What is
obesity?
Obesity
is more than just a few extra pounds.
Obesity is the heavy accumulation of fat
in your body to such a degree that it
rapidly increases your risk of diseases
that can damage your health and knock
years off your life, such as heart
disease and diabetes.
The fat may be equally distributed
around the body or concentrated on the
stomach (apple-shaped) or the hips and
thighs (pear-shaped).
For
medical purposes, the body mass index
(BMI) is used to determine if your
weight is in the healthy range.
Doctors use BMI because it compares your
weight against your height.
- You
are in the normal range if your BMI
is between 18.5 and 25 (kg/m2).
- You
are overweight if your BMI is
between 25 and 30.
- You
are obese if your BMI is 30 or
higher.
- You
are morbidly obese if your BMI is 40
or higher.
How common
is obesity?
Around
one in four men and one in three women
are overweight, according to government
statistics.
While slightly more women than men are
obese (24 per cent versus 23 per cent),
in the last ten years there has been a
greater increase in the number of men
who are obese.
The Department of Health predicts that
if this trend continues, by 2010 around
6.6 million men will be obese compared
to 6 million women.
Stomach obesity, where weight is
concentrated on the tummy, is the most
common type of obesity and affects 30
per cent of adult men.
Obesity and stomach obesity are rapidly
increasing, especially in young people.
Around
one in three children between the ages
of 2 and 15 are overweight. While in
total more girls than boys are
overweight, a greater number of boys are
obese.
- 14 per
cent of boys are overweight.
- 17 per
cent of girls are overweight.
- 19 per
cent of boys are obese.
- 18 per
cent of girls are obese.
Government
statistics also show that children are
more likely to have a weight problem if
one parent is overweight, and this risk
is increased if both parents are
overweight or obese.
What problems can obesity cause?
Psychologically, being overweight can
affect your body image and damage
self-esteem. In some cases this can
cause social anxiety and depression.
Common physical problems include:
-
difficulties breathing
-
difficulties walking or running
-
increased sweating
- pain
in the knees and back
- skin
conditions such as acne
-
gallstones.
The following
medical conditions are also more common
in obese people than in those of normal
weight:
- high
blood pressure
- high
cholesterol
-
diseases related to hardening of the
arteries such as heart attack and
stroke (cardiovascular disease).
- Type 2
diabetes
- some
types of cancer.
These
conditions are often known as
obesity-related diseases and are some of
the most common causes of death before
the age of 75. This is why obesity
increases your risk of mortality.
What causes obesity?
Obesity
can be hereditary, so some people are at
increased risk.
Genetic factors can affect appetite, the
rate at which you burn energy (metabolic
rate) and how the body stores fat.
Examples of genetic diseases are
polycystic ovary syndrome (PCOS) and
hypothyroidism.
But even if your genes make weight gain
more likely, it is not inevitable that
you will be overweight.
Obesity develops from:
-
overeating
-
irregular meals
- lack
of daily physical activity.
This is why
obesity has trebled since 1980, when
only 6 per cent of men and 8 per cent of
women were obese. In this time our
lifestyles have changed rapidly, with
the ready availability of convenience
foods and car journeys replacing walks
to work and school.
It is lifestyle that determines how the
genes develop.
Medicines such as antidepressants,
corticosteroids and oral contraceptives
can also cause weight gain.
When is obesity dangerous?
If you
have a BMI of more than 25, you should
lose weight. The same is true if you
carry too much fat around the middle
because this increases your risk of
heart disease and diabetes.
Your waist should be no more than
102cm/40" (men) or 88cm/35" (women),
with stricter targets for Asians of less
than 90cm/35" (men) and 80cm/32"
(women).
To reduce your risk of cardiovascular
disease further, you should watch your
waistline and make sure it's no more
than 94cm/37" (men) and 80cm/32"
(women).
How
is obesity treated?
Initially, your doctor will suggest you
lose weight through a change in diet and
an increase in physical exercise.
Clinical guidelines are to aim for a
weight loss of between 5kg and 10kg
(11-22lb) over three months. This equals
about 0.5kg or 1lb per week.
If you are obese, losing this amount
will have a positive effect on your risk
of cardiovascular disease and diabetes
by reducing blood pressure, blood sugar
(glucose) and cholesterol levels.
A dietitian can help you lose weight by
giving nutritional advice on buying and
preparing foods and designing a
weight-loss plan.
Weight-loss plans are usually based on a
low-fat diet of between 1500 and 2000
calories a day, which will result in a
weight loss of 5 to 10kg in more than 90
per cent of obese people.
How
do diet and exercise help?
