Obesity refers to obesity from a body mass index (BMI) ? 30 kg / m2. Related complications include cardiovascular disease (especially in people with excess abdominal fat), diabetes, certain cancers, gallstones, fatty liver, cirrhosis, arthritis, reproductive disorders in men and women, mental disorders and, for those with BMI = 35, premature death. Diagnosis is based on the body mass index. Treatment includes lifestyle modifications (eg. As diet, physical activity and behavior) and pharmacological or surgical patients for certain measures.
The prevalence of obesity is high in the United States among all age groups (see Table: Changes in the prevalence of obesity according to NHANES); 35.7% of adults are obese. The prevalence among blacks (49.5%) the highest, compared with Mexican Americans (40.4%) and whites (34.3%). Black-skinned and Mexican-American men higher income groups are more likely to be obese than those in lower income groups. However, women of higher income groups are independent of ethnicity, rarely obese, and most obese adults do not belong to lower income groups.
Obesity refers to obesity from a body mass index (BMI) ? 30 kg / m2. Related complications include cardiovascular disease (especially in people with excess abdominal fat), diabetes, certain cancers, gallstones, fatty liver, cirrhosis, arthritis, reproductive disorders in men and women, mental disorders and, for those with BMI = 35, premature death. Diagnosis is based on the body mass index. Treatment includes lifestyle modifications (eg. As diet, physical activity and behavior) and pharmacological or surgical patients for certain measures. The prevalence of obesity is high in the United States among all age groups (see Table: Changes in the prevalence of obesity according to NHANES); 35.7% of adults are obese. The prevalence among blacks (49.5%) the highest, compared with Mexican Americans (40.4%) and whites (34.3%). Black-skinned and Mexican-American men higher income groups are more likely to be obese than those in lower income groups. However, women of higher income groups are independent of ethnicity, rarely obese, and most obese adults do not belong to lower income groups. Changes in the prevalence of obesity by age group NHANES 1976-1980 2003-2004 2007-2008 2009-2012 2-5 years 5% 13.9% 10.4% 12.1% 6.5% 18.8% 6-11 19 6% 18.0% 12-19 Yes hre 5% 17.4% 18.1% 18.4% 20-74 years 15% 32.9% 33.8% 35.7% NHANES = National Health and Nutrition Examination Surveys. Obesity and its complications result in the US each year to 300,000 premature deaths. After that, these preventable cause of death after smoking is a close second. Etiology The causes of obesity are probably multifactorial and include a genetic predisposition. Ultimately, obesity results from a long-term imbalance between energy intake and energy expenditure, including the use of energy for basic metabolic processes and the energy expenditure during physical activity. Genetic factors The BMI is inherited to about 66%. Genetic factors affect signaling molecules and receptors that use the hypothalamus and the digestive system to regulate food intake (Singnalwege in the regulation of food intake). These factors can be inherited or arise in utero due to certain conditions (so-called. Genetic imprinting). Rarely arises obesity by abnormal blood levels of peptides such. As leptin, controlling food intake, or by abnormalities of peptide receptors, for example. B. of the melanocortin-4 receptor. Singnalwege in the regulation of food intake Präabsorptive and postabsorptive signals of the gastrointestinal tract and changes in plasma nutrient levels provide short and long-term information to control food intake. Gastrointestinal hormones (e.g. glucagon-like peptide 1 [GLP-1], cholecystokinin [CCK] peptide YY [PYY]) reduce food intake. Ghrelin, distributed primarily by the stomach, increases food intake. The distributed from adipose tissue leptin informs the brain about the state of fat deposits. Leptin suppresses appetite in normal weight people, but a high leptin levels correlated with an increased percentage of body fat. For weight loss, the leptin levels may decrease and then sends a hunger signal to the brain. The hypothalamus linked various signals for producing a balanced energy balance and thus activates signaling pathways that lead to the increase or decrease in food intake: Neuropeptide Y (NPY), the agouti-related peptide (ARP), the ?-melanocyte stimulating hormone (?