Teenage Obesity - The Dangers of obesity
There is no question that the number of Americans with the word "obese" is dramatically increasing every year. The problem is not limited to adults, the rate of adolescent obesity has also increased dramatically. Recent research tells us that about 15% of all American teenagers are overweight. This refers to some 9 million young people, which is almost three times the number of overweight teens in 1980
Research has several causes of teenage obesity, including poor eating habits and physical inactivity. Teens' bodies are still developing and they need a balanced diet and to engage in healthy forms of regular exercise. Some doctors describe young people as a "grass-eaters." They just eat what they want when they want, regardless tailored to her body. This explains the high consumption of fast food among young people. Moreover, many young people spend their free time watching TV or video games, resulting in a predominantly sedentary lifestyle.
In order to prevent teenage obesity, it is important for young people to eat a healthy, balanced diet, including plenty of fruits and vegetables, lean protein, appropriate levels of low-fat dairy products, and complex carbohydrates. Teens should avoid high-fat, high caloric foods such as those on the fast-food menu. You should also find ways to train. It is not as simple as "hitting the gym," instead, young people find fun ways to move. There is nothing wrong with an aerobics class or two, but there is nothing more motivating than the participation in a leisure or after-school sports team. Young people can shoot hoops, join a swim or track team, play volleyball or baseball, or enjoy a round of golf on the weekend. Exercise is not trivial to enjoy and a healthy balance of good eating habits is combined with weekly exercise to keep going a long way, young people at a healthy weight.
One of the largest predictors of teen obesity is the weight of the teen's parents. If both parents are overweight, their children have a 80% change also develop obesity. Simply put, children follow in their parents'footsteps by observing their parents' habits. Parents should develop a healthy eating and exercise habits and encourage their children to do the same. It is a duty of parents to lead by example.
Obesity leads to chronic diseases such as heart disease, diabetes, cancer and high blood pressure at the other questions. Not only that excess weight can a person's self-esteem to the extent that they become depressed affect. This is especially true for young people as a unique stage of development, their self-esteem are affected. Obesity can cause teenagers to have large levels of psychological distress, feelings of isolation and negative self-image.
Many teenagers instead of unrealistic expectations of themselves and face stressful peer pressure. Many are bullied or opportunities to develop socially closed their peers. Teens may want to lose weight, but not the resources or support they need to achieve their goals. It is important that they have the support of their colleagues and parents to drastic changes that could actually save their lives.
Drug therapy of obesity?
From ancient Greece is known that overweight people who wanted to lose weight, were encouraged to eat only once a day, to do hard work, not to take baths, sleeping on hard beds, and as long as possible to walk around naked. The treatment of obesity has fortunately changed, but how effective are the deals we offer patients today? Inpatient treatment methods are in place for years, but there are still major problems in outpatient care. Because doctors generally are not able to reduce the weight of obese patients in the long term, they are - just as the person concerned - frustrated. Whether the new, with much advertising costs presented medicines can help you out of this predicament is to be presented below.
Diagnosis and Classification: With clinical view it is of course a diagnosis of obesity and, probably also a treatment indication. For a more detailed classification (see Table 1), the body mass index (BMI) calculated (body weight: Körpergröße2 [kg/m2]). This value correlates better than the Broca-index with the mass of body fat and can also be easily determined. Since especially the fat abdomielle a predictor for cardiac risk - the belly stressed (android) obesity affects compared with the thigh stressed (gynoid) adverse off - plays a crucial role in fat distribution patterns. Fat distribution may be determined only indirectly (measuring the subcutaneous fat layer with infrared method, bioelectrical impedance, densitometry, nuclear or radiographic procedures). In practice and in the clinic has, however, the tape measure as a simple, cheap and proven effective meter. The waist turns, independent of body size, as a guide for cardiac risk (14). There is an increased or significantly increased cardiovascular risk in men aged 94 and a girth of 102 cm and for women aged 80 and 88 cm compared with normal weight. In scientific studies, unfortunately, different classifications of obesity are used. International is establishing itself more to grading by the WHO.