Your body needs a certain amount of
energy (calories) each day. Excess
energy is stored as fat. The more
active you are, the more calories
your body needs.
By eating less than your body needs
and exercising more, you force your
body to use its existing fat stores
for energy.
By burning excess fat, you lose
weight.
When is
medical treatment necessary?
Your
doctor will usually only consider
medicines for weight-loss if changes to
diet and exercise are not effective.
Three medicines for weight-loss are
available on the NHS: orlistat (Xenical),
sibutramine (Reductil) and rimonabant (Acomplia).
You will still need to follow a
calorie-controlled diet and start an
exercise plan while taking these drugs.
Treatment with Xenical and Reductil will
only be continued after three months if
you have lost 5 per cent of your body
weight in that time.
While these medicines can help you to
lose weight, there may be a gradual
reversal of any weight loss after you
stop treatment. To help avoid this, you
will need to continue with changes to
your diet and exercise levels.
Medicines for obesity are not yet
recommended for young people under the
age of 18 because we have no knowledge
of possible negative effects on puberty
and later eating behaviour.
Orlistat (Xenical)
Xenical reduces the amount of fat
that is absorbed from the bowels.
Your doctor can prescribe this drug
if you are obese, or if your BMI is
higher than 28 and you have a
related risk factor such as high
blood pressure, high cholesterol or
diabetes.
Common side-effects include
headache, urgent or increased need
to open the bowels, flatulence
(wind) with discharge, and oily or
fatty stools.
Sibutramine (Reductil)
Reductil acts on chemicals in the
brain called serotonin and
noradrenaline to make you feel
fuller for longer.
Your doctor can prescribe this drug
if you are obese or have a BMI
higher than 27 with a risk factor
for heart disease, and you haven't
been able to lose weight through
lifestyle change within the last
three months.
Common side-effects include loss of
appetite, constipation, dry mouth
and problems sleeping.
Rimonabant (Acomplia)
Acomplia is a new drug that blocks
CB1 receptors in the brain and fat
tissues that control appetite and
the desire for sweet and fatty
foods. This reduces appetite and
cravings for these types of foods.
A doctor can prescribe this drug if
you are obese or have a BMI higher
than 27 with a risk factor for heart
disease. The NHS guidelines say it
should only be given to people
who’ve tried Xenical and Reductil
and they haven’t worked.
Common side-effects include nausea,
nose and throat infections, and
psychological problems such as
depression and anxiety. For this
reason, this medicine isn’t suitable
for people who are vulnerable to
mental health problems.
What about
weight reduction surgery?
You can
be considered for weight-loss surgery if
you are morbidly obese, or if you have a
BMI between 35 and 40 and have a risk
factor for an obesity-related disease.
This type of surgery is known as
bariatric surgery.
Gastric banding
Gastric banding or 'lap banding'
limits the capacity of the stomach
so you feel full after eating a
small amount of food.
Keyhole surgery is used to tie an
inflatable band around the top part
of the stomach, creating a small
pouch at the top. This limits the
amount of food your stomach can
hold.
Food then slowly passes from the
pouch into the lower part of your
stomach and on into your digestive
system.
The operation is reversible.
Gastric bypass
Gastric bypass is permanent surgery
on the stomach to reduce the length
of the digestive tract and stop food
being absorbed.
A small pouch is created at the top
of the stomach.
Part of the intestine is then
grafted to the top of this pouch so
food bypasses the stomach and much
of the intestine, meaning it can't
be digested.
Gastric balloon insertion
Gastric balloon insertion is a less
permanent type of surgery.
A balloon is placed on the end of a
thin, flexible tube called an
endoscope. It is inserted into your
stomach via your mouth.
Liquid or air is then pumped into
the balloon so it partially fills
the stomach. This creates a feeling
of fullness.
The balloon is usually removed after
six months.
Complications
of weight-loss surgery include the usual
risks of surgery and long-term digestive
problems such as nausea, heartburn,
vomiting and diarrhoea.
After surgery your body absorbs less
food, but it will also absorb less
vitamins and nutrients. This means you
are at greater risk of diseases caused
by vitamin and mineral deficiency such
as anaemia and osteoporosis.
In
the long term
While
plenty of diets and slimming products
claim to offer quick fixes, obesity is
not something that can be cured or
brought under clinical control within a
few weeks or months.
Treatment such as diet and exercise may
need to continue for years.
Weight-loss plans from a GP or dietician
are an effective way to lose weight, but
a greater challenge is to achieve a way
of life that maintains weight and
reduces the chances of putting it back
on.
This can only be achieved by permanently
changing your eating and exercise
habits.
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For more Consult at
aerodoctor@pilots-medical.com
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