Current concept of obesity

Tags: obesity, physical activity, Mazzeo, overweight and obesity, body fat, Sport Science, obesity in the United States, health expenditure, Journal of Physical Education and Sport, Obesity Reviews, Tafuri D., Childhood obesity, global epidemic, D. & Raiola, health outcome, chronic disease, American Heart Association, Tafuri, D., Tafuri, energy expenditure, Journal of the American Medical Association, Mazzeo F., Santamaria S., Physiol Behav, American Diabetes Association, National Heart, Lung, and Blood Institute, health system, World Health Organization, Filomena Mazzeo, body mass index, health care, European Countries, mental disorders, health outcomes, health care costs, genetic factors, physical activities
Content: Mazzeo, F.: Current concept of obesity
Sport Science 9 (2016) Issue 2: 42-48
CURRENT CONCEPT OF OBESITY Filomena Mazzeo University of Naples Parthenope, Department of Science and Technology, Italy Original scientific paper
Abstract "Globesity" is a word used by the World Health Organization (WHO) to describe the global epidemic of overweight and obesity. The gain weight is due to numerous factors such as an unhealthy lifestyle, a wrong diet, a lack of exercise, the change in way to live and genetic factors. It is reported that the accumulation of fat in the body starts in childhood and changes depending on sex, age and ethnicity. The illnesses linked to high body fat are obesity, type 2 diabetes, osteoporosis, depression, and cancer of the breast and colon. There are different tests that measure the quantity of body fat but the most used is the Body Mass Index. According to it, a person is obese when his BMI is equal or superior to 30 points. Researchers showed that diet and exercise play an important role in the treatment and prevention of obesity in patients with obesity as useful variables to predict CVD risk beyond adiposity and emerging evidence showed also the importance of cardiorespiratory fitness, skeletal muscle mass and strength. Regular exercise (and proper nutrition) can help reduce body fat as well as protect against chronic diseases associated with obesity. The (WHO), with Health 2020, is engaging all Countries to develop an efficient approach in order to resolve health diseases.The aim of this review is to discuss on obesity: epidemiology etiology, different methods to measure it, the role of physical activity and governments to solve it. Additional research may foster understanding about how and what sport to can help promote Energy balance and healthy body weight. Moreover, a new pharmacological target to fight obesity and its associated diseases are represented by Endocannabinoid system. Key words: obesity, overweight, sport, weight loss, pharmacology, physical activity.
Introduction Obesity is and has been one of the most important health problems in the U.S. and in many other countries. There is considerable evidence that links obesity with certain diseases of the cardiovascular, endocrine, neurological system and diabetes (Mazzeo et al 2010). It is a medical condition which occurs when the body mass index is superior or equal to 30 kg of body weight/m2 of height. It is characterized by the accumulation of excess fat that can lead cardiovascular dysfunction, diabetes mellitus type 2, disorders of the osteoarticular system, stroke, metabolic syndrome and cancer(Berthoud 2005; Must et al. 1999 ). Obesity is caused by a combination of excessive food intake, lack of physical activity and genetic predisposition. The WHO talks about "globesity" with the meaning of the global epidemic of overweight and obesity. Obesity, in fact, is a problem for even more countries and for the entire society: from the children to adults (Wilborn et al. 2005 ). Indeed, his incidence has increased in the last twenty years, especially in developed societies (Mazzeo et al. 2016; Ogden et al. 2006; Flegal et al. 2010).It was demonstrated that an adult affected by obesity is a result of childhood with the same problem (Mason et al. 2008; World Health Organization Regional Office for Europe 2014). The body of a obesity person is undergoing a premature aging process. An obese man can die 13 years before than a normal one (Fontaine et al. 2009) and the die risk increase of 30% every 15kg of overweight , due to the development of diseases (Sassi et al. 2010; Schmid et al. 2005). The main 42
reason why people gain weight is the change of their life style due to the technological development (Lakdawalla et al. 2002).Additional reason is the consumption of too much calories, which are increased, from 1980, about 12%. The entire society, introduce a surplus of calories that real need for their bodies. They come, for example, from fizzy beverages, rich in sugars or from fat food (Putnam et al. 2002; Mazzeo et al. 2010). Moreover, the wrong habit to eat before the main meals is increased over the time (Nielsen et al. 2003) In addition, there are genetics factors that are involved in this pathology (Finucane et al. 2011). Evaluation of people's weight People weight in adults varies with sex, height and age and there are various methods to measure it.Body mass index (BMI) is a measure of body fat based on people weight in relation to their height. It is divided by the square of his/her height (Messina et al. 2015). Even though it does not measure body fat directly, it is inexpensive and easy-to-perform. The index includes six weight conditions: from underweight to obesity III, as Table 1. A person with a BMI of 29.9 is considered overweight but just with 0.01 point more (30 BMI), he is obese (Wilborn et al. 2005; Orzano et al. 2004). The main problem linked to this index is his paradox. According to it, bodybuilders could have the same BMI of a sedentary, fat, people. It, in fact, does not consider the fat quantity in the person body and his musculature.