- MSH), the cocaine and amphetamine-related transcript (CART), orexin and melanin-concentrating hormone (MCH) increase the food intake. Adrenocorticotropic hormone (corticotropin, CRH) and urocortin brake the food intake. Genetic factors regulate the energy consumption incl. The basic metabolism, induced by food intake and thermogenesis of heat generation by nichtwillentlich controlled activity. Genetic factors have a greater effect on the distribution of body fat, v. a. of the abdominal adipose tissue (metabolic syndrome (syndrome X)) as to the determination of Körperfettmenge.Umweltfaktoren It Weight gain occurs when the caloric intake exceeds energy demand. Important determinants of energy consumption are portion size and energy density of the food. High-calorie foods (such. As processed foods), high-carbohydrate diet and the consumption of soft drinks, fruit juices and alcohol promote weight gain. Diets high in fruit and vegetable content, fiber and complex carbohydrates, with water as the principal liquid dispenser minimizes the weight gain. A life in mainly sedentary supports Gewichtszunahme.Steuernde factors Prenatal maternal obesity, prenatal maternal smoking and intrauterine growth restriction interfere with weight regulation and contribute to weight gain during childhood and later. Persistent obesity in infancy or childhood makes it difficult to decrease body weight in later life. About 15% of women take at least 9 kilograms to with each pregnancy. Too little sleep (usually <6-8 hours / night) can lead to weight gain by the mirrors for the saturation hormones that stimulate the appetite, change. Active ingredients such as corticosteroids, lithium, traditional antidepressants (tricyclics, tetracyclics, monoamine oxidase inhibitors), benzodiazepines, anticonvulsants, thiazolidinediones (eg., Rosiglitazone, pioglitazone), ?-blockers and neuroleptics promote weight gain. In rare cases, the weight increase is caused by one of the following diseases: brain damage caused by tumors (e.g., by a craniopharyngioma.) Or infections of the hypothalamus that stimulate the excessive calorie consumption hyperinsulinism caused by tumors of the pancreas hypercortisolism due to Cushing's syndrome, resulting in mostly abdominal obesity (rare cause of serious weight gain) developed hypothyroidism eating disorders at least two pathological eating habits may be associated with obesity: binge eating is the rapid consumption of large quantities of subjective loss of control Essanfalls and subsequent psychological distress (binge eating disorder). This eating disorder excludes compensatory behaviors such as vomiting. 1-3% of men and women are affected by it; in people who participate in weight loss programs, these are 10-20%. The obesity by binge eating usually has a serious expression, often much body weight is increased or decreased and there are clear psychological abnormalities. The Night-Eating Syndrome manifests itself in the absence of food intake in the morning, one in the evening hyperphagia, and insomnia with food in the middle of the night. At least 25-50% of the daily amount of food to be taken after dinner. About 10% of people who seek treatment for severe obesity, suffering from this eating disorder, but leads the nightly food for other people to massive weight gain. Rarely has a similar disorder by using a sleeping pill as zolpidem is induced. Similar but less extreme eating patterns contribute more common in a massive weight gain. For example, leads to eating the evening meal also to excessive weight gain in individuals who do not suffer the Night-eating syndrome. Complications following complications are associated with obesity on metabolic syndrome (syndrome X) diabetes mellitus cardiovascular disease liver disease (nonalcoholic steatohepatitis [fatty liver] and cirrhosis) Gallbladder Disease Gastroesophageal Reflux Obstructive Sleep Sex organs including infertility Many cancers osteoarthritis Social and psychological problems insulin resistance, dyslipidemia and hypertension (metabolic syndrome) can develop, which often leads to diabetes mellitus and coronary heart disease (metabolic syndrome (syndrome X)). These complications are more likely in patients where the fat is abdominal concentrates which have a high serum triglyceride levels, a family history of type 2 diabetes mellitus or premature cardiovascular disease or a combination of these risk factors. Obesity is also a risk factor for nonalcoholic steatohepatitis (can lead to cirrhosis of the liver) and reproductive disorders such as low serum testosterone levels in men and polycystic ovary syndrome, the (Polycystic ovary syndrome, PCOS) in women. Obstructive sleep apnea occurs when excessive neck fat constricts the airway during sleep. Breathing stops night hundreds of times for short periods of (Obstructive Sleep Apnea). This disorder is often left undiagnosed, can cause loud snoring and excessive daytime