Obesity
01 Feb 2012
The obesity is the status of an individual with a body mass well above what is desirable or acceptable, usually due to an accumulation of body fat one . The human obesity has been recognized as a disease in 1997 2 by the WHO . This organization defines ” overweight and obesity as an abnormal accumulation or excessive body fat can affect your health . ” Its prevention is a problem of public health in developed countries. It can have a significant impact on the health of the individual.
This multifactorial disease is considered today as a metaphor pandemic , although it is not an infectious disease 3 .
Definition
The clinical forms are numerous, with pathophysiological mechanisms and pathological consequences different, so it is better to speak of “obesity”. To evaluate these obesity should be analyzed two parameters that affect the complications of the disease independently from each other: excess fat, and adipose tissue distribution.
Phenotypes
4 types of obesity are described:
Type I: The excess fat is distributed in the body without preferential localization;
Type II: excess fat is concentrated on the trunk and abdomen: there is talk of abdominal obesity;
Type III: the accumulation of fat in the abdomen is: it comes to visceral obesity;
Type IV is localized fat in the hips and thighs (glutéofémoral level): this is a gynoid obesity.
Pathophysiology
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Obesity is associated with inflammation systemic chronic subacute: it was indeed found in the bodies of obese people continually circulate inflammatory mediators such as TNF-alpha and the interleukin-6 and their concentrations normalize with weight loss. It is recognized that adipose tissue hypertrophy is a source of these mediators and that they, in turn, inhibit lipolysis and weight loss 4 .
Another source recently discovered is the small intestine , which enters an inflammatory condition when exposed to a diet high in fat , this transformation may precede the onset of obesity, according to recent results 5 . There is an excess of bacteria of the phylum of Bacteroidetes and too little of the phylum Firmicutes in the colon of obese 6 . Consumption of high doses of lipids due, at least in animals, a marked decrease of several families of bacteria in the colon , including Bacteroides and bifidobacteria . The decrease in bifidobacteria is, in turn, correlated with inflammation and endotoxemia 7 .
The systemic inflammation contribute largely to explain the association between obesity and diabetes 8 , the asthma 9 , the cancer 10 and depression 11 , and other comorbidities .
The intestine, in the obese person, not just in a state of inflammation but is also a source of calories greater than in the person of normal weight. The intestinal flora obesogenic is able to extract more energy from food as the normal flora. It it also produces more than fermentation. If the intestinal flora is transplanted to a healthy host, colonization will cause a gain of body fat 6 .
Fat cells also secrete mediators known as adipokines that regulate body weight: the more fat cells are numerous, are more abundant these adipokines and, in particular, leptin (from the Greek Leptos , slender), who report to the nervous system the opportunity to spend the stored energy and not to consume more. However, obese people and animals suffer from leptin resistance. The arcuate nucleus , located in the médiobasale of the hypothalamus , does not meet the high levels of leptin circulating in the body of the obese person, so that it behaves as if there were no caloric surplus. Limit of normal fat intake would reduce this phenomenon 12 . However, because of his state of leptin resistance, the expense and energy consumption of an obese person tend to stay in balance characteristic of a thin person. In addition, continuous exposure to high concentrations of leptin is in itself a cause of obesity, as the mediator of the hypothalamic receptors tend to decrease in responsiveness to leptin, as occurs in the syndrome of resistance to insulin . Finally, the blood-brain barrier tends to be less permeable to this adipokine.
Contrary to popular opinion that leptin is essentially a stimulator of satiety and energy expenditure acting on the hypothalamus, it has recently become clear that other parts Plastic Storage Containers of the brain governing pleasure to eat on an empty stomach were inhibited by leptin. This mechanism, like that which governs the maintenance of excess weight, would be treated conservatively for his benefit during evolution: leptin would lose weight in a situation of excess fat (moderate) but would also eat-in situation of scarcity 13 .
The prebiotic , a class of dietary fiber necessary for the metabolism of the human microbiota , are doubly involved in weight regulation: first, they increase satiety, modulating the levels of gut-derived mediators such as peptide YY The ghrelin and GLP-1 (glucagon-like peptide-1, glucagon-like peptide 1 ) 14 on the other hand, prebiotics such as the inulin and oligosaccharides have a similar anti-inflammatory action and regulation gut 7 .
Like other disorders characterized by chronic inflammation, obesity is associated with an alteration of the composition of the cell membrane . Concentrations of polyunsaturated fatty acids omega-3 and omega-6 , precursors of two families of Relevant Life Insurance messengers paracrine / autocrine involved in inflammation (see prostaglandins ), reflect a particularly marked decline in the concentrations and metabolism, overall anti-inflammatory, Omega-3 (while the omega-6 precursor of prostaglandin E2, in particular, are unchanged compared to healthy denver martial arts subjects) 15 . It is the balance between the two classes of lipids that determines the trend of the cell to generate and maintain inflammation. Polyunsaturated fatty acids are called pleiotropic because they act on a wide variety of physiological mechanisms. In addition to their structural role and protector, as constituents of the membrane, and their function in the immune response, they operate at the gene expression and signal transduction. And omega-6 stimulate, and omega-3 inhibit the formation of adipose tissue in the perinatal period 16 . In just four generations, all things being equal, a decreased omega-3/omega-6 ratio increases the expression of genes involved in fat overweight 17 .
