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Monday, December 22, 2014

Causes, Prevention And Treatment Of Obesity In Children

What is obesity ?


Obesity is a medical condition in which body fat has accumulated so much that this may have a negative effect on the health. This can lead to a shorter life expectancy and / or more health problems. People with a body mass index (BMI) higher than 30 kg / m2 considered obese. The BMI is calculated by dividing body weight in kilograms by the square of height in meters. Obesity wild animals is quite rare but not uncommon in humans and animals, which are often overfed and too little exercise.

Obesity increases the risk of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain forms of cancer, osteoarthritis, and asthma. Obesity is usually caused by a combination of excessive intake of food energy (overeating), lack of exercise and genetic predisposition. In some cases the cause is, however, mainly in the genes, endocrine disorders, medications or psychiatric illness. There is little evidence for the view that some obese people eat little yet gain weight by a slow metabolism; usually obese people consume more energy than their slim counterparts due to the energy required for the maintenance of a large body.

Diet and exercise are the main components of the treatment of obesity. It is possible to improve the quality of the power by less energy rich food (with less fat and sugar) and more dietary fiber to eat. Optionally, one may use anti-obesity drugs to inhibit the appetite or the fat absorption, in combination with an appropriate diet. When diet, exercise and medications have no effect, a gastric balloon can help to lose weight. It is also possible to reduce the gastric contents and / or to shorten the intestine by means of an operation. As a result, there occurs before saturation and reduces the ability to absorb nutrients from food.

Obesity is one of the world leading preventable cause of death and is becoming more common in adults and children. The authorities therefore regard it as one of the most serious public health problems in the 21st century. In a large part of the modern world (especially in the Western world) will give rise to obesity stigmatization. Still, it was once widely seen as a symbol of wealth and fertility, and in some parts of the world is still the case.

How to prevent childhood obesity


Before the 20th century obesity rarely. In the period just after the second world war until 1960 increased the weight of the average person in the United States, but only few were obese. In 1960 almost the entire population was well fed, but one was in General not too heavy. In the period since 1980, the growth in the number of ranks of epidemic proportions. In 1997 the World Health Organization (WHO) officially recognized obesity as a global epidemic. In 2008, 35% of the world's population overweight, while 10% of men and 14% of women were obese. This figure is much higher in affluent areas, such as the United States, where in 2008 62% overweight and obese and 26% had was in Australia, where these figures are respectively 35% and 28%. The percentage of severe obesity rises in the United States, Australia and Canada faster than overall obesity percentage.

Youth Obesity adopted in the 21st century epidemic: the percentages are increasing both in the developed world and the developing countries. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile. The reference data on which these percentiles, are from the period 1963 to 1994 and are not clouded by the recent increases in obesity rates. Childhood obesity in the period since the 80s of the last century by a factor of two to five increased in developed countries and almost four times in developing countries. The obesity rate among Canadian boys increased from 11% in the 80 to over 30% in the 90s of the last century, among Brazilian children increased that percentage in the same period of 4 to 14%. Approximately 18% of children in the US is obese.

Obesity Causes And Risk Factors


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Obesity generally is a result of a combination of factors.

At individual level, a combination of excessive food consumption and lack of exercise is considered to be the explanation for most cases of obesity. In a limited number of cases, the cause primarily genetic, medical or mental illness. In contrast, the rapid rise of obesity at the community level is seen as the result of readily available and tasty food, an increasing reliance on cars and machine production.

A number of other possible factors are:

-Eetziekte such as binge eating disorder
-Increase in the amount of carbohydrates and added sugars in the diet, in particular fructose
-Stress
-Too little sleep

In 2006, listed ten other possible reasons for the recent increase in obesity in an overview:

-Too little sleep
-Endocrine disruptors (environmental pollution disrupts fat metabolism)
-Less variation in ambient temperature
-Decline in smoking, smoking suppresses appetite
-Increased use of medications that can cause weight gain (eg. atypical antipsychotics)
-Relatively increasing age and ethnic groups whose members are often heavier
-Pregnancy at a later age (which children may be more susceptible to obesity)
-Epigenetic risk factors from generation to generation
-Natural selection at a higher BMI
-Choosing a similar partner that leads to a concentration of risk factors for obesity (consequently the number of people with obesity is relatively increased).

