Overweight and Obesity


   Obesity is a metabolic alteration characterized by an excessive accumulation of body fat, such as to determine an impairment of health status. The common orientation is that above a certain body weight it should be considered a chronic pathology like diabetes and high blood pressure.

    It has been demonstrated for years that obese subjects have a reduced qualitative and quantitative life expectancy and therefore the commitment of health professionals must be aimed at finding increasingly effective and stable answers.

    It is often associated with an annual increase in the risk of mortality, mainly through hemodynamic and metabolic complications which are about 2.5 times greater than those of normal-weight subjects.
The prevalence of obesity is increasing in all Western countries, to the point of being defined as an epidemic.

    In the USA it contributes to 300,000 deaths / year, thus becoming the 2nd leading cause of death after smoking.

    In the patient suffering from morbid obesity, since medical therapy can be ineffective in the long term, the experts of the National Institute of Health agree that the only solution is to gradually but radically change the lifestyle of the subject.

Effects of abdominal obesity on the body

    The excess adipocyte favors a series of negative processes on the endocrine system and on the metabolism, which can be summarized as follows:

    The normal control mechanism of food intake is altered, mediated mainly by leptin. This substance does not inhibit the appetite as it should and therefore further intake of food is favored, with a constant worsening of the metabolic situation;

    Increases the production of free fatty acids, which are produced by excess fat cells. The increase in these lipid components in the blood contributes to increasing the values ​​of triglycerides and LDL cholesterol in the blood with a progressive increase in total cardiovascular risk. Not only. The excess free fatty acids put themselves in "competition" with glucose and are used in their place by the muscles, so there is an increase in blood sugar, that is, glucose in the blood. The increase in blood glucose leads to a response from the pancreas, which increases the production of insulin. Not only: in these circumstances even the elimination of excess insulin by the liver is not effective, so there is an increase in insulin in the blood in the presence of hyperglycemia;

   Excess fat promotes hypertension by increasing the effect of adrenaline on small vessels, which are therefore more "tight" (vasoconstriction), and due to the increased activity of cortisol mediated by cells. This stress hormone increases the synthesis of adrenaline;

    Acting on the renin angiotensin system, which is normally activated only in case of need after pressure drops, the excess of fat favors the increase in pressure. It also tends to decrease the elimination of sodium by the kidneys with a further increase in pressure.

BMI calculation

   The most widespread numerical index for identifying the state of obesity is the so-called BMI (Body Mass Index), or Body Mass Index, which compares the body weight, expressed in kg, to the body surface expressed as body height in meters squared .

   The BMI (or BMI = body mass index), the numerical value obtained from the weight ratio expressed in kg and the height expressed in m squared, is the most used indicator today in the clinical evaluation and in the classification of the Overweight and the Obesity.

   The BMI, despite being a more accurate method of measuring total fat than the body weight considered alone, has limits that must be taken into account:

   Subjects with stature less than 150 cm or more than 200 cm have very high or very low BMI values, while they are not overweight and underweight.

To-peso 18.5
Normal weight from 18.5 to 24.9
Overweight from 25.0 to 29.9
Class I obesity (moderate) from 30.0 to 34.9
Class II obesity from 35.0 to 39.9
Class III obesity> 40
Inappropriate diets

   Because many times the do-it-yourself or inappropriate diets are not successful:
Sometimes the habit of doing diets alone or completely excluding food from one's diet does not lead to any benefit, on the contrary it determines a resistance to weight loss which is determined by biological, psychological and behavioral mechanisms put in place by the body in response to a sudden and drastic drop in caloric intake.

   In this way we witness an initial weight loss that will stop when the caloric intake of the diet will match the energy expenditure at rest.

   The only way to lose weight and continue to lose weight is the difference between what is consumed and what is introduced.

   The adipose mass is metabolized to compensate for the calories not consumed with the diet.

Childhood obesity

    Italy is at the top of the list in Europe for the number of overweight children and the figures are set to worsen as Europe overweight at school age grows at a rate of about 400,000 cases a year.

    From 30 to 60% of obese children maintain excess weight in adulthood and have, more frequently than expected, metabolic alterations and complications compared to obesity that occurs in adulthood which will have a greater risk of mortality in its life and morbidity.

    The obese child can develop a psychological discomfort that can contribute to the establishment of a Food Behavior Disorder (it has been estimated that in children the eating disorders are present for 3-5%), with a low self-esteem as shown by recent studies .

     The causes can be multi factorial which calls into question food, sedentariness, genetic factors and environmental factors.

    Having one or both obese parents is the most important risk factor for the appearance of obesity in a child. Studies on homozygous twins and adopted subjects, through the correlation of the weight of the subjects themselves and of the adoptive and natural parents, have shown that the degree of heritability of the overweight varies from 60 to 70%; therefore, observing the families of obese children has shown that having one or both obese parents increases the likelihood of being obese. But also the changes in the lifestyle of children in recent years with a reduction in recreational-type physical activity and the increase in electronic games and computer use has greatly facilitated the establishment of parology

    Another factor to take into consideration is the precocity of the "adiposiy rebound": normally after the age of one year, the values ​​of BMI (Body Mass Index: weight in kg / height in m2) decrease until they reach the value minimum around 5-6 years and then increase again. An increase in BMI values ​​before 5 years (early adiposity rebound) is recognized as an early indicator of the risk of developing obesity.

Metabolic syndrome

    The metabolic syndrome is a set of alterations of glucose metabolism (hyperglycemia), lipidemic (hypertriglyceridemia and low HDL cholesterol) vascular (arterial hypertension) in the presence of an excessive accumulation of visceral fat (abdominal, between the organs). It represents the most important risk factor for cardiovascular diseases. It is considered a preclinical condition and therefore a risk factor and not a disease.

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