Overweight And Obesity

What is obesity?

As obesity a high body weight is referred to in relation to body size. In a narrower sense, so is only the so-called pre-obese meant, in contrast to the severe overweight, overweight or obesity. The medical specialty that deals with obesity, is the Bariatric.

What causes obesity?

Major risk factors are:

-Lack of exercise (and thus low energy consumption)
-Gratification behavior (snacking)
-Genetic factors
-High fructose content (especially in finished products) stimulates the storage of fat
-Psychological factors (eg. as depression, eating disorders, z. B. binge eating)
-Side effect of medications such. As with cortisone or some psychotropic drugs such as some -Antidepressants, antipsychotics and mood stabilizers.
-Metabolic disorders
-Lack of sleep and night work
-Food intolerance

These causes are reinforced by advertising for high-calorific: alcoholic beverages, sweets, fats, ready meals, fast food, sweets, snacks. WHO and EU want to restrict this by restrictions on advertising, especially in youth advertising.

It always affect genetic and other factors lifetime simultaneously, they by no means represent alternative modes of action is.

An indication of a genetic condition favoring of overweight found in studies on isolated grown twins ("Twin Studies"). The twins studied were similar in their weight characteristics rather their biological parents than their adoptive parents. Other research findings suggest that genetic defects in decreased secretion of the hormone can cause leptin, which plays an important role in the regulation of appetite.

Crucial (and only modifiable factors) are the living conditions, personal eating habits and exercise habits. The rate and extent of obesity in different populations have increased dramatically with the availability of food, were possible that without appropriate genetic changes in this period. An influence of living conditions can be found in every case of obesity.

For the spread of the phenomenon of "overweight" are essentially two changes of social circumstances responsible:

-Very much is the everlasting and inexpensive availability of high-calorie foods in particular.
-The decreased physical activity (professional work usually physically not so onerous, for. Example, by increasing the screen work, in leisure time high TV consumption) is responsible for ensuring that we have a lower energy consumption. The implications, of course, for every individual in varying degrees. Globally, it affects particularly the now adolescent youth. The rising youth obesity is both a result of hypercaloric diet as well as the increasing poverty of movement. It is thus more energy consumed than is needed.

According to a study by the German Institute of Human Nutrition, which was conducted in mice, there is a link between the consumption of fruit sugar (fructose) and overweight, which is not due to an increased calorie intake, but on an influence of fat and carbohydrate metabolism. In fact, people could also be demonstrated in a study that fructose is converted into body fat much faster by the body than sugar (glucose). The results of this study also indicate that fructose intake stimulates lipogenesis (fat synthesis) and the storage of fats from the diet increases.

Can lead to night work and sleep loss to obesity, is at least partially attributed to a disruption of the insulin budget: in animal studies has been shown that disturbances of the internal clock in the experimental animals led to insulin resistance.

Marriage and Partnership 
In a longitudinal study published in 2007, over 5 years with 8000 people, including 1200 pairs 12 to 28 years of age showed that newly married women and men significantly more weight rose as couples who lived together but not married. Were lowest weight gains in singles. An author of the study suggested that the marriage reducing the incentive to stay slim.

Importance of body fat distribution

Has been shown in scientific studies, that the "inner belly fat" (fat in the abdominal area) is directly linked with cardiovascular disease. A measurement of the waist circumference is considered as the simplest way to determine the amount of fat in the abdomen. A waist circumference over 88 cm for women and 102 cm in men indicates an increased risk for cardiovascular disease.

Medical sequelae

It is disputed whether already pre-obesity represents a serious health risk, as recent studies of the Centers for Disease Control and Prevention showed that so-called. Obese a higher life expectancy than the so-called. Have normal weight. Only when a true obesity (BMI of 30 and above), the mortality risk increases again. A new large meta-analysis shows that only a BMI of 35 there is an increased mortality compared with normal weight.

