Obesity Surgery

Obesity is the condition of a person suffering from an enlarged body fat, resulting in excess weight, spread across the board in various areas of the body fat.

Obesity has been recognized as a disease in 1997 by WHO. This organization defines "overweight and obesity as an abnormal or excessive accumulation of body fat that can affect health." Its prevention is a public health problem in developed countries. It can have a significant impact on the health of the individual.

Multifactorial disease that is considered today by abuse of language as a pandemic, although it is not an infectious disease.

The choice of indicators
Fats (and other lipids), as are the sugars (carbohydrates), are used to store energy in the body. The sugars provide a readily available energy, fat can store much energy in little space.

Fat is stored in cells called lipocytes or adipocytes. In case of large stock, there are two situations:

* Overweight: adipocytes store more fat and gain weight;
* Obesity: when adipocytes reach saturation, they multiply.

Current evaluations of obesity involve mass (often referred to as the "weight") and size.

Other markers
There are also other indicators of overweight: the waist / hip turn. It must be less than 1 in men and 0.85 in women.

It is also noteworthy that fat mass is distributed differently in men and women. It represents 10 to 15% of body weight of men and 20 to 25% by weight of the woman. It usually accumulates on the abdomen and thorax in humans, on the hips and thighs in women.

It should not be confused with obesity and metabolic syndrome. In order to be affected by this syndrome, it is necessary to present three of the following risk factors:

* Abdominal perimeter above 102 cm for men and 88 cm for women,
* A fasting blood glucose greater than 1.1 g / l (110 mg / dl) or treatment
* A triglyceride levels greater than 1.5 g / l (150 mg / dl) or treatment
* An HDL (good cholesterol) of less than 0.4 g / l (40 mg / dl) in men and 0.5 g / l (50 mg / dl) in women (or on treatment),
* Blood pressure greater than 13 / 8.5 or under treatment.

It is therefore possible to suffer from metabolic syndrome without being obese, and you can be overweight without suffering from metabolic syndrome.

In 2005, according to global estimates of WHO, there were approximately:

* Approximately 1.6 billion adults (aged over 15 years) and at least 20 million children under five are overweight (BMI> 25)
* At least 400 million adults are obese (BMI> 30)

WHO estimates that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.

Previously overweight and obesity were considered as problems specific to high-income countries but increase dramatically in low and middle-income countries, mainly in urban areas.

Developing countries
There are 115 million obese in 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;
* Oil production is an activity funded 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. .

Mexico is the second country in the world for the obese in the population, just behind the United States. Obesity affects 30% of adults, or 44 million Mexicans, and 40% knew of overweight.

In 2002, China is experiencing a major obesity (2.6% of the population with a BMI greater than or equal to 30) and overweight in general (14.7% of the population with a BMI greater than or equal to 25), which affects approximately 215 million Chinese. The problem is mainly present in young (between 7 and 18) where he experienced a sharp increase of around 28 times between 1985 and 2000, mainly among boys. The causes are similar to those of Western countries. The figures for 2008 confirm the strong increase in obesity in China: 90 million Chinese are obese and 200 million overweight. Now a quarter of adults are overweight or obese in 2008, compared to only 8.8% in 1989.

In the poorest countries, obesity is socially valued. For example, in Mauritania, girls of marriageable age are fattened to be more attractive and to maximize their chances of finding a spouse. Unlike developed countries, it affects people off, it is therefore a sign of success and wealth.

The physiological process
Obesity often results from an imbalance between:

* Daily energy intake (or AET: total energy, total calories) made by food:
o carbohydrates (sugars slow or rapid, glycemic index higher or lower): sucrose, glucose, fructose, etc.. ;
o lipids (fats) found in vegetable oils and animal fats in particular;
o and protein, vegetable (seaweed, lentils, for example) or animals (meat, fish).
* And the sum of energy expenditure:
o heat exchange with the environment (temperature), even more important than the outside temperature is low;
o energy necessary for the functioning of the body (eg digestion).. The brain alone consumes about 20% of total energy;
o physical exertion: walking, sports, physical activities of any kind.

When the organization receives more than it spends, it stores a part of the contribution, in the form of fat in adipose tissue. However, the metabolism, very different depending on the individual plays an important role, and some people will more easily become obese than others (including genetic factors).

