Consequences and complications of obesity (co-morbidity)
Obesity is a term often identified with the term overweight which means the increase in body weight over your ideal weight on account of excessive water (edema) or body mass (athletes, body builders), or severe bone, rather than at the expense of body fat . Obese people have more weight than their ideal body weight, and that excess fat is mostly (85%) and a small amount of water and muscle.
Moderate obesity is an ideal body weight increased by 15%. Extreme obesity is the ideal weight has increased by 25%, while malignant (extreme) when it ideal body weight increased over 60%. Women are more often obese while men are more often overweight. Obesity in women is most pronounced after the age and after menopause. Men are usually overweight from 25 to 40 years.
History
Obesity is the oldest and still the most common metabolic disorders in man. Testifying to various sculptures of ancient civilizations, the Greek Caryatid, Egyptian sphinx and many art gallery.
Why obesity occurs?
Obesity occurs when caloric intake is greater than energy needs over the long term without adequate energy consumption. Then the excess calories stored in the body in the form of energy reserves (glycogen, fat) and consumed in the case of increased need or if the body is starving. It is clear, therefore, that the obesity will not come if there is a balance between food intake and energy expenditure.
1 g of fat = 9 calories
1000 g of pure fat = 9000 kcal
1000 g of body fat = 85% fat + 15% water, and the cell
1000 g of body fat = 85/100 * 9000 kcal = 7600 calories, ie. for every 3000-3500 calories that we take the surplus and not spend it we will get 1/2 kg of fat.
What are the causes of obesity?
By now familiar to many factors that influence obesity, and some still in the testing phase. It is now thought that obesity occurs because of several different factors (hereditary traits, psychological, cultural, social, metabolic and physiological), ie. that obesity is a multicausal disease that usually occurs as a result of the interaction of genotype (inherited genetic characteristics individuals), and environmental factors.
Heredity
The legacy is cited as one of the most important factors in the pathogenesis of obesity. Some authors consider that it makes 90% of the causes of obesity, but recent studies suggest a 30-40% figure. The fact is that obesity is more common in families, suggesting that genetic factors have an impact. However, family members share not only genes but also the lifestyle and eating habits, and the separation of the influence of genetic difficult. Studies of adopted adults confirm this fact because it has been observed that the body weight of these adopted people closer to the body weight of their biological parents, but people have accepted them. Numerous studies of twins has also confirmed the fact that the legacy is very important.Example: Twelve pairs of twins were put on a diet of 1000 kcal was higher than their needs for a period of 100 days. Accompanied by an increase in body mass. The observed similarities in the evening to the number of pounds of VAT and subcutaneous adipose tissue in the same pair of twins (and more like Homo than in heterozygous) than among individual members of the respondents. Almost identical results were obtained when implemented subsequently reducing diet.
Also the mixed disorder of mitochondrial level because they are the main producers of energy.Mitochondria are the inherited from the mother and this explains koleraciju between birth weight and weight biological mothers. If the biological mother of obese in later years there is a 75% chance that the child is obese, and vice versa.
In recent years, talks about the special proteins produced by the body and is responsible for the feeling of satiety. If this abnormal protein a person eats a large meal does not feel satiety. 1995 discovered the abnormal gene B3 adrenergic receptor that is responsible for the utilization of fat metabolism so slow, and fat accumulate in adipose tissue. Other researchers believe that the disorder at the level of the hypothalamus and the feet back mechanism.
Defective metabolism ie. inability of effective use of energy (ATP), reduced enzyme (lipase), decreased activity of the enzyme for the mobilization of fat and elevated levels of enzymes for fat storage.
Intrinsically greater number of fat cells in obese patients or a particular type of fat cells that hypertrophied easily be one of the causes of obesity. Getting in body weight during the period between 12 and 18 months of age, 12 and 16 and in adulthood.
The environmental factors
In different environments, cultures and time there are different ideals of good looks. Overweight people have long been considered as a symbol of health and wealth. Ritual food intake is related to the joyous moments (ceremony, celebration, expression of hospitality), as well as sad moments (dace).
Psychological Factors
Many people eat to dispel bad feelings (frustration, boredom, insecurity, anger, sadness), food is often used as a substitute for what is lost (the love, work), much like smoking, drinking. About 30% of obese binge phase (binge eating disorder). The company requires beautiful, slender, and obese people are therefore discriminated against in various professions, she feels unwanted, depressed, eat more, and because of their appearance becomes even more depressed again and comfort in foods (vicious circle).
Physiological Factors
Basal metabolic rate (primary energy needs to sustain life) declines after 25 years, because growth stops and minimizes the effect of hormones that affect the construction of the body and increases the catabolic processes that do not require additional energy. So that age has an impact on the occurrence of obesity.
Physical activity is an important factor that affects the energy consumption. It also decreases with age. For people who live in the same family creates a conditioned reflex to eat more food in the tradition of other family members.
Assessment Weight management
There are several ways to calculate the ideal body weight:
Standard tables (Weight to high tables) - acceptable weight for a person known height
Disadvantages:
- Does not determine the percentage of fat, that is. not deferred fat from muscle tissue
- Do not distinguish between the average and the desired body weight;
- 5% of the population (extremely low or high) are not taken into account;
- Some do not take into account the age and sex;
- The greatest problem for doctors is that table to choose;
The rule of the thumb (the thumb and index finger of one hand is placed around the wrist the other hand).
Tables of growth for children
The formula DEMO
For men: ITT = (TV-100) - (TV-150/4) + (G-20/4)
For women: ITT = (TV-100) - (TV-150/2.5) + (G-20/4)
ITT ideal body weight; television body height; G-year
This formula is quite old and today it is rarely used. The reasons are that it is limited to a period of 20-40 years, modern recommendations require a lower calorie intake for a more modern and easier lifestyle (new technologies, cars, remote control, etc.).. ITT ideal body weight; television body height; G-year
Measurement of obesity
Each individual is a heavy 0.5 mg was "Sizifof job." The efforts of the international group were focused on a single measure independent of the other parameters and so in 1990. was adopted as the method of choice for measuring obesity - BMI.
What is BMI?
BMI (Body Mass Index) - the relationship between weight and height that is used to assess the impact of obesity as a risk factor for health. It is a mathematical formula that correlates with body fat in adults, and is calculated as weight in kilograms divided by body height in meters squared.
BMI = BW (kg) / [TV (m)] 2
TT = body weight
TV = body height
TT = body weight
TV = body height
As the health risk is determined based on the Body Mass Index's?
BMI nourishment risk of becoming ill from BMI risk of becoming ill from BMI and comorbidities *
<18.5 skinny low minimum
> 18.5 - 25 obese Low Moderate
> 25 - 30 overweight moderately high
> 30 - 35 overweight high very high
> 35 - 40 very obese Very high Extremely high
> 40 extremely obese Extremely high Extremely high
* Co-morbidity is a disease associated with obesity, which worsens with increasing BMI, and often improves if obesity is successfully treated.
Co-morbidity related to obesity:
Hypertension
Cardiovascular Disease
Dyslipidemia
Type II diabetes
Sleep apnea
Osteoarthritis
Sterility
Other pathological conditions:
* Idiopathic intracranial hypertension
* Varicose veins of the lower extremities
* Gastroesophageal reflux
* Urinary stress incontinence
The presence of one or more comorbid conditions increases the health risks tied to BMI.
When the health risk assessment appropriate?
BMI is used to assess health risks in adults. Do not depend on gender and age because it has a wide range of applications (19 to 70).
When the BMI does it work?
* Children in the growth phase,
* Pregnant women and nursing mothers,
* For persons with a pronounced musculature (body builders and athletes)
* In patients with scoliosis and kyphosis or other anomalies which can not be adequately estimate height.
Distribution of fat
Although the total amount of body fat important parameter for the assessment of health risk, schedule (distribution) of fat, also, an important parameter, even independent.
There are two types of schedules (distribution) of fat:
1 "Apple Shape"-apple-android type of obesity-upper-upper distribution distribution. Adipose tissue is concentrated around the abdomen and in the upper parts of the body. This type of obesity is common in men and women after menopause because it reduces estrogen, and increases testosterone. However, that is not always the rule. This type of obesity carries an increased risk of hypertension, type II diabetes, heart disease and certain forms of carcinoma.
2 Pear shape "-pear-gynoid type of obesity-d istribution upper-lower distribution. Adipose tissue is concentrated around the waist, hips and thighs. Was more common in obese women.
Fat distribution can be assessed by measuring:
Scope waist-hip (WHR Waste to Hip Ratio), ie. krojačko centimeters to measure waist circumference and dividing by the volume of the hip in inches.
WHR Sex
> 1
Men
> 0.8 Women
This ratio is an important indicator of fat distribution, particularly abdominal fat, and a good indicator for the assessment of health risks. Value to 1 for men and 0.8 for women up to the lower limit value. Values over these carry the risk of developing independently, but also associated with obesity.
