World Day of obesity It is commemorated every March 4 since 2020 to raise awareness about this epidemic disease that is increasing in all age groups, reduces life expectancy and alters the quality of life of those who suffer from it. Obesity and overweight is defined as an abnormal or excessive accumulation of fat that can be detrimental to health.
It can be determined if a person is overweight/obese with the body mass index (BMI), which is obtained by calculating weight divided by height squared. This index is divided into ranges that indicate the degree of overweight/obesity: an individual has normal weight if the BMI is between 18.5 and 24.9, overweight when the index is between 25 and 29.9, and obesity when the BMI is is greater than 30 points.
In Argentina, the IV national survey of risk factors (2018) showed that the prevalence of excess weight is 61.6% (36.3% overweight and 25.3% obese): in summary, 6 out of 10 Argentines over the age of 18 is overweight and even 1 in 4 is obese. These results present an increase compared to those of the previous survey (57.9% overweight + obesity in 2013). The trend continues to increase with respect to the previous relevant ones. The worrying thing is that obesity is also increasing in the population of children and adolescents.
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According to data from the World Health Organization, obesity has tripled in the world in the last 20 years and is responsible for 4 million deaths each year, while new data from the World Atlas of Obesity predict that 1 in 5 women and 1 in 7 men will be obese by the year 2030, which would be equivalent to more than one billion people. The same survey highlights that the majority of those living with obesity are found in low- and middle-income countries, and that the highest rates of obesity are found in the Americas region, for both men and women.
It is a risk factor for cardiovascular disease
From the Argentine Society of Cardiology (SAC) they affirm that obesity is a risk factor independent of others to develop cardiovascular disease, heart failure, atrial fibrillation (arrhythmia) among many other conditions and reduce life expectancy. Even any of these associated diseases can occur even with a totally normal blood test.
“Obesity discriminates, marginalizes, stigmatizes those who suffer from it, excluding many people from labor and social systems and even from small details of daily life, but the most important thing is that it is a disease that in most cases shortens the life, and that requires specialized medical follow-up and a multidisciplinary approach,” said the cardiologist and nutritionist Paola HarwiczAdvisor to the Cardiometabolism Council of the Argentine Society of Cardiology.
“Obese person needs helpgiven that she has a chronic, multi-causal, progressive and recurrent disease (declared as such by the World Health Organization in 2008), not a problem of will and, for this reason, she must have access to serious treatments and tools to be able to be addressed like other chronic diseases such as diabetes, hypertension, etc.”, added the cardiologist carolina salvatoriadvisor to the Council of Cardiology of the same institution.
For the cardiologist and director of that Council, Ezekiel Strong“Obesity is responsible for the development of a large number of non-communicable diseases (NCDs); excessive body fat or its abnormal distribution produces an inflammatory state and is associated with various metabolic complications (increased risk of insulin resistance, type 2 diabetes, arterial hypertension), endocrinological, immunological, mechanical or functional, which increase the risk of cardiovascular disease, cancer, fatty liver, sleep apnea, depression and infertility, among many other conditions”.
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From the SAC, aligned with other national and international scientific societies, they affirm that obesity is a disease where different factors are combined: genetic, metabolic, emotional, stress, an environment with great availability and overconsumption of food (obesogenic environment) added to the low level of of physical activity.
“Although the BMI provides us with a very useful parameter, specialists usually also consider the percentage of total body fat and its distribution. For example, a high-performance athlete may have a high BMI at the expense of greater muscle mass. For this reason, there are other measurements that provide greater precision, such as calculating the percentage of total body fat with a bioimpedance device, which allows defining the percentage of fat, being normal when it is less than 22% in men or less than 33%. in women,” Salvatori noted.