sleepiness and increases the risk of high blood pressure, heart rhythm disturbances and the metabolic syndrome. Obesity can the so-called. Cardiopulmonary syndrome of the obese (obesity hypoventilation syndrome) cause. A disabled breathing causes hypercapnia, reduced CO2 sensitivity of the respiratory center, hypoxia as well as cor pulmonale and limited life expectancy. This syndrome occurs in isolation or as a result of obstructive sleep apnea. Osteoarthritis and disorders of tendons and fascia can be caused by obesity. Even skin problems are typical, as increased perspiration and skin secretions favor fungal and bacterial growth and cause by intertrigo caused infections. Obesity predisposes sufferers for cholelithiasis, gout, deep vein thrombosis, pulmonary embolism and several types of cancer (especially colon and breast cancer). Obesity causes social, economic and psychological problems because obese people often face prejudice, discrimination, an unfavorable body image and low self-esteem. For example, people may be underemployed or unemployed. Diagnostic BMI waist circumference Partial physical constitution In adults, the BMI is defined as the ratio of body weight (kg) and the square of the height (m2) and is used for screening for overweight or obesity. A BMI of 25-29.9 kg / m2 indicates overweight, a BMI ? 30 kg / m2 to obesity (see Table: body mass index (BMI)). However, the BMI is a rough screening tool and has in many populations its limits. Some experts believe that the BMI thresholds should vary according to ethnicity, gender and age. So, for example, some complications in certain non-white populations at a significantly lower BMI than whites to develop. In children and adolescents is known as overweight if the BMI is in the age- and gender-growth curves of the Centers for Disease Control and Prevention (CDC) of the US Department of Health ? 95th percentile (CDC web site). Clinical Calculator: Body Mass Index (Quetelet's index) body mass index (BMI) * Normal Overweight Obese Extremely obese BMI 18.5 to 24 25-29 30-34 35-39 40-47 48-54 Size (cm) body weight (kg) 150-154 44-58 58-70 70-82 81-94 93-113 111-131 155-159 47-61 62-74 75-87 87-100 99-120 119-138 160-164 50-65 66- 79 79-93 93-106 105-128 127-147 165-169 54-70 70-84 85-99 98-113 112-136 135-156 170-174 87-74 75-89 90-105 105-120 119-145 143-166 175- 179 60-78 79-95 95-110 110-127 126-154 152-175 180-184 64-83 84-100 100-117 117-134 134-161 160-185 185-189 67-87 88-105 106-124 124-141 141- 170170-196 190 71-90 93-108 112-127 130-145 149-175 179-201 * A BMI below the specified values ??indicates underweight. Calculations are in metric units (kg, m), but the table shows for US readers in inches and pounds. the threshold for the weight is lower with a BMI of 23 kg / m2 for Asians, Japanese and Australian Native. In addition, the BMI can be high in muscular athletes who lack excess body fat, and it can be normal or low in formerly obese people who have lost muscle mass. Waist circumference and the presence of metabolic syndrome are more suited to predict the risk of metabolic and cardiovascular complications than does the BMI. Waist circumference, which increases the risk of complications of obesity varies by ethnicity and gender: White men:> 93 cm (> 36.6 in), in particular> 101 cm (> 39.8 in) White women> 79 cm (> 31.1 in), in particular> 87 cm (> 34.2 in) Indian men:> 78 cm (> 30.7 in), in particular> 90 cm (> 35.4 in) Indian women> 72 cm judged (> 28.3 in), in particular> 80 cm (> 31.5 in) physical constitution also, the physical constitution, the respective proportion of body fat and muscle tissue, in the diagnosis of obesity. Although probably unnecessary for clinical routine, an analysis of the physical constitution can still be helpful if clinicians are wondering if the BMI is raised because of muscle tissue or excessive fat. The percentage of body fat can be by means of a measurement of the skin fold thickness (usually over the triceps) or the circumference of the upper arm mid determine (Physical examination). With an analysis of bioelectrical resistance (BIA, bioelectrical impedance analysis), the body fat percentage can be easily and non-invasively determine. The BIA enables direct assessment of total body water percentage. Of these, the proportion of body fat is derived indirectly. The BIA method is considered very reliable for healthy people and people with just a few chronic conditions such as moderate obesity or diabetes mellitus that do not change the percentage of body water. Whether a BIA measurement for patients with implanted defibrillator carries risks, is still unclear. By hydrostatic weighing (densitometry) under water, the percentage of body