Waist
Measuring waist circumference is another way to estimate the distribution of body fat. He is an adequate indicator of intra-abdominal fat and health risk. It has been observed that people (men) who have a waist circumference over 94 cm are at increased risk, and over 102 cm greatly increased risk of becoming ill.People (women) who have a waist circumference over 80 cm are at increased risk, and more than 88 cm have a greatly increased risk of becoming ill. High ratio of abdominal fat is associated with hypertension, decreased glucose tolerance, hyperinsulinemia and dyslipidemia (atherogenic plasma lipid profile-usually elevated triglycerides and decreased HDL). These symptoms indicate today as syndrome X. Certain forms of cancer have been observed in these patients, as well as heart disease. All patients with a BMI of less than 40 should be measured and the waist because he alone or associated with high BMI is a risk factor. People who have a BMI over 40 do not have to measure waist circumference because their health risks already extremely high.
So nies and moderate or mild obesity should heal if the abdominal tissue rich in fat because it increased the number and size of fat cells-adipocytes is associated with their increased metabolic activity. From this tissue fatty acids are released directly into the portal circulation, which leads to accumulation of triglyceride in plasma as a result, we have hyperinsulinemia-insulin secretion occurs because the resistance to glucose and leads to an increase and glucose.
Obesity is a serious chronic disease that can lead to many medical complications that reduce the quality of life and shorten the life span, and whose treatment has a high cost. Obese people have a higher morbidity and mortality (every pound over ideal body weight reduces the life span of a month).
1 Hypertension. One of the most common complications. It is believed that the cause of the disorder in the creation of matter that produces adipose tissue and increased insulin that occurs with obesity. About 30% of people with weight over 15 kg of ideal have high blood pressure. Also, and distribution of fat ("apple" - android obesity), not only increased amounts of fat influences as an independent risk factor for high blood pressure. Adipose tissue is metabolically active and fatty acids via the portal vein to the liver where sinetetišu triglycerides leading to insulin resistance and hyperinsulinemia.
2 Cardiovascular and cerebrovascular diseases. Numerous studies have shown that regardless of other risk factors of these diseases arise as a consequence of obesity, especially the "apple" (android) obesity. People who are 10% overweight have an average of 20% increased risk of developing cardiovascular disease. For every 10% increase in TT, systolic blood pressure increase of 6.5 mm Hg, plasma cholesterol to 12 mg, and 2 mg of glucose / dl blood. As mentioned increased amount of adipose tissue in the stomach is associated with insulin resistance, hyperinsulinemia, increased blood pressure and atherogenic plasma lipid profile.This complication usually occurs in people who are overweight for many years (15 or more), so for them we hypertension, type II diabetes (insulin-independent) and high cholesterol (LDL). The risk of these complications is higher for males and 50 years than in women up to 50 years due to increased human activity affecting the increase in free fatty acids in the liver and triglyceride synthesis. In women after menopause due to increased human activity is changing the distribution of fat so that the fat accumulates them in the upper parts of the body ("apple", android type), thus increasing the risk for these diseases. It is believed that HDL concentrations decreased in these individuals because it bind fat cells in the adipose tissue.
3 Hypercholesterolemia. Cholesterol is determined by genetic factors (2/3) and nutrition (1/3). Any increase in total fat and cholesterol increases. In obese patients as much as 53 times greater risk of high cholesterol in the blood.
4 Diabetes. Even moderate abdominal obesity in particular may increase the risk of insulin-dependent diabetes. Adipose tissue plays a double role in the development of diabetes:
- Increases the need for insulin (hyperinsulinemia) and creates insulin resistance, and all that remains sensitive to insulin,
- Reducing the number of receptors for insulin (considered to be the consequence of a cytokine hormone-like substances).
Reduction of body weight leads to improved blood glucose control and hyperlipidemia.
5 Cancer. In men increases the risk of prostate, colon, and in women the risk of breast cancer increased by 3 times and 7 times in the uterus and ovary. This in addition to the risk of total fat plays a major role and distribution of fat ("apple" or android type).
6 Arthritis. The cause of degenerative arthritis in the obese is not clear but there is a clear correlation between elevated uric acid (Acidum uricuma) in the blood, which causes gout and obesity. Some believe that adipose tissue produces cytokines that destroy cartilage in the joint, while many believe that it is mechanical rather than metabolic problem.
7 Gallbladder diseases - cholelithiasis. The main reason is hiperholesterolonemija. Increased intake of fatty foods increases cholesterol in the blood, and Bile is more saturated with cholesterol. Gall bladder contraction is difficult, hipomotilitet and frequent cholesterol gallstone and gallbladder inflammation in obese patients. Obese young women (20 to 30 years) have a 6 times greater risk compared with normal weight, while women over 60 who are obese one-third with cholelithiasis.
8 Picwikov syndrome (sleep apnea, hipoventilacioni syndrome). Obesity is the single most important cause of this syndrome, which is characterized by a brief cessation of breathing during sleep (about 1 min), heart rate was irregular, and the result can be a fatal heart attack in his sleep. Patients usually wake up when they stop breathing. This can be repeated several times during the night, so the patient is tired, work capacity will be reduced.
9 Disorders of the digestive tract. In obese is a common hiatus hernia due to gastroesophageal reflux, pancreatitis, hemorrhoids (due to venous stasis) and others.
10th Complications in pregnancy. In obese pregnant women are frequent toxemia (toxicosis in gravid), childbirth is extended.
11th Mental disorders. They range from feelings of uselessness, emotional distress (anxiety) to severe depression.
12th Non-medical complications of obesity.
- Expensive life (food, clothing, footwear, furniture and transport),
- Movement discomfort (pain in my back and feet)
- Difficult to find a spouse, a job,
- Loneliness (reduced social contacts)
- Inactivity.
Treatment of obesity
"Many obese patients will never undergo therapy. Among those who undergo treatment for the reduction of body weight, most will not lose weight, and those who lose them and get them going again," say the famous nutritionist Dr. AJ Stunkarda with Standfordskog University. *
Why is mršavljanje hard? (Why patients do not follow the child?)
changing any habit is hard; says the man is a creature of habit. If the person is young, educated and motivated, changing habits will be easier for her,
result of the child is not seen immediately,
many patients are discouraged if they see the person they prescribe diet obese
What should a patient do to make it easier to comply with a child?
-To learn the basic concepts of obesity and healthy eating
-To find a motive, and set realistic goals
-A change of habits
-To learn to recognize the signs of success (strained muscles, fatigue, loss, change of constitution)
-Not to be discouraged by failure and did not stop seeing the doctor. You need to bear in mind that obesity is a chronic disease that requires continuous monitoring and treatment
Weight loss is only part of the problem of obesity treatment. The second part, more difficult and more important, is how to maintain the achieved, the desired (ideal) body weight. The best way to combine the reduction diet, increase physical activity and change in feeding habits.
General Instructions
The safest is to lose a week 1/2 kg to 1 kg.
Physical activity is an integral part of therapy.
Ready to wait for a stabilization period, a period when the weight is a long period retains the same value.
Maintain the achieved weight and not be discouraged.
It is an encouragement to the patient by the physician, the environment, and Self Support Group.
The scientific method of weight loss
Reduction in caloric intake
-Increased physical activity
-Change of behavior
Drug therapy-
-Surgical methods for treatment of obesity
-Treatment of malnutrition
The simplest way is to eat nutritionally adequate foods (lean meats, dairy products, low-fat, whole grains, fruits and vegetables), low in calories. It is desirable to have at least three meals and two snacks. Breakfast and dinner should be around 20% of total energy intake, 30% lunch and snacks for 15% of total energy intake. Avoid sauces, fatty foods, cakes, cookies, pastries and strong spices which increase appetite (chili pepper, hot pepper, pepper, cayenne "Aleva" pepper etc..). Stop 'snacking' between meals. Remove visible fat (fat from meat, soups and other dishes). Prefer meat and vegetables cooked or dry roasted, not fried.Keep taking care of visokokaloricnih drinks such as Coca-Cola and other soft drinks, cocoa, alcohol, syrup, thick juices. Instead we prefer to take unsweetened mild, herbal teas, natural Cedeno juices and mineral water. To the best planned intake should:
a) make diet foods into groups where each group of foods can be replaced with another of the same group and
b) providing the finished menu. The best guide to adequate intake of all food groups is the respect of the recommendations, "nutritional pyramid", which gives us information about how much should be represented in each food group daily intake.
II Along with the reduction diet the patient is offered to increase their physical activity, but gradually and cautiously. At first it can be a daily, routine activities: hiking-instead of by car;-stairs instead of riding the elevator; daily walk-instead of sitting in front of the TV. Later you proceed to systematically leisure activities. It is best to opt for one of the following actions: fast walking, cycling, swimming or tennis. In the beginning it is enough for 10-15 minutes of fast walking or other aerobic activities, and increase the length of time, duration and frequency. For example. patient should initially be a quick walk 10-15 minutes three times a week. You should then increase the length or term, and therefore the time to workout for at least 30 minutes every day. Later, should try to track that spins for a short period, and thus will increase the intensity of training and will continue at the same pace and length will be increased gradually slopes.Patients who May whatever health problem you should consult your doctor before beginning training.They are advised to do the "step test", "trade mill" and ECG. It is advised to healthy male persons over the age of 40 and females over 50 years. Contraindications for physical activity as angina pectoris, arrhythmias, malignant hypertension, severe anemia, varicose veins, uncontrolled diabetes.