“Another very simple way to assess the risk is through the measurement of the waist circumference, also called the Waist-Hip Index, which is done with a centimeter at the level of the navel to define if the person presents a greater location of adipose tissue than visceral level (organs), acceptable values are up to 88 cm in women and up to 102 in men.It constitutes a strategy that allows us to know the concentration of fat at the central level, a determining factor of greater cardiovascular risk when associated with more frequently with metabolic syndrome, arterial hypertension, diabetes, metabolic disorders and fatty liver, among others,” concluded Dr. Forte.
The Argentine Society of Cardiology presented the following recommendations to address the problem of obesity:
1. healthy nutrition, with education from an early age. The approach to the patient with obesity is complex; different stimuli facilitate access to food, so it is important to have a safe environment, plan meals where the supply of fresh foods, rich in fibers, such as vegetables, fruits, legumes, whole grains, prevails, without forgetting an adequate contribution of proteins such as eggs, lean meats (beef, pork) chicken, and increase the consumption of fish. Have dairy for its richness in calcium and vitamin D. In turn, as a source of fat, prefer olive, canola or sunflower oil, nuts, avocado and olives. Currently, we have a wide availability of ultra-processed foods, fried foods, baked goods, sweets, delivery, etc., which can only be contemplated for social gatherings and limit the consumption of sugary drinks and alcohol.
Another point to keep in mind is work on the concept of “hunger and satiety”. Human beings perceive hunger differently: ‘physiological’ hunger, which occurs when several hours go by without eating and the body generates signals to incorporate food (headache, feeling in the pit of the stomach). On the other hand, “hedonic” hunger, which arises when we are faced with a visual stimulus such as seeing a delicious ice cream or favorite dish or smelling the aroma of fresh bread, our brain triggers signals in the reward center that encourage consumption. . Finally, ’emotional’ hunger arises when we use food to cope with an emotion such as boredom, anger, frustration, anxiety, stress, sadness or joy. It is important to identify and recognize those triggers to modify behaviors and be able to face these situations.
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2. Fight against a sedentary lifestyle, promoting physical activity and exercise. “The general recommendations in this group of patients are to perform cardiovascular resistance exercise, reaching a cumulative period of 150 to 300 minutes per week (divided into sessions of a minimum of 10 minutes) at moderate intensity or 75 to 150 minutes of high intensity. In addition , should be complemented with two or three weekly stimuli of muscular strength work and flexibility exercises”, graphed the cardiologist and sports specialist Ivana Paz, Scientific Secretary of the Council of Cardiology of the SAC.
3. Psychological support to work on eating habits and behaviors. The doctor will evaluate in each case if the patient needs a multidisciplinary approach with the support of psychoanalysis, a special nutrition regimen and follow-up by a sports specialist.
4. Stress management and meditation. Achieve better stress management and implement meditation as a way to control different stimuli and manage emotions.
5. Adequate rest. Another variable to consider is that the person can sleep well, at least 7 hours, since these are situations that could threaten their mood, their eating behaviors and ultimately against the prognosis of success of their treatment. Patients with obesity often have difficulties in achieving these goals, and “in recent years, new therapeutic alternatives for people with obesity have generated great expectations in the medical community. Scientific Societies have been promoting a ‘paradigm shift’ in the conception and view of obesity, understanding that the success of the treatment does not depend exclusively on the will of the patients. In this context, new drugs have emerged that are safe and effective” comments Dr. Ezequiel Forte. Its indication is clear: evaluate the pharmacological treatment of patients with obesity (BMI > 30 or in overweight patients and other associated comorbidities), according to the recommendations of the different guidelines and individualize the indication for bariatric surgery in people with BMI > 40 or with BMI >35 with comorbidities.
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“Currently we have pharmacological treatments with direct intervention on the messengers that act on appetite and facilitate changes in eating behavior,” said Salvatori. However, the specialist insists, any medical treatment for obesity must be prescribed and carried out under the supervision of a specialized medical professional, without forgetting that these medications are a complement to the aforementioned lifestyle change measures.
“From the Argentine Society of Cardiology, on this day we promote awareness about this disease, and we show the need to implement healthy lifestyle changes, which are the pillars to combat it,” he concluded.
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