It is known that not only the amount of excess weight, but also the distribution of fat (waist-hip ratio) influences the risk for cardiovascular diseases. Thus, the International Diabetes Federation has set an increased waist circumference as one of the criteria for the diagnosis of metabolic syndrome in 2005.

Consequences of obesity can be:

-Cardiovascular disease
-Type 2 diabetes mellitus
-Metabolic Syndrome
-Non-alcoholic fatty liver disease
-Hormonal disorders
-Intertrigo, striae
-Unfavorable course of heart failure
-Reactive depression and social problems

In addition, you may experience:

-Joint damage (above knee joint) due to increased mechanical stress
-Premature wear of the spine (intervertebral osteochondrosis)
-Decreased fertility. 9 kg weight gain increases the probability of infertility by 10%.

Obesity can be caused not only psychologically, but can also attract psychosocial sequelae after themselves: those affected often feel excluded, or they distance themselves from socially. It is a vicious circle: in order not to introduce yourself with obesity in swimming trunks, for example, less (swimming) is driven sport.

Political measures to combat obesity

The federal government has the action "Healthy diet and exercise" launched in Germany in 2007. The aim is that 37 million overweight or obese adults and 2 million children in Germany to move to a healthier diet and exercise behavior and thereby reduce the prevalence of overweight sustainable. In the course of the debate was requested by some politicians to increase the VAT rate to 19% for candy. However, the former Consumer Affairs Minister Horst Seehofer rejected a higher rate of VAT for sweets.

In 2008, the federal cabinet has the National Action Plan IN FORM - adopted German initiative for healthy eating and exercise more. This action replaces the healthy eating and exercise and will run until the 2020th

Tackling obesity

Countless books, magazines, TV shows and websites are using the issue as obesity can be combated most effectively dealt. Common advice is intensive exercise and a change of diet (diet). The views on which diet is the right one, however, differed from author to author. Critics regard that - especially in unusual diets such as Atkins diet and raw food - a diet without medical supervision carried out carries a health risk.

Are mainly used in heavy overweight non-invasive tools such as drug appetite suppressants or drugs (eg. Orlistat) or medical devices (fat binder in the digestive tract, eg. L112) to reduce the fat intake or surgical procedures in which removes the body fat or stomach (by resection, shunt) or the reduced stomach volume is reduced (by balloon or ring).

If the excess weight is due to a pathologically disturbed eating behavior (eg, binge eating), have medical measures against obesity as a pure combat symptoms of little use if not at the same time the eating disorder in the psychological way is treated. One possible benefit represent self-help groups.

Since, in particular contributes the reduction of carbohydrates to improve all cardio-vascular risk factors, particularly diets high in fat content and low carbohydrate content (Low-Carb High-Fat Diets called.) Also effective for long-term weight reduction seem to be. Also various meta-studies highlight the efficacy of carbohydrate-reduced diets.

A recent meta-analysis, which only randomized controlled trials were considered (from 1 January 1980 to 28 February 2005) and published by the Cochrane study could show that low-carbohydrate, non-caloric-restrictive dieting are at least as effective, such as reduced-fat caloric-restrictive diets for weight loss as part of a year. Nevertheless, it should be balanced if desired positive changes in triglycerides and HDL-cholesterol compared with the potentially deteriorating LDL-cholesterol levels are desirable.

A more recent study (January 2000-March 2007), which low-carb with low-fat compared diets, showed that weight, HDL, triglycerides, and systolic blood pressure were significantly better developed in the groups who followed a low-carb diet. In addition, the dropout rate was higher in the low-fat groups. The authors conclude that a better effectiveness of low-carb diets for weight reduction.

A meta-analysis of the American Journal of Clinical Nutrition in 2013 comparing low-carb, Mediterranean, Vegan, vegetarian, low-glykemischer index, fiber-handed and high-protein diets with control diets. The authors concluded that low-carb, Mediterranean, low-glykemischer index, and high-protein diets are effective to improve cardiovascular risk factors.

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