Although there is a considerable amount of evidence that supports the influence of these mechanisms on the increase in obesity, the final proof has yet been produced and the authors argue that these factors are likely to have less influence than the factors described in the previous paragraph.

In childhood obesity wear, as with obesity in adults, many factors contribute to the increasing percentages. Changes in eating habits and lack of physical exercise are seen as the two main causes of rising rates. Because childhood obesity often persists into adulthood, obese children are often tested for hypertension, diabetes, hyperlipidemia and fatty liver.

Treatment for obesity


The treatment of obesity is based on the two pillars of an energy-restricted diet and increased exercise.

-Previously, the aim in the treatment of obesity to the attainment of a normal weight. Such an aim is, in practice, for a lot of patients do not feasible. It also appears from sommig medical research that a limited weight loss of 5-15% risk of complications decreases already strong. Therefore rather nowadays sought that limited weight loss. Even more important than weight loss is the retention of these. Because diet programs must lead to short-term weight loss, but it is often difficult to maintain this weight loss. Here it is often necessary to exercise and eat less until a permanent part of one's lifestyle. The success rate of long term weight loss through lifestyle changes is low, ranging from 2-20%. Changing the diet and lifestyle is effective in reducing excessive weight gain during pregnancy and improves outcomes for both the mother and the child.

-Much research focuses on new drugs to combat obesity, which is seen as the biggest health problem in developed countries. Some nutritionists believe that these research funds could be better devoted to advice on good nutrition, healthy eating and promoting a more active lifestyle. A drug that it is prescribed for obesity, as keeping a diet and exercise is not working, is orlistat. The drug is currently generally available and is approved for long term use. However, the average weight loss of 2.9 kg over 1 to 4 years is modest and little is known about the long term effects of this medicine complications of obesity. The use often causes intestinal problems as a side effect and there are concerns about adverse effects on the kidneys. There are two other medications available. Lorcaserin (Belviq) was compared with a placebo and leads in one year a mean weight loss of 3.1 kg (3% of body weight) over placebo. A combination of phentermine and topiramate (Qsymia) is also somewhat effective. Rimonabant and sibutramine because of low efficacy and high risk of serious side effects is now removed from the market.

-Also, bariatric surgery is used to reduce the stomach capacity (reduces food intake) and / or the length of the intestine (decreases food intake). This can be done by, for example, a gastric reduction through the afnieten of a part of the stomach, by the placing in the stomach of an inflatable balloon, by removing a portion of the length of the intestine (gastric bypass). Surgery for severe obesity leads to long-term weight loss and lower mortality. In one study, bariatric surgery compared with standard measures for weight loss. After 10 years of surgery showed a weight loss of 10% to 25% (depending on the type of surgery which has been performed) and to lead 29% lower mortality.
Removing or bypassing a portion of the length of the intestine provides the most weight loss, and in addition, an improvement of possible diabetes. This is probably due to the release of hormones by the intestine, acting on insulin and also give a feeling of fullness. The weight loss is on average a kilo or fifty, sixty, but there is a mortality rate of 0.1% to 1% against. Bariatric surgery as a treatment for obesity is therefore only appropriate treatment for people whose obesity substantial risks entails:

*BMI of greater than 40 or
*BMI of greater than 35, and still other risk factors such as diabetes, hypertension, cardiovascular disease, sleep apnea

However, because of the costs and the risks of complications researchers are looking for other effective but less invasive treatment methods.

-Research in 2013/14 from Groningen University and Purdue University shows that it is counterproductive to suggest overweight people on their own responsibilities regarding their weight (unhealthy diet, lack of exercise) and to point to the fact that they are much society money. The effect is often that the person in question will persist in unhealthy behaviors. If, however, pointed out on other causes of obesity (such as oversupply of unhealthy foods and snacks) than the person appears to be overweight are more likely to choose healthy foods. The results are published in the journal Psychology and Health.
Treatments used in children, mainly influencing the lifestyle and techniques to change behavior, although exercise of stimulation in children so far with little success. In the US, drugs for this age group is not allowed.

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