The effects of a lack of omega-3 also extend to the neurophysiology of obesity. Following the discovery of the importance of the transmission endocannabinoid (which led to the placing on the market Rimonabant , which was subsequently withdrawn because of his psychiatric adverse events), researchers wanted to know if the omega-3 , whose importance in neurology is undeniable but poorly understood at the synaptic level, may be involved in this system. It was shown that omega-3 were essential to the action of endocannabinoids: in a state of deficiency, the animals could reach the state of depression (in some areas) usually caused by endocannabinoids and behavioral alterations that resulted from were similar to those caused by a fender flares typical Western diet is to say, causing a deficiency of omega-3 18 .
To be able to burn excess calories, a person suffering from overweight should not only increase its energy expenditure but also have muscles that can adequately respond to stress. Of biopsies showed that muscle in obesity, not the number of mitochondria – the power plants of the cell – which is not enough, but their performance. Exercise and caloric restriction can, as in the healthy person, to increase the number of mitochondria, however, the cellular respiration remains constrained, so that the enzymes of the pyruvate dehydrogenase and the Krebs cycle , upstream, generate an excess of metabolites and their treatment is even more inadequate it depends on a conversion of NADH to NAD +, an operation performed by the mitochondria 19 . Cellular respiration is inhibited in the visceral fat in obese, giving rise to abdominal obesity 20 . According to animal studies, such mitochondrial disruption, in liver , precede the fatty liver and the insulin resistance observed in obese people – and weight gain 21 .
Diagnosis
The fat (and other lipids ), like sugars ( carbohydrates ) are used to store energy in the body. Sugars provide a readily available energy, fats are used to store a lot of energy in little space. Fat is stored in cells called lipocytes or adipocytes . In case of large stock, two situations are distinguished: overweight (fat cells store more Bankruptcy fat and gain weight) and obesity (when adipocytes reach saturation, they multiply).
The current estimates of obesity involve the mass (which is often called the “weight”) and size. The ideal solution would be to more accurately determine body fat, body fat is knowledge that the true risk factor, especially when its distribution is visceral 22 .
Body mass index
Main article: body mass index .
BMI Defined as
18.5 to 25 normal
between 25 and 30 overweight (overweight)
beyond 30 obesity
35 to 40 severe obesity
Beyond 40 morbid obesity
The primary metric used is the body mass index (BMI). It takes into account the morphology of the individual even though it may be unusually biased in the case of athletes with a very large muscle mass. For adults, the BMI is equal to the weight (in kilograms ) divided by the square of the height of the person (in meters ) 23 :
Example: 75 kg / (1.75 m) ² = 75 / (1.75 x 1.75) = 75 / 3.0625 = 24.49 (the final result was rounded and it is in kg / m, but most of the time we [who?] does not write the unit)
It can be calculated with a specific impedance balance or by a fairly complex calculation based on the diameter of the arms, forearms, thighs, buttocks and hips. A normal level of fat is between 17 and 22%. However, BMI has a significant variation on a global scale. The standard BMI is mainly based on a population of European type. This index is not applicable to other types of population. Asians, Africans or the Pacific have body mass index differ from those of European populations.
We [who?] also knows now [when?] that BMI is a tool to measure the weight / size is not sufficient to assess risk of disease among the obese person.
Other markers
Do not confuse obesity and metabolic syndrome . Indeed, to be affected by this syndrome, you must submit three risk factors listed against 24 . It is therefore possible to have metabolic syndrome without being obese, and an individual can be obese without metabolic syndrome. There are also other indicators of overweight: the ratio waist / hip. It must be less than 1 in men and 0.85 in women. The diameter of the neck (or neck strap ) may provide a reliable indicator of abnormally high BMI in children over 8 years. It is also associated with the apnea obstructive sleep, diabetes and hypertension in adults.
Fat mass is distributed differently in men and women. It represents 10-15% of body weight of men and from 20 to 25 weight% of women. Instead, it accumulates on the abdomen and thorax in humans, on the hips and thighs in women.
Parameters of the syndrome
metabolic Men Women
Waist circumference > 102 cm > 88 cm
Glucose fasting > 1.1 g / l (110 mg / dl) 25 > 1.1 g / l (110 mg / dl) 25
Triglycerides > 1.5 g / l (150 mg / dl) 25 > 1.5 g / l (150 mg / dl) 25
HDL (“good cholesterol”) 13 / 8.5 25 > 13 / 8.5 25
Epidemiology
In 2005, according to the WHO global estimates, there were about 26 : 1.6 billion adults (aged over 15 years) and at least 20 million children under five are overweight (BMI> 25), at least 400 million obese adults (BMI> 30). In 2010, according to the WHO 27 , involved 43 million overweight children under five. WHO estimates that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese 26 . Previously overweight and obesity were seen as problems specific to high-income countries but increase dramatically in countries with low and middle-income, mostly in urban areas 26 .
Developed countries
Main article: Obesity in France and Obesity in the United States .
Histogram comparing the percentage of obese people in member countries of the OECD in 2000-2001.
Changing rates of obesity in some OECD countries.
The proportion of obese tended to stabilize since the late 2000s in the United States 28 .
In France, in 1965 , only 3% of school-age children were obese according to BMI and were 13.3% in 2000 29 , 26% in Canada (obesity and overweight), 30 and 16% United States 31 . The childhood obesity is a major problem: acquired before five years, it persists into adulthood. The latest figures for French adults 32 account for 14.5% of the adult population obese (6.5 million) against 8.7% in 1997. This growth is faster among women (81.9% in 12 years).
A study by the Regional Directorate for Health and Social Affairs (DRASS) conducted in 2002 in the Paris region has refined this observation: 6.2% of students in large section (4-5 years) enrolled in public schools were suffering from obesity level I and level II of 3.3%. 11.8% of children in priority education networks (REP, poor), against 8.7% of the total population, are obese level I, 4.5% against 2.9% of grade II .