Mazzeo, F.: Current concept of obesity Table 1. Classification of BMI.
BMI Below 18.5 18.5-24.9 25.0 -29.9 30 ­ 34.9 35 ­ 39.9 40
Classification Underweight Healthy weight Overweight Obesity I Obesity II Obesity III
Figure 1. Different people with the same BMI.
Table 2. Data of subject A and B
Muscle Mass Fat Mass Bone Mass Body Fat Total Weight Height
A 88.7 kg 13.8 kg 3.8 kg 13% 106.3 kg 1.83 m
B 69.5 Kg 25.8 Kg 2.8 Kg 26.3 % 98.1 Kg 1.76 m
As you can see in Figure 1 and in Table 2, although the fat mass of person A is smaller than subject B and the first one has a greater weight, they have the same BMI (31.7) which indicates that both are affected by obesity (De Lorenzo et al. 2001)
Tests to diagnose obesity could be
-
Waist circumference, Sagittal Diameter and
Waist-To-Hip Ratio. They are measurements for
estimating the amount of fat mass deposited under
the skin and inside the abdominal cavity;
-
Skinfolder Caliper which measures only the
fat under the skin;
-
Water Displacement Tests ­ Fat floats. This
test consists in submerging a person in water and
calculating the volume of the displaced water from
the weight of the displaced water;
-
Electrical Measurements that calculates the
percentage of body fat by measuring the difference
electrical characteristics of fat and other body
tissues;
Sport Science 9 (2016) Issue 2: 42-48
-
Blood test. This is the most common test
recommended by physicians. Thanks to it, it is
possible to know how many fat there is in the blood
and if a person suffers from disorders, such as
thyroid disorder;
-
Plicometry is a technique that, through a
device called plicometer, evaluates the thickness of
cutaneous plicae or folds(Rona et al. 2006). It is
based on the relationship between the
subcutaneous adipose tissue and thin body mass;
-
Densitometry, which is another technique
that observes how thin tissues absorb, determined
electromagnetic waves in comparison with fat
tissues;
Etiology Obesity be determined by different factors such as genetics (Hamilton et al 2007; Messina et al. 2015), but the main is the lack of physical activity, which is linked to an energy imbalance. People, in fact, intake too much food they need causing a weight gain. Moreover, an unhealthy diet in which there are a high consumption of sugar, fat and salt and low intaking of minerals, vitamins and other micronutrients can lead to weight gain (Mazzeo et al. 2016). Furthermore, the lack of exercise and the change of environmental lead people to spend time indoor, in front of their devices. The preference to stay at own home is due to the fear of crime. Nevertheless, leisure activities are changed: people, in fact, do less manual actions and even more sedentary activities (Fontaine et al. 2003). In addition, despite the fact genetic factors are rare to determine obesity, some people are predisposed to obesity. They, indeed, suffer from genetical disorders such as Prader ­Willi syndrome and Bardet-Biedl syndrome. Nevertheless, there are some hormones, insulin, leptin, neuropeptide Y, cortisol, ghrelin, norepinephrine, serotonin, inteleukin-6 TNF and other pepetides involved in obesity (Messina et al. 2015). Orexyn, for example, is involved in the above-mentioned illness(Messina et al. 2015). It is a neurotransmitter, which regulates the sleep-wakefulness and appetite(Date et al. 1999; Tao et al. 2006). The distribution of orexin neurons and their receptors explains how they are involved in numerous physiological processes, including the modulation of the sleep, the arousal and of the energy expenditure, suggesting an important role in development of obesity(Tsujino, Sakurai 2009; Hara et al. 2001; Kotz 2006). Obesity is associated with decreased levels of orexin(Bronskэ J 2007). Orexin system regulates and consolidates sleep/ wake patterns. Narcoleptic patients, with a lack orexin, have altered sleep patterns, highly fragmented sleep and elevated body mass index(Kok et al. 2002). This shows how important is the orexin in maintaining normal sleep/wake patterns and energy homeostasis.