The benefits of physical activity
-Good general sense, the reduction of depression, stress and anxiety (nervousness).
-Beneficial effect of kardiovaskulrni respiratory and musculoskeletal system.
-Increases HDL ("good cholesterol").
-Lowers blood pressure
-Tolerance to insulin is reduced leading to significant regulation of blood sugar,
-Reducing the cardiovascular complications and other causes of mortality,
-Increases muscle mass at the expense of body fat, skin and muscles become tense because the exercise consume more fat and carbohydrates and less protein, while the diet without exercise consume more protein.
-Physical activity helps a lot in maintaining the achieved weight.
There is a controversial relationship between physical activity and starvation. While some believe that hunger increases after physical activity due to loss of power, others have noted that a person is not hungry, and that even the appetite decreases. However, the general conclusion is that fast walking, jogging (1.5-3 km distance) and other physical activities for up to 30 min did not affect the patient's usual appetite.
III It is believed that obesity is the result of bad habits related to eating disorders that are learned throughout life and that changing these habits basis for successful treatment of obesity. This is based on facts:
-Obese person brings an excessive amount of food (calories)
-Obesity is learned or acquired disorders,
-Overweight and obese individuals differ in their feeding,
Behavioral behavior include:
Define the problem (history of obesity, relationship with friends, work and emotions) Usredsredivanje the immediate cause that led to the overflowing food intake in the past, the cause of which he now says that uncontrolled eating. Behavior change refers to it to reduce the amount, type and frequency of food intake.This treatment requires psychiatric treatment that can be done through individual therapy or group work, and as a form of treatment can be used hypnosis. It is used in cases where the patient can not define your problem so it must go back in time with the help of psychotherapy and correct model of their behavior related to feeding first on the subconscious level.
IV Obesity is a serious chronic disease as well as other chronic diseases (diabetes, hypertension) requires long-term treatment (treatment) to achieve control of body weight and prevent many complications.
Drug therapy is a useful adjunct to the strictly indicated cases, but not a substitute for reduction diet, change of habits and physical activity. Drugs for obesity can be divided into two major groups:
Anorectic drugs (drugs that suppress appetite)
Divided into:
1 those who act through the central nervous system (CNS agents), ie. increase the production of serotonin and catecholamines (norepinephrine) in the brain and reduce the appetite and increase the feeling of satiety. They can be kateholinergici (amphetamine and phentermine) and serotoninergici (dexfenfluramine and fenfluramine) and the combination of these two drugs,
those that are not CNS agents (fiber).
2 Drugs that reduce the absorption of fat. He is best known Orlistat (Xenical). These drugs performs the selection of fat receptors and interfere with fat receptors have not carried out the selection of greasy receptors among which is the reason neapsorpcije fat-soluble vitamins, including beta-carotene.
Indications for carefully selected patients who have a BMI over 30, which is a major health risk, and patients with a BMI over 27 but with severe complications of obesity.
Contraindications:
-To improve the aesthetic appearance,
-Pregnancy and lactation,
-Addicts and alcoholics,
-Eating disorders (bulimia nervosa, bingeating)
-Depression and use of antidepressant medication,
-Migraine
-Glaucoma
-Diabetes,
Oboljena-cardiac, arrhythmia, high blood pressure,
-Planning of surgery under general anesthesia.
These drugs are taken short, a few weeks or months to facilitate patient is dieting, not as the only form of treatment. Prolonged use of three months is not recommended because then complications arise, and it was observed that after six months, body weight does not change what is believed to be related to the emergence of drug resistance. Studies in more than a year on the use of these drugs are Raden. Otherwise, the use of most of these drugs do not cause side effects except for certain that off the list (off label use), or prohibited. The effects are drowsiness, anxiety, euphoria, increased pressure and pulse. Primary pulmonary hypertension is a rare but potentially fatal disorder that may arise in the application of these drugs (pentermin that affects blood vessels in the lungs and results in death in 45% of cases). You need time to recognize the symptoms in patients who are on this drug, such as shortness of breath, chest pain, fatigue, and joint swelling, and immediately stop the treatment. It is noted that they occur in patients taking these drugs for more than three months. In 1997. The 24 women are suffering from valvular heart defects (changes are only Widen with carcinoid tumors that produce serotonin), and links them is that they are taking a combination of drugs for obesity, fenfluramine and dexfenfluramine, which as we have said withdrawn from use.
Orlistat (Xenical)
No effect on the CNS. Selectively interferes with the absorption of fat, and the system is not working does not affect appetite. It reduces fat absorption by 30%. However, a person who is on this drug should be dieting. The recommended dose is three times 120 mg. It is contraindicated in patients who have a chronic malabsorption or cholestasis with organic causes of obesity such as hypothyroidism. The negative effects of drugs are oily stools, incontinence, flatulence.
The benefits of drug therapy
Body weight decreases as the number of health risks (blood pressure, cholesterol, triglycerides, insulin requirements).
More studies are needed to determine whether weight loss by appetite supresanata can actually improve health. These medications are not magic formulas do not work after a single use. They can not take the place of dieting and physical activity to take place but just can not help the person to go on a diet and exercise and lose weight and maintain that condition. Since the basal metabolism increased in people with excess thyroid hormone it was logical to examine its effect in the treatment of obesity, however, this therapy has been rejected because it can be more harmful to the patient due to increased protein degradation (negative nitrogen balance) than would be reduce the health risks of obesity.
In these methods are limited to patients with a BMI over 40, and if their BMI 30-35 with severe comorbidity.
One method is ligation of the jaw (Jow Wiring). The patient can take only liquid food, milk, juices, supplements of vitamins and minerals, and can not chew. They usually enter 1000 kcal per day.Disadvantages: sore gums, infections and monotony of a child, taking visokokaloricnih drinks which reduces the efficiency of the method.
Lipetomija is an old technique excision of subcutaneous adipose tissue (fat part of the crop).
Liposuction involves the local extraction of fat from fat cells and it is not changing the number of fat cells.
Partial gastrectomy is a common procedure in extreme obesity to reduce the capacity of the stomach and food intake.
Complications:
Dumping syndrome is observed in 15-30% of patients. There is an early (5-15 minutes after eating) and late (1-3 hours after eating) Dumpingov syndrome
steatorrhea - fat loss through the stools. The cause is unknown. It is explained by the insufficient activation of pancreatic lipase or under the influence of intestinal bacteria.
deficit of vitamins and minerals (folic acid, B12, A, D, E and K vitamins, calcium and iron)
Intestinal bypass (bypassing) can be:
surgical removal of the small intestine ("end to end") and
bridging a portion of the small intestine ("end-to-side").
The results of this procedure are that it reduces the absorption of fat in only 25-75% (normal fat is absorbed 95%).
Complications:
-Creation of oxalate stones of unknown etiology,
-Hypokalaemia, hypocalcaemia, hypomagnesaemia,
-The least desirable effect is liver failure and death. Unknown cause.
Its advantages:
-Weight loss
-Lower cholesterol and triglycerides in the blood so that it becomes a normal lipoprotein profile
-Blood pressure is normal
-Diabetics have a reduced need for insulin and improved glucose tolerance
All of these methods carry a risk of morbidity and mortality, particularly bypass procedures.
VI Partial or total starvation is one of the oldest methods of losing weight. In recent years, post is popular for weight loss and good spiritual feelings. If the diet is less than 1200 kcal per day a person must be under the supervision of a doctor. Very low calorie diets (400 kcal per day) and low-calorie diet (800 kcal per day) can be successful although there have been cases of sudden death in a small number of patients. There may be other complications that are not life-threatening patient: slow heartbeat, slow pulse, hair loss, weakness, low blood pressure, menstrual disorders, infection of the gums. These patients should be monitored liver enzymes, electrolytes (especially potassium loss), keto bodies, dehydration, increased Acidum urikuma and psychological changes. If the person is not under a doctor's supervision could occur: fluid and electrolyte disorders, severe cardiovascular disorders, deficiencies in minerals and vitamins and the occurrence of bile stones (50% spontaneously disappear, 25% have no symptoms, and in 25% of patients required surgical treatment). If the child for a period exceeding two months the skin becomes dry, scaly, hair and nails stop growing, heart heartbeat becomes irregular, the damage of the CNS and death. At first, the euphoria may occur due to high keto bodies passing through the brain barrier. The success of therapy regulates blood pressure, blood sugar levels and blood lipids. This therapy experienced doctors use in the treatment of obese patients with more than 25-100 kg overweight, and not for the loss of a few extra pounds.
If you used this diet to reduce a few extra pounds initial effect in patients immediately visible because mostly losing water, muscle mass, and then at the end of fat with which, as a rule, such a diet holds up to ten days and fat and were able to begin the process of decomposition, and the patient encouraged by the initial effect of resuming normal diet and the cycle is repeated.