The INVS note in early 2008 stabilization of overweight in children, but one in six adults is still obese 33 .
According to a report of the International Association for the Study of Obesity (2007), 22.5% of Germans and 23.3% of German women are obese 75.4% of men and 58.9% of women suffer from an overweight in Germany, placing them in first place in Western Europe 34 . Also in Europe, the population of the United Kingdom with 27% obese, a rate similar to that of the United States 35 .
million obese individuals are counted in the developing countries , paradoxically in some of these countries, people suffering from obesity and other suffering from malnutrition coexist. This is partly explained by two phenomena of economic origin: the fall in world sugar and oil production is an activity sponsored by the States in many countries. Therefore, oil and sugar are the cheapest food, which facilitates access for these populations to the detriment of other products, which can lead to deficiencies in protein , vitamins , trace elements , etc. .
The Mexico is the second country in the world for the share of obese people, just behind the United States. Obesity affects 30% of adults, 44 million Mexicans, and 40% experiencing an overweight 38 .
In 2002 , the China experienced a significant increase in obesity (2.6% of the population with a BMI greater than or equal to 30) custom t shirts and overweight in general (14.7% of the population with a BMI greater than or equal to 25), and that affects about 215 million Chinese. The problem is mainly present in young (between 7 and 18) where he experienced a sharp increase in the order of 28 times between 1985 and 2000 , mainly boys. The causes are similar to those of Western countries 39 . The 2008 figures confirm the strong rise in obesity in China: 90 million Chinese are obese and 200 million overweight 40 . Now one quarter of adults are overweight or obese in 2008, compared to only 8.8% in 1989 41 , 42 .
In the poorest countries, obesity is socially valued. For example, in Mauritania, young girls of marriageable age are fattened to be more attractive and maximize their chances of finding a spouse. Unlike developed countries, for wealthy people, it is therefore a sign of success and wealth 43 .
Causes
Process obesogenic
The two major factors (the Big Two) 44 traditionally involved in the development of obesity are consumption and energy expenditure. In this framework, maintaining a healthy weight is a matter of energy accounting.
Daily energy intake (or AET: total energy intake, amount of calories 45 ) from the diet including carbohydrates (sugars slow or fast, to glycemic index higher or lower): sucrose , glucose , fructose , etc.). the lipids (fatty acids) found in vegetable oils and animal fats and include proteins , plants (algae, lenses for example) or animal (meat, fish).
And the amount of energy expenditure: heat exchange with the environment (thermoregulation), even more important than the outside temperature is denver auto accident lawyer low energy required for the functioning of the body ( digestion for example).. The brain alone consumes about 20% of the total energy and physical exertion (walking, sports, physical activity leaders).
When the body receives more than it spends, it stores a part of the contribution in the form of fat in the adipose tissue . However, the metabolism , very different in different individuals, is important, and some people will more easily become obese than others.
Overconsumption and malnutrition
“Junk food” in the Charlotte Regional Medical Center, Punta Gorda, Florida .
For the first time in history, a large cheap auto transport proportion of humans can eat sufficiently, even overeating or eating without regard to their needs (such as eating too quickly, which does no feeling of satiety and stop when the meal). Previously, episodes of food shortages and famines were recognized.
This overabundance of food is due to the industrial means of production of food, who bring their own problems.
Fight against obesity, not against all fat types and functions of lipids in the body
Sterols :
Cholesterol (to 2 / 3 manufactured by the liver) cholesterol brought in food is generally not harmful. However the excessive production (or low) by the liver from fat consumed, increased cardiovascular risk. In blood tests, one must also distinguish between “good” cholesterol (HDL) and “bad” (LDL), only involved in cardiovascular disease. It is the ratio between the two to watch, more than the total cholesterol.
Phytosterols (oils, cocoa, fruits, vegetables): regulation of cholesterol levels, anti-inflammatory properties, reducing the risk of cancer and hyperplasia of the prostate, strengthening the immune system, increased levels of DHEA.
Tocopherols :
Alpha (Vitamin E), beta, gamma, delta oils (except coconut and palm): antioxidants , lower cardiovascular risk and cancer.
Phospholipids and sphingolipids (egg, soy, wheat germ) useful to the brain (neurons) and cell chiropractic marketing membranes.
Fatty acids :
saturated (meat, butter, cream, corn oil, etc..) increased cardiovascular risk (CV) at doses consumed by the majority in most developed countries. The food industry often preferred fat substitute for butter, but they are even worse by the trans unsaturated they contain:
” trans unsaturated “(Refined oils, chips and fries industrial, fried foods, pastries without butter, bakery, supermarket, hard margarines, crackers, a drink, crackers, cakes, breads, quiches, pies and pasta pie industrial , breaded products, spreads, sauces, salad dressing, mayonnaise industrial fat beef, mutton, dairy products): Increased risk of very high CV 46 : increase in bad cholesterol (like butter) and also lower right 47 .
” monounsaturated (cis) , “whose Ω9 ( olive oil , vegetable oil, duck fat, goose, chocolate): Reduced risk CV
Polyunsaturated omega-3 (walnut oil, soybean, canola, flax, currants, cassis, olive, oily fish, shellfish): CV risk reduction, but in excess cardiovascular disease and immunity. The Ω3 require Ω6 enough to be assimilated, but the doses of Ω3 consumed in developed countries are (much) too low compared to Ω6.
