Obesity
Diseases

Ddd

https://authoritynutrition.com/forskolin-review/

Glutathione Decrement Drives Thermogenic Program In Adipose Cells, 2015

Treg obesity 2016

OBESITY

Obesity, a complex metabolic and behavioral disorder, has emerged to be a global health concern. According to the World Health Organization, over 200 million men and nearly 300 million women are afflicted with obesity.
In the United States alone, obesity plagues more than one-third (35.7%) of adults and nearly one fifth of youths as reported in the latest National Health and Nutrition Examination Survey. Obesity contributes to a myriad of diseases. Specifically, obesity is a modifiable risk factor for hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, and certain forms of cancers (uterine, breast, colorectal, kidney, and gallbladder), all of which substantially increase one’s morbidity and mortality.
As a result, obesity and obesity-related comorbidities attribute to nearly 300,000 deaths and total cost of $70 billion to $200 billion on healthcare expenditure annually in the United States.
According to the Centers for Disease Control and Prevention,an individual is considered to be obese if the body mass index (BMI) is ≥30 kg/m2.

Although the exact etiology remains to be elucidated, it is postulated that a gamut of factors attribute to obesity,including genetics, metabolism, behavior, environment, culturalbackground, and socioeconomic status.

Because of its mixed nature,behavioral and lifestyle modifications continue to be the cornerstone or obesity treatment. Pharmacotherapy, however, is recommended in conjunction with diet and exercise for patients whose BMI is ≥30 kg/m2 or for patients whose BMI is ≥27 kg/m2 with concomitant obesity-related risk factors or diseases (ie, hypertension, dyslipidemia,coronary heart disease, type 2 diabetes, and sleep apnea).

Over the years, clinicians have attempted various pharmacologic therapies in an effort to manage obese patients who require more aggressive treatment, albeit with variable success.
Since the 1930s, clinicians have experimented with neurotransmitter modulators to induce satiety and to augment appetite suppression. In 1936, amphetamines (ie, dexamphetamine, methamphetamine)were first introduced as potential weight loss agents by means of releasing norepinephrine from presynaptic vesicles in the lateral hypothalamus to modulate satiety. However, the overall utility was limited because of their dependency and abuse potential. Decades later in 1959, an amphetamine-like analog, phentermine, was approved for short-term use of up to 3 months, which remains to be the only antiobesity harbinger still available today.
By means of its central-acting property, phentermine decreases the desire for food and increases metabolism, attributing to an average of 3.6 kg additional weight loss
compared with a placebo at 6 months.

As with all sympathomimetic drugs, phentermine is associated with possible adverse effects, including headache, insomnia, irritability, palpitations, nervousness, and blood pressure elevation.

The choice of antiobesity pharmacologic agents remained scanty until the pharmaceutical industry introduced 2 new agents in 2012.

(1) Obesity is on the rise globally: One in three adults in the world (1.46 billion) were overweight or obese in 2008, up by 23% since 1980. (2) Where overweight or obese people live is changing: North Africa and the Middle East, and Latin America now have almost the same percentage of overweight or obese people as Europe. Graphics: ODI

NEW ANTI-OBESITY AGENTS: LORCASERIN.

Digitando “obesity” Google restituisce quasi 80 milioni di risultati che rimandano a poche indiscutibili evidenze scientifiche e a innumerevoli siti web che alimentano miti e false credenze sulla vera epidemia del 21° secolo.

Esasperati dalle idiozie sul tema che condizionano pratica clinica, priorità della ricerca, scelte dei pazienti e politiche sanitarie, Casazza K et coll. hanno pubblicato oggi sul N Engl J Med una rigorosa tassonomia di falsi miti, supposizioni e certezze sull’obesità, corredata dalle opportune evidenze scientifiche.

I falsi miti: ovvero le inossidabili credenze popolari che resistono a dispetto di robuste evidenze scientifiche che dimostrano il contrario.