It was observed that the long-run diet of 400 kcal and 800 kcal diet have the same effect.
A modified method of fasting therapy
1 Harvard 400-600 kcal liquid diet plus a light dinner of 200 kcal
This diet contains essential amino acids (beef, chicken, skim milk, eggs, cheese).
2 Commercial product that contains essential amino acids, electrolytes, minerals and vitamins.
3 The formula contains only amino acids.
However, these ready-made formulas have begun to break through the shops and numerous deaths have been registered (kipokalemija) were withdrawn from the free sale which reaffirmed that every child must be strictly individual.
Conditions that preclude diet
Despite the fact that patients have the need or desire to get rid of excess pounds the presence of certain clinical or pathological mental condition may be the reason why the patient can not, temporarily or permanently, to undergo treatment diet.
Diet is temporarily turned off by:
- Pregnancy
- Lactation
- Unstable mental disorders
- Unstable clinical condition
Diet is conducted with clinical evaluation will be stopped when:
- Cholelithiasis
- Osteoporosis
Permanently excluded diet:
- Anorexia Nervosa
- Terminal stages
Weight loss during pregnancy and lactation is not recommended. If the mother is breastfeeding her baby has a higher caloric needs (an average of 500 calories per day of added) to ensure adequate milk production. When the mother is overweight or obese, weight loss of 2 pounds a month will not affect the decrease in milk production, but that the mother has to carefully monitor whether her baby's appetite is satisfied. The loss of body weight over 2 kg per month in the first months after childbirth is not recommended.
Patients who suffer from mental disorders (eg, schizophrenia) must first be stabilized with a psychiatrist before reduction diet regime approaches. Stabilization of the situation is very important for efekasnost treatment of weight loss.
Unstable clinical condition - if the patient has a disease that requires medical treatment or surgical procedure which may deteriorate due to implementation of the child, the treatment must be postponed.
Cholelithiasis - if the patient has cholelithiasis (pebbles in the gallbladder) condition can worsen with loss of body weight. Therefore, before making a decision about dieting should be evaluated the risks and benefits of treatment for the patient. Increased risk for the formation of gall stones occur if they BMI over 25 They are much more common among obese patients than in normal weight patients, and their frequency of occurrence is exactly proportional to the degree of obesity, especially in women. Weight loss, especially rapid, sudden loss of a potential asset deterioration cholelithiasis, ie. create new stones, and this situation will not improve by applying child.
Osteoporosis - This condition, too, may be exacerbated by the loss of body weight. Therefore here has to make decisions and to assess the risk and benefit of weight loss. It is evident that increased body weight and body fat, preserve the integrity of bone (bone density), and weight loss results in reduced bone mineralization and increased risk of fracture. The benefits of weight loss in these patients (greater mobility, reduced risk of arthritis) must be taken into account and the risk of fractures that occur as a result of weight loss. If the decision is made to implement reduction diet, it must be added supplements of vitamins and minerals, it is necessary to include physical activity, and possibly hormone therapy to protect bone mineralization in these patients.
In person I anorekticnih BMI less than 18 excludes diet.
Terminal condition - requirements for weight loss in these patients are extremely rare. They are usually prescribed a diet adequate for the current situation.
The doctor may agree with the patient whether it will be implemented reducing diet or just dieting to maintain the existing weight which order to prevent the eventual development of obesity.
If a decision is made on the implementation of reduction diet:
1 It is necessary to assess BMI and determine that the new value would be acceptable to the patient, for example. if the BMI is less than 30 can be pursued to reduce it to 20-27. However, if more than 30 realistic goal is not reduced by more than two units of existing;
2 Explain to the patient that he has to create an energy deficit, ie. to burn calories in order weakened.
This can be achieved in three ways:
reduced food intake, ie. weight loss diets as well as educating patients to choose foods that have less fat when purchasing, to increase the intake of fruits and vegetables, to change the technique of cooking, reduce the portions and be guided by the recommendations of the nutritional pyramid. Reducing diet may be moderate (1200-1500 calories for women and 1400-2000 kcal for men), low-calorie (800-1200 calories) and very low-calorie (less than 800 kcal). The generally accepted view is that we should not lose more than 2-4 kg per month, ie. to reduce calorie intake by 500 kcal of energy intake required.
Increased consumption of energy through physical activity, which will in addition help in losing fat eliminate stress and tension;
Combining weight loss diets and physical activity.
3 Changing lifestyle allows patients to healthy eating and increased physical activity into practice. It requires a doctor's support, family and friends, which helps the patient to change his attitude and the belief that weight loss is unrealistic.
Prevention of Obesity
Obesity is almost becoming the world's biggest health problem 21 century. Until recently, obesity was considered to be more aesthetic than medical problem, odnosnozdravstvenim problem. Only since the 1980s. The obesity is gaining importance as a health problem. Most people are frightened by AIDS or malaria as a global health problem, disregarding the fact that obesity has a much greater impact on the incidence of various diseases and premature mortality. Interestingly, now that obesity is on the rise not only in the developed countries of the West but also in developing countries where malnutrition is a burning issue. Thus, for example. in Ghana Nutritional status of the population were found to have a higher percentage of the population over 25 BMI which was not the case before, when he was among the majority of the population was less than 18.4.
It also increases the number of obese people in most European countries, despite to the campaign to combat obesity. For the last ten years the number of obese people has increased in these countries to 10-40%. Very concerned that childhood obesity is also on the rise, and 30% of obese children become obese according to studies adults. 22 million children (under 5 years) are obese, and it is believed that 10% of school children in industrialized countries, too, are obese.
The quiet epidemic of obesity leads to an increase in the number of people who have a range of health problems caused by obesity as a risk factor (hypertension, hypercholesterolemia, heart disease, type II diabetes, cholelithiasis, malignant disease, degenerative arthritis, mental problems, quality of life is diminished, mortality increased ).
Health economic and psychosocial consequences of obesity are obvious. A lot of money is given to treating the consequences of obesity (comorbidity) until only recently through the involvement of the whole society (social scientists, architects, technologists, mass media) for the prevention of obesity, which is not enough for the involvement of health professionals, but also the whole society. It is believed that obesity has become a major issue until after the industrial revolution, when the work became easier, shorter working hours, and food intake was still remained the same or even higher because the man became surrounded by an abundance of food. Automation of work, sedentary lifestyle, too, have contributed to fewer calories consumed.
Prevention of obesity is of vital importance. It is the key to reducing the number of morbidity and mortality of diseases that afflict modern man. When it comes to disease prevention, terms primary, secondary and tertiary prevention.
Under Primary prevention involves influencing obesity prevention health educational performance at an early age. Under the secondary prevention involves the treatment of obesity and prevention of complications. Tercijalana involves treatment of complications. It is now thought that these terms should be replaced by a broader term, ie. one that includes the general prevention of obesity and adopted the name of primordial prevention. Given that obesity is a global problem of prevention of this need to engage the whole society, it was concluded in Stockholm on Congress to prevent obesity.
Primordial prevention includes:
A healthy lifestyle that includes the introduction of physical activity as an integral part of everyday life, and healthy eating.
1 Physical activity-physical activity can easily fit into the schedule of daily duties. Walking, cycling, using stairs instead of elevators, walking fast can easily become part of your lifestyle. They should be practiced at least 30 minutes every day.
2 Healthy eating means governing principles of proper nutrition and adherence to the rules given to us by the nutritional pyramid:
The base of the pyramid are various types of cereals, cereal products and flour. This food group should provide 40% of the energy value of foods. When choosing foods prefer the black bread and products made of whole wheat flour in order to increase fiber intake. Reduce intake of pasta;
Narrower part of the pyramid includes vegetables and fruits, which should provide about 35% of the total energy value. Of this fruit waste 17% of energy, and 18% vegetables. When choosing foods that take into account the higher rate of juicy fruits and vegetables, and a much smaller quantity of fruit is rich in fats (nuts, almonds, walnuts) and starchy vegetables (potatoes);
Even narrower part of the pyramid consists of meat and meat products, milk and milk products. Each of these food groups should be represented with 10%. The advantage always given lean meats (white poultry, veal, fish, beef). Choose skim milk and dairy products with less fat;
The narrowest part of the pyramid are fats, oils and sugars. They should eat the minimum amounts that will provide 5% of total energy intake;
Proper nutrition begins with the grocery shopping!
Take care of food preparation (cooking, baking on Teflon, grilled, with a minimal amount of fat, avoid frying, roasting);
The total amount of food distributed to more meals so that the distance is not greater than 5 or less than 3 h. The best is that there are 3 main meals and two snacks;
Limit salt intake only in food preparation, not dosoljavati your meal, salads;
Consult a specialist for a proper diet that will give you a professional and practical guidance about healthy feeding, determine BMI, which will keep the patient (taking into account the potential morbidity);
Create a balance between the entered and calories burned through physical activity; seek to change the bad habits of behavior related to nutrition.