Associated diseases Fat accumulation starts during childhood. At beginning, children are "physiologically" overweight (Mazzeo et al. 2010). Later, the fat mass decreases up to 5 years and goes back up to 10 years (James
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Mazzeo, F.: Current concept of obesity et al. 2006). In the puberty, there is a different fat distribution between male and female: with a decreasing in the first one and an increasing in the second. Table 3. Illnesses linked to obesity
Cardiovascular Hypertension Type 2 Diabetes and some cancers Musculoskeletal Hyperuricemia (which predisposes to gout) Endocrine disease Gastrointestinal gastroesophageal reflux disease (GERD) Renal and genitourinary problems Neurologic Respiratory disorders
congestive heart failure, enlarged heart and its associated arrhythmias, dizziness, Varicose veins, pulmonary embolism lipidemic imbalance, the increase in triglycerides and total cholesterolemia breast (postmenopausal), colon, endometrial, ovary, cervical and gall bladder cancer in women and colon, rectum and prostate cancers in men Osteoarthritis immobility, osteoarthritis, low back pain polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility fatty liver disease, cholelithiasis (gallstones), hernia, and colorectal cancer erectile dysfunction , urinary incontinence, chronic renal failure, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirthbreast cancer (female), uterine cancer (female), stillbirth stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia, idiopathic intracranial hypertension. obstructive sleep apnea, obesity hypoventilation syndrome, asthma
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Sport Science 9 (2016) Issue 2: 42-48 As regard fatty tissue, important changes occur in adipocytes which are involved in hyperplasia and hypertrophy processes according to age. However, in obese child the increase in the number of adipocytes is higher than normal person (Korth et al. 2007; Kaur et al. 2003). Obesity means not only not to be able in performing daily activities but it is a risky condition health due to the illnesses linked to it (Table 3). In order to psychological disease, may occur depression, low self-esteem, body dysmorphic disorder, social stigmatization, really dangerous, especially among in children and adolescents (Dehghan et al. 2005). Spread of the gain of weight In 46 European countries on 51, more than 50% people areaffected by overweight and more than 20% by obesity (Altavilla et al. 2014). In particular, Hungary, Czech Republic, Greece, The UK and Luxemburg show higher levels of percentage compared toItaly, Sweden, The Netherlands, Austria and France (In European countries, a range of 16-20% of death it was caused by the above mentioned disease while in the United States at least 300.00 deaths every year is due to this health condition (Ogden et al. 2006). Those diseases depend on the level on various factors. As regard the level of education, it is showed that his increasing leads the decreasing of chances to get sick. In Europe, it is estimated that 26% of obese men and 50% of obese women is due to the low education (James et al. 2006). As concern the unhealthy life style, it is reported that In Italy, Denmark, France, The Netherlands, Norway, Switzerland, Sweden and Great Britain, 60-100% of weight gain is due to the excessive ingestion of food is rather than the lack of exercise(World Health Organization Regional Office for Europe. 