fat can be determined most accurately. Because this method is expensive and time consuming, it is often used in research in clinical practice. In order for a person underwater can be weighed, it must exhale completely before immersion. Using imaging techniques such as CT, MRI and dual-energy X-ray absorptiometry (DEXA) can be the percentage and distribution of body fat is also estimated, but these tests are only in research durchgeführt.Weitere test method Obese patients should focus on the common comorbid disorders such as obstructive sleep apnea, diabetes, dyslipidemia, hypertension, fatty liver and depression are analyzed. Screening tools can help. So the clinician can z. As for obstructive sleep apnea using an instrument such as the STOP-BANG questionnaire (see table: STOP-BANG risk score for obstructive sleep apnea) or the apnea-hypopnea index (total number of apnea or hypopnea episodes occur per hour of sleep, diagnostics). Obstructive sleep apnea often remains undiagnosed, and obesity increases the risk for this disorder. Forecast unchecked, increases the expression of obesity continues to rise. The likelihood and severity of complications increase proportional to the absolute amount of fat, fat distribution and total muscle mass. After weight loss, most people return to their pretreatment weight within five years. Therefore, a lifelong obesity management program is required, like for any other chronic disease. Therapy Nutrition Management Physical Activity Behavioral therapy drugs (eg. As phentermine, orlistat, lorcaserin, phentermine / topiramate) Bariatric Surgery Even a weight loss of only 5-10% improves overall health, the risk of cardiovascular complications (for help. B to decrease. hypertension, dyslipidemia, insulin resistance) or to reduce its severity and could also lessen the severity of other complications and comorbidities such as obstructive sleep apnea, fatty liver, infertility and depression. With the support of healthcare workers, friends, family members and structured programs sufferers can lose weight and maintain their weight later. Nutrition A balanced diet is important for weight loss and weight maintenance. The strategies include: eating smaller meals and avoiding or careful selection of snacks replacing refined carbohydrates and processed foods with fresh fruits, vegetables and salads replacement of soft drinks or juices by water restriction of alcohol consumption to a moderate level consumption of fat-free or low carbon milk products are part of a healthy diet and help to provide a sufficient amount of vitamin D low fat (especially low in saturated fat), high-fiber diets with a moderate restriction of calorie intake to 600 kcal / day and the minor replacement of protein with carbohydrates long term lead to the best results , Foods with a low glycemic index (see table: Glycemic Index of some foods) and cod liver oil or monounsaturated vegetable fats such as olive oil reduce the risk of cardiovascular disease and diabetes. The use of replacement meals can help you lose weight and maintain weight; these products can be used regularly or intermittently. Diets that are too restrictive in order to maintain, not likely to lead to long-term weight loss. Diets that the calorie intake to <50% of the turnover (basal energy expenditure, BEE, review of supportive measures for nutrition: energy expenditure) limit, also described as very low-calorie diet consisting only 800 kcal / day. A very low calorie diet may be indicated in obese patients, but such diets must be supervised by a doctor, and after a weight loss food intake should be increased gradually to increase weight regain to verhindern.Körperliche activity Physical activity energy consumption, the basal metabolic rate and thermogenesis by food intake. It regulates appetite, which then develops along with calorie needs. Other advantages that are associated with physical activity, include: higher insulin sensitivity improved plasma lipid profile lower Bluddruck better oxygen utilization improved psychological well-being reduced risk of breast and colon cancer higher life expectancy strengthening exercises (against resistance) increase muscle mass. Since muscle tissue burns more calories at rest than fat tissue, increases a grown muscle mass permanently the basal metabolic rate. Physical activity that is interesting and is connected to fun is maintained more likely. A combination of aerobic exercise and strength training is better than either alone. Guidelines recommend physical activity of 150 min / week for the maintenance of health and of 300-360 minutes / week, to reduce weight and keep. The development of a physically active lifestyle can help to