Epidemiology: Epidemiological studies show that with increasing prevalence is currently around half of all adult Germans are overweight and one in five is obese (1,2), and there are clear regional differences. As part of the international WHO MONICA study (monitoring trends and determinants in cardiovascular disease ") in the early eighties, were examined in several regions of Germany, 6213 men and 6608 women aged between 35 and 64 years in terms of cardiovascular risk factors. The lowest prevalence of obesity was found in men and women in the Rhine-Neckar region (13% and 12%), the highest prevalence in men in the outskirts of Augsburg (20%) and women in Halle / Saale (27%; 3).
Obesity as a risk factor: the N. Engl J. Med has recently been a large prospective study published that shows the relationship between BMI and mortality in men and women. (4, Sat AMB 1999, 33, 93b). The relative risk (RR) of dying was for men with a BMI <22.0 and> 26.4 kg / m² in women and increased <20.5 and> 24.9 kg / m² significant. The RR for death from all causes or cardiovascular death was 2.58 and 2.90 for white men with a BMI> 35 kg / m² particularly high.
The cause for the increased mortality of obese people, several diseases are concerned, which are often associated with significant obesity: coronary heart disease, stroke, diabetes mellitus, hypertension, osteoarthritis and some cancers. The likelihood of developing diabetes mellitus type 2, in obese men 40 times and in obese women around the 90fache increased compared to normal weight (5.6). J.C Seidell. calculated from large prospective studies that 64% were male and 77% of the female type 2 diabetics have been spared this diagnosis, they had kept their normal weight. Mathematically, 15-30% of cardiac deaths were prevented when the BMI is never more than 25 kg / m² would have increased (1). A March 1999 published case-control study examined 268 patients and found that to get the RR, arthritis of hand, knee or hip, is elevated in women in the highest BMI-third to 10 times compared to the lower third (7
That already leads a weight loss of 5-10% to a marked decrease of known cardiac risk factors is well documented (8) and for this reason, theoretically desirable. Generally, however, weight loss and a greatly fluctuating body weight is not associated with a reduction in mortality (33). Many studies demonstrate just the opposite. A possible reason for this at first sight paradoxical finding is that weight loss often caused by diseases that can lead to premature death. Thus we must distinguish between intentional and unintentional weight loss. However, it is difficult to epidemiologically between intentional weight loss (in the U.S. wants to remove 25% of men and 40% of women, 9, 34) and weight reduction to differentiate by consuming unrecognized disease with increased lethality. Williamson, D.F., et al. first time in 1995 showed that lower in obese white women with obesity-related comorbidities an intentional weight loss, mortality by 20% (10).
In Int. J. Obes. was published in 1999 an interesting study that distinguishes between the loss of body weight and body fat (11). In this aspect, two prospective studies, the Tecumseh Community Health Study and the Framingham Heart Study, analyzed a total of 4621 subjects, which was next to the body weight and body fat (thickness of subcutaneous fat) were measured. A weight loss of 4.6 kg and 6.7 kg, the relative risk of death increased by 29% and 39%, any reduction in skin fold thickness of 10.0 mm and 4.8 mm, however, reduced the RR of dying by 15% and . 17%.
Causes of obesity: leptin (ob protein) is the product of the ob gene and is formed predominantly in white adipose tissue. The leptin concentration in serum is proportional to BMI. Leptin receptors are encoded by the db gene and control in the hypothalamus, the hunger and satiety center, the release of neuropeptides that stimulate or inhibit our food intake.
In experimental studies was reduced by parenteral administration of leptin, the food intake and increased thermogenesis. Knock-out mice in which the ob gene is defective form, no leptin and fall on by hyperphagia, fat deposition, growth failure, hypercortisolism, and infertility. A monogenic non-syndromic genetic defect was first described in 1997 in humans as a cause of obesity. Eleven other single-gene defects have been discovered recently (12). Overall, the proportion of obese patients with monogenic mutations is very low, as well as syndromes associated with obesity (eg Prader-Willi syndrome). It is believed that polymorphic defective designs, it is weaker, however, occur much more frequently.
n addition to genetic factors is of importance to the lifestyle a major role in the development of obesity. By sedentary decreases our energy consumption, on the other hand increased energy food to fat deposits. In some studies, the effect of prolonged television was tested for the obesity. Of 4063 examined 8-16-year old children were those who watch TV more than 4 hours a day (at least 26% of children), a significantly higher fat percentage and BMI compared to those who watch less than 2 hours a day (13). In an accompanying editorial in the reduced energy consumption and the increased food consumption in front of the TV and is indirectly discussed the influence of advertising for food on television as a cause of weight gain.