Obesity is a term often identified with the term overweight which means the increase in body weight over your ideal weight on account of excessive water (edema) or body mass (athletes, body builders), or severe bone, rather than at the expense of body fat . Obese people have more weight than their ideal body weight, and that excess fat is mostly (85%) and a small amount of water and muscle.
Moderate obesity is an ideal body weight increased by 15%. Extreme obesity is the ideal weight has increased by 25%, while malignant (extreme) when it ideal body weight increased over 60%. Women are more often obese while men are more often overweight. Obesity in women is most pronounced after the age and after menopause. Men are usually overweight from 25 to 40 years.
History
Obesity is the oldest and still the most common metabolic disorders in man. Testifying to various sculptures of ancient civilizations, the Greek Caryatid, Egyptian sphinx and many art gallery.
Why obesity occurs?
Obesity occurs when caloric intake is greater than energy needs over the long term without adequate energy consumption. Then the excess calories stored in the body in the form of energy reserves (glycogen, fat) and consumed in the case of increased need or if the body is starving. It is clear, therefore, that the obesity will not come if there is a balance between food intake and energy expenditure.
1 g of fat = 9 calories
1000 g of pure fat = 9000 kcal
1000 g of body fat = 85% fat + 15% water, and the cell
1000 g of body fat = 85/100 * 9000 kcal = 7600 calories, ie. for every 3000-3500 calories that we take the surplus and not spend it we will get 1/2 kg of fat.
What are the causes of obesity?
By now familiar to many factors that influence obesity, and some still in the testing phase. It is now thought that obesity occurs because of several different factors (hereditary traits, psychological, cultural, social, metabolic and physiological), ie. that obesity is a multicausal disease that usually occurs as a result of the interaction of genotype (inherited genetic characteristics individuals), and environmental factors.
Heredity
The legacy is cited as one of the most important factors in the pathogenesis of obesity. Some authors consider that it makes 90% of the causes of obesity, but recent studies suggest a 30-40% figure. The fact is that obesity is more common in families, suggesting that genetic factors have an impact. However, family members share not only genes but also the lifestyle and eating habits, and the separation of the influence of genetic difficult. Studies of adopted adults confirm this fact because it has been observed that the body weight of these adopted people closer to the body weight of their biological parents, but people have accepted them. Numerous studies of twins has also confirmed the fact that the legacy is very important.Example: Twelve pairs of twins were put on a diet of 1000 kcal was higher than their needs for a period of 100 days. Accompanied by an increase in body mass. The observed similarities in the evening to the number of pounds of VAT and subcutaneous adipose tissue in the same pair of twins (and more like Homo than in heterozygous) than among individual members of the respondents. Almost identical results were obtained when implemented subsequently reducing diet.
Also the mixed disorder of mitochondrial level because they are the main producers of energy.Mitochondria are the inherited from the mother and this explains koleraciju between birth weight and weight biological mothers. If the biological mother of obese in later years there is a 75% chance that the child is obese, and vice versa.
In recent years, talks about the special proteins produced by the body and is responsible for the feeling of satiety. If this abnormal protein a person eats a large meal does not feel satiety. 1995 discovered the abnormal gene B3 adrenergic receptor that is responsible for the utilization of fat metabolism so slow, and fat accumulate in adipose tissue. Other researchers believe that the disorder at the level of the hypothalamus and the feet back mechanism.
Defective metabolism ie. inability of effective use of energy (ATP), reduced enzyme (lipase), decreased activity of the enzyme for the mobilization of fat and elevated levels of enzymes for fat storage.
Intrinsically greater number of fat cells in obese patients or a particular type of fat cells that hypertrophied easily be one of the causes of obesity. Getting in body weight during the period between 12 and 18 months of age, 12 and 16 and in adulthood.
The environmental factors
In different environments, cultures and time there are different ideals of good looks. Overweight people have long been considered as a symbol of health and wealth. Ritual food intake is related to the joyous moments (ceremony, celebration, expression of hospitality), as well as sad moments (dace).
Psychological Factors
Many people eat to dispel bad feelings (frustration, boredom, insecurity, anger, sadness), food is often used as a substitute for what is lost (the love, work), much like smoking, drinking. About 30% of obese binge phase (binge eating disorder). The company requires beautiful, slender, and obese people are therefore discriminated against in various professions, she feels unwanted, depressed, eat more, and because of their appearance becomes even more depressed again and comfort in foods (vicious circle).
Physiological Factors
Basal metabolic rate (primary energy needs to sustain life) declines after 25 years, because growth stops and minimizes the effect of hormones that affect the construction of the body and increases the catabolic processes that do not require additional energy. So that age has an impact on the occurrence of obesity.
Physical activity is an important factor that affects the energy consumption. It also decreases with age. For people who live in the same family creates a conditioned reflex to eat more food in the tradition of other family members.
Assessment Weight management
There are several ways to calculate the ideal body weight:
Standard tables (Weight to high tables) - acceptable weight for a person known height
Disadvantages:
- Does not determine the percentage of fat, that is. not deferred fat from muscle tissue
- Do not distinguish between the average and the desired body weight;
- 5% of the population (extremely low or high) are not taken into account;
- Some do not take into account the age and sex;
- The greatest problem for doctors is that table to choose;
The rule of the thumb (the thumb and index finger of one hand is placed around the wrist the other hand).
Tables of growth for children
The formula DEMO
For men: ITT = (TV-100) - (TV-150/4) + (G-20/4)
For women: ITT = (TV-100) - (TV-150/2.5) + (G-20/4)
ITT ideal body weight; television body height; G-year
This formula is quite old and today it is rarely used. The reasons are that it is limited to a period of 20-40 years, modern recommendations require a lower calorie intake for a more modern and easier lifestyle (new technologies, cars, remote control, etc.).. ITT ideal body weight; television body height; G-year
Measurement of obesity
Each individual is a heavy 0.5 mg was "Sizifof job." The efforts of the international group were focused on a single measure independent of the other parameters and so in 1990. was adopted as the method of choice for measuring obesity - BMI.
What is BMI?
BMI (Body Mass Index) - the relationship between weight and height that is used to assess the impact of obesity as a risk factor for health. It is a mathematical formula that correlates with body fat in adults, and is calculated as weight in kilograms divided by body height in meters squared.
BMI = BW (kg) / [TV (m)] 2
TT = body weight
TV = body height
TT = body weight
TV = body height
As the health risk is determined based on the Body Mass Index's?
BMI nourishment risk of becoming ill from BMI risk of becoming ill from BMI and comorbidities *
<18.5 skinny low minimum
> 18.5 - 25 obese Low Moderate
> 25 - 30 overweight moderately high
> 30 - 35 overweight high very high
> 35 - 40 very obese Very high Extremely high
> 40 extremely obese Extremely high Extremely high
* Co-morbidity is a disease associated with obesity, which worsens with increasing BMI, and often improves if obesity is successfully treated.
Co-morbidity related to obesity:
Hypertension
Cardiovascular Disease
Dyslipidemia
Type II diabetes
Sleep apnea
Osteoarthritis
Sterility
Other pathological conditions:
* Idiopathic intracranial hypertension
* Varicose veins of the lower extremities
* Gastroesophageal reflux
* Urinary stress incontinence
The presence of one or more comorbid conditions increases the health risks tied to BMI.
When the health risk assessment appropriate?
BMI is used to assess health risks in adults. Do not depend on gender and age because it has a wide range of applications (19 to 70).
When the BMI does it work?
* Children in the growth phase,
* Pregnant women and nursing mothers,
* For persons with a pronounced musculature (body builders and athletes)
* In patients with scoliosis and kyphosis or other anomalies which can not be adequately estimate height.
Distribution of fat
Although the total amount of body fat important parameter for the assessment of health risk, schedule (distribution) of fat, also, an important parameter, even independent.
There are two types of schedules (distribution) of fat:
1 "Apple Shape"-apple-android type of obesity-upper-upper distribution distribution. Adipose tissue is concentrated around the abdomen and in the upper parts of the body. This type of obesity is common in men and women after menopause because it reduces estrogen, and increases testosterone. However, that is not always the rule. This type of obesity carries an increased risk of hypertension, type II diabetes, heart disease and certain forms of carcinoma.
2 Pear shape "-pear-gynoid type of obesity-d istribution upper-lower distribution. Adipose tissue is concentrated around the waist, hips and thighs. Was more common in obese women.
Fat distribution can be assessed by measuring:
Scope waist-hip (WHR Waste to Hip Ratio), ie. krojačko centimeters to measure waist circumference and dividing by the volume of the hip in inches.
WHR Sex
> 1
Men
> 0.8 Women
This ratio is an important indicator of fat distribution, particularly abdominal fat, and a good indicator for the assessment of health risks. Value to 1 for men and 0.8 for women up to the lower limit value. Values over these carry the risk of developing independently, but also associated with obesity.
