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What is obesity? |
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Obesity is a heavy accumulation
of fat in the body's fat cells to such a serious degree that
it rapidly increases the risk of obesity-associated diseases
and mortality.
The fat may be equally distributed on the body, on the
stomach (apple-shaped) or on the hips and thighs
(pear-shaped). An excellent method to measure obesity and
overweight is the Body Mass Index (BMI). It is calculated as
your weight (in kg) divided by your height (in metres)
squared. People of average weight are considered to have a
BMI between 18.5 and 25 (kg/m2), and people with
a BMI of 25 to 30 (kg/m2) are considered
overweight, while people with a BMI of over 30 (kg/m2)
are considered obese. |
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How common is obesity? |
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Obesity is found a little more among men than women. Stomach
obesity is more frequent and occurs in 30 per cent of adult
men and, to a lesser degree, in adult women. Obesity and
stomach obesity are rapidly increasing, especially in young
people.
The occurrence of obesity has increased by five fold since
the Second World War and many obesity experts now believe we
are seriously at risk of developing an obesity epidemic in
the Western world in the next generation or even sooner..
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What are the serious obesity-related diseases? |
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Most
importantly, being overweight and obese may cause several
psychological problems like a feeling of inferiority, often
caused by discrimination. Furthermore, many physical
problems are related to obesity, like difficulties in
breathing, personal hygiene, pain in the knees and back and
skin problems.
People suffering from obesity more frequently have high
blood pressure and diseases related to hardening of the
arteries, with blood clots in the heart and the brain. Other
related problems include non-insulin dependent diabetes,
gallstones, some types of cancer, difficulties in mobility
and increased risk of mortality. |
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What causes obesity? |
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Obesity can be hereditary, hence some people are at
increased risk. However, obesity only develops from
overeating, irregular meals and lack of daily physical
activity.
Many people think that when a disease is hereditary, it is
inevitable that you will suffer from the condition but this
is not true.
If the people in Europe had grown up in China with plenty of
non-fat foods and hard daily work in the rice fields, only a
few of them would be overweight or fat. It is lifestyle
which determines how the genes develop. The fact that the
existence of obesity has increased by five times since the
Second World War, is hardly due to a change of our genes. On
the contrary, our lifestyles have changed rapidly.
Besides genes, food and physical activity, it is possible
that other so far unknown elements may play a part. |
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When is obesity dangerous? |
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With a
BMI of more than 25, it is advisable to change lifestyles
and lose weight, especially if it is stomach obesity
(apple-shaped). The waist circumference may be used in order
to determine if you are apple-shaped. Men with a waist
circumference of more than 94cm (37in) and women with a
waist of more than 80cm (31.5in) should not further increase
their weight. An increased risk of obesity-related diseases
is present with a waist circumference of more than 102cm
(40in) for men and more than 88cm (34.6in) for women. Test
if you are apple or pear shaped here. If your BMI is more
than 30, it is required that you lose weight. |
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How is obesity treated? |
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A
weight loss of 5 or 10kg among obese patients has a very
positive effect on the risk of heart and blood-vessel
diseases. The weight loss will not only reduce blood
pressure and blood-cholesterol, but also have a beneficial
impact on obesity-related diseases.
The help of a dietitian can result in weight loss of 5 to
10kg in more than 90 per cent of patients put on regular
diets of, for instance, 1500 to 2000 kilocalories per day,
based on calorie-counting.
Another option to attain the same result involves changing
to an unlimited consumption of low-fat foods. After losing
weight, thorough guidance on shopping and preparation of
foods with a fat-energy-percentage of 20 to 25 per cent is
of paramount importance, in order to stop the weight being
put back on.
Furthermore, it is important to increase daily physical
activity. Patients, who do not reach a satisfactory
weight-loss on a diet, may be subjected to medical or
surgical treatment. |
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When is medical treatment necessary? |
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Obviously, not everybody needs medical treatment. If an
obese patient loses weight by diet and exercise, there is no
need for such treatment. Furthermore, many people do not
want to have medical treatment
The main problem is to limit the treatment to persons who
actually need it such as:
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those with a BMI of more than 30kg/m2 who have
not reduced weight by diet changes, exercise or lifestyle
changes.
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those with BMI of more than 28kg/m2 and the
presence of risk elements or complications.
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those with BMI of more than 28kg/m2 who have
experienced a previous rapid increase of weight.
Medication for obesity is not yet recommended for children
as we have no knowledge of possible negative effects on
puberty and later eating behaviour. |
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How to maintain your weight after weight loss? |
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Weight
loss is obtained most effectively by diets provided by
professionals. However, by far the greater challenge is
achieving a way of life that maintains the weight and
reduces the chances of putting it back on.
Obesity is a disease that you cannot expect to be cured of
or be under clinical control within a few weeks or months.
Thus, short-term treatment with medicines should be rare.
Medical treatment must be expected to be necessary for
years, possibly your whole life, in order to maintain the
weight-loss and reduce illness. However, there is a lack of
experience in medical treatment of obese patients for more
than two years.
The information concerning efficiency and safety of
medicines used in combination with other medicines is very
limited. Until we obtain more knowledge, medical treatment
should be reserved for patients with high risk of
complications, or patients who already have complications,
for whom it is very important to maintain their weight. |
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Which medicines may be used for medical treatment? |
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Medications for obesity treatment contribute to weight loss
and increase the number of patients who achieve a weight
loss of more than 5 or 10kg. After the weight loss has been
completed, the medicine helps prevent the patient from
regaining the weight.
Medicines that reduce appetite help the patient eat less and
stick to their diet. They work even without dieting but the
loss is larger when there is a combination of the two. This
is possibly due to an increased feeling of fullness and the
reduction in hunger pangs because of the medication.
Some appetite-reducing medications increase the burning of
calories, which intensifies the appetite reducing effect.
Another type of medication called orlistat (Xenical) reduces
the fat absorption from the bowels. It is only active in the
bowels and, therefore, doesn't have the typical side effects
frequently seen for appetite-reducing medications. For
efficient diets, where patients with a BMI above 35kg/m2
achieve a weight loss of about 15kg within a period of six
months, appetite reducing medications and other medicines to
treat obesity may contribute to an extra weight loss of 3 to
6kg. Medication should only be used in a treatment program
including diet, exercise and lifestyle changes. |
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