Obesity

It is not possible to conjure a unifying theory which will explain why some people become fat while others remain lean John Garrow BMJ 1983;286:1684

Obesity is an excess of adipose tissue. It is usually measured by body mass index or by the table of the Metropolitan Life Insurance Company of New York.

It is not a single disorder, but rather a heterogeneous group of disorders that are associated with varying types and degrees of risk for morbidity and for mortality. It is a syndrome , like fever or anaemia, with no single cause. Il is rarely secondary to endocrinological diseases such as hypothalamic conditions, mixoedema, Cushing’s syndrome. In the great majority is primary. The genetic influence on obesity has been clearly demonstrated. Periods of rapid and substantial weight gain sustained at any age, but particularly during early or late childhood, suggest hyperplasia of fat cells.The major complications of obesity are: diabetes mellitus (+133%), cerebrovascular disease (+53%), coronary artery disease (+35%), hypertension accidents (+18%), cancer (+16%), respiratory disease (apnoea sleep disease), gallstones, hernias, arthritis, varicose veins. 

Obeses usually experiments  the weight cycling syndrome. In fact they try many times, during their life, to go on a diet but every time they reach to lose some weight gradually they recover the weight lost and some more since finally they get heavier and heavier. The management of obesity is difficult and the rate of success, as defined by adequate weight loss followed by a prolonged period without regaining the lost weight, is quite low, therefore it should be entrusted to a specialist. The essence of treatment is to reduce the food energy and to increase caloric expenditure. It can be managed by behavior modification, diet, exercise. Sometimes occur surgery and some drugs. Psychological intervention is essential. No patient will go day after day denying himself or herself the usual pleasures of eating unless he or she is well motivated. Some useful questions are: why do you want to lose weight? What weight would you like to be? Have you ever been on a diet and what happened? Who shops and cooks at home? Does your family support you? Answering to this question is the first step if you want go on a diet and reach a good result. Finally there is no single diet for everybody but the diet must be tailor made.

Degree of obesity

(clic here for calculation)

 Weight with adjustment for height using body mass index calculated as weight (Kg)/ height (m) squared, is recommended by the

World Health Organization Expert Committee for assessing the degree of obesity

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