OBESITY – ‘CENTURY DISEASE’

Obesity is a chronic disease defined by a body mass index (BMI) greater than 30 kg/m2. BMI allows a general examination of the nutrition status and is defined as the weight (in kg) divided by the square of the height (in meters). According to epidemiology studies, there is a strong relationship between body weight and mortality, and the incidence of obesity‑related conditions (such as diabetes, hypertension) increases from a BMI over 25 kg/m2. Obesity is an excessive calorie intake as compared to the energy used by an individual over a long period of time.

Classification of body weight depending on the BMI

status BMI Disease Risk
Underweight < 18,5 Increased
Normal weight 18,5 – 24,9 Normal
Overweight 25,0 – 29,9 Increased
Degree I obesity 30,0 – 34,9 High
Degree II obesity 35,0 – 39,9 Very high
Degree III obesity > 40.0 Extremely high

Science has made great progress in understanding the molecular mechanisms that control the amount of body fat, but a genetic cause for obesity has been identified only in a few cases. The “epidemic” increase of the overweight prevalence in the last decades is undoubtedly caused by a change in environment factors, promoting sedentariness and intake of high calorie food (fats, concentrated sweets) against vegetables, fruit and cereals. Obesity running in the family is not caused – except for rare occasions – by a common genetic base, but by a “legacy” including a certain diet and lifestyle (e.g. spending free time in front of the TV or doing other sedentary activities) leading to overweight.

Obesity is associated with numerous complications, many of which are clinically serious, altering the quality of life and leading to illnesses and premature death. The main complications are metabolic ones (diabetes, dyslipidemia – change of blood lipids leading to onset of atherosclerosis), cardiovascular complications (high blood pressure, coronary disease, stroke, thrombophlebitis), respiratory complications (hypoventilation, sleep apnea), osteoarticular complications (gout, joint injuries – especially those sustaining weight: knee, hip, lumbar spine), cancers (esophagus, gallbladder, colon, breast, uterus, cervix, prostate), genital complications (menstrual cycle disorders and infertility), gastrointestinal complications (bile lithiasis, non-alcoholic steatohepatitis).

Weight loss improves many of these complications and prevents occurrence of other complications. The positive effects are proportional with the degree of weight loss and are manifest even when a small step is taken to lose weight – 5% of the original weight.

Many overweight people manage to lose weight for a short period of time by keeping a diet, but the long-term success is harder to obtain. The therapeutic “artillery” is: diet, physical effort, psychotherapy, medication, bariatric surgery (the last two apply for special cases).

The first condition for success is for the subject to be motivated – he should want to make an effort to lose weight – this requires time and will power. Motivation can be reinforced by awareness – understanding the risks of being overweight and the benefits of losing weight; in addition, awareness helps the “candidate” to set realistic goals for himself/herself (e.g. a loss weight of 10% in 6 months), thus avoiding the disappointment when the results obtained are not the same as those promoted by TV commercials. This methods aims to change lifestyle and dietary habits, increasing physical activities which are essential for a durable effect. Reducing the food intake by 500 kcal/day and integrating physical activities in everyday life ensure a negative energy balance and a weight loss of about ½ kg per week and of 10% in 6 months. In order to help the patient follow the food regimen for a long period of time, it is important for the food regimen not to be very restrictive (not below 1000 kcal/day), to be varied and flexible, otherwise boredom and frustration will interfere with the initial enthusiasm. Food should satisfy the need of the individual for proteins, vitamins, minerals and should be adapted to related health problems; a diet with 1300 – 1400 kcal/day, proteins about 1 g/kg ideal weight and less than 30% calories as fat (below 50 g/day) is favored.

Example of a diet plan with 1400 kcal/day

FRUIT: apples, wild strawberries, strawberries, raspberry, blackberries, mulberry, blueberries, cherries, sour cherries, peaches, apricots, nectarine, tangerines, oranges, kiwi, avocado, papaya, pine apples, quince, wax cherries, bananas, pears, plums, grapes, pomegranate, mango, melon, grapefruit 300g
DAIRY PRODUCTS: sweet milk, curd, yogurt, fermented milk, kefir 500g
POTATOES , rice, semolina, pasta, beans, green peas weighed and boiled – 150g
BREAD or polenta: 400 g = 100 g bread 100g (4-5 slices)
MEAT lean meat (boiled or grilled): fowl, beef, veal, lamb, pork
FISH 
lean fish (boiled or grilled)
CHEESE:
feta cheese, soft cow cheese, green cheese
200g
FAT: butter, oil, margarine, cream, whipped cream – no fried or roasted flour food - 2 tablespoons
VEGETABLES: tomatoes, eggplants, bell peppers, cucumbers, peppers, zucchini, nettle, spinach, orach, sorrel, salad, lettuce, dandelion, pilewort, radish, okra, green bean, mushrooms, cabbage, cauliflower, chicory, turnip, asparagus, red cabbage, Brussels cabbage, broccoli, carrot, celery, beetroot, onion, leek, garlic, parsnip, parsley – salads may be soured with lemon or vinegar – 500g
EGGS 1 every 2 days
FORBIDDEN FOOD: sugar, flour, biscuits, cakes, pastry, chocolate, candies, jam, marmalade, halva, Turkish delight, ice-cream, sweet refresher, alcoholic beverages, unfermented wine, honey, dry fruit (plums, raisins, figs, dates) and oleaginous fruit (almonds, nuts, peanuts, seeds)

EQUIVALENT:  250 ml milk = 100 g fruit (by 10% HC)

20 g bread (one slice) = 50 g potatoes = 80 g polenta

Physical activities help obtain a negative energy balance and reduce the loss of muscle tissue during diets; in addition, it has been shown that physical activities decrease the risk of cardiovascular disease and diabetes, regardless of the effect on body weight; physical activity has other benefits as well: stimulates the respiratory function, gets the heart going, prevents osteoporosis, maintains mobility, balance and agility, increasing the chances of an independent life up to older age. To lose weight and maintain it after a diet, about 30 minutes/day of intense physical activity (jogging, aerobic, cycling) or 60-75 minute/day of moderate physical activity (e.g. fast walking) are necessary for at least 4-5 days a week. Many overweight people find it hard to do this, so at first it is best to set modest goals, and after that progressively increase the physical activities as the body resistance increases; in addition, physical effort can be integrated into our everyday life by choosing to walk instead of using a motored vehicle and climbing stairs instead of taking the elevator.

The psychological help facilitates awareness in the overweight subject of the incorrect food regimen and lifestyle that promoted weight gain. For this purpose, self-monitoring (keeping journals with calorie intake and physical activity), being aware and avoiding situations that lead to a high food intake (conflicting situations or social circumstances), social support (parents, friends, colleagues – who can be a source of permanent encouragement when fighting against weight gain) are useful.

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