink high calorie, sweets or chocolates contain 500 calories, a third of the needs of a school, (according to the director general of public health, Francisco García Ruiz).

 

b) sedentary lifestyle

Currently, the sedentary activities (television, video games, computer...) subtract and even, sometimes, reverse the physical activity. 20% Of schoolchildren does nothing of exercise out of class, girls are sedentary, and more pronounced form.

During the week, more than 90% watching TV, most between one and three hours, but there are another 18 percent that goes to the screen more three hours a day, bending the weekend. Six out of ten adds a "moment" of up to one hour with the console or computer

The car, the elevator, appliances , make that we save, average about 400-500 calories per day. as regards a few decades ago. Now we eat less, but the acalorica density is greater.

We educate our children in a correct diet

We must teach them that is preferable to an Apple to a bun, and explain why. We are critical of the advertising of these products and prevent them against vending machines. We also need to take note.

We monitor the menus in school canteens and convince our children that eat everything. We must be informed of what you have eaten at school for to complement in house food, if necessary.

We has physical activity for our children

Physical activity helps fight obesity. But to do this, the physical activity should be on a daily basis, not only on weekends.

We cannot settle for the physical education of schools since they are far from the recommendations of five hours a week and, in free time, requires the effort of transporting and small, to swim with them, or riding a bike.

 

 

 

 

CHILDHOOD OBESITY

In developed societies, obesity (OB) is the most common nutritional disorder during childhood and adolescence. Considered by who as the "epidemic of the 21st century" their frequency has increased progressively in the course of the last few years in relation to poor nutritional habits and the more sedentary, being our country one that presents a greater number of cases in Europe. 13.9% Of Spanish between 2 and 24 years the children and young people is obese and 26% are overweight. It is a source of physical and psychological disorders and tends to self perpetuate itself with serious repercussions on health during adult life.

 

WHEN WE SAY THAT A CHILD IS OBESE?

 

Obesity during childhood and adolescence is defined as an exaggerated increase of weight (at the expense of fat) which can mean a risk for health, either at the time that occurs or at later ages.

  

Or Through physical examination : for the identification of children and obese adults uses the body mass index (BMI) or Quetelet index. BMI is calculated by dividing body weight (kg.) by height squared (m2). The pediatrician, measured and weighed to the child in every review of health and calculates BMI. Normal BMI values for each age are collected in graphs of percentiles (same as those used to control weight and height). According to the percentile in which the child is included in the diagnosis of normal, overweight (i.e., at risk for obesity) or obesity. For example; 8 Years John weighs 35 kg. and measures 138 cm. your BMI is 18.4 = normal, 8 years Pedro weighs 35 Kg. but measures 120 cm. your BMI is 24.3 = obesity. It is a very reliable index because changes in BMI in adolescence predicted elevations in young adults and is a valid indicator of the morbidity mortality in adults.

 

Or Other complementary tests : on occasions, will be necessary analyses of blood, ultrasound... to rule out complications. Child with high BMI should be controlled in following visits especially if presented associated risk factors.

 

RISK FACTORS:   ·        family history: cardiovascular disease, high cholesterol, diabetes or obesity ·       personal background: high blood pressure, increased cholesterol, increased BMI greater than 2 points in the previous year or existence of concern over weight with emotional or psychological manifestations related to overweight or your perception.

 

WHAT ARE THE CAUSES OF CHILDHOOD OBESITY?

 

There are two types of obesity: the OB exogenous or nutritional (responsible for 99% of the cases) and the secondary to different diseases (some syndromes, neurological and endocrine diseases) which constitute only 1%.

 

The nutrition OB is an anomaly which involves genetic and environmental factors. But the rapid increase in the number of cases is due mostly to environmental factors, i.e. some unhealthy eating habits, along with a decrease in physical activity.

 

·       Children and especially teenagers often consume foods high in fat and low nutritional value: sweet pastries, ice cream, pastry, pre-cooked products, sugary liquids (queue, packaged juice), inlay... at the same time decreasing the consumption of fruits and vegetables.

·       Sedentary lifestyle, associated many times a long time watching TV, leads to a decrease in energy expenditure and favours the development of obesity. It also contributes to go to school by car or bus, not play outdoors and the hours of study or computer. In addition child primetime slots feature a high number of ads that promote the intake of fast food with low nutritional value.

 

 

WHAT IS IMPACT OBESITY ON THE HEALTH OF CHILDREN?

 

The OB has important repercussions on health both in children and in adolescents that will then affect adult life. The most important are:

 

·       psychological: loss of self-esteem and body image rejection, aggravated by social rejection suffered by his own colleagues.

·       orthopedic (flat feet, hips and back disturbances).

·       hypertension and cholesterol increased, especially in adolescents. I.e. becomes in a population with high risk of cardiovascular disease in adulthood.

·       Other: In extreme cases respiratory alterations, fatty liver, gallbladder, digestive and skin alterations alterations.

 

The knowledge of these alterations by parents and patients is important to raise their awareness of the importance of the problem.

TREATMENT OF OBESITY.

 

The treatment of obesity is complex and requires a multidisciplinary team (pediatrician, dietitian and psychologist).It is mainly based on:

 

1) the establishment of a proper diet

(2) increasing physical activity

(3) modify eating habits

 

 

1. Diet: In the pediatric age group have to cover all the nutrients necessary to support adequate growth, so it does not tend to be severe restrictions.

 

Recommended:

 

·         ·       a healthy diet (Mediterranean diet), that includes all groups of foods, rich in fruit, vegetables, legumes and foods rich in carbohydrates (pasta, rice and bread) slow absorption, nuts and fish. ·       avoid "snacking", respect the schedule of meals, ·       perform a full breakfast ·       eliminate foods high in fats of poor quality (industrial pastry, salami, butter...) remove the visible fat from the meat, Cook the chicken without skin, used for cooking olive oil, avoid the fried and breaded and increase the consumption of white fish and decrease of meat ·       some children can take low-fat milk ·       increase the consumption of fiber to increase their feeling of satiety (bread or pasta integral) ·       avoid consumption of sugary liquids (colas and packaged fruit juices)

 

 

Or a full breakfast made up of dairy, cereals (bread, breakfast cereals, biscuits...) and fruit, not only improves the performance at school but that prevents the consumption of less nutritious foods to mean tomorrow. It is important that parents raise children with enough time so that they can have breakfast sitting and without hurry.

 

Or These are recommendations General and suitable also for the population in general. The child with obesity you should follow the instructions from your pediatrician and recommended diet must identify in each case.

 

 

2. Physical exercise: increasing physical activity is a key part in the treatment. It is important that the child chooses a sporting activity that can combine with other activities between 3 and 5 times a week. It is essential that you like because if not to abandon it soon. In addition you must walk to school (if relatively close) and climb the stairs whenever possible. Decrease the hours of television, the hours of computer and video games.

 

3. Modification of food habits: The school, next to the family, are the educational environments of greater influence on the acquisition of healthy eating habits and lifestyles.

 

 

 

 

 

 

Teresa out Masip

Pediatrician