Polyunsaturated omega-6 oils (grapeseed, sunflower, walnut, corn, soy, canola, olive, poultry fat): CV risk reduction, but in excess cardiovascular disease and immunity. Obesity is well recognized in infants or fetuses, unable to blame snacking or no exercise. Food, too rich in Ω6 , the mother is involved, even the composition of milk powder, based on that of the milk of mothers consuming too much Ω6 . (Studies Gérard Ailhaud [1, pp14-16]).
Numerous foods are available, 7 days 7 and 24 of 24, regardless of the meal, which can promote a snack food with high caloric load. Nibbling the most used one is definitely based on fatty and sugary foods (candy, chips ,…). These products are generally high in simple carbohydrates and fat. While energy intake is largely met by these products, the sensation of satiety is still not obtained. Finally, during a meal, always the same food (which was traditionally the case), satiety (loss of desire to eat) indicates that an individual has sufficient energy intake, when food is consumed are unusual, this information is distorted. The food industry has transformed numbers of foods that have had their glycemic index increase and distorting the usefulness of calories: the calories from protein are not the same, in overall balance, as provided by carbohydrates. Result: many products ” light “fat-free but also very low in protein and loaded with sweeteners. Refining and the presence of sweetness in these new processed foods creates a true “drug addiction”, which, over the years leads to suffering physiochemical obese when the body is private.
Critics also go to the role of television, both by physical inactivity it causes the viewer and the effect of advertising for food products often fatty and sugary. Regarding the influence of advertising, a group of French scientists responsible for nutrition issues asserted in 2008, in an article entitled ” fatten the children to save the TV ” 48 , and referring to “recent reports”: “There even a link between high exposure to television advertising and obesity of children aged 2 to 11 and adolescents 12 to 18 years. Exposure to television advertising for foods of high energy density (including sugar and fat) is associated with a higher prevalence of obesity. ”
Contemporary societies are a source of stress . Many people can then feel a moral vacuum in them, they compensate with food. (See bulimia ).
As for food, the amount of sugar consumed is not the only criterion, the quality (glycemic index, whole versus refined sugar) plays a lot, so the fat is not the only criterion, their quality also plays an important role: oils are cold pressed, for example much more favorable than refined oils (extracted from hot, eliminating much of the beneficial contributions, including anti-oxidants, and / or solvents ) and more favorable than saturated fats. plans : they can paradoxically sometimes contribute to obesity. Indeed, poor diets (low in protein and too restrictive) promote the loss of muscle mass, which is directly related to metabolism. After these bad regimes, there is slowing of metabolism and accelerated recovery of weight . These bad diets are deficient, mainly intake protein .
Fructose corn industrially extracted, which is added as a sweetener such beverages, has been implicated in the increased prevalence of obesity 49 .
There is a parallelism between consumption of fructose and the incidence of obesity. Fructose, even if it is “natural” is a carbohydrate (sugar) to be consumed in moderation 50 . In addition, fructose does not induce little or secretion of insulin , and no secretion of leptin (Greek Leptos , slender), a hormone involved in satiety. Insulin and leptin are two major elements of the regulation of food intake. Thus, in equal amounts, fructose provides as many calories as sugar or glucose kitchen, but does not induce as early satiety, resulting in higher consumption, resulting in weight gain that n ‘ would probably not have occurred if the sweet taste was due to sugar or glucose kitchen 51 . Fructose increases the levels of ghrelin , a hormone that stimulates appetite … 52 There are reports of a correlation between fructose consumption and obesity, especially central obesity (also called abdominal obesity ) is usually seen as the more deleterious 53 , 54 , 55 , 56 , 57 .
Sedentary lifestyle
Sedentary lifestyle and overconsumption
The sedentary lifestyle is an important factor: the sharp reduction in physical activity due to the development of transport ( car , public transport, elevators …), new technologies (remote controls, television , computers ,…) does not balance the energy balance. The abundance of food is not necessarily caused an increase in energy intake would explain the epidemic of obesity. It was found at present lower daily energy intake which is still higher than the daily energy expenditure [ref. needed] . This last element is a factor in obesity.
Artificial air conditioning and heating
Assisted thermoregulation: new technologies since the 1980s have led to the introduction of air conditioning and heating to facilitate the stabilization of body temperature. The body does not fight against changes in temperature which does not cause significant energy expenditure in the brown adipose tissue , weakens the system of thermoregulation and changes the basal metabolic rate 58 .
Sleep disturbances
The sleep disturbances cause several changes in neuroendocrine obesogenic causing over-consumption of food, but also other more subtle changes in the management of metabolic energy 44 , for less than 6 hours of sleep is known to be risk-taking weight 59 , this being due to a leptin levels lower than the predicted percentage of body fat in patients of the study 60 . There is evidence that the reduction of sleep time decreases the benefits of a diet 61 weight loss. An Australian study confirms the role of sleep deprivation in children: every hour of sleep in less than 3 to 5 years results in 0.7 kg more at the age of 7 years compared to the average weight a reference population of similar age 62 .
in utero
A study published in 2011 and based on 101 children of overweight mothers is already affecting the metabolism of the fetus and the embryo , already announcing metabolic disorders for the child and future adult (lifelong) This is why some researchers from Imperial College London that prevention should begin in utero. A high BMI of the mother before pregnancy predisposes statistically heavier babies, and whose liver is richer in fat, as well as an increased risk of metabolic disorders 63 , remains to be done by genetic causes, and only related to obesity of the mother and to understand the relationship of cause and effect.
Endocrine disruptors
Another recent change in human history is the pollution of the endocrine system by synthetic chemicals. The endocrine disrupting chemicals , especially persistent organic pollutants , are increasing in number and quantity in the environment and in the body. Their ability to imitate or oppose certain hormones (estrogen, testosterone, thyroid hormones, in particular) is demonstrated and several types of evidence designate how the suspects in the recent “epidemic” global obesity 44 , 64 .