Cambiamenti piccoli e duraturi mirati al consumo di calorie producono grandi effetti sul peso nel lungo termine.
Nel trattamento dell’obesità è fondamentale porre obiettivi realistici per evitare che i pazienti si sentano frustrati e perdano così meno peso.
Una perdita di peso rapida e consistente determina a lungo termine risultati meno rilevanti rispetto a una perdita di peso lenta e graduale.
Valutare la disponibilità a intraprendere una dieta è importante per aiutare i pazienti che vogliono dimagrire.
Le lezioni di educazione fisica, così come attualmente impartite nelle scuole, rivestono un ruolo importante nel prevenire o limitare l’obesità infantile.
L’allattamento al seno previene l’obesità.
Durante un rapporto sessuale vengono bruciano da 100 a 300 calorie a testa.

Le supposizioni: ritenute per lo più verità indiscusse non sono mai state dimostrate né smentite dalla ricerca (aree grigie).

Fare regolarmente colazione (rispetto a saltarla) previene l’obesità.
Nella prima infanzia apprendiamo abitudini relative all’esercizio fisico e all’alimentazione che influenzeranno il nostro peso per tutta la vita.
Mangiare più frutta e verdura permette di dimagrire, o di non prendere peso, anche in assenza di altri cambiamenti comportamentali o ambientali.
La continua alternanza di aumenti e cali ponderali (es. dieta a yo-yo) si associa a un aumento della mortalità.
Gli spuntini contribuiscono all’aumento di peso e all’obesità.
La disponibilità di marciapiedi e parchi in un contesto urbano influenza l’obesità.

I fatti: ragionevoli certezze supportate da adeguate evidenze scientifiche

I fattori genetici giocano un ruolo importante, ma ereditarietà non è sinonimo di destino: infatti, piccoli cambiamenti ambientali possono determinare un calo ponderale analogo ai farmaci più efficaci.
Le diete sono molto efficaci per perdere peso, ma provare a mettersi a dieta o raccomandare a qualcuno di farlo in genere non ha grandi effetti a lungo termine.
Indipendentemente dal peso corporeo o dalla perdita di peso, l’incremento dell’attività fisica migliora la salute.
A lungo termine un’adeguata attività fisica aiuta a mantenere il peso forma.
Il persistere delle condizioni che favoriscono il dimagrimento facilita il mantenimento del peso forma.
Per i bambini in sovrappeso, i programmi che prevedono il coinvolgimento dei genitori e del contesto familiare sono più efficaci per ottenere calo ponderale e mantenere il peso forma.
La fornitura di pasti e l’utilizzo di prodotti sostitutivi dei pasti aiuta a perdere più peso.
Alcuni farmaci possono aiutare i pazienti a perdere peso in maniera significativa e a mantenere i risultati ottenuti per tutto il periodo di assunzione.
In pazienti selezionati, la chirurgia bariatrica determina una riduzione di peso a lungo termine e riduce sia l’incidenza del diabete, sia la mortalità.

Chissà cosa ne pensano i dietologi e nutrizionisti italiani, visto che molti dei miti e delle supposizioni continuano a sostenere le illusioni dei pazienti obesi!

Magari Vespa ci organizza l’ennesima puntata “Porta a Porta” dedicata alle diete, tema a lui molto caro, dopo politica e delitti eccellenti.

Myths, presumptions, and facts about obesity, 2013

Fulltext

DEFINITION

A status with BODY WEIGHT that is grossly above the acceptable or desirable weight, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).

EPIDEMIOLOGY

Populations Affected
Overweight and obesity affect people of all ages, sexes, racial/ethnic groups, and educational levels. This serious health problem has been growing over the years. In fact, overweight and obesity in adults have doubled since 1980, and overweight in children and teens has tripled.

Adults
According to the National Health and Nutrition Examination Survey (NHANES) 2003–2004, about one-third of adults in the United States are overweight and slightly more than one-third are obese, this situation doesn't differ a lot from other countries.
The survey about US also shows differences in overweight and obesity according to racial/ethnic groups.
In women, overweight and obesity are highest for non-Hispanic Black women (about 82 percent), compared to about 75 percent for Mexican American women and 58 percent for non-Hispanic White women.
In men, overweight and obesity also are higher for minority groups. They’re highest for Mexican American men (about 76 percent), compared to about 71 percent for non-Hispanic White men and about 69 percent for non-Hispanic Black men.