Treatment of obesity: Two new drugs for the treatment of obesity have come on the market. The strategy of the company to highlight this particular risk factor has led to success, as is the clinical significance of obesity discussed everywhere. This also opens the possibility to call behavioral options to consciousness. Obesity is in fact no dramatic situation, but by his own behavior caused. To change this behavior are possible if they are embedded in a favorable therapeutic environment.
Of professional societies and expert committees of evidence-based treatment guidelines have been published (15, 16). They include a multi-disciplinary approach in the light of BMI, waist circumference and associated disease. Therapy is targeted at long-term weight loss of 5-10% since this leads to a decrease of already substantial risks. Figure 1 shows a simplified regimen. The detailed guidelines of the German Society of obesity on the Internet to poll (16).
An applied to at least two years of therapy approach should consider the following five principles: 1 Food conversion, 2 Movement therapy, 3 Behavioral training, 4.Chirurgische procedure, 5 Drug therapy.
1. Dietary changes: a meta-analysis published in 1998 shows that the percentage of fat in the diet plays an important role in the development, but also in the treatment of obesity (17). The average food in Germany is too rich in fats and refined carbohydrates and low in complex carbohydrates (eg potatoes, rice, pasta, bread) and fiber. We recommend a low-fat, kohlenhydratliberalisierte, fiber-rich mixed diet. The fat intake should be 60-70 g / d does not exceed, complex carbohydrates that also have a good saturation effect, however, can be fed abundantly. The energy proportion should be distributed as follows: 30% fat, 20% protein, 50% carbohydrates. It is recommended that "soft drinks" with mineral water or "light beverages" to replace. Alcohol has a high calorific value and inhibits the biological oxidation of fatty acids, it should be reduced for these reasons.
2. Exercise therapy: kg With a reduction in body weight of 10 will find the fat from the muscle mass (3-4 kg) and thus also decreases the metabolic rate. To counteract this and to increase the energy consumption, should be 3 sports units / week is completed by at least half an hour duration. This mainly depot fat is mobilized, a low intensity level recommended in order to achieve a heart rate of 180 minus your age. Particularly suitable are hiking, swimming and cycling. In any case, a sport should be selected that is also fun. Prior to such exercise therapy has a relevant coronary heart disease are excluded.
3. Behavioral Training: In obese, the proportion of those who have serious mental or psychosomatic comorbidities, estimated at 30-40%. These patients should be explored and supported psychosomatic. But through the remainder of the patients in the ideal case, a training program with analysis of recent weight history and eating behavior, and evaluation of the triggering situations and reasons for the failure of previous attempts to lose weight. Relaxation techniques should learn, anticipate problem situations and self-esteem will be strengthened.
4. Surgical procedures: When conservative treatment attempts fail repeatedly come reversible surgical procedure, such as vertical gastroplasty to Mason or the increasingly used "gastric banding" in question. The gastric band is laparoscopically created under general anesthesia and constricted below the gastric cardia ml reservoir of about 20 from. Even after low food intake occurs a feeling of satiety, which continues through the delayed gastric emptying even longer. Postoperatively, there are frequent vomiting after a few weeks, however, the patient has become accustomed to the new stomach volume. The weight loss is usually large. Kuzmak found a decrease in obesity by 50-83% at one year (32) and 20-40% of patients are refractory to treatment, however, as they take high-calorie, liquid diet that ("sweet-eaters"). The complication rate is 15% and the mortality rate is at 0.25 to 0.4%.
5. Drug therapy: treatment for obesity have been and are many drugs available. But only two substances, orlistat (Xenical) and sibutramine (Reductil) have shown in large long-term clinical efficacy studies. Thyroid hormone, amphetamine derivatives, dexfenfluramine, and diuretics are obsolete because of their ineffectiveness or because of significant adverse drug effects.