reduce weight and measures halten.Verhaltenstherapeutische doctors may recommend different behavioral interventions that help patients to lose weight. These include: support for self-control stress management Emergency management problem solving stimulus control support can be provided by a group, a friend or family member. Participating in a support group can improve with lifestyle changes and thus promote weight loss compliance. The more frequently people attend group meetings, the greater the support, motivation and control they get, and the greater their responsibility, which leads to greater weight loss. The self-inspection can (including the logging of the number of calories of foods) include driving a food diary, regular weighing, as well as observing and recording behavior. Other useful information for the records the time and location of food intake, the presence or absence of other people and the atmosphere. Doctors can provide feedback on how patients improve their eating habits. Stress management means helping patients to identify stressful situations and develop strategies for dealing with stress, which expressly does not apply to food (eg. As walks, meditation, breathing techniques). Emergency management includes providing concrete rewards for positive behavior (eg. As for a longer walk or waiving of certain foods). Rewards can be made by other people (eg., By members of a support group or practitioner of a health care practitioner) or (z. B. by buying new clothes or tickets to a concert) is its own reward. Even a verbal reward (praise) can be useful. Problem solving means identifying and planning ahead for situations where the risk of unhealthy diet is increased (eg. As traveling, going out to eat) or the possibility of reduced physical activity (eg. As driving over land) is. Stimulus control involves the identification of resistances to a healthy diet and an active lifestyle and developing strategies to overcome this resistance. So you can avoid about to go to a fast food restaurant or reproach sweets in the house. For a more active lifestyle can be an active hobby search (z. B. gardening), enroll in regular group activities (eg. As training courses, sports teams) are going to walk more, make it a habit to the stairs instead of the elevator to use and always choose a place in parking lots at the very end, resulting in a longer walk. Websites, applications for mobile devices and other technical equipment can also in compliance with lifestyle changes and help in weight loss. Applications can help patients to set a goal for weight loss, to monitor their progress to track food intake and physical activity aufzuzeichnen.Arzneimittel drugs (eg. As orlistat, phentermine, phentermine / topiramate, Lorcaserin) are indicated if the BMI ? 30, or when the BMI ? 27 is in patients who show complications (eg. as high blood pressure, insulin resistance). Usually a drug treatment leads to excessive weight loss (5-10%). Orlistat disables the intestinal lipase, thus reducing the fat absorption and improves blood glucose and lipid levels. Since Orlistat is not absorbed, systemic effects are rare. Flatulence, oily stools and diarrhea are common, but leave in the second year of treatment mostly after. should be taken with fatty meals three times a day 120 mg of the active ingredient. A vitamin supplement is to use at least 2 hours before or after administration of orlistat. Malabsorption and cholestasis Orlistat is contraindicated in irritable bowel syndrome and other gastrointestinal symptoms Orlistat is poorly tolerated. Orlistat is available without a prescription. Phentermine is a centrally acting appetite suppressant for short-term use (? 3 months). The usual initial dose is 15 mg / day and increased to 30 mg / day 37.5 mg / day or 2 times 15 mg / day. Common side effects include increased blood pressure and heart rate, insomnia, anxiety and constipation. Phentermine should not be used in patients with pre-existing cardiovascular disease, poorly controlled hypertension, hyperthyroidism, or a history of drug abuse or addiction. A twice-daily doses a day can help control appetite throughout the day better. The combination of phentermine and topiramate (used to treat seizures and migraine) leads to weight loss for up to 2 years. The initial dose in the dosage form with delayed release of active ingredient (phentermine 3.75 mg / 23 mg topiramate) can after 2 weeks to 7.5 mg / 46 mg, and then, if necessary, be gradually increased to a maximum of 15 mg / 92 mg to the maintain weight loss. Because of the risk of birth defects, the combination (pregnancy category X) Women of childbearing potential should be given only when it counterpoint