Because of this accumulation of evidence in vitro , in vivo , and epidemiological these pesticides , plasticizers , antimicrobial and flame retardants act as metabolic disorder in obesity, but also the metabolic syndrome , and type 2 diabetes It is now agreed to call metabolic disruptors or metabolism ( metabolic disruptors ) 65 .
Pharmaceutical environment
Of iatrogenic factors (see iatrogenesis ) are well known: in addition to contraception (oral, injectable, or intradermal device), we must mention psychotropic treatments:
neuroleptics
antidepressants (especially older ones, especially tricyclics)
some anticonvulsants and analgesics neurotropic
Microbiological environment
Several recent studies have shown an association between the state of the microbial ecology of the gut (the microbiota ) and obesity. Weight loss is also accompanied by a tendency to restore the intestinal flora. This has an impact on inflammation, insulin sensitivity and fat accumulation, three factors involved in obesity 66 .
Hereditary factors
The contribution of heredity is slowly being better known. 6 or 7 genes are involved in monogenic forms (due to a single gene) of obesity. A score of others – to little effect – cause or facilitate obesity due to the combined action of several genes. But even this does not all the mechanisms, nor any heritability associated with this disease 67 . All these genes encode proteins expressed in the brain chicago dui attorney (the hypothalamus or in neurons that regulate appetite) 67 .
The genes responsible have been identified that participate in the production by adipocytes of leptin , a hormone (protein) acting on the central nervous system control of appetite and spending energy .
A mutation affecting the gene encoding the receptor β3-adrenergic 68 , they found mainly on the surface of adipocytes, could also be a cause of obesity. Indeed, during a physical effort, they have normally function to trigger the release of fatty acids (stored as triglycerides) in adipose tissue, due to a stimulation of the receptor by an agonist ( adrenaline ). Once this process is initiated (β3-Adr → Gs protein → adenylyl cyclase → cAMP → protein kinase A → Lipase ), fatty acids are released free auto insurance quotes into the bloodstream. The various cells of the body and can capture these fatty acids (which diffuse freely through the plasma membrane), direct them to the mitochondrial matrix (via conversion to acylcarnitine acylCoA → → acylCoA) and convert acetyl-coenzyme A ( Beta-oxidation ), to be used in the Krebs cycle and respiratory chain in order to produce energy ( ATP ). Thus it seems logical that a malfunction of these receptors is a cause of persistent fat in those affected.
A rare and severe forms of obesity (1% of cases associated with mental retardation) is associated with the missing (deletion) of a piece of chromosome 16, when these 30 genes are missing, the failure to provide that to a single copy of these genes multiplied by 50 the risk of overweight 67 .
Lifestyle factors also affect genetic . One hypothesis is that the body has been used for millennia to have to cope with the lack, natural selection would have favored those able to store in times of plenty to cope with periods of scarcity. Ironically these people would then be less suitable for an abundance regularly. Phen375 The best example of this interaction between genetic and lifestyle is provided by the Indians Pimas . Indeed the people are divided into two communities, one living in Arizona to the United States and the other in the Sierra Madre in Mexico 69 . Half of the Pimas of Arizona adults are diabetics and 95% of them are obese 70 and the differential of the BMI is around 10 (34.2 to 24.9) among the Pimas of Arizona and those Mexico 71 , and the prevalence of obesity is 70% 72 .
Moreover, with the same power and same physical practice, weight gain varies among individuals (depending on metabolism ). Obesity is higher in families where Pima slowing of metabolic rate at rest was demonstrated 73 .
A mutation in the FTO gene significantly increase the risk of obesity, and especially since this mutation is homozygous (that is, present on both chromosomes) 74 .
Other causes
In very young children, risk factors for overweight from the prenatal period can be diagnosed 75 : They include: overweight of the mother in early pregnancy, excessive weight gain during pregnancy, gestational diabetes, and smoking .
Smoking cessation would lead to weight gain a few pounds related to the metabolic action of nicotine . This effect, known to the public, appears also as a brake – especially among women – the decision to stop smoking.
Cultural factors, in Mauritania , obesity is a canon of female beauty sung by the poets: the girls are “thrown” from a young age 76 .
Consequences
Physiology
An individual suffering from obesity runs several risks. The mortality increases when the BMI exceeds 25 kg / m² and life expectancy decreases especially since this index is above 77 . The optimal level is an index between 22.5 and 25 kg / m². Below this threshold, mortality would also increase significantly 78 .
Diabetes : while diabetes mellitus ( type 2 diabetes ) is usually from 40 years, are emerging diabetes mellitus as a teenager in the obese;
hypertension , stroke and stroke , it should be noted that no relationship was found between the risk of heart failure and obesity, that “it is general or abdominal 79 ;
Obese pregnant women, pregnancy and childbirth are more at risk (hypertension in pregnancy, thromboembolism, CS), and perinatal morbidity and mortality is increased, there is also a significant increase in CIV of cleft lip and ‘ocular abnormalities Chicago Criminal Lawyer in children born to obese mothers (while overweight is not associated with the sur-risk ) 80 . Being overweight increases the risk of miscarriage and also decreases the chances of a successful in vitro fertilization due to hormonal disorders 81 ;
Sleep apnea ;
Various joint problems: arthritis , vertebral … ;
addiction to food Psychological: feeling of depression , malaise, depression and “void” between meals, which leaves when eating.