2014). The prevalence of overweight among children younger than 16 years is between 10% and 20% in the European Region, with rates higher among children in southern Europe. Their dietary habits are not optimal for health. They, in fact, intake low quantities of fruits and vegetable and too much sweetened beverages. Moreover, the level of physical activity decreases during adolescence and in particular among the girls. The social and economic environment in which adolescents grow up often determines their behavior (Weinsier et al. 1998). It is showed that a premature approach to sex, alcohol and prohibited substances expose the adolescents not only to direct health risks but depressive disorders and eating disorders. Obesity increases with the age. Even though men are more overweight than women (42.6% against 32.1%), higher percentage of those last one are morbidly obese than men (2.7% against 0.9% respectively). Furthermore, people of difference ethnicity have difference predisposition to obesity. Women of minority ethnic group have higher levels of central obesity compared to the others. In particular, Black African, Black Caribbean and Pakistani female are more affected by obesity, respectively with 38.5%, 32.1% and 28.1%, than 23.2% of the general
Mazzeo, F.: Current concept of obesity population. On the contrary, Chinese women have the lowest level of obesity with only 7.6% (Harvey 2002; Stubbs 2004). Regarding the men, obesity among general population is 22.7%. The lowest level is recorded among Bangladeshi followed by Chinese people (5.8% and 6%), while the highest level (22.7%) is reported on Black Carribean men. Economic cost and outlook for action There are direct medical costs linked to the obesity(Hammond Ross and Ruth Levine 2010). It is estimated that only in 2006 The UK spent 3.23 billion pounds, that is 5% of the National Health System(Allender and Rayner 2007). Similar situation isfound in The Netherlands where the above-mentioned costs is 4% of the NHS, while in The USA are increasing. They, in 2000, were between 5 and 7% but in2008 between 910%(Wolf and Colditz 1998). China recorded in 2003 a 3.7% of expenditure while Switzerland, in 2002, 3.5%(Zhao et al.2008). In addition, it is shown that 54-69 aged people who are affected by obesity with a BMI range of 30-35 cause an increasing of expenditure of 25% compared to normal weight. Moreover, when there is a BMI range 35-40 the costs increase over 50% and reach at 100% in sever obese with a BMI super to 40 (Andreyeva et al. 2004). Since the last decades of the last millennium has shown an increasing worldwide interest in the issue of health. In September 2012, at the session of the WHO Regional Committee for Europe, it was approved by 53 European Countries, an important document entitled Health 2020. Its aim is improve health and reduce health inequalities. The document is based on the awareness that good health leads to the benefits of all sectors and the whole of society. It, in fact, is essential for economic and Social Development. "The health sector is responsible for: developing and implementing national and subnational health strategies; setting health goals and targets for improving health; assessing how the policies of other sectors affect health; delivering high quality and effective health care services; and ensuring core public health functions. It also has to consider how its health policy decisions affect other sectors and stakeholders." According to the document, fair access to education, good work conditions, housing and income support health, like a virtuous process (Fig. 2). Education
Good Health
Good job
Housing
Income
Figure 2. Benefits for all sectors
Sport Science 9 (2016) Issue 2: 42-48 In contrast, the growth of chronic disease and mental disorders, the lack of social cohesion, the environmental dangers and financial uncertainties make improving health even more difficult and threaten the sustainability of health and welfare systems. A large burden of disease in European Countries, particularly chronic non-communicable disease, severely affects labor markets and productivity. Diseases lead to disparities in employment opportunities and wages, affect productivity at work and increase sick leave and the demand for welfare benefits (Zhao et al.2008). Moreover, health costs represent a great challenge to governments due to the fact that it has grown more than economic growth in many Countries in where the health share of government budgets is larger than ever, and health care costs have grown faster than gross domestic products (Hammond and Levine2010). However, for at least some of these countries, data show a lack of