Waist
Measuring waist circumference is another way to estimate the distribution of body fat. He is an adequate indicator of intra-abdominal fat and health risk. It has been observed that people (men) who have a waist circumference over 94 cm are at increased risk, and over 102 cm greatly increased risk of becoming ill.People (women) who have a waist circumference over 80 cm are at increased risk, and more than 88 cm have a greatly increased risk of becoming ill. High ratio of abdominal fat is associated with hypertension, decreased glucose tolerance, hyperinsulinemia and dyslipidemia (atherogenic plasma lipid profile-usually elevated triglycerides and decreased HDL). These symptoms indicate today as syndrome X. Certain forms of cancer have been observed in these patients, as well as heart disease. All patients with a BMI of less than 40 should be measured and the waist because he alone or associated with high BMI is a risk factor. People who have a BMI over 40 do not have to measure waist circumference because their health risks already extremely high.
So nies and moderate or mild obesity should heal if the abdominal tissue rich in fat because it increased the number and size of fat cells-adipocytes is associated with their increased metabolic activity. From this tissue fatty acids are released directly into the portal circulation, which leads to accumulation of triglyceride in plasma as a result, we have hyperinsulinemia-insulin secretion occurs because the resistance to glucose and leads to an increase and glucose.
Obesity is a serious chronic disease that can lead to many medical complications that reduce the quality of life and shorten the life span, and whose treatment has a high cost. Obese people have a higher morbidity and mortality (every pound over ideal body weight reduces the life span of a month).
1 Hypertension. One of the most common complications. It is believed that the cause of the disorder in the creation of matter that produces adipose tissue and increased insulin that occurs with obesity. About 30% of people with weight over 15 kg of ideal have high blood pressure. Also, and distribution of fat ("apple" - android obesity), not only increased amounts of fat influences as an independent risk factor for high blood pressure. Adipose tissue is metabolically active and fatty acids via the portal vein to the liver where sinetetišu triglycerides leading to insulin resistance and hyperinsulinemia.
2 Cardiovascular and cerebrovascular diseases. Numerous studies have shown that regardless of other risk factors of these diseases arise as a consequence of obesity, especially the "apple" (android) obesity. People who are 10% overweight have an average of 20% increased risk of developing cardiovascular disease. For every 10% increase in TT, systolic blood pressure increase of 6.5 mm Hg, plasma cholesterol to 12 mg, and 2 mg of glucose / dl blood. As mentioned increased amount of adipose tissue in the stomach is associated with insulin resistance, hyperinsulinemia, increased blood pressure and atherogenic plasma lipid profile.This complication usually occurs in people who are overweight for many years (15 or more), so for them we hypertension, type II diabetes (insulin-independent) and high cholesterol (LDL). The risk of these complications is higher for males and 50 years than in women up to 50 years due to increased human activity affecting the increase in free fatty acids in the liver and triglyceride synthesis. In women after menopause due to increased human activity is changing the distribution of fat so that the fat accumulates them in the upper parts of the body ("apple", android type), thus increasing the risk for these diseases. It is believed that HDL concentrations decreased in these individuals because it bind fat cells in the adipose tissue.
3 Hypercholesterolemia. Cholesterol is determined by genetic factors (2/3) and nutrition (1/3). Any increase in total fat and cholesterol increases. In obese patients as much as 53 times greater risk of high cholesterol in the blood.
4 Diabetes. Even moderate abdominal obesity in particular may increase the risk of insulin-dependent diabetes. Adipose tissue plays a double role in the development of diabetes:
- Increases the need for insulin (hyperinsulinemia) and creates insulin resistance, and all that remains sensitive to insulin,
- Reducing the number of receptors for insulin (considered to be the consequence of a cytokine hormone-like substances).
Reduction of body weight leads to improved blood glucose control and hyperlipidemia.
5 Cancer. In men increases the risk of prostate, colon, and in women the risk of breast cancer increased by 3 times and 7 times in the uterus and ovary. This in addition to the risk of total fat plays a major role and distribution of fat ("apple" or android type).
6 Arthritis. The cause of degenerative arthritis in the obese is not clear but there is a clear correlation between elevated uric acid (Acidum uricuma) in the blood, which causes gout and obesity. Some believe that adipose tissue produces cytokines that destroy cartilage in the joint, while many believe that it is mechanical rather than metabolic problem.
7 Gallbladder diseases - cholelithiasis. The main reason is hiperholesterolonemija. Increased intake of fatty foods increases cholesterol in the blood, and Bile is more saturated with cholesterol. Gall bladder contraction is difficult, hipomotilitet and frequent cholesterol gallstone and gallbladder inflammation in obese patients. Obese young women (20 to 30 years) have a 6 times greater risk compared with normal weight, while women over 60 who are obese one-third with cholelithiasis.
8 Picwikov syndrome (sleep apnea, hipoventilacioni syndrome). Obesity is the single most important cause of this syndrome, which is characterized by a brief cessation of breathing during sleep (about 1 min), heart rate was irregular, and the result can be a fatal heart attack in his sleep. Patients usually wake up when they stop breathing. This can be repeated several times during the night, so the patient is tired, work capacity will be reduced.
9 Disorders of the digestive tract. In obese is a common hiatus hernia due to gastroesophageal reflux, pancreatitis, hemorrhoids (due to venous stasis) and others.
10th Complications in pregnancy. In obese pregnant women are frequent toxemia (toxicosis in gravid), childbirth is extended.
11th Mental disorders. They range from feelings of uselessness, emotional distress (anxiety) to severe depression.
12th Non-medical complications of obesity.
- Expensive life (food, clothing, footwear, furniture and transport),
- Movement discomfort (pain in my back and feet)
- Difficult to find a spouse, a job,
- Loneliness (reduced social contacts)
- Inactivity.
Treatment of obesity
"Many obese patients will never undergo therapy. Among those who undergo treatment for the reduction of body weight, most will not lose weight, and those who lose them and get them going again," say the famous nutritionist Dr. AJ Stunkarda with Standfordskog University. *
Why is mršavljanje hard? (Why patients do not follow the child?)
changing any habit is hard; says the man is a creature of habit. If the person is young, educated and motivated, changing habits will be easier for her,
result of the child is not seen immediately,
many patients are discouraged if they see the person they prescribe diet obese
What should a patient do to make it easier to comply with a child?
-To learn the basic concepts of obesity and healthy eating
-To find a motive, and set realistic goals
-A change of habits
-To learn to recognize the signs of success (strained muscles, fatigue, loss, change of constitution)
-Not to be discouraged by failure and did not stop seeing the doctor. You need to bear in mind that obesity is a chronic disease that requires continuous monitoring and treatment
Weight loss is only part of the problem of obesity treatment. The second part, more difficult and more important, is how to maintain the achieved, the desired (ideal) body weight. The best way to combine the reduction diet, increase physical activity and change in feeding habits.
General Instructions
The safest is to lose a week 1/2 kg to 1 kg.
Physical activity is an integral part of therapy.
Ready to wait for a stabilization period, a period when the weight is a long period retains the same value.
Maintain the achieved weight and not be discouraged.
It is an encouragement to the patient by the physician, the environment, and Self Support Group.
The scientific method of weight loss
Reduction in caloric intake
-Increased physical activity
-Change of behavior
Drug therapy-
-Surgical methods for treatment of obesity
-Treatment of malnutrition
The simplest way is to eat nutritionally adequate foods (lean meats, dairy products, low-fat, whole grains, fruits and vegetables), low in calories. It is desirable to have at least three meals and two snacks. Breakfast and dinner should be around 20% of total energy intake, 30% lunch and snacks for 15% of total energy intake. Avoid sauces, fatty foods, cakes, cookies, pastries and strong spices which increase appetite (chili pepper, hot pepper, pepper, cayenne "Aleva" pepper etc..). Stop 'snacking' between meals. Remove visible fat (fat from meat, soups and other dishes). Prefer meat and vegetables cooked or dry roasted, not fried.Keep taking care of visokokaloricnih drinks such as Coca-Cola and other soft drinks, cocoa, alcohol, syrup, thick juices. Instead we prefer to take unsweetened mild, herbal teas, natural Cedeno juices and mineral water. To the best planned intake should:
a) make diet foods into groups where each group of foods can be replaced with another of the same group and
b) providing the finished menu. The best guide to adequate intake of all food groups is the respect of the recommendations, "nutritional pyramid", which gives us information about how much should be represented in each food group daily intake.
II Along with the reduction diet the patient is offered to increase their physical activity, but gradually and cautiously. At first it can be a daily, routine activities: hiking-instead of by car;-stairs instead of riding the elevator; daily walk-instead of sitting in front of the TV. Later you proceed to systematically leisure activities. It is best to opt for one of the following actions: fast walking, cycling, swimming or tennis. In the beginning it is enough for 10-15 minutes of fast walking or other aerobic activities, and increase the length of time, duration and frequency. For example. patient should initially be a quick walk 10-15 minutes three times a week. You should then increase the length or term, and therefore the time to workout for at least 30 minutes every day. Later, should try to track that spins for a short period, and thus will increase the intensity of training and will continue at the same pace and length will be increased gradually slopes.Patients who May whatever health problem you should consult your doctor before beginning training.They are advised to do the "step test", "trade mill" and ECG. It is advised to healthy male persons over the age of 40 and females over 50 years. Contraindications for physical activity as angina pectoris, arrhythmias, malignant hypertension, severe anemia, varicose veins, uncontrolled diabetes.