Increased risk of dementia and loss of acute cognitive . Several indications suggest a link between obesity and dementia in obese in later life. The CNRS and INSERM 82 in 2006 have confirmed a linear relationship between excess weight and certain cognitive abilities 83 , at an earlier stage, the adult middle-aged healthy. The follow-up of 5 years (1996-2001) of a population (2223 men and women from 32 Wire Cart Covers to 62 years) showed a deterioration in cognitive test scores in those standards for body mass index ( BMI ) hcg diet plan higher.
The study eliminated some potential biases (education level, diabetes, blood pressure), but it is unclear when such performance is affected by obesity itself or the lifestyle or certain foods most often consumed by those who are victims of obesity, or genetic causes that are contributing factors of obesity or for other reasons not well understood. Substances stored Denver Divorce Attorney and / or issued by fat cells may inhibit brain function, as do the vascular effects of obesity, which is suspected of being responsible for certain dementias. In these individuals, cognitive aging seems to be improved by addressing the factors of early disruption of feeding behavior and metabolism.
The memory is particularly affected; from BMI 20 kg/m2, 9 of 16 words are stored against 7 for those with a BMI over 30 kg/m2, and memory declined slightly in five years for higher BMI in the study.
cancer : the occurrence of certain cancers is correlated with body mass index 84 . This is especially bladder cancer , those of the pancreas , the stomach 85 . In women, high weight increases the risk of developing breast cancer , the endometrium , the kidney , the esophagus as well as some leukemias . Obesity is responsible for approximately 5% of cancers in postmenopausal women 86 and could be responsible for nearly 70,000 annual cancer in Europe 87 .
In 1992 , obesity was the cause of an estimated 55,000 deaths in France, mainly cardiovascular disease and diabetes 88 . Moreover, due to complications of diabetes, obesity is the leading cause of blindness before age 65 in France, and the leading cause of amputation . This excess mortality is found among all ages, ethnicities and genders 89 .
The body mass index in children is directly correlated with the risk of developing cardiovascular disease as an adult 90 , but it seems that if we can normalize the weight in children, it reduces or even one eliminates over-cardiovascular risk associated with childhood obesity 91 .
Psychology
Obesity can lead to depression , malaise, complex inhibition, rejection of his body and his own personality. The obese individual risk of suffering from discrimination and shelving. It suffers from the condition in his love life. According to a study presented at the International Conference on Obesity in Amsterdam in 2009, “obese men and 18 have almost 50% less likely to be married at the age of 30 or 40 years” 92 .
Company [ modify ]
Economic cost
Obesity is an economic cost, including from the increase in medical expenses and induced lower productivity at work. According to a report of the International Labour Organisation (ILO), ” Studies have shown that the risk of absenteeism is twice as high among obese workers than among healthy workers. Obesity accounts for 2-7 percent of total health expenditure in developed countries. In the U.S., the cost caused by obesity is estimated at 99.2 billion dollars. ” 93 .
In the U.S., medical expenses of an obese person in 2008 are higher than 36% of those with normal weight 94 . In the same country in 2005, nearly 16% of health budget is spent on diseases related to obesity 95 .
Sign of decadence
The development of obesity is in the eyes of some experts, one of the signs of decadence of a society. This theme is particularly developed by the British historian Niall Ferguson 96 which refers to the conclusions of the classic British historian Edward Gibbon on the physical decline of citizens at the end of the Roman Empire.
The issue of obesity as a sign of decline of the United States is also highlighted by geopolitical scientist, like the French Dominique Moisi , citing obesity in 2008 among the signs of decline in the U.S.: “The evolution of their bodies, with the increasing number of obese people, deepening their debt, lack of appetite for U.S. troops outdoor adventures are all symbols of what could amount to a decline. ” 97 .
U.S. authorities are beginning to recognize the strategic implications of the problem. Thus, the 1 st March 2006 , at a conference at the University of South Carolina , the Surgeon General (responsible for federal health) of the United States, Richard Carmona , compared with obesity a “terror from within “, questioning in particular, concerning the future Americans,” Where will our soldiers, sailors, airmen? Where will our policemen, our firefighters [...]? ” 98 .
Prevention
Obesity is a problem that addresses the medium and long term, with a medical or psychological. The medical and psychological aim to monitor that obesity and its complications do not worsen. Obesity can be largely avoided by balancing energy intake to maintain normal weight. As a precaution, a regular diet, based on respect for meal times, to better control what can be consumed. The National Health and Nutrition Programme was established in France to fight against this scourge. It offers nutritional guidelines on its website 99 [ref. insufficient] .
The food industry tends to put cheap raw materials in ready meals to reduce the manufacturing cost, including the salt , the sugar and fat produced from of hydrogenated oils containing unsaturated fatty acids, trans , increasing high cardiovascular risk. It is also strongly recommended to have a physical activity minimum. Failure to perform a sport , do at least half an hour of walking per day [ref. needed] .
Finally, psychological factors ( pleasure of eating ) and social (eating together, during a meal) play a very positive 100 . Indeed, the act of eating should not be only a medical but also a source of pleasure. Guilt can be a contributing factor of obesity.
Children and obesity
It was not until the year 2000 to appear for an international definition of childhood obesity 101 .
Prevention among children is important. They are the most susceptible to advertising demands for food, they are naturally attracted to sweet tastes, and many of the children was very early accustomed to an imbalance of power, including in the womb, if she had an unbalanced diet. This is even more difficult to counteract those bad habits that they are older, it takes more time and patience for them and their families.
Because of modern lifestyles, it becomes difficult for parents to contribute to good nutrition for their children:
work schedules of parents doing that they are often less available;
distance grandparents for professional reasons, they can not keep children home from school and send them to “culinary culture”
loss of traditional nutritional markers which formed the strength of certain regions or countries (including France in the South West , or in the Mediterranean countries ).