Children and Teens
According to NHANES 2003–2004, overweight and the risk for overweight is rising in children and teens. The survey shows that:
About 19 percent of school-aged children and about 17 percent of teens are overweight.
About 18 percent of school-aged children and about 17 percent of teens are at risk for overweight.
There are also some differences in overweight according to racial/ethnic groups.

Income
Overweight and obesity are also common in groups with low incomes. Women with low incomes are about 50 percent more likely to be obese than women with higher incomes. Among children and teens, overweight in non-Hispanic White teens is related to a lower family income.
Low-income families also buy more high-calorie, high-fat foods, which may add to the problem. This is because they tend to cost less than more healthful foods such as fruits and vegetables.

CAUSES

Energy Balance
For most people, overweight and obesity are caused by not having energy balance. Weight is balanced by the amount of energy or calories you get from food and drinks (this is called energy IN) equaling the energy your body uses for things like breathing, digesting, and being physically active (this is called energy OUT).
Energy balance means that your energy IN equals your energy OUT. To maintain a healthy weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that helps you maintain a healthy weight.
The same amount of energy IN and energy OUT over time = weight stays the same
More IN than OUT over time = weight gain
More OUT than IN over time = weight loss
Overweight and obesity happen over time when you take in more calories than you use.

Physical Inactivity
Many Americans aren’t very physically active. There are many reasons for this. One reason is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity.
Other reasons for not being active include: relying on cars instead of walking to places, fewer physical demands at work or at home because modern technology and conveniences reduce the need to burn calories, and lack of physical education classes in schools for children.
People who are inactive are more likely to gain weight because they don’t burn up the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for heart disease, high blood pressure, diabetes, colon cancer, and other health problems.

Environment
Our environment doesn’t always help with healthy lifestyle habits; in fact, it encourages obesity. Some reasons include:
Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.
Work schedules. People often say that they don’t have time to be physically active given the long hours at work and the time spent commuting back and forth to work.
Oversized food portions. Americans are surrounded by huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn’t balanced with physical activity.
Lack of access to healthy foods. Some people don’t live in neighborhoods that have supermarkets that sell healthy foods such as fresh fruits and vegetables. Or if they do, these items are often too costly.
Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do.

Genes and Family History
Studies of identical twins who have been raised apart show that genes have a strong influence on one’s weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese. Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat.
Because families also share food and physical activity habits, there is a link between genes and the environment. Children adopt the habits of their parents. So, a child with overweight parents who eat high-calorie foods and are inactive will likely become overweight like the parents. On the other hand, if a family adopts healthful food and physical activity habits, the child’s chance of being overweight or obese is reduced.

Health Conditions
Sometimes hormone problems cause overweight and obesity. These problems include:
Underactive thyroid (also called hypothyroidism). This is a condition in which the thyroid gland doesn’t make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You’ll also feel tired and weak.
Cushing’s syndrome. This is a condition in which the body’s adrenal glands make too much of the hormone cortisol. Cushing’s syndrome also can happen when people take high levels of medicines such as prednisone for long periods of time. People with Cushing’s syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs.
Polycystic ovarian syndrome (PCOS). This is a condition that affects about 5 to 10 percent of women of childbearing age. Women with PCOS often are obese, have excess hair growth, and have reproductive and other health problems due to high levels of hormones called androgens.

Medicines
Certain medicines such as corticosteroids (for example, prednisone), antidepressants (for example, Elavil®), and medicines for seizures (for example, Neurontin®) may cause you to gain weight. These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water—all of which can lead to weight gain.

Emotional Factors
Some people eat more than usual when they are bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity.

Smoking
Some people gain weight when they stop smoking. One reason is that food often tastes and smells better. Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain.

Age
As you get older, you tend to lose muscle, especially if you’re less active. Muscle loss can slow down the rate at which your body burns calories. If you don’t reduce your calorie intake as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain around 5 pounds during menopause and have more fat around the waist than they did before.

