Obesity

DEFINITIONS

Obesity is excess weight as a result of the accumulation of excess body fat.

Everyone needs some body fat to store energy as heat insulation, shock absorber and other functions.
The average woman has more body fat more than men. Comparison between the normal body fat weight is approximately 25-30% in women and 18-23% in men.
Women with more body fat than 30% and men with more body fat than 25% are considered obese.

Someone who has a weight 20% higher than the midpoint of the range of normal weight is considered obese.
Obesity is classified into 3 groups:
- Obesity lightweight: excess weight 20-40%
- Obesity is: being overweight 41-100%
- Obesity weight: excess weight> 100%.
Severe obesity was found as much as 5% of the people who are fat.

Attention not only to the amount of fat filled, but also to the location of body fat accumulation.The pattern of body fat distribution in men and women tend to differ.
Women tend to accumulate fat in the hips and buttocks, so that gives pear. While the men usually accumulate fat around the abdomen, thus providing a picture like apples.
But it is not an absolute; sometimes on some men looked like a pear and some women look like apples, especially after menopause.

Someone who accumulated a lot of fat in the abdomen may be more susceptible to various health problems associated with obesity. They have a higher risk. Pear picture better than the picture of an apple.

To distinguish between these two images, has found a way to determine whether a person is shaped like an apple or pear, which is by calculating the ratio of waist to hip.
The waist is measured at the narrowest point, while the hip was measured at the widest point; and waist size divided by hip size.
A woman with a waist size of 87.5 cm and 115 cm hip size, has a waist-hip ratio of 0.76.
Women with a ratio of waist: hip more than 0.8 or men with a ratio of waist: hip more than 1, say an apple-shaped.

CAUSE

Scientifically, obesity is due to consuming more calories than needed by the body.
Cause of the imbalance between calorie intake and burning is still not clear.

Occurrence of obesity involves several factors:

1. Genetic factors.
Obesity tends lowered, so alleged to have genetic causes. But the family members not only share genes, but also food and lifestyle habits, which can promote obesity.
Often difficult to separate the lifestyle factors with genetic factors.
Recent research shows that the average genetic factors have an impact for 33% of one's body weight.

2. Environmental factors.
Gene is an important factor in many cases of obesity, but the environment also plays a significant role. These environments include behavioral / lifestyle patterns (eg what to eat and how many times a person to eat and how their activities).
A person certainly can not change the genetic pattern, but he can change eating and activity patterns.

3. Psychological factors.
What's in a person's mind can affect eating habits.
Many people reacted to his emotions by eating.

One form of emotional disturbance is a negative self-perception. This interference is a serious problem in many young women who suffer from obesity, and can cause excessive awareness of kegemukannya and discomfort in social interaction.

There are two abnormal eating patterns that could be the cause of obesity is eating in a number of very many (binge) and eat at night (syndrome eating at night).
Both diets are usually triggered by stress and disappointment. Binge similar to bulimia nervosa, in which a person eat in a number of very large, the difference in this case did not binge followed by spitting back what has been eaten. As a result of calories you consume so much.
In the syndrome eating at night, is the reduced appetite in the morning and followed by excessive eating, agitation and insomnia at night.

4. Health factors.
Some diseases can cause obesity, including:
- Hypothyroidism
- Cushing's syndrome
- Prader-Willi syndrome
- Several neurological disorders that can cause someone a lot of eating.

5. Drugs.
Certain medications (eg steroids and some anti-depressants) can cause weight gain.

6. Growth factor.
Adding the size or number of fat cells (or both) will increase the amount of fat stored in the body.
Obese people, particularly those of obesity in childhood, can have sampak fat cells 5 times more than people whose weight is normal.
The number of fat cells can not be reduced, because the weight loss can only be done by reducing the amount of fat in each cell.

7. Physical activity.
Lack of physical activity is probably one of the main causes of the increasing incidence of obesity in the middle of a prosperous society.
People who do not actively require fewer calories. Someone who tend to consume high-fat diet and physical activity are not balanced, will be obese.

SYMPTOMS

Excessive accumulation of fat below the diaphragm and chest wall in the can pressure the lungs, causing breathing problems and shortness of breath, even if the patient is only a mild activity.

Respiratory problems can occur during sleep, causing cessation of breathing for a while (sleep apneu), so that by day patients often feel sleepy.

Obesity can cause a variety of orthopedic problems, including lower back pain and aggravate osteoarthritis (particularly in the hip, knee and ankle).

Common skin disorders.
The obese person has a body surface is relatively narrow compared with their weight, so body heat can not be disposed of efficiently and sweat more.

Often found in edema (swelling due to accumulation of fluid) in the legs and ankles.

COMPLICATIONS

Obesity is not only unsightly but the eye is a terrible health dilemma. Obesity is directly harmful to one's health.
Obesity increases the risk of some chronic diseases such as:
- Diabetes type 2 (arising in adolescence)
- High blood pressure (hypertension)
- Stroke
- A heart attack (infarct myocardium)
- Heart failure
- Cancer (certain types of cancer, such as prostate cancer and colon cancer)
- Gall bladder stones and bladder stones
- Gout and arthritis gout
- Osteoarthritis
- Sleep apneu (failure to breathe normally while asleep, causing reduced oxygen levels in the blood)
- Pickwickian syndrome (obesity accompanied by facial redness, underventilasi and sleepy).