That is why nutrition education is very important in school. Experiences in several French cities (EPODE: “Together, prevent childhood obesity” 102 ) show the usefulness and effectiveness of this education, both for children and their parents: it is the children who are the ambassadors of a balanced diet to their parents. For obese children, a family care, psychological and medical importance.
Prevention policies
Americas [ change ]
There are many organizations fighting against obesity in the United States: Stop Obesity Alliance (Alliance against obesity) is based in Washington DC.
In California , the Education Code provides for physical education classes in public schools: 200 minutes of exercise at least every 10 school days in primary, secondary 400 online cash advance minutes. The states of Florida , Arkansas and Pennsylvania have recently initiated programs to sensitize parents on childhood obesity through the schools: for example, schools of Arkansas families send a letter warning them of the obesity of their children since 2003. Schools have introduced more fruits and vegetables in menus and increased the sugar-free drinks. The governor of Arkansas, Mike Huckabee and Bill Clinton announced in 2006 that producers of soda have decided to replace sugary drinks in vending. This policy has helped to stop the progression of obesity in children 103 . Cadburry Schweppes, Pepsi and Coca-Cola announced that they will withdraw their sodas in schools in September 2008 104 . Coca-Cola also launched a new drink called Enviga that would lose weight 104 .
The company McDonald’s , considered to be partly responsible for obesity because of the size of its menus and its business practices (seen in Super Size Me ) has decided to fund the fight against obesity and diabetes by making a donation two million in the Scripps Research Institute 105 .
In 2002 , the release of the book Fast Food Nation reopens the debate on obesity in the United States. In 2004 , the documentary film Super Size Me of the American Morgan Spurlock highlights the dangers of fast food that cause the increase in obesity. Health authorities in the municipality of New York decided to ban industrial fats in 24,000 restaurants that the city’s 106 . They also require fast-food to enlarge the calories on their menus. In Chicago , a proposed ban of fat derived from industrial hydrogenation are being considered in 2006. The fast food chain Kentucky Fried Chicken announced in October 2006, the substitution of these fats in the oil of soybeans in its 5500 U.S. restaurants from April 2007 107 . The fast-food in Manhattan are required to display calories on their menus 108
The City of Los Angeles in September 2007 plans to propose a “two-year moratorium on building new fast food in poor neighborhoods south of the city” 109 .
Europe
Main article: Obesity in France .
In France , a public awareness campaign launched in 2002 encourages people to eat at least five fruits and vegetables a day and practice the equivalent of a half hour of walking per day (National Nutrition Health – PNNS and PNNS 2). In 2007 , the food advertising to children should be smaller and a message should indicate that the excess risk of such products can cause: on the chains for children and in the youth programs are broadcast small print at the bottom of commercials advice “eat five fruits and vegetables a day”, “you spend good” and “avoid eating too much fat, too sweet, too salty.” The effectiveness of the health message is questionable, “half of consumers do not understand it and think it signals a food good for you” 110 .
To prevent childhood obesity, the second National Health and Nutrition Plan (PNNS) 2006/2010 has been set up. The plan includes three major steps. Remove the advertising for certain foods and beverages sweetened in youth programs. Encourage the removal of sweets boxes to store food. And introduce new nutritional guidelines for school meals . Concerning the abolition of advertising, it is still not on the agenda, the law called ” Hospital, patients, health and territory , “enacted in 2009 , having rejected the principle 110 . As part of the second PNNS, the High Health Authority in September 2011 issued a recommendation of good practice on Overweight and obesity in children and adolescents (updated its 2003 recommendations) to improve the quality the medical care of children and adolescents overweight or obese. Under this recommendation, in France , the estimated prevalence of overweight including obesity was in 2006, according to the references of the International Obesity Task Force (IOTF), 18% in children 3 to 17, including 3 , 5% had obesity is higher in disadvantaged populations. The probability that the obese child is an adult varies between studies from 20 to 50% before puberty, 50 to 70% after puberty.
The High Authority of Health has also published in September 2011 a recommendation of Practice on Overweight and obesity in adults: medical management of first resort . In 2009, the study cited by Roche ObEpi this recommendation, the prevalence of obesity (BMI ≥ 30 kg/m2) among French adults aged 18 and over was 14.5% and of overweight (25 ≤ BMI ≤ 30 kg/m2) of 31.9% (16). The prevalence of obesity was higher among women (15.1%) than men (13.9%) and increased with age in both sexes with a peak in the age group 55-64 years.
The Belgian is developing its program PNNS-B 2006 – 2010 111 .
Treatments
A diet rich in fruits and vegetables is at the base of support.
Treatments are, in principle, caloric restriction for weight reduction. Among the methods used, there are diet, physical activity and personal support 112 .
Diets and physical activity
The diets are of several kinds:
caloric restriction “balanced” 113 and is a moderate decrease of 600 kcal per day over the usual ration. According to some, it is she who has the best efficiency [ref. required] on weight because it reduces the weight of about 5 kg a year.
dietary modifications without caloric restriction: reduced fat, increased fruit, cereals and vegetables. The effect is small but not negligible: 2 kg a year.
the Mediterranean diet , which has proven itself in terms of benefit in preventing cardiovascular disease. It is suggested in patients with hypercholesterolemia, when there is coronary disease.
very low calorie diets: less than 800 to less than 600 kcal / d. They can be sources of deficiencies if they are extended.
the low-fat diets in which lipids accounted for only 10-15% of inputs ( Dukan diet for example). Its effectiveness is controversial 114 .
the protein diets , low carbohydrate ( Atkins diet ) but rich in fat and protein, no restriction in calories, but that increase satiety. They have some efficacy 115 and would be even in the short term, slightly higher than other plans 116 , 117 . This advantage is no longer found in the medium term 118 .
fasting therapeutic clinics is increasing rapidly, especially in Russia, Ukraine, Germany 119 , Spain 120 , Japan, the United States, Canada, Thailand, India and the Philippines.
