Obesity

Last updated on September 25th, 2018
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Obesity is a number one health problem in modern society. Nowadays, over 30% of adult people in many countries of the world suffer from this disease. Unfortunately, obesity involves too many spheres: genetic, behavioral, social and economic. Therefore, its treatment requires an individual approach more than other disorders do.

It is known that obesity can be transmitted genetically from parents to children. Thus, if a child is moderately overweight in childhood, he or she will probably become obese in adulthood. Some people think it is OK that their kids are little overweight, since they are healthy. But the truth is that with aging, children may gain different health disorders (obesity may affect the cardiovascular and respiratory systems, cause gallbladder disease, diabetes and even cancer).

To diagnose obesity, doctors use a BMI (body mass index) – the body mass in kilograms to height in meter squared ratio. A patient is considered overweight, when the BMI is 25 and higher, but less than 30. If a patient has BMI 30 or even more, he or is diagnosed obese.

The body sizes change too. The main measurement is waist circumference and hips circumference ratio. Normal waist / hips ratio is considered as follows (average numbers): men – 0.85 (maximum) and women – 0.75 (maximum).

Body mass regulation

Our body constantly needs energy to work properly. Our brain, tissues, organs, muscles and bones – everything needs energy, regardless of our mealtime. Normally, our body has its storages of energy. These storages are located in the liver (glycogen) or fat tissue. The body starts using it when no food is consumed.

Obesity: risk factors

As you know, obesity increases the risk of different diseases.

For example:

  • Hypertension
  • Atherosclerosis
  • Type 2 diabetes
  • Cardiac arrhythmia
  • Cancer (prostate, breast cancer, colorectal cancer, etc.)
  • Sleep apnea
  • Breathing problems
  • Early menopause
  • Hormonal imbalance
  • Osteoporosis
  • Irregular menstruation
  • Skin pathology
  • Dementia, etc.

Some people just don’t realize that when they overeat a little bit but every single day, they gain extra weight. In general, excess 50 kcal per day might give you about 2 kg of extra weight a year. But if a person gets used to overeat regularly, then this eating behavior becomes a habit and the body weight increases year by year.

Usually, people overeat because they feel hungry all the time. This pathologic hunger can be caused by several reasons: stress, bad eating habits, shift work and others. The hunger is regulated by hypothalamus in the brain and it is a very complicated process.

Obesity treatment

Today, there are different methods, ways and tools to treat obesity. But all of them depend on the same factors: BMI, cardiovascular risks and spread of fat tissue over the body.

­All starts with hypothalamus, since it regulates the energy. This little guy collects the signals from hormones, and body organs and sends them to the central nervous system, transforming them to substances able to reduce or increase our appetite.

Those people whose BMI is 27 or above, are at risk of obesity and need a good treatment. Generally, early weight loss is quite an easy process – people lose a great amount of weight in a short time, or small amount but regularly. However, the later weight loss is usually much slower; sometimes patients hit the plateau and give up.

Here are some points that may help most overweight people to start their weight loss journey:

Day regimen

Scientists agree that morning sun provides weight loss. According the research, people, who go out in the morning sun regularly, have slim body shape, while those who enjoy sun rays after lunch – are more prone to overweight. Doctors recommend walking under the sun between 8.00 a.m. and 2.00 p.m. Sunlight can greatly change the energy balance in the body.

Diet

Firstly, let us be clear: a weight loss diet does not mean starvation. Most people do a common mistake – they eat massively all their life and when they start the weight loss therapy – stop eating at all. It is not right and even dangerous for health!

A weight loss diet means a proper diet plan based on balanced consumption of fats, carbs and proteins. These are essential substances for our body, so even if we want to lose extra pounds, we still need them. The food is the same, but the number of calories is different. For example, an average calorie supply of a healthy person is 2000 kcal per day. If an individual wants to lose weight, he should reduce this number by 500 kcal (1500-1400 kcal/day). This amount is enough to keep the body healthy.

The best way to keep a low-calorie diet and stay healthy is to eat small portions of food 4-5 times a day. Herewith, your meals should include proteins, carbs and even fats. Three main meals (breakfast / lunch / dinner) and two snacks in between are more than enough. If total amount of calories throughout a day does not exceed 1500 kcal – your body should lose about 500 grams of weight per week (minimum index).

It is not recommended to reduce the daily caloric intake to 1000 kcal per day, only a doctor can do that and a patient should stay under his supervision for the entire therapy. In addition, doctors recommend using some low-calorie products like sweeteners (saccharin, aspartame, sodium cyclamate, sucrose, etc.) and fat substitutes (imitation of taste of fatty foods, based on proteins or carbohydrates, helps to reduce fat consumption, most popular and FDA approved – Olestra).

Change in eating behavior

Some people are certain – they keep a good diet, because they start eating less than before the weight loss therapy. Usually, the picture looks like this: excess weight ⇒ diet (small amount of food) ⇒ lack of essential nutrients ⇒ stress and fatigue (deficiency of vitamins and other essential elements) ⇒ slip up ⇒ overeating. Actually, it is a vicious circle, since most overweight people take extreme measures and stop eating normally.

