Obesity

Definition:
It is a medical condition characterized by increased weight due to fat, objectified by a BMI> 30 kg/m2

Prevalence:
20-25% of the population (all ages) is affected by obesity. Predominantly urban population is affected. Especially prevalent in

women. It is a primary atherogenic risk factor.

Findings weight status:
= G/Î2 BMI (kg/m2)

Body mass index values
BMI (kg/m2) Classification
<18.5 underweight
18.5 to 24.9 normal weight
25-29.9 overweight
≥ 30 obese
Risk factors and / or cause of obesity:
1. Genetic factor:
* Default 25-75%
* Family aggregation
2. Individual factors, socioeconomic and lifestyle
* Age
* Sex
* Physiological circumstances: obesity menopause adipozo-genital syndrome in adolescents
* The economic and educational
* Inactivity
* Eating behavior: calorie diet with increased intake of carbohydrates and lipids.
* Smoking
* Psychological factors
* Medicines
Classification of obesity:
I. Criteria ETIOPATHOGENY
1. Primary OB
2. OB secondary
II. Clinical criteria
1. OB android
2. OB gynoid
III. In chronological
1. OB juvenile
2. Adult OB

Clinical picture:
* Assess weight
Findings ideal weight:
* Formula Broca
G = H – 100
* Formula Lorentz
GI = (I-100) – (H-150) / 4
After these formulas, the difference between the actual weight (actual) and ideal (normal) is 15-20% corresponds to the degree of obesity between 20-30% corresponds to the degree of obesity, over 30% of grade III obesity corresponds .
* Diagnosis morphotype
* Pathogenesis (cause)
Obesity is characterized by generalized uniform deposit of fat.
Obesity located:
– Gynoid type: body fat is deposited mostly in the lower half of the body
– Type android: fat is deposited mostly in the upper half (neck and groin).
Laboratory tests:
• Fasting plasma glucose, OGTT, CT, TGL, HDL-Co, LDL-Co, ex. Endocrinology, EKG, liver function tests.
• Measurement of skin fold thickness: method of choice for assessing obesity in children.
• waist-hip ratio allows classification Android or gynoid obesity.

Complications and associated diseases
1. Cardiovascular: hypertension, coronary heart disease, stroke, venous thrombosis
2. Metabolic type 2 diabetes, dyslipidemia, insulin
3. Gastrointestinal hiatus hernia, gallstones, colorectal cancer, hepatic steatosis
4. Respiratory: dyspnea, hypoventilation, sleep apnea
5. Neurologic sciatica
6. Breast diseases: cancer, gynecomastia
7.Genitourinary polycystic ovary, urinary incontinence, reduced fertility, pregnancy complications
8. Orthopedic: osteoarthritis
9. Psychological: depression, anxiety
Overweight patient management. Strategies suggested by WHO (1998)
* Prevent Obesity
* Weight loss
– Optimizing lifestyle
– Medicines
– Bariatric surgery
* NEW WEIGHT MAINTENANCE
Treatment:
Means for lowering and weight maintenance:
. Lifestyle changes
* Diet
* Physical Activity
* Change in eating habits
. Pharmacotherapy
. Weight loss surgery (bariatric surgery)
1. Diet:
 calorie
Diets  <800 kcal/24 hours, but not zero calories) – ¯ with 1.5-2.5 kg / week kcal/24 1200 hours – ¯ of 0.5-0.6 kg / week
 diet ad libitum, hipolipidică
 hypoglucidic
 G 120-150 g / day, fruit, vegetables, and ¯ quantity of bread and potatoes
 Hipolipidic
 than 40 g L (0.7-0.8 g / kg / day), especially unsaturated.
 Normoproteic
 1 g P / kg / day – of milk fat, lean meat, in particular fish
2. Practice exercise:
Energy consumption:
* Walk slowly: 50-100 kcal / h
* Walk Faster: 300 kcal / h
* Cycling, Swimming, Tennis: 600 kcal / h
* Climbing stairs: 1,000 kcal / h
3.Drug treatment represented by anorexigenic medication.
4. Surgery
Used for:
* BMI ≥ 40 kg/m2;
* BMI ≥ 35 kg/m2 in the presence of complications of obesity;
methods of decreasing failure / maintenance applied for one year