Diagnosis

Measuring body fat.

Not easy to measure a person's body fat. The following methods require special equipment and conducted by trained personnel:
- Underwater weight, weight measurements performed in water and then body fat is calculated based on the amount of water remaining.
- BOD POD is an egg-shaped room that has been computerized. Once a person enters BOD POD, the remaining amount of air used to measure body fat.
- DEXA (dual energy X-ray absorptiometry), resembling bone skening. X-rays are used to determine the number and location of body fat.

The following 2 ways simpler and not complicated:
- Term of skin, skin fold thickness in several parts of the body is measured by term (a metal tool resembling a forceps).
- Bioelectric impedance analysis (analysis bioelektrik prisoners), the patient stand on a special scale and number of electric current flowed harmless to the body and then analyzed.

Examination can give inaccurate results if not done by experts.

Table weight-height.

This table has been used since a long time to determine whether a person overweight.
Table usually has a weight range for a given height.

Problems that arise is that we do not know where the best tables should be used. Many tables can be used, with a range of different weight. Some tables include frame size, age and sex, the other tables are not.
Deficiency of this table is the table does not distinguish between excess fat and excess muscle.Seen from the table, a very muscular person may appear obese, when in fact it is not.

Body Mass Index (BMI).

BMI is a measurement that connects (compare) with high weight loss.
BMI is a mathematical formula where the weight (in kilograms) divided by height (in meters) square.
Someone said if you are obese have a BMI value of 30 or more.

TREATMENT

Restricted calorie intake and increasing physical activity is the most important component in weight management. Both these components are also important in maintaining weight after weight loss.
Must be a change in the pattern of physical activity and begin to live a healthy eating habits.

First step in treating obesity is to assess the patient's body fat and health risks in a way to calculate BMI.
Health risks associated with obesity will increase with the increase in BMI:
- Low Risk: BMI <27
- High risk: BMI 27-30
- High Risk: BMI 30-35
- The risk is very high: BMI 35-40
- The risk is very high: BMI of 40 or more.

The type and weight training and calorie restriction on the amount each person differently and given medication tailored to the circumstances of the patient.
- Patients with low health risk, the diet was (1200-1500 calories / day for women, 1400-2000 calories / day for men) along with sports
- Patients with high health risk, low-calorie diet (800-1200 calories / day for women, 1000-1400 calories / day for men) with sport
- Patients with high health risk or very high, get an anti-obesity drug with a low-calorie diet and exercise.

Possible weight loss long-term success will be higher if a doctor working in a professional team involving dieticians, psychological and professional sports.
This team will help the patient to:
- Achieving lifestyle changes permanent
- Monitor the development of the patient
- Provide support and encouragement
- Find and help reduce sources of stress
- To prevent recurrence.

Drugs.

There are 2 main types of drugs used to treat obesity:

1. Drugs that reduce appetite, for example fenfluramin, deksfenfluramin, fentermin.
2. Drugs that block the absorption of nutrients from the intestine, for example orlistat (blocking fat absorption in the intestines).

Feelings of hunger and satiety regulated by brain chemicals called neurotransmitters. Examples of neurotransmitters are serotonin, norepinephrine and dopamine.
Anti-obesity drugs are appetite suppressants work by increasing levels of this neurotransmitter in the junctions between nerve endings in the brain (these junctions called synapses).Fenfluramin (fen) and appetite suppressants deksfenfluramin primarily by increasing the release of serotonin by nerve cells. But fen and deksfen has withdrawn from the market since September 1997 because these drugs cause pulmonary hypertension and fen caused heart valve damage.

Fentermin suppress appetite by causing the release of norepinephrine by nerve cells. Fentermin it can still be used to treat obesity, but only for short-term (several weeks).
Side effects of this drug are headache, insomnia (difficulty sleeping), irritability and restlessness.

Choosing a weight-loss program is safe and successful.

The elements that must be considered in choosing a weight-loss program:

1. Diet should be safe and meet all the recommended daily requirements (vitamins, minerals and protein). Diet to lose weight should be low in calories.
2. Weight-loss program should be directed to lose weight slowly and stable.
3. Before a weight-loss program started, conducted a thorough health examination.
4. Programs that follow should include weight maintenance after weight loss is achieved.Weight maintenance is the hardest part of weight control.
The selected programs should include changes in eating habits and physical activity permanently, to alter the lifestyle of the past to support the occurrence of weight gain.
This program should be conducted behavioral changes, including education in healthy eating habits and long-term plan to deal with weight problems.

Obesity is a chronic condition (chronic). Obesity is often considered a temporary condition that can be solved for several months with a strict diet.
Weight control is a long term business. To be safe and effective, any weight-loss program should be directed to long-term approach.

Surgery should only be done on the weight obesity. In general, this surgery is safe and efficient.