Obesity is a problem that is treated in the medium and long term, with a medical or psychological. The medical and psychological care is to monitor that obesity and its complications does not worsen. Obesity can be largely avoided by balancing their energy intake to maintain normal weight. As a preventive, a regular diet, based on respect for meal times, can better control what we consume. PNNS the National Nutrition Health Program (in France or Belgium) offers nutritional benchmarks.

The food industry tends to make cheap raw materials in ready meals to reduce the cost of production, including salt, sugar and fat produced from hydrogenated oils containing trans fatty acids, increasing strong cardiovascular risk.

It is also strongly recommended to have a minimum physical activity. Failure to practice a sport, be at least half an hour of walking per day.

Finally, psychological factors (eating pleasure) and social (eat during a meal) play very well. Indeed, the act food should not only be a medical procedure but also a source of pleasure. Guilt can be an aggravating factor of obesity.

Children are most at risk
Prevention among children is important:

* They are more sensitive to the demands for food advertising
* They are naturally attracted to sweet tastes
* Much of the children was very early accustomed to an imbalance of power, including in the womb of their mother if she had an unbalanced diet. This is especially difficult to counteract these bad habits they are older, it takes more time and patience for them and their entourage.

Because of modern living, it becomes difficult for parents to contribute to good nutrition for their children:

* Working hours of parents that they are often less available;
* Removal of grandparents for professional reasons, they can not keep children home from school and send their "food culture"
* Loss of traditional nutritional benchmarks that were 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. The experiments carried out in several French cities (EPODE program: "Together prevent obesity in children) demonstrate the usefulness and effectiveness of this education for both children and their parents: they are children who are the ambassadors of a balanced diet from their parents ...

For obese children, support family, psychological and medical support is essential.

Diets are of several kinds:

* Caloric restriction "balanced" and moderate to a decrease of 600 kcal per day compared with the usual ration. According to some, it has the best efficiency [Ref. necessary] on the weight because it reduces the weight about 5 kg at one year.
* Changes without food caloric restriction: reduced fat, increased fruits, cereals and vegetables. The effect is small but not negligible: 2 kg a year.
* The Mediterranean diet, which has proved its worth in terms of benefit in preventing cardiovascular disease. It is suggested in patients with hypercholesterolemia, when there is coronary disease.
* The very low calorie regimes: less than 800 to less than 600 kcal / d. They can cause deficiencies if they are extended.
* The low-fat or fat accounted for only 10 to 15% of inputs (eg Dukan regime). Its effectiveness is controversial.
* Plans high protein, low in carbohydrates (Atkins diet), but rich in fat and protein, placing no restriction in calories, but can increase satiety. They have some efficacy and are even in the short term, slightly superior to other schemes. This advantage no longer in the medium term.
* Fasting therapy clinics is increasingly practiced, especially in Russia, Ukraine, Germany, Spain, Japan, the USA, Canada, Thailand, India, Philippines.

The evaluation of the effectiveness of these plans is difficult, because published studies attempting to do so are "open" (the patient knows what kind of regime it is submitted) and their interpretation is likely some bias. Moreover, they are of short duration.

In practice, dietary advice without accompanying a moderate and limited effectiveness over time (high probability of regaining weight).

Herbalists recommend the use of certain medicinal plants or extracts of plants, in addition to a well-balanced diet.

* Plants that cut appetite (anorexic): hoodia, eucalyptus, laurel sauce, coca, Catharanthus, phyllantus niruri, Orthosiphon, algae, gum, Konjac
* Plants "burn fat", which would increase thermogenesis: seaweed and fucus, green tea, mate, guarana, coleus, Garcinia
* Plant sugars but which do not calories: sweet herb Stevia or Paraguay, or bramble Rubus suavissimus sweet China.
* Plants that act by increasing the hepatic activity (plants depurative): dandelion, artichoke, rosemary, Mary thistle, turmeric, hercampuri (gentianella)
* Plant calming to reduce the stress often involved in obesity and can better withstand the diet: the wort (Hypericum), the California poppy (Eschscholtzia), valerian (Valeriana), linden (Tilia)

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