Overweight Health Problems

Introduction

The definition of obesity is an excess of fat in the body. Overweight, unlike obesity, simply refers to a condition in which the body weighs more than normal. In general, overweight is defined as the appropriate weight according to height, so athletes have low fat and muscle, so they meet the criteria of overweight but are not often obese. Conversely, even if you don’t gain a lot of weight, people with high body fat percentages in your body can be seen around us. These cases should be viewed as thin-outside-fat-inside (TOFI) because of the high risk of obesity-related diseases (dyslipidemia, diabetes).

Obesity is growing rapidly around the world. Humans have developed genes that can store energy for food shortages during evolution. However, with the development of the industry, obese patients increased rapidly as the consumption of high-calorie, high-fat foods increased and energy consumption decreased. As the number of obese people increases, diabetes and cardiovascular diseases, which are considered obesity-related diseases, are also rapidly increasing, and mortality rates are rapidly increasing. As such, obesity is a disease that is deeply related to genetic and environmental factors and causes various complications, and is therefore a disease that cannot be easily controlled by individual will. Treating obesity only on the cosmetic side is a misconception, and obesity is a disease that must be treated because it is a direct cause of various complications and death.

Causes and Risk Factors

Overweight is usually caused by eating more calories from food than is consumed by the body in activity or life. Factors that can contribute to this imbalance include the following:

• Lack of activity (sitting lifestyle)
• Overeating
• Malnutrition
• Hereditary
• Hormonal imbalance (hypothyroidism, etc.)
• Disorders due to repeated attempts to lose weight
• Eating Disorder
• Alcohol poisoning
• Stress
• Insufficient sleep
• Taking Antipsychotics
• Withdrawal Symptoms of Smoking Cessation

The amount of body fat is consciously controlled to some extent by controlling appetite or food preferences in the brain. Not all of these mechanisms are exactly known, but each individual has some point in the brain to control their weight, and these thresholds vary from person to person. It is a commonly accepted theory that there are genetic factors, past experiences, and the environment in which you live. Some people naturally tend to maintain a different weight than others, which is easy for some people to avoid being overweight, but for others it can be much harder. This also suggests that a person’s reference point may change depending on circumstances and conditions.

Obesity-related Diseases

Obesity is a source of all kinds of diseases and increases in body fat causes various diseases. Type 2 diabetes, dyslipidemia, hypertension, fatty liver, disease, coronary artery disease (angina, myocardial infarction), angina pectoris, sleep apnea, gout, osteoarthritis, dysmenorrhea, colorectal cancer, and breast cancer are the major obesity-related diseases. The same complications can occur, especially in childhood obesity, and childhood obesity has a higher risk of potential disease, so it is important to consult or manage them early.

1. Cardiovascular Disease

Increasing weight also increases the amount of blood needed by the human body and the heart of an obese person can not afford enough blood supply, you can quickly breathe and fatigue even a little. Cardiovascular diseases that can cause obesity include hypertension, dyslipidemia, coronary artery disease (angina, myocardial infarction), and stroke. Many things can happen at once.

The positive correlation between obesity and blood pressure is well documented and greatly increases the risk of high blood pressure among obese people. Also, when they lose weight, their blood pressure decreases. Or hyperlipidemia is common among obese people. It is characterized by high triglycerides and low density lipoprotein cholesterol and low density lipoprotein cholesterol. These metabolic abnormalities are more common when you have abdominal obesity.

2. Diabetes

Risk factors associated with diabetes include uncorrectable things such as sex and age, and correctable things like obesity, eating, and decreased physical activity. Many of these risk factors affect the development of diabetes, so people with high risk factors can develop diabetes even if they are not obese, while in some cases obesity is sufficient to cause diabetes. In obesity, the risk of developing diabetes is three times higher than normal weight. Diabetes caused by obesity is not caused by a lack of insulin to control blood sugar, but due to insufficient insulin, especially abdominal obesity is associated with this insulin resistance. If an obese person loses 5 to 10 percent of their weight, the risk of developing diabetes decreases by 50 percent.

3. Metabolic Syndrome

Various cardiovascular risk factors such as increased blood pressure, abdominal obesity, dyslipidemia, and elevated blood sugar appear simultaneously. The main cause of metabolic syndrome is visceral fat causing metabolic abnormalities. Therefore, the management of abdominal obesity is important to prevent metabolic syndrome.