correlation between health expenditure and health outcome (Fig. 3) health expenditure health outcome Figure 3. Lack of correlation between health expenditure and health outcome Health 2020 suggests, with the aim to contain costs, spending more resources in health promotion and disease prevention. In this contest, media plays an important role to promote healthier behavior by informing people about the risks of obesity and other causes of disease. Moreover, in order to remove the adverse effects of illness and inequalities on every sectors, European governments should have to engage in intersectional approaches for health, including economic, social and political benefits of good health. In particular, it is important to create new skills in managing conflicts of interest and finding new ways of tackling intractable complex problems. Together with Member States, WHO has a special responsibility to exercise such leadership and to support health ministries in achieving their goals. Moreover, "Empowering people, citizens, consumers and patients is critical for improving health outcomes, health system performance and patient satisfaction. The voice of civil society, including individuals and patient organizations, youth organizations and senior citizens is essential to draw attention to health-damaging environments, lifestyles or products and to gaps in the quality and provision of health care. It is also critical for generating new ideas." 45
Mazzeo, F.: Current concept of obesity According to Health 2020, even though children are exposed to marketing pressure to intake foods high in saturated fat, trans-fatty acids, free sugar or salt, the preventive actions are simple and cheap. It need, in fact, promoting the awareness of the benefit of a physical activity: for example, through urban design and planning the school day, schoolbased health literacy programmers; peer-to-peer education; and the development of youth organizations (WHO. Health 2020, 2013). Physical activity Physical activity describe all movement produced by skeletal muscles which increases energy expenditure, whether exercise or sport (Altavilla et al. 2014, Pizzuto et al, 2016, Raiola et al, 2016).Physical activityincludes cardiorespiratory fitness, body composition, muscle strength and flexibility. Exercise is a subset of physical activitythat is planned, structured, repetitive, and purposeful in thesense that improvement or maintenance of physical fitness isthe objective (Mazzeo et al 2015). A important interrelationshipexists between the total dose of activity (totalamount of energy expended in physical activity) and the intensity(the rate of energy expenditure during such activity) at which the activity is performed.Intensity reflects the rate of energy expenditure during exerciseand is usually expressed in metabolic equivalents or METs, where1 MET equals the resting metabolic rate of 3.5 mL O2 ·kg-1 min-1(Altavilla et al.2014). Relative intensity refers to the percentof aerobic power utilized during exercise and is expressed aspercent of maximal heart rate or percent of O2max. In relative terms, thisintensity is considered light for a 20-year-old healthy personbut represents a vigorous intensity for an 80-year-old person. At present daily participation in moderate and vigorous physical activities is low, and activity decreases with increasing age (Mazzeo et al 2016). The role of sport and physical activity in children, for optimising bone mass and reducing obesity and insulin resistance, people with cardiac disease and older people, merit special attention. Effective strategies exist for managing obesity yet are rarely used by physicians. For general health benefits 30 minutes of at least moderate intensity physical activity is recommended on 5 or more days of the week (Mazzeo et al 2016). This can be achieved by doing all the activity in one session or through several shorter bouts of activity of 10 minutes or more. The activity can be structured sport or lifestyle activity (part of everyday life e.g. climbing stairs, brisk walking) or combination of both.
