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.