Orlistat: We've reported on this matter (AMB 1998, 32, 68). It is a synthetic derivative of lipstatin, a natural product of Streptomyces toxytricini. Orlistat acts primarily intraluminal by covalent inhibition of gastric and pancreatic lipase and reduced hydrolysis of triglycerides. The absorption of monoglycerides and fatty acids is reduced. The fat excretion in feces increased with normal diet of typically 4% to 30%. this leads to a kcal energy loss of about 300 / d.
Orlistat is rarely detectable in the serum, however, be 1.5-4% of the metabolized substance excreted in the urine. The half-life is 14-19 hours. In dose-finding studies, has the gift of 3 times 120 mg / d proved to be the main meals with more fat than optimal. The daily cost of treatment with Xenical are at 6.86 DM and, like that of Reductil, not covered by health insurance.
So far, 7 larger randomized, placebo-controlled long-term studies have been published (18-24, see Table 2). In all studies, there was a run-in phase of 4 weeks to 6 months duration in which the compliance of the patients was examined. In 6 trials, all subjects initially placebo tablets. Those who are less than 70-75% of the tablets had taken were excluded from the study, the rest were then randomized to placebo or orlistat. Study participants were advised by diet. Only a few studies additionally an exercise program or a behavioral training was offered.
The weight loss was after a year in the active treatment group on average 8.9% in the placebo group was 5.8%. The difference in weight loss was significantly different in all studies. In most studies, "improved" is also total cholesterol, HDL and LDL.
The dropout rate varied from study to study between 25 and 85%. Up to 95% of subjects in the active treatment group suffered from intestinal side effects (see Table 4). Adverse effects were usually transient and occurred particularly in the first 3 weeks. According to the patients they were mainly mild to moderate. It is striking that more patients in the placebo group discontinued the study, which is probably due to the lower weight loss. Which occurred in the drug group, symptoms were dependent on the amount of fat consumed: those who ate lots of fat, also had more frequent complaints - an opinion of the advertising manager of Roche ideal biofeedback procedure!
The serum concentration of beta-carotene and fat soluble vitamins decreased in almost all studies in the drug group. Some patients had to be substituted fat-soluble vitamins orally, because the vitamin concentrations in two consecutive measurements were below the normal range. After administration of vitamin preparations, the concentrations increased again in the normal range. It is therefore recommended during treatment with orlistat general to take multivitamin supplements.
An interaction of orlistat with digoxin, sustained release nifedipine, phenytoin, atenolol, furosemide, captopril, and oral contraceptives has not been established. The maximum plasma concentration of R-warfarin (coumarin-derivative) was delayed for an hour, but the rest was under the pharmacokinetics Orlistat not changed (25).
In one study were more cases of breast cancer to less than orlistat. There is no plausible explanation for it. A detailed analysis of several independent experts found that the majority of the tumors must have existed even before the trial begins. Nevertheless, because of this study, the decision is for the approval of orlistat by the FDA in the United States failed narrowly (26). A new study XENDOS Xenical Swedish study should clarify whether the risk of breast cancer is increased by treatment with orlistat. In previous studies, there was no evidence of an increased incidence of gastrointestinal cancers due to the increased fat in the faeces. However there have only limited long-term experience.
Sibutramine: Sibutramine is a serotonin and norepinephrine reuptake inhibitor. They have inter alia two effects, namely, food intake decreased by inhibition of appetite and increased energy consumption by increasing the beta3-receptor-mediated thermogenesis. Sibutramine is well absorbed and undergoes extensive first-pass metabolism in the liver. It is characterized cytochrome P-450 provides two active metabolites with a half-life of 14-19 hours. The starting dose is 10 mg / d. Doses are food independent. The weight loss is inadequate, i.e. the weight after four weeks, only 2% below starting weight, the dose to 15 mg / d increased. Occurring adverse effects (see Table 4), the dose to 5 mg / d reduced (27). The daily treatment costs at 10 mg dose of DM 4.56 and 15 mg / d 5.19 DM
Because of possible side effects it is recommended that regular monitoring of blood pressure and pulse. Coronary heart disease is a relative contraindication to sibutramine. Caution should be taken when co-administration of QT-prolonging agents, as well as co-medication of drugs that are metabolized by cytochrome P-450 or induce this enzyme.