Sport Science 9 (2016) Issue 2: 42-48 To prevent obesity 45-60 minutes of moderate intensity physical activity each day may be needed. To maintain weight loss 60-90 minutes of moderate intensity physical activity each day may be required in people who have been obese and have lost weight. Frequent and regular aerobic exercise has been shown to help prevent or treat serious and life-threatening chronic conditions such as high blood pressure, heart disease, Type 2 diabetes, insomnia, depression and obesity (Diehl and Choi 2008). Physical activity carried out regularly and with at least thirty minutes a day, combined with an adequate diet, determines, in a medium-long period, an increase of energy and thus a corresponding decrease adiposity (Mazzeo et al 2010). Conclusion Adults, sedentary people may suffer from obesity and may develop chronic diseases such as coronary heart disease, hypertension, hypercholesterolemia, cancer, musculoskeletal disorders(Finucane et al.; Orzano and Scott 2004; Raiola et al. 2015). Moreover, some population are more predisposed to obesity such as: Black African and Pakistani female and Black Caribbean - male and female(Orzano AJ, Scott JG 2004). There are lots instrument to diagnose obesity but the most useful is the Body Mass Index. An exercise training, an healthy life style and an efficient health system may resolve the problem of gain weight (Altavilla et al, 2014, Guetano et al, 2015). It is important combine the above mentioned the suggestions to have a real change (Hamilton et al. 2007). The government play an important role to impose new life style models in which people have to spent more time outdoor, doing physical exercises and eating more fruits and vegetable rather than fat, salted foods (Kotz CM 2006).Moreover, for pharmacological therapythe endocannabinoid system represent a new pharmacological target for obesity treatment. The endocannabinoid system, which is well known for its contributions in certain mental processes such as relaxation, improvement of pain and anxiety, and sedation initiation, has been recently reported to play an essential role in regulating appetite and metabolism to maintain energy balance, leading to the acceptance that endocannabinoid system is closely related to obesity (Hu Zhu and Huang 2009). Nevertheless, governments have better to spend the health expenditure in order to improve other society sectors and offer to the people best conditions to live and stay healthy.
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TRENUTNI KONCEPT PRETILOSTI Sazetak "Globesity" je rijec koja se koristi od Svjetske zdravstvene organizacije (WHO) kako bi se opisalo globalnu epidemiju debljine i pretilosti. Prirast tezine je prisutan zbog brojnih faktora kao sto su nezdrav nacin zivota, pogresna prehrana, nedostatak tjelesne aktivnosti, promjene u nacinu zivota i genetskim faktorima. To je izvijestilo da nakupljanje masti u tijelu pocinje u djetinjstvu i mijenja se ovisno o spolu, dobi i nacionalnosti. Oboljenja povezana s visokom tjelesnom masti su pretilost, dijabetes tipa 2, osteoporoza, depresija, rak dojke i debelog crijeva. Postoje razliciti testovi koji mjere kolicinu masti u tijelu, ali od najvise koristi je indeks tjelesne mase. Prema tome, osoba je pretila kada je njen BMI jednak ili vei od 30 bodova. Istrazivaci su pokazali da prehrana i tjelovjezba igraju vaznu ulogu u lijecenju i prevenciji pretilosti u bolesnika sa pretilosu kao korisne varijable za predvianje KVB rizika izvan pretilosti i novih dokaza, a pokazali su takoer vaznost kardiorespiratorna kondicija, skeletna misina masa i snaga. Redovita tjelovjezba (i pravilna prehrana) moze pomoi u smanjenju tjelesne masti, kao i zastita protiv kronicnih bolesti povezanih s pretilosu. WHO, sa Zravstvom 2020, angazira sudjelovanje svih zemalja u razvijanju ucinkovitog pristupa u cilju rjesavanja bolesti. Cilj ovog pregleda je da se raspravlja o pretilosti: epidemiologije etiologije, razlicite metode za mjerenje, uloga fizicke aktivnosti i vlade da se to rijesi. Dodatna istrazivanja mogu poticati razumijevanje o tome kako sport moze pomoi u promicanju energetske ravnoteze i zdrave tjelesne tezine. Stovise, nova farmakoloska meta u borbi protiv pretilosti i pridruzene bolesti je predstavljena Endocannabinoid sustavom. Kljucne rijeci: pretilost, prekomjerna tezina, sport, mrsavljenje, farmakologija, tjelesna aktivnost.
Received: July 17, 2016 Accepted: December 15, 2016 Correspondence to: Filomena Mazzeo,MD,PhD Assistant Professor in Pharmacology and Clinical Toxicology Department of Science and Tecnology University of Naples "Parthenope" Tel : 0039 0815476648 E-mail: [email protected] 48

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