DESCRIPTION OF OBESITY It is an accumulation of abnormal or excessive fat at a level that can harm health.
HOW IS OBESITY CALCULATED? The most commonly used method is the calculation of body bulk index (BBI).You can do this yourself. You need to know your height (in meters) and your weight. Kilogramme ÷ (height x height) for example your height is 1.74 meter and your weight is 70 kilogramme. BBI =70 ÷ (1.74 x 1.74) =23 You can see what this means it in the following table: CLASSIFICATION
if less than 18
if less than 16
16.00 - 16.99
17.00 - 17.49
18.50 - 24.99
25.00 - 29.99
30.00 and more
30.00 - 34.99
40.00 and more
If your body bulk index (BBI) is over 25, you should receive professional help as soon as possible. HEALTH PROBLEMS THAT CAN ARISE DUE TO OBESITY Obesity can cause and aggravate the risk of many diseases directly or indirectly. These are: • • •
coroner cardiac disease; type 2 diabetes; hypertension; 1
• • • • • • • •
dyslipidaemia (an abnormal amount of lipids e.g. cholesterol and/or fat in the blood); apoplexy; gallbladder diseases; obstructive sleep apnoea; respiratory problems; osteoarthritis in the joints carrying weight; some cancer types [endometrial (uterus), breast, prostate, colon]; decline in self-respect.
There is a clear relation between obesity and death. Cardiovascular diseases are the primary reasons for deaths. TREATMENT First of all the fact that obesity is a disease should be accepted and preventative steps should be taken before it occurs. The treatment of obesity is a process requiring the determination and active inclusion of the individual for a long period of time. Five methods are used in obesity treatment: 1) Diet • At the beginning of treatment realistic weight loss targets should be determined. As a realist target loss of 5-10 % weight should be aimed for in 6 months. • In general alimitation of 500-600 kcal a day brings loss of weight of 0.5 kg a week and 10 % in 6 months. • To limit the intake of total energy in a day many obese people skip meals but the motive of hunger causes the intake of more food afterwards. So it is important to make sure that they have 20-25 % in breakfast, 30-35 % in lunch and 30-35 % in dinner in order to suppress the feeling of hunger. 2) Exercise • Cardio and respiratory checks should be made before onset of physical activity regime. • At the beginning medium physical activity should be promoted 30-45 minute a day, 35 days in a week. To use up 2,000 kcal in a week, nearly 7 hour (420 minutes) of exercise should be done in a week. 3) Treatment of Behaviour •
The aim is to change the negative behaviour related to nutrition and physical activity into positive behaviour.
For obesity behaviour is treated generally for 12-20 weeks in 10-15 groups with 1-2 hour sessions a week under supervision of a therapist. This can be followed by once a week for 6 months then meetings 1-2 times a month for 2 years.
It is suggested to this behaviour treatment is carried out in conjunction with medical treatment or a diet with very low calories.
It is also important to increase the physical activity of individuals who have difficulty in adopting new diet suggestions.
The treatment of behaviour increases the motivation of the individual.
4) Pharmacological Treatment Treatment with medicine suggested by the doctor. 5) Surgical Treatment SUGGESTIONS FOR THE TREATMENT OF OBESITY A- Suggestions related to shopping Your relative should: • • • • •
go shopping with a full stomach, always prepare a list of shopping, take enough money for the list, always choose food with low energy not watch programmes or adverts related to food on television.
B- Planning Suggestions Your relative should: • • • • • •
Plan beforehand what to eat in order to limit their food consumption, Take exercise rather than having snacks in their leisure time at home or in the office, Have a glass of cool water after waking up in the morning, before, during and after meals, Eat the suggested food in the planned time (as 5-6 meals), not skip any meals, Acquire the habit of having a bowel movement everyday, when waking up, Measure and record of their weight after waking up in the morning, with the same clothing.
C-Suggestions related to activities regarding meals; Your relative should: • • • • • • • • • • • • •
Not have food lying around and easy to reach, Not spend too much time in the kitchen, Not have the food which is not recommended at home, Try to have small portions at mealtimes, Not keep serving bowls of food on the table, Leave the table as soon as the meal finishes, Leave food on the plate if necessary, Chew their food as much as possible and eat slowly, Not do other activities while having their meals (such as watching TV, reading), Not have anything to eat after dinner (tea without sugar, lime tree may be drunk) Wait a while before having more food., Try to avoid situations where they may eat a lot of food. Avoid alcohol, rich sauces and unnecessary additions in meals.
D-Other suggestions Your relative should: • • • •
Increase their physical activity by not using their car or the bus for a short journey, not take the elevator, walk quickly and try to do the housework by themselves. Try to be with active and lively people, Try to cook low energy meals (not adding fat to meat dishes, decreasing the fat amount in meals, boiling, grilling or baking rather than frying) Be patient in relation to losing weight and look for other activities than eating e.g. reading, going for a walk etc.
MOST FREQUENT QUESTIONS FOR THE DOCTOR From patient or relatives • • • • • • • • • •
Is there connection between obesity and hypothyreosis? Is there any correlation between weight and acne, and alcohol consummation during the slimming? Is there the correlation between the obesity and hypertension? Which doctor should be contacted: (i) an endocrinologist or (ii) a therapist or nutritional therapist? What is a gastric bypass surgery? On what degrees of obesity can be applied gastric bypass? What kind of surgery assists for morbid obesity? What is laparoscopic surgery? What sweets can be used in reducing diet? How to reduce appetite?
What answer we should prepare for the doctor • •
How many times per day do you/or your relative eat? You have to prepare list of food, you ate last few days.
About Your Symptoms or Diagnosis • • • • • • • • • • • • • • •
What is the disease or condition? How serious is my disease or condition and how will it affect my home and work life? What is the short-term and long-term prognosis for my disease or condition? What caused the disease or condition? Is there more than one disease or condition that could be causing my symptoms? Should I be tested for a certain disease or condition? What symptoms should I watch for? How can I be tested for a disease or condition, and what will these tests tell me? What tests will be involved in diagnosing my disease or condition? How safe and accurate are the tests? When will I know the test’s results? Will I need more medical tests? Do I need a follow-up visit and if so, when? Do I need to take precautions to avoid infecting others? How is the disease or condition treated?
REFERENCES Collective of authors, 2003. Vademecum Medici (6th edition). Osveta Bratislava Lau D. C., Douketis J. D., Morrison K. M., Hramiak I. M., Sharma A. M. , Ur E. (2007). Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ 176 (8): S1â€“13.