The obesity, obesity, obesity (rare obesity) is a term for severe obesity by going beyond the normal increase in body fat mass. The demarcation between the different degrees of severity is usually about the body mass index (BMI).
obese Stone Age statuetteobese Stone Age statuette
Definition and delimitation
Obesity means being overweight and excess body fat. Overweight is by means of body mass index (BMI) is measured and classified. A particular disadvantage are fat deposits in the abdominal cavity and internal organs. Indicators for the percentage of body fat and its distribution are the abdominal circumference and waist-hip ratio.
BMI to the first self-assessmentBMI to the first self-assessmentCategory (according to [1]), BMI (kg / m²)Underweight <18.5Normal weight 18.5-24.9Overweight 25-29.9Obese class I 30-34.9Obese class II 35-39.9Obese class III> = 40
On the basis of body weight and BMI, only conditional statements about the risk of comorbidities such as cardiovascular disease. For the cardiovascular risk is less than the degree of obesity but the fat distribution pattern is critical. Particularly detrimental effect here fat deposits in the abdominal cavity (especially the omentum majus) and the internal organs. This deep abdominal fat - experts call it "intra-abdominal fat" or "visceral fat" - is very metabolically active. It affects the lipid and carbohydrate metabolism (glucose metabolism), so that its lipid disorders and diabetes result.
An initial self-diagnosis is simple: measure the waist circumference. An increased risk is for women from 88 inches in front, an area of risk in men starting from 102 cm.
Sporty highly trained people have a lot of muscle tissue of high density and can thus achieve a high BMI without being too much fat or overweight have to be.
Causes
The following causes must be distinguished:
genetic factors
poor diet and too much of a hand - not enough exercise (energy consumption) on the other hand,
eating disorders as addiction
Overweight is more common in industrialized countries, where only a few people doing hard physical work and the food is plentiful and people often suffer "identity crises". The so-called emerging countries but also increasingly affected.
Genetic factors
Genetic factors (heredity) characterize the basal metabolic rate, food utilization and the fat distribution pattern. The food utilization was in the days of "hunting and gathering" an important survival feature: if you could store the excess in fat cells, could live on them in times of scarcity. Twin studies have shown that obesity has a strong genetic component.
Socio-cultural factors
Socio-cultural factors (nutrition sociology) to seduce both overnutrition, as well as to malnutrition and lack of exercise:
Sedentary activity
Slight movement by car, elevator, escalator
Passive leisure time (television, computer games, hanging out)
Frustration, boredom, stress
Goods surplus
Food as a substitute for emotional and personal attention
Education: "The dish is eaten empty", "eat something, then you'll something!"
no common meals, convenience foods instead of cooking
negative role models: Overweight parents have overweight children
Fast Food: Portion size, eating speed, fat content
Flavor enhancer glutamate (prevents satiety)
Dyes, which make the food look palatable
Advertising for sweets and fat
Taste imprint of sugar (soft drinks, baby food, sweetened tea)
Yo-yo effect when dieting
Overweight the ideal of beauty in some cultures
Lack of information, lack of education, lack of alternative products, such as Cured meats with the fat content is reduced and the animal fat is replaced with vegetable oil.
The increasing prevalence of obesity in western countries also correlates with the shortening of sleep, the higher average temperature in houses, the decrease in the number of cigarettes smoked and the increase in weight of the ancestors. People with higher body weight have more children and obesity is caused by genetic factors, and consequently in the proportion of obese people in the population. The increase in life expectancy also plays a role, as in 40 - to 79-year-old obese patients, the proportion is about three times as high as in younger ones. The increasing use of neuroleptics may also increase in obesity rates have caused. There is evidence that the proliferation of pesticides, dyes, flavors and aromas, plastics or solvents promotes obesity. An older mother is a risk factor for the child to be overweight, and mothers were the last decades of aging. Obese women tend to marry obese and therefore the children born at increased genetic risk have to be obese themselves [2].