The benefits of physical activity
-Good general sense, the reduction of depression, stress and anxiety (nervousness).
-Beneficial effect of kardiovaskulrni respiratory and musculoskeletal system.
-Increases HDL ("good cholesterol").
-Lowers blood pressure
-Tolerance to insulin is reduced leading to significant regulation of blood sugar,
-Reducing the cardiovascular complications and other causes of mortality,
-Increases muscle mass at the expense of body fat, skin and muscles become tense because the exercise consume more fat and carbohydrates and less protein, while the diet without exercise consume more protein.
-Physical activity helps a lot in maintaining the achieved weight.
There is a controversial relationship between physical activity and starvation. While some believe that hunger increases after physical activity due to loss of power, others have noted that a person is not hungry, and that even the appetite decreases. However, the general conclusion is that fast walking, jogging (1.5-3 km distance) and other physical activities for up to 30 min did not affect the patient's usual appetite.
III It is believed that obesity is the result of bad habits related to eating disorders that are learned throughout life and that changing these habits basis for successful treatment of obesity. This is based on facts:
-Obese person brings an excessive amount of food (calories)
-Obesity is learned or acquired disorders,
-Overweight and obese individuals differ in their feeding,
Behavioral behavior include:
Define the problem (history of obesity, relationship with friends, work and emotions) Usredsredivanje the immediate cause that led to the overflowing food intake in the past, the cause of which he now says that uncontrolled eating. Behavior change refers to it to reduce the amount, type and frequency of food intake.This treatment requires psychiatric treatment that can be done through individual therapy or group work, and as a form of treatment can be used hypnosis. It is used in cases where the patient can not define your problem so it must go back in time with the help of psychotherapy and correct model of their behavior related to feeding first on the subconscious level.
IV Obesity is a serious chronic disease as well as other chronic diseases (diabetes, hypertension) requires long-term treatment (treatment) to achieve control of body weight and prevent many complications.
Drug therapy is a useful adjunct to the strictly indicated cases, but not a substitute for reduction diet, change of habits and physical activity. Drugs for obesity can be divided into two major groups:
Anorectic drugs (drugs that suppress appetite)
Divided into:
1 those who act through the central nervous system (CNS agents), ie. increase the production of serotonin and catecholamines (norepinephrine) in the brain and reduce the appetite and increase the feeling of satiety. They can be kateholinergici (amphetamine and phentermine) and serotoninergici (dexfenfluramine and fenfluramine) and the combination of these two drugs,
those that are not CNS agents (fiber).
2 Drugs that reduce the absorption of fat. He is best known Orlistat (Xenical). These drugs performs the selection of fat receptors and interfere with fat receptors have not carried out the selection of greasy receptors among which is the reason neapsorpcije fat-soluble vitamins, including beta-carotene.
Indications for carefully selected patients who have a BMI over 30, which is a major health risk, and patients with a BMI over 27 but with severe complications of obesity.
Contraindications:
-To improve the aesthetic appearance,
-Pregnancy and lactation,
-Addicts and alcoholics,
-Eating disorders (bulimia nervosa, bingeating)
-Depression and use of antidepressant medication,
-Migraine
-Glaucoma
-Diabetes,
Oboljena-cardiac, arrhythmia, high blood pressure,
-Planning of surgery under general anesthesia.
These drugs are taken short, a few weeks or months to facilitate patient is dieting, not as the only form of treatment. Prolonged use of three months is not recommended because then complications arise, and it was observed that after six months, body weight does not change what is believed to be related to the emergence of drug resistance. Studies in more than a year on the use of these drugs are Raden. Otherwise, the use of most of these drugs do not cause side effects except for certain that off the list (off label use), or prohibited. The effects are drowsiness, anxiety, euphoria, increased pressure and pulse. Primary pulmonary hypertension is a rare but potentially fatal disorder that may arise in the application of these drugs (pentermin that affects blood vessels in the lungs and results in death in 45% of cases). You need time to recognize the symptoms in patients who are on this drug, such as shortness of breath, chest pain, fatigue, and joint swelling, and immediately stop the treatment. It is noted that they occur in patients taking these drugs for more than three months. In 1997. The 24 women are suffering from valvular heart defects (changes are only Widen with carcinoid tumors that produce serotonin), and links them is that they are taking a combination of drugs for obesity, fenfluramine and dexfenfluramine, which as we have said withdrawn from use.
Orlistat (Xenical)
No effect on the CNS. Selectively interferes with the absorption of fat, and the system is not working does not affect appetite. It reduces fat absorption by 30%. However, a person who is on this drug should be dieting. The recommended dose is three times 120 mg. It is contraindicated in patients who have a chronic malabsorption or cholestasis with organic causes of obesity such as hypothyroidism. The negative effects of drugs are oily stools, incontinence, flatulence.
The benefits of drug therapy
Body weight decreases as the number of health risks (blood pressure, cholesterol, triglycerides, insulin requirements).
More studies are needed to determine whether weight loss by appetite supresanata can actually improve health. These medications are not magic formulas do not work after a single use. They can not take the place of dieting and physical activity to take place but just can not help the person to go on a diet and exercise and lose weight and maintain that condition. Since the basal metabolism increased in people with excess thyroid hormone it was logical to examine its effect in the treatment of obesity, however, this therapy has been rejected because it can be more harmful to the patient due to increased protein degradation (negative nitrogen balance) than would be reduce the health risks of obesity.
In these methods are limited to patients with a BMI over 40, and if their BMI 30-35 with severe comorbidity.
One method is ligation of the jaw (Jow Wiring). The patient can take only liquid food, milk, juices, supplements of vitamins and minerals, and can not chew. They usually enter 1000 kcal per day.Disadvantages: sore gums, infections and monotony of a child, taking visokokaloricnih drinks which reduces the efficiency of the method.
Lipetomija is an old technique excision of subcutaneous adipose tissue (fat part of the crop).
Liposuction involves the local extraction of fat from fat cells and it is not changing the number of fat cells.
Partial gastrectomy is a common procedure in extreme obesity to reduce the capacity of the stomach and food intake.
Complications:
Dumping syndrome is observed in 15-30% of patients. There is an early (5-15 minutes after eating) and late (1-3 hours after eating) Dumpingov syndrome
steatorrhea - fat loss through the stools. The cause is unknown. It is explained by the insufficient activation of pancreatic lipase or under the influence of intestinal bacteria.
deficit of vitamins and minerals (folic acid, B12, A, D, E and K vitamins, calcium and iron)
Intestinal bypass (bypassing) can be:
surgical removal of the small intestine ("end to end") and
bridging a portion of the small intestine ("end-to-side").
The results of this procedure are that it reduces the absorption of fat in only 25-75% (normal fat is absorbed 95%).
Complications:
-Creation of oxalate stones of unknown etiology,
-Hypokalaemia, hypocalcaemia, hypomagnesaemia,
-The least desirable effect is liver failure and death. Unknown cause.
Its advantages:
-Weight loss
-Lower cholesterol and triglycerides in the blood so that it becomes a normal lipoprotein profile
-Blood pressure is normal
-Diabetics have a reduced need for insulin and improved glucose tolerance
All of these methods carry a risk of morbidity and mortality, particularly bypass procedures.
VI Partial or total starvation is one of the oldest methods of losing weight. In recent years, post is popular for weight loss and good spiritual feelings. If the diet is less than 1200 kcal per day a person must be under the supervision of a doctor. Very low calorie diets (400 kcal per day) and low-calorie diet (800 kcal per day) can be successful although there have been cases of sudden death in a small number of patients. There may be other complications that are not life-threatening patient: slow heartbeat, slow pulse, hair loss, weakness, low blood pressure, menstrual disorders, infection of the gums. These patients should be monitored liver enzymes, electrolytes (especially potassium loss), keto bodies, dehydration, increased Acidum urikuma and psychological changes. If the person is not under a doctor's supervision could occur: fluid and electrolyte disorders, severe cardiovascular disorders, deficiencies in minerals and vitamins and the occurrence of bile stones (50% spontaneously disappear, 25% have no symptoms, and in 25% of patients required surgical treatment). If the child for a period exceeding two months the skin becomes dry, scaly, hair and nails stop growing, heart heartbeat becomes irregular, the damage of the CNS and death. At first, the euphoria may occur due to high keto bodies passing through the brain barrier. The success of therapy regulates blood pressure, blood sugar levels and blood lipids. This therapy experienced doctors use in the treatment of obese patients with more than 25-100 kg overweight, and not for the loss of a few extra pounds.
If you used this diet to reduce a few extra pounds initial effect in patients immediately visible because mostly losing water, muscle mass, and then at the end of fat with which, as a rule, such a diet holds up to ten days and fat and were able to begin the process of decomposition, and the patient encouraged by the initial effect of resuming normal diet and the cycle is repeated.