Pregnancy
During pregnancy, women gain weight so that the baby gets proper nourishment and develops normally. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies.

Lack of Sleep
Studies find that the less people sleep, the more likely they are to be overweight or obese. People who report sleeping 5 hours a night, for example, are much more likely to become obese compared to people who sleep 7–8 hours a night.
People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity over time. Hormones that are released during sleep control appetite and the body’s use of energy. For example, insulin controls the rise and fall of blood sugar levels during sleep. People who don’t get enough sleep have insulin and blood sugar levels that are similar to those in people who are likely to have diabetes.
Also, people who don’t get enough sleep on a regular basis seem to have high levels of a hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin (which normally helps to curb hunger).

SIGNS AND SYMPTOMS

Weight gain usually happens over time. Most people know when they’ve gained weight. Some of the signs of overweight or obesity include:

• Clothes feeling tight and needing a larger size.
• The scale showing that you’ve gained weight.
• Having extra fat around the waist.
• A higher than normal body mass index and waist circumference.

DIAGNOSIS

The most common way to find out whether you’re overweight or obese is to figure out your body mass index (BMI). BMI is an estimate of body fat and a good gauge of your risk for diseases that occur with more body fat. The higher your BMI, the higher your risk of disease. BMI is calculated from your height and weight.
IBM Calculator
Health care professionals also may take your waist measurement. This helps to screen for the possible health risks that come with overweight and obesity in adults. If you have abdominal obesity and most of your fat is around your waist rather than at your hips, you’re at higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men.

RISKS

Heart Disease
This condition occurs when a fatty material called plaque (plak) builds up on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Plaque narrows the coronary arteries, which reduces blood flow to your heart. Your chances for having heart disease and a heart attack get higher as your body mass index (BMI) increases. Obesity also can lead to congestive heart failure, a serious condition in which the heart can’t pump enough blood to meet your body’s needs.

High Blood Pressure (Hypertension)
This condition occurs when the force of the blood pushing against the walls of the arteries is too high. Your chances for having high blood pressure are greater if you’re overweight or obese.

Stroke
Being overweight or obese can lead to a buildup of fatty deposits in your arteries that form a blood clot. If the clot is close to your brain, it can block the flow of blood and oxygen and cause a stroke. The risk of having a stroke rises as BMI increases.

Type 2 Diabetes
This is a disease in which blood sugar (glucose) levels are too high. Normally, the body makes insulin to move the blood sugar into cells where it’s used. In type 2 diabetes, the cells don’t respond enough to the insulin that’s made. Diabetes is a leading cause of early death, heart disease, stroke, kidney disease, and blindness. More than 80 percent of people with type 2 diabetes are overweight.

Abnormal Blood Fats
If you’re overweight or obese, you have a greater chance of having abnormal levels of blood fats. These include high amounts of triglycerides and low-density lipoprotein (LDL) cholesterol (a fat-like substance often called “bad” cholesterol), and low high-density lipoprotein (HDL) cholesterol (often called “good” cholesterol). Abnormal levels of these blood fats are a risk for heart disease.

Metabolic Syndrome
This is the name for a group of risk factors linked to overweight and obesity that raise your chance for heart disease and other health problems such as diabetes and stroke. A person can develop any one of these risk factors by itself, but they tend to occur together. Metabolic syndrome occurs when a person has at least three of these heart disease risk factors:

1. A large waistline. This is also called abdominal obesity or “having an apple shape.” Having extra fat in the waist area is a greater risk factor for heart disease than having extra fat in other parts of the body, such as on the hips.
2. Abnormal blood fat levels, including high triglycerides and low HDL cholesterol.
3. Higher than normal blood pressure.
4. Higher than normal fasting blood sugar levels.

Cancer
Being overweight or obese raises the risk for colon, breast, endometrial, and gallbladder cancers.

Osteoarthritis
This is a common joint problem of the knees, hips, and lower back. It occurs when the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain.

Sleep Apnea
This condition causes a person to stop breathing for short periods during sleep. A person with sleep apnea may have more fat stored around the neck. This can make the breathing airway smaller so that it’s hard to breathe.

Reproductive Problems
O