Pathological factors
Eating disorders and addiction must be accepted whenever the change in dietary habits and changes in exercise habits are difficult or seem impossible. Of these, many overweight and obese people are affected. Among the causes of eating disorders and addiction see there.
Metabolic diseases are only about 2% of cases the cause of obesity: thyroid function, impaired cortisol metabolism (Cushing's syndrome). Some drugs can promote weight gain: hormones, antidepressants, antipsychotics, corticosteroids. The assumption is also associated with infection by the adenovirus type HADV-36.
Follow
Obesity is correlated with a variety of diseases. This may have meant
that cause these diseases, obesity,
that obesity leads to these diseases or
that they have a common unknown cause.
For the listed consequences of obesity is often only a correlation. Whether the cause is obesity really is, therefore, still unclear. To be on the risk of these diseases are nevertheless associated with the consequences of obesity, although this is not often shown or may even be wrong.
Overweight and obesity (obesity) are high risk factors for developing cardiovascular disease. Will there be two of the risk factors diabetes (diabetes), dyslipidemia (high cholesterol, or LDL) or high blood pressure to, the risk of cardiovascular disease (cardiometabolic risk factors) dramatically increases, so does the risk of premature death.
Smoking and stress also increase the risk of occlusion of the heart and brain vessels carers.
Obesity is responsible for an increased incidence of many diseases of civilization. It increases the risk for hypertension (high blood pressure), diabetes mellitus type 2 (adult onset, diabetes), heart attacks, atherosclerosis, strokes, cancer, arthritis and osteoarthritis, joint pain, foot deformities (stamps foot), gallbladder disease, gout, and obstructive sleep apnea syndrome. The danger of a weak veins / venous thrombosis, also caused by obesity, has long been misunderstood.
Obesity reduces fertility. 9 kg weight gain increases the likelihood of infertility by 10%. [3]
The psychological consequences of obesity are serious. Sufferers often feel a failure and Geeks. Often, psychological and even economic damage to those affected, because obesity is not tolerated by society and victims are often ostracized professionally.
The well also financial and socio-economic consequences of obesity are enormous. Serious damage to the musculoskeletal apparatus (joint, muscle strains, bone deformation, damage to ligaments, tendons and bursae, spine and disc herniation, as well as bone growth disorders in children and adolescents) can lead to many secondary therapy and major surgery.
Treatment
Depending on the cause, various therapies are shown. Realistic goals are a slight weight loss or weight stabilization. [4]
Weight loss
A weight reduction not only leads to a reduction of the risk factor obesity, but also has positive effects on cardiac and vascular risk factors. The weight loss is often difficult, however: the fat reserves on the hips and belly are created only once, build it from the body difficult. Especially with obesity, the treatment proves to be very difficult. In particular, setbacks or lack of success cause the patient (as well as dentists and their families) often to abandon the project altogether. In addition, are often co-morbidities that complicate the suffering of the patient and must be handled in parallel. It makes more sense, therefore, the early practice of a healthy lifestyle to prevent weight gain.
Diet and exerciseDietDiet
Nutrition and physical activity are to a large extent a matter of habit. For patients without mental illness elements a simple information for healthier food and support for the change in diet and more exercise may well succeed. However, it is not scientifically proven that diet provides the best remedy. Most are advised to avoid more dietary fiber (sa whole foods) and fats, and saturated fats should be replaced by foods with essential fatty acids. Increase physical activity is the main antagonist in the energy balance. In particular, endurance sports like cycling, swimming, hiking and jogging are performed consistently over months and years of weight loss.
Eating disorder
If an eating disorder usually lasting several weeks treatment in a specialist clinic is required (see: Psychosomatic Clinic), supplemented by regular long-standing involvement in a support group (eg, Overeaters Anonymous).
Therapy
If a behavioral change in diet and exercise is difficult, it is clear that obesity is not just a phenomenon of civilization, but behind it serious and causative psychosocial problems. To overcome this, a specially oriented psychotherapy is required. The goal is to identify the individual causes of eating disorders and learn alternative behaviors. Has also proved effective in the treatment group. In parallel the person works regularly in a support group with like-minded people.