The evaluation of the effectiveness of these plans is difficult because the literature trying to do is “open” (the patient knows what type of plan is submitted) and their interpretation is therefore likely some bias. In addition, they are short-lived. In practice, the dietary advice without accompaniment are moderately effective and time-limited (high probability of regaining weight) 121 .
Herbalists recommend the use of certain medicinal plants or plant extracts, in addition to a balanced low-calorie diet 122 .
plants that suppress appetite (anorectics): Hoodia, eucalyptus, laurel sauce, coca, Catharanthus, Phyllanthus niruri, orthosiphon, seaweed, locust bean gum, konjac
plants “burn fat”, which increase thermogenesis: kelp and seaweed, green tea, maté, guarana, coleus, garcinia
sweetening plants but do not provide calories: sweet herb Stevia or Paraguay, or bramble Rubus suavissimus sweet of China.
plants that act by increasing the activity liver (cleansing herbs): dandelion, artichoke, rosemary, milk thistle, turmeric, hercampuri (gentianella)
plants calming to reduce stress often involved in obesity and to better support the low-calorie diet: St. John’s Wort (Hypericum), the California poppy (Eschscholtzia), valerian (Valeriana), linden (Tilia)
Physical activity without caloric restriction, allows itself to have a moderate decrease in weight. The association of physical activity on a diet is more effective than each component separately 123 . It is not necessarily sports. It is necessary to encourage regular physical activity. This allows the retention, long-term weight loss of 124 .
Therapy
It has been shown that active support of such behavioral therapy improves the efficiency of dietary measures in relation to groups without therapy (-4 to -8 kg) 125 . Family therapy with spouses were slightly more effective, as opposed to group therapy that are not more effective than individual therapy.
Drug
The assessment of drug therapies for obesity was weak: all drugs promoted in recent decades have been characterized as major breakthroughs have all but disappointed, mainly because of their side effects 126 .
Central stimulants have many side effects, sometimes severe and are abandoned in most countries:
Fenfluramine and dexfenfluramine withdrawn from the market worldwide in 1997 .
Amfepramone (diethylpropion, banned in Belgium since October 2001.
Phenylpropanolamine (norephedrine) prohibited in Belgium since 1 st October 2002.
Amphetamine , Methamphetamine , very rarely prescribed, usually made and sold illegally.
Nicotine , psychostimulant moderate ( alkaloid major plant Nicotiana tabacum ), acting as parasympaticomimétique low concentrations, causes a release of adrenaline from the glands medulla via splanchnic nerves , the hormone that among pay day loan other “target” liver cells ( leading to a rise in blood sugar , which can be correlated with a decreased appetite) and fat cells, causing a release of fatty acids which can then be catabolized by the different cells in the body in order to produce energy. Studies on rats have shown that daily nicotine adimistration décroittre could make the mass of adipose tissue 127 , 128 .
Nb: Nicotine does not tobacco, the risk of cancer linked to smoking far outweigh any “positive” effects induced by nicotine.
Three drugs have been developed recently and have some efficacy in the short term (loss of 3 to 5 kilos compared with placebo over 6 months). They nevertheless exhibit some side effects can be serious and long-term effectiveness is questionable:
the sibutramine hydrochloride monohydrate . In 2010, the European Medicines Agency recommends suspension of authorizations, however, the marketing of this molecule 129 , due to cardiovascular events Storage Bins caused.
the orlistat : an inhibitor of gastrointestinal lipases. The latter drug is prescription (that is, without need for a prescription) in the United States since 2006 130 .
The Rimonabant , an inhibitor of receptor cannabinoid type I, a significant decrease in weight and associated metabolic disorders ( diabetes , dyslipidemia ) 131 . Because of these psychiatric side effects, a request to withdraw the authorization for the contract was made in October 2008 by the European health authorities 132 and became effective.
None of these drugs is higher compared to the other. They must be taken for at least several years [ref. needed] and stop back often causes weight. It is not known if they have a positive effect in preventing cardiovascular disease, although some decrease various risk factors for cardiovascular disease : thus the orlistat reduce the progression of diabetes in high-risk subjects and rimonabant reduce the waistline and improve HDL cholesterol levels and triglycerides 133 .
Other molecules are being tested as tesofensine 134 or the liraglutide 135 (agonist GLP-1: glucagon-like peptide 1). Also of note highlighting the role of bile acids in the activation of a protein TGR5. This protein, activated in the muscle or brown fat, leads to increased energy expenditure, in the small intestine, it controls the secretion of GLP-1 136 . A drug composed of 6-ethyl-23-methyl-cholic was in 2011, being developed under the name of INT-777 137 .
Trials of a vaccine are antighréline (in 2011) being tested in mice 138 .
Bariatric surgery
Main article: Bariatric surgery .
Bariatric surgery is to restrict the absorption of nutrients, decreasing, in fact, daily calorie intake. The gastric band reduces food intake and gastric banding is to reduce the size of the stomach by removing a portion, so as to reduce food intake, but also the production of a hormone secreted by the stomach ( the ghrelin ) that is causing the sensation of hunger when the stomach is empty (the rate of this hormone increases when the stomach is empty and decreases after a meal).
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