yogabook / pathologie / obesity

obesity

Adiposity (obesity)

Definition of

According to the WHO definition, obesity is a BMI (weight divided by height squared) greater than 25; above 30 it is considered to require treatment and is called obesity. Age, gender, physique and muscle/fat mass ratio are not included in the BMI, which is why it is a very rough and sometimes quite erroneous value: many muscular, well-trained and endurance-trained athletes with a rather low body fat percentage and, in particular, little critical abdominal fat (muscles have a high fat content) are overweight. According to the BMI, many muscular and endurance-trained athletes with a rather low body fat percentage and especially little critical abdominal fat (muscles have a higher weight than fat) have obesity, e.g. Vladimir Klitschko with 112 kilograms at 2.02 meters tall (BMI 27.45), Oliver Kahn with 1.88 meters and 91 kg (BMI 25.7)! Indicators or measurements for the proportion of body fat and its distribution are for example

1. Abdominal circumference
2. Waist-hip ratio
3. Caliper skin fold measurement
4. Bioelectrical impedance analysis BIA (usually as a scale, not particularly accurate, also dependent on hydration)
5. Hydrostatic weighing (impractical)
6. Dual Energy X-ray Absorptiometry (DEXA, approx. 20 min, 50-70 , very accurate)

The Body Adiposity Index (BAI) = (hip circumference in cm) / (body length in m) to the power of 1.5 – 18 is therefore more useful than the BMI. However, all current measures do not include other important factors such as bone density, bone and joint diameter, shoulder width (differences in the decimeter range!). Due to the increased morbidity and mortality, obesity is not just a deviation from the norm but a chronic disease. In 2009, 51% (47% in 1999) of the German population was overweight, 15% of whom were obese. Obesity is largely a disease of industrialized nations with reduced physical activity and an oversupply of inexpensive food and luxury foods. Increasingly, emerging countries are also affected. Obesity is categorized according to BMI:

1. Grade 1: 30 – 25
2. Grade 2: 35 – 40
3. Grade 3: over 40(obesity permagna or morbid obesity)

Apart from special forms such as the truncal obesity typical of hypercortisolism, a distinction is made between two fat distribution patterns:

1. Android obesity: Male fat distribution pattern with emphasis on the abdomen, also known as abdominal, central or visceral obesity or „apple type“.
2. Gynoid obesity: Female fat distribution pattern with emphasis on the hips, also known as peripheral or gluteofemoral obesity or „pear type“.

Android obesity seems to harbor the greater health risks.

ICD E66

Cause

1. Predominantly positive energy balance in the longer term: imbalance between exercise/physical performance and the amount and type of food and stimulants consumed
2. Increased consumption of sugary drinks
3. Increased consumption of saturated fats

Predisposing

1. Sedentary occupation
2. Mechanized locomotion (car, elevator, etc.)
3. sedentary leisure activities
4. Psychogenic overeating, i.e. eating as a means of survival and a substitute: boredom, loneliness, frustration, stress, rejection, problems, etc.
5. Oversupply of readily available foods and luxury foods of dubious health quality, especially those low in fiber and those that are highly processed and easily absorbed
6. detrimental upbringing and conditioning, e.g. „eat your plate empty“ as a value, „eat to become big and strong“, supposed ethical motivations with comparisons to countries with hunger…
7. Irregular meals
8. Fast food with several detrimental effects: Appetite stimulant, portion size, speed, reduced nutrient content,.
9. Appetizer and flavor enhancer
10. Food additives that stimulate the appetite other than through the sense of taste: visually, olfactorily
11. Advertising in the food and beverage industry
12. spoiled and altered sense of taste
13. repeated diets (improvement of nutritional evaluation in response to qualitative or quantitative nutritional deficiency)
14. Cultural influences and developmental factors, e.g. obesity as a sign of prosperity and prestige, compensation for longer periods of hunger, e.g. after wars …
15. Sports in which body mass is an important advantage
16. Low level of schooling and education
17. low social status (level of education, household income and occupational status), which is even more pronounced for women
18. Genetic disposition (basal metabolic rate, food utilization, fat distribution pattern)
19. Educational factors and family culture (independent of genetic factors, proven in adopted children)
20. Secondary in hypothyroidism (underactive thyroid), hypercortisolism of various causes, hyperinsulinism
21. possibly as a result of infection with adenovirus type Ad-36 (transforms stem cells into fat cells)
22. Side effects of medication: Insulin, hormonal contraceptives, antidepressants, neuroleptics, corticosteroids, beta blockers
23. Consequence of discontinuing medication or stimulants: Smoking, sympathomimetics, Viagra
24. Prenatal factors: e.g. type 2 diabetes mellitus in the mother
25. Lack of sleep

Diagnosis

1. Body height and weight, waist circumference
2. Clinical examination
3. Fasting blood glucose
4. Cholesterol, triglycerides
5. Uric acid
6. Creatinine
7. TSH
8. Albumin/creatinine ratio
9. ECG
10. Medical history of eating habits, exercise habits, medical history, psychological factors

Symptoms

1. Limited physical performance
2. Shortness of breath, dyspnea
3. Avoidance behavior towards exercise and exertion, which leads to a vicious circle
4. Heartburn, reflux
5. Hyperhidrosis (increased internal exertion, poorer heat dissipation due to the insulating fat)

Complications

1. Diabetes mellitus
2. arterial hypertension
3. Cardiovascular diseases: CHD, angina pectoris, myocardial infarction, apoplexy, vascular dementia.
4. Metabolic disorders such as hypercholesterolemia
5. Hypertension
6. Arteriosclerosis
7. Reflux
8. Breast cancer
9. Osteoarthritis
10. Degenerative WS diseases, disc hernias
11. Gout
12. Gallbladder diseases, gallstones
13. Obstructive sleep apnea
14. Alzheimer’s disease
15. Psychological, social, professional consequences
16. Increased joint wear, especially knee joint, hip joint and ankle joint
17. Sleep apnea (obstructive), consecutive lack of energy and psychological changes
18. Varicose veins, increased risk of thrombosis

Therapy

1. Sustainable improvement in eating behavior, quantitatively and qualitatively, long-term negative energy balance from – 500 kcal / d, sufficient drinking quantity of at least 2.5 l / d
2. Sustainable improvement in exercise behavior (1 kg of fat to be lost corresponds to 7 weeks of jogging for 15 minutes a day)
3. Psychotherapy, possibly therapy for an eating disorder
4. Involvement of the surrounding area if necessary
5. Factors favoring success are: higher intelligence, higher social status, late onset of obesity, severe subjective complaints, measurable health problems, strong personality. An eating disorder is a major obstacle. In the long term, 10-20% of weight reductions are successful (in the sense of 50% of the original weight reduction)