Outpatient or inpatient rehabilitation in a specialist clinic for eating disorders and psychosomatic clinic is an excellent start on the way to change behavior and lifestyle. It is usually funded by health insurance or pensions.
"Diet"
Given the multiple causes for the development of overweight and obesity, there is no single measure that alone ended the derailment of the weight permanently. Many providers of diets, it always manages to convince stakeholders of their special way so that it is possible that their eating habits for the duration of the diet completely aligned to the diet rules. It is often very quick to radical reductions in weight. When the diets but do not lead to the time of the diet also realized fundamental change in the whole eating and exercise behavior, contact the old habits after the diet through again. This, and the yo-yo effect is inevitably the overweight again. As an introduction to a new eating and lifestyle are all but diets that lead to better selection of food to their professional preparation and wise classification of food intake during the day. An important aid in the quest for a lasting control of body weight, regular physical activity sufficient. Aids such as an introduction to other tastes as sweet to eat fat and calories, and control of appetite by drug Esshormons awakening of serotonin can only be complementary aids. Without the extensive changes in eating and exercise habits, they do nothing.
Pharmacological intervention
If the change in eating and exercise habits is difficult, the cause must be found and fixed. In particularly difficult cases may be permanent relief from the pressures of hunger is a valuable aid. Pharmacological therapy should also be carried out exclusively by the physician. In the U.S., often there is the-counter 5-hydroxy-tryptophan (5-HTP), unless taken for the improvement of the waking and sleeping patterns as well as antagonists of serotonin for a reduction in body weight over time. Here are sufficient studies about it yet, but it is reported only minor side effects. The continuous ingestion of 5-HTP Vorhormons but requires the medical examination, particularly since it is not only in the cerebrospinal fluid of the brain, but throughout the body. When hunger control by serotonin reuptake inhibitors as well as in the single in Germany or wrongly approved "anorectic" drug called sibutramine (trade name Reductil ®), there have been significant physical side effects. Long-term use of 5-HTP is therefore critical to observe. Recently, the active substance is rimonabant approved, but again be without change in diet and more exercise hardly achieved results.
Surgical intervention
If all fail conservative treatments, bariatric surgery is used, which for a body mass index of over 40 will often be the only viable treatment option.
Distribution
As the epidemiological data point to an increasing obesity in all countries where a sufficient food supply for at least parts of the population exists. Possible genetic causes are denied on the grounds that the gene pool of the population do not have in the past one to two decades of significant change. This is made by others by pointing to an effective selection pressure over millions of years in question, the selection pressure made man the master of saving energy. Thousands of years ago he was settled there, a favorable environment and convenient food crops allowed. Essentially done today otherwise. The sedentary refers to one's own four walls, including the car can be counted. So it is no wonder that hardly any of the many diets offered WOULD sustainable and that there is hardly a program for the reduction of excess weight was sustained success so far.
The obesity as a complex disease affecting all social classes and age groups (but not in each case the same mass) and is not confined to developed countries. Were in 1995 still 200 million adults worldwide are obese, they were in 2000, 300 million, of which 115 million in developing countries. Were in Austria in 1991, 8.5% of adults are obese, there were already 11% in 2000. Across Europe, 10-20% of men and 15-25% of women were obese. Here, a rise in obesity prevalence is observed towards the south and east. This is also true for Austria - with the highest proportion of overweight in the east and the lowest proportion in the Tyrol and Vorarlberg.
In Germany, for decades seen an increase in prevalence. Sun pointed in 1999 to only one-half to one third of the population to a medically desired BMI 24.9. According onwards up survey of 2003 were 12.3% of men and 11.3% of women aged 18 and over were obese (ie BMI 30 or higher). [5]
Worldwide, according to WHO, more than 300 million people with obesity. Once the problem was confined for decades on the wealthy industrialized countries, has recently been observed an increase in diet-related diseases in developing countries like India or China. There currently is seen in overweight doubling each year.
In the U.S., the CDC estimates that 30% of the population with a BMI above 30 kg / m² were obese. [6]
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