Weight loss therapy is not just the diet (eating low-calorie foods), but also the way you think about food. Thus, to diet properly, achieve great results and not to slip up, it is recommended to keep in mind some rules and stick to them every day:

  • Separate food intake from other activities (TV, parties, restaurants, etc.)
  • Control time of meals (take your meals at the same time daily)
  • Control the rapidity of your food consumption
  • Keep a food diary and record everything you have eaten throughout a day
  • Avoid situations when you would overeat.

If you change your thinking about food, you will see how easy the weight loss diet can be. Remember: we eat to live, not live to eat.

Physical exercises

People, who think they can lose weight by just dieting and taking special pills, are wrong. Our body is a complicated mechanism and a very smart one by the way. Modern lifestyle and technologies made us forget that in old times we used to move around a lot more than today. If we check out some historical facts and pictures, we will not see so many obese people there. Because people moved a lot. Our body needs to waste all those calories it consumes with food. This is how our Mother Nature made us.

Since today time is gold, we use cars and public transport to move, our muscles do not get enough load. Gym, sports and simply walking can help to increase your daily physical activity. The best way to start losing extra pounds is to increase the caloric consumption (to increase your energy expenditure). Actually, every single person is different and he needs an individual exercise plan, according to his body abilities.

It is important not to stress your cardiovascular system and increase your physical exercises gradually to avoid side effects. At the beginning, patients are recommended to walk or to ride a bicycle. Swimming is good too, especially for morbidly obese people. Remember: low-intensity but long-term exercises are as effective as intense exercises, performed during a short time. Moreover, they prevent trauma, joint injuries and severe muscle pain. You may attend gym, better to hire a personal trainer so that he can make up a personal exercise plan for you. Or you may increase your daily physical activities, working in the garden, jogging, walking the dog, house cleaning – anything that involves muscle work.

Surgery

“The last thing I would ever do”, say many people who suffer from obesity. Unfortunately, there are such severe forms of obesity that surgery may become the only solution. Before making any decision, people should get more information about weight loss surgeries. Gastroplasty is very popular these days. It is a fact that some people become food addicts. They cannot stop eating. Therefore, gastric bypass or biliopancreatic diversion surgeries are most common gastroplasty procedures today that solve this problem.

These procedures proved to be effective and help to lose about 50% of even 75% of the fat tissue. In fact, gastric bypass is the most popular surgery to get rid of extra pounds, since it rarely causes metabolic disorders and other side effects. Biliopancreatic bypass surgery not as popular as gastric bypass surgery, because of chronic diarrhea, hypoproteinemia and vitamins deficiency.

If person was extremely obese and managed to lose more than half of his body weight, he might need to get rid of a saggy skin. Another type of weight loss surgery is a body contouring surgery. Unfortunately, people cannot tighten their skin after a huge weight loss without this surgery.

Drug treatment

The first drug used for obesity treatment was amphetamine. This medical substance provided an appetite suppressant effect. However, doctors do not use this drug anymore, since it is very toxic and addictive. Two more drugs with similar effect were used after amphetamine – Fenfluramine and Dexfenfluramine. However, soon these weight loss medications were withdrawn from the market because many patients suffered from cardiac side effects (heart valves) after using these substances.

Nowadays, scientists keep studying different substances to reduce the body weight. Thus they are mostly focused on: caffeine and ephedrine (that increase energy levels); Methylcellulose (substance which increases the volume of food in the stomach) and Naloxone or Naltrexone (opioid receptor antagonists). But their effects on a patient’s body as well as side effects or allergic reactions are not fully understood yet.

Only two anti-obesity drugs are used these days. These drugs have been well studied, tested on patients and are approved for the treatment of obesity. They are called Orlistat and Sibutramine. These drugs, however, are not the “magic pills” and people should stick to a low calorie diet and exercises when using them.

  • Orlistat pancreatic lipase inhibitor reduces fat absorption in small intestines.

The main effect of Orlistat drug is inhibition of pancreatic lipase that helps reducing digestion of lipid (fat absorption) in the stomach and intestines. It does not reduce the appetite, but prevents the absorption of extra fat from food you eat. The dose is 120mg, used three times a day.

Orlistat concentration in the blood plasma is low. The drug is excreted with feces and urine. The benefit of Orlistat weight loss drug is that people can use them within a long time (2 years) without a break. The only side effects of Orlistat are frequent defecation and steatorrhea (excess fat in stool). There are no contraindications for use of Orlistat.

Sibutramine serotonin and noradrenaline reuptake inhibitor increases energy supplies and reduces the appetite of obese patients.

The main effect of Sibutramine drug is appetite suppression and increased metabolism. The dose is 10 mg per day. This medication stimulates satiety and helps burning the excess fat tissue (visceral fat) in overweight patients.

Sibutramine is excreted out of the body by kidneys mostly. During clinical trials of Sibutramine, the following side effects were recorded: dry mouth, insomnia, high blood pressure and tachycardia. The only contraindication for use of Sibutramine is cardiovascular or cerebrovascular disorders.

References:

BMJ-British Medical Journal. “Early to mid-life obesity linked to heightened risk of dementia in later life.” ScienceDaily. ScienceDaily, 21 August 2014

 

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