It was observed that the long-run diet of 400 kcal and 800 kcal diet have the same effect.
A modified method of fasting therapy
1 Harvard 400-600 kcal liquid diet plus a light dinner of 200 kcal
This diet contains essential amino acids (beef, chicken, skim milk, eggs, cheese).
2 Commercial product that contains essential amino acids, electrolytes, minerals and vitamins.
3 The formula contains only amino acids.
However, these ready-made formulas have begun to break through the shops and numerous deaths have been registered (kipokalemija) were withdrawn from the free sale which reaffirmed that every child must be strictly individual.
Conditions that preclude diet
Despite the fact that patients have the need or desire to get rid of excess pounds the presence of certain clinical or pathological mental condition may be the reason why the patient can not, temporarily or permanently, to undergo treatment diet.
Diet is temporarily turned off by:
- Pregnancy
- Lactation
- Unstable mental disorders
- Unstable clinical condition
Diet is conducted with clinical evaluation will be stopped when:
- Cholelithiasis
- Osteoporosis
Permanently excluded diet:
- Anorexia Nervosa
- Terminal stages
Weight loss during pregnancy and lactation is not recommended. If the mother is breastfeeding her baby has a higher caloric needs (an average of 500 calories per day of added) to ensure adequate milk production. When the mother is overweight or obese, weight loss of 2 pounds a month will not affect the decrease in milk production, but that the mother has to carefully monitor whether her baby's appetite is satisfied. The loss of body weight over 2 kg per month in the first months after childbirth is not recommended.
Patients who suffer from mental disorders (eg, schizophrenia) must first be stabilized with a psychiatrist before reduction diet regime approaches. Stabilization of the situation is very important for efekasnost treatment of weight loss.
Unstable clinical condition - if the patient has a disease that requires medical treatment or surgical procedure which may deteriorate due to implementation of the child, the treatment must be postponed.
Cholelithiasis - if the patient has cholelithiasis (pebbles in the gallbladder) condition can worsen with loss of body weight. Therefore, before making a decision about dieting should be evaluated the risks and benefits of treatment for the patient. Increased risk for the formation of gall stones occur if they BMI over 25 They are much more common among obese patients than in normal weight patients, and their frequency of occurrence is exactly proportional to the degree of obesity, especially in women. Weight loss, especially rapid, sudden loss of a potential asset deterioration cholelithiasis, ie. create new stones, and this situation will not improve by applying child.
Osteoporosis - This condition, too, may be exacerbated by the loss of body weight. Therefore here has to make decisions and to assess the risk and benefit of weight loss. It is evident that increased body weight and body fat, preserve the integrity of bone (bone density), and weight loss results in reduced bone mineralization and increased risk of fracture. The benefits of weight loss in these patients (greater mobility, reduced risk of arthritis) must be taken into account and the risk of fractures that occur as a result of weight loss. If the decision is made to implement reduction diet, it must be added supplements of vitamins and minerals, it is necessary to include physical activity, and possibly hormone therapy to protect bone mineralization in these patients.
In person I anorekticnih BMI less than 18 excludes diet.
Terminal condition - requirements for weight loss in these patients are extremely rare. They are usually prescribed a diet adequate for the current situation.
The doctor may agree with the patient whether it will be implemented reducing diet or just dieting to maintain the existing weight which order to prevent the eventual development of obesity.
If a decision is made on the implementation of reduction diet:
1 It is necessary to assess BMI and determine that the new value would be acceptable to the patient, for example. if the BMI is less than 30 can be pursued to reduce it to 20-27. However, if more than 30 realistic goal is not reduced by more than two units of existing;
2 Explain to the patient that he has to create an energy deficit, ie. to burn calories in order weakened.
This can be achieved in three ways:
reduced food intake, ie. weight loss diets as well as educating patients to choose foods that have less fat when purchasing, to increase the intake of fruits and vegetables, to change the technique of cooking, reduce the portions and be guided by the recommendations of the nutritional pyramid. Reducing diet may be moderate (1200-1500 calories for women and 1400-2000 kcal for men), low-calorie (800-1200 calories) and very low-calorie (less than 800 kcal). The generally accepted view is that we should not lose more than 2-4 kg per month, ie. to reduce calorie intake by 500 kcal of energy intake required.
Increased consumption of energy through physical activity, which will in addition help in losing fat eliminate stress and tension;
Combining weight loss diets and physical activity.
3 Changing lifestyle allows patients to healthy eating and increased physical activity into practice. It requires a doctor's support, family and friends, which helps the patient to change his attitude and the belief that weight loss is unrealistic.
Prevention of Obesity
Obesity is almost becoming the world's biggest health problem 21 century. Until recently, obesity was considered to be more aesthetic than medical problem, odnosnozdravstvenim problem. Only since the 1980s. The obesity is gaining importance as a health problem. Most people are frightened by AIDS or malaria as a global health problem, disregarding the fact that obesity has a much greater impact on the incidence of various diseases and premature mortality. Interestingly, now that obesity is on the rise not only in the developed countries of the West but also in developing countries where malnutrition is a burning issue. Thus, for example. in Ghana Nutritional status of the population were found to have a higher percentage of the population over 25 BMI which was not the case before, when he was among the majority of the population was less than 18.4.
It also increases the number of obese people in most European countries, despite to the campaign to combat obesity. For the last ten years the number of obese people has increased in these countries to 10-40%. Very concerned that childhood obesity is also on the rise, and 30% of obese children become obese according to studies adults. 22 million children (under 5 years) are obese, and it is believed that 10% of school children in industrialized countries, too, are obese.
The quiet epidemic of obesity leads to an increase in the number of people who have a range of health problems caused by obesity as a risk factor (hypertension, hypercholesterolemia, heart disease, type II diabetes, cholelithiasis, malignant disease, degenerative arthritis, mental problems, quality of life is diminished, mortality increased ).
Health economic and psychosocial consequences of obesity are obvious. A lot of money is given to treating the consequences of obesity (comorbidity) until only recently through the involvement of the whole society (social scientists, architects, technologists, mass media) for the prevention of obesity, which is not enough for the involvement of health professionals, but also the whole society. It is believed that obesity has become a major issue until after the industrial revolution, when the work became easier, shorter working hours, and food intake was still remained the same or even higher because the man became surrounded by an abundance of food. Automation of work, sedentary lifestyle, too, have contributed to fewer calories consumed.
Prevention of obesity is of vital importance. It is the key to reducing the number of morbidity and mortality of diseases that afflict modern man. When it comes to disease prevention, terms primary, secondary and tertiary prevention.
Under Primary prevention involves influencing obesity prevention health educational performance at an early age. Under the secondary prevention involves the treatment of obesity and prevention of complications. Tercijalana involves treatment of complications. It is now thought that these terms should be replaced by a broader term, ie. one that includes the general prevention of obesity and adopted the name of primordial prevention. Given that obesity is a global problem of prevention of this need to engage the whole society, it was concluded in Stockholm on Congress to prevent obesity.
Primordial prevention includes:
A healthy lifestyle that includes the introduction of physical activity as an integral part of everyday life, and healthy eating.
1 Physical activity-physical activity can easily fit into the schedule of daily duties. Walking, cycling, using stairs instead of elevators, walking fast can easily become part of your lifestyle. They should be practiced at least 30 minutes every day.
2 Healthy eating means governing principles of proper nutrition and adherence to the rules given to us by the nutritional pyramid:
The base of the pyramid are various types of cereals, cereal products and flour. This food group should provide 40% of the energy value of foods. When choosing foods prefer the black bread and products made of whole wheat flour in order to increase fiber intake. Reduce intake of pasta;
Narrower part of the pyramid includes vegetables and fruits, which should provide about 35% of the total energy value. Of this fruit waste 17% of energy, and 18% vegetables. When choosing foods that take into account the higher rate of juicy fruits and vegetables, and a much smaller quantity of fruit is rich in fats (nuts, almonds, walnuts) and starchy vegetables (potatoes);
Even narrower part of the pyramid consists of meat and meat products, milk and milk products. Each of these food groups should be represented with 10%. The advantage always given lean meats (white poultry, veal, fish, beef). Choose skim milk and dairy products with less fat;
The narrowest part of the pyramid are fats, oils and sugars. They should eat the minimum amounts that will provide 5% of total energy intake;
Proper nutrition begins with the grocery shopping!
Take care of food preparation (cooking, baking on Teflon, grilled, with a minimal amount of fat, avoid frying, roasting);
The total amount of food distributed to more meals so that the distance is not greater than 5 or less than 3 h. The best is that there are 3 main meals and two snacks;
Limit salt intake only in food preparation, not dosoljavati your meal, salads;
Consult a specialist for a proper diet that will give you a professional and practical guidance about healthy feeding, determine BMI, which will keep the patient (taking into account the potential morbidity);
Create a balance between the entered and calories burned through physical activity; seek to change the bad habits of behavior related to nutrition.
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