Obesity: Get informed

Obesity has become a serious public health problem in recent years and has been affecting younger and younger individuals, as well as causing complications that are leading to excess mortality.

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Obesity

Definition of obesity according to BMI (Body Mass Index)

From a medical point of view, obesity is defined as "excess weight through an abnormal or excessive fat accumulation".

Fat tissue has two ways of storing fat: either by increasing the amount stored in each of the fat cells or by multiplying the number of fat cells. It then becomes difficult to remove excess cells.
To assess the severity of obesity, the WHO (World Health Organization) has defined categories based on the Body Mass Index (BMI) according to the following formula: BMI = Weight/Height².

IMC Interpretation

< to 16.5 Malnourished
16.5 to 18.5 Slim
18.5 to 24.9 Normal build
25 to 29.9 Overweight
30 to 34.9 Moderate obesity
35 to 39.9 Severe obesity
> 40 Massive or morbid obesity

In addition, the measurement of the umbilical perimeter, more commonly referred to as the waist circumference, makes it possible to identify excess fat in the abdomen. When this measurement is greater than 88 cm in women (outside pregnancy) or 102 cm in men, abdominal obesity is considered to exist.

Finally, gynaecological obesity is defined as excess fat mainly in the thighs, as is usually the case for women. Android obesity occurs when fat deposits are mainly located in the abdomen (abdominal obesity).

>> Living with obesity: talk about it on the forum

The causes of obesity

Several factors can be responsible for obesity: diet, heredity, sedentary lifestyle, hormonal or glandular disorders, psychological and/or sociological disorders, or even certain medications.

Environmental factors and behavioral changes are a major factor in the increase in obesity due to overeating and lack of physical activity. In addition, the destructuring of meals, physical inactivity and increased snacking promote weight gain.

Genetics also plays an important role. It is proven that a child with an overweight or obese parent will be at a 40% risk of being overweight or obese themselves. If both parents have weight problems, then the child's risk of being overweight or obese increases to 80%. It drops to 10% if both parents are of normal build.

Complications of obesity

In addition to the rheumatological, respiratory and social consequences, the major risks associated with overweight and obesity are diabetes and cardiovascular disease. Overweight and obesity increase the prevalence of high blood pressure by 2.5 and 4 times, respectively; dyslipidemia by 2 and 3 times (hypercholesterolemia or mixed or isolated hypertriglyceridemia), respectively; and type 2 diabetes by 3 and 7 times, respectively. Currently, one third of obese people receive treatment for hypertension and 14.5% for diabetes.

Obesity treatments

A healthier lifestyle

Since one of the main objectives is weight loss, nutrition is a central part of patient care. The objective is to institute new eating habits by diversifying food intakes and reducing the energy density of food, while taking into account the traditions, tastes and economic possibilities of the individual. A nutritionist or dietician can help the individual adopt new habits.

Regular physical activity is very beneficial (at least 30 minutes of physical exercise every day, including walking, cleaning...). It is important to set realistic goals and gradually increase the daily amount of exercise to at least 30 minutes.

Psychological support may be considered because depression may lead to obesity.

In general, recommendations should be progressive and priority because it may be unreasonable for an individual to completely change his or her lifestyle in the first six months. The individual needs to be able to set short-term goals, such as losing 1.5 pounds a month and to keep up with the motivation.

Drug treatment

In order to avoid abuse and accidents with early drugs (including amphetamine derivatives), new molecules developed to combat obesity are prescribed under strict conditions.
Orlistat is one of the most widely used drugs today. It blocks the action of enzymes that are involved in fat digestion and thus prevents fat absorption. Due to its mechanism of action, the majority of side effects are digestive side effects.

Surgery

There are several types of surgical procedures that aim to reduce the absorption capacity of the stomach: sleeve gastrectomy, mini gastric bypass, gastric bypass or gastroplasty (gastric band).

It is highly recommended and encouraged to speak to your doctor to find the solution that best suits your lifestyle.

>> Click here to read the feedback of a Carenity member about their gastric band

Advice after surgery

In order to readjust the stomach after surgery, the intake of liquid food is recommended first. Then, gradually, more solid foods will be reintroduced into the diet.

In general, patients are advised to:

- ingest small amounts of food and chew the food well;
- eat meals sitting down and in peace;
- stop eating as soon as a feeling of full is sensed;
- do not drink at the same time as eating food;
- eat a balanced and varied diet to avoid nutritional deficiencies;
- maintain an adequate protein intake;
- avoid soft drinks, sugary drinks, sauces and fries, fatty foods, and sweets.

Some stomach toxic drugs such as aspirin, anti-inflammatory drugs and corticosteroids should be avoided. The acidity of these drugs can weaken and attack the stomach lining. So don't forget to talk to your doctor about these concerns.

Bariatric surgery and pregnancy

Bariatric surgery is not commonly an issue or concern when considering pregnancy. Nutritional observation may be advised or required and it is recommended to speak to your doctor about any concerns.

Obesity figures

Obesity is a real public health issue. In the United States, in 2010, the average prevalence of obesity among adults was estimated at 35.7%, or 78 million; and 16.9% among children and adolescents, or 12.5 million.

In Europe, the prevalence of obesity has tripled in many countries since the 1980s and continues to increase at an alarming rate, particularly among children. Childhood obesity is a real health crisis, with about 20% of children being overweight. Obesity accounts for 2-8% of health expenditure and 10-13% of deaths in different parts of Europe.

Sources: INPES, INSERM, High Authority of Health. Article written under the supervision of Dr. Marcel ICHOU, general practitioner in Paris.

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