4. Digestive Disease

Functional gastrointestinal disorders such as fatty liver (especially non-alcoholic fatty liver), indigestion, chronic constipation, gastroesophageal reflux disease, and gallstones are known to be associated with obesity. The most common gastrointestinal disease in obese people is gallbladder disease. The increase in cholesterol secreted by bile at weight gain seems to be associated with the development of gallstones. Excessive weight loss can also make gallstone disease worse. In obese people, liver disease, especially fatty liver, is common and accompanying liver dysfunction improves with weight loss.

5. Musculoskeletal Disease

In particular, degenerative arthritis of the lower back and knee and disc herniation are associated with obesity. An increased risk of back pain is common in obese people. Low back pain can lead to decreased physical activity, which can increase obesity, and conversely, obesity can increase the risk of back pain by increasing the mechanical burden on the spine. This can change your gait, increasing the strain on your spine while reducing the efficiency of shock absorption in your spine.

6. Female Reproductive System Disease

Obesity is associated with a variety of gestational complications such as polycystic ovary syndrome, puberty, such as faster menarche in obese children, and precocious puberty, miscarriage, gestational diabetes, and high blood pressure. This increased risk is independent of obesity in adulthood as well as in childhood or adolescence. Abdominal obesity increases the effects of androgens and is an important cause of dysmenorrhea and infertility. In people with polycystic ovary syndrome, losing weight improves menstrual and hormonal abnormalities.

7. Cancer

Endometrial cancer, ovarian cancer, and breast cancer are known to be associated with obesity among colon cancer, prostate cancer, kidney cancer, thyroid cancer, esophageal cancer, and female cancer. The relative risk of cancer in obese people is also high in both men and women.

8. Respiratory Disease

Obesity is known to negatively affect respiratory function and increase the risk of respiratory symptoms. Sleep apnea is a common problem in obese men and women. Abdominal obesity and neck size are especially associated with obstructive sleep apnea. This is due to the narrowing of the upper respiratory tract in the lying position and can even cause sudden death in severe cases. Other respiratory problems associated with obesity include pulmonary hypertension and increased postoperative risk.

Diagnosis

Obesity is a state where fat accumulates more than normal, so it is most accurate to measure and measure the amount of fat in the body. However, it is difficult to accurately measure the actual amount of fat, which is indirectly evaluated, and one of the most commonly used methods is measuring body mass index and waist circumference.

1.Body Mass Index (BMI)

Body mass index is your weight (kg) divided by the square of your height (㎡). BMI is one of the most used methods by researchers and medical practitioners, although it does not reflect muscle mass, genetic causes, and other personal differences.

The extent to which you are overweight varies from time to time and from country to country.However, for Westerners, people with a body mass index of 30 kg / ㎡ or more are called obesity (World Health Organization guidelines). Classified as obesity. (World Health Organization Asia Pacific Regional Guidelines).

2. Diagnosis of Abdominal Obesity Using Waist Circumference

Abdominal obesity, where fat is largely accumulated in the abdomen, is more dangerous due to the metabolic complications associated with obesity, such as high blood pressure, diabetes, and dyslipidemia. Waist measurement is a widely used indicator of abdominal visceral fat. Abdominal obesity is diagnosed when the waist is 90 or more in men or 85 or more in women.

Measure your feet at 25-30 cm intervals and breathe comfort. Measure with the ruler the midpoint between the lowest position and the highest position of the pelvis. If there are many subcutaneous fats and the waist overlaps, lift the subcutaneous fat while standing upright.

3. Diagnosis of Obesity by Body Fat Percentage using Bioelectrical Impedance Analysis

Since the body’s fat and muscles flow differently, it’s a way of calculating the percentage of fat using the difference in the flow of electricity. This method is simple, can measure body fat, water content, and fat loss, and it is widely used in hospital before and after treatment of obesity because of relatively low cost and high reproducibility. However, because the error is large depending on the amount of water in the body, it is recommended to consider the following precautions before the test.

(Drinking 2 weeks before the test, diuretics a week before the test affects the results of the test and may be less accurate for cigars that increase the amount of water in the body depending on the menstrual cycle.)

Depending on the body fat percentage, more than 25% of men and more than 30% of women can be said to be obese.

4. Dual Energy X-Ray Absorption (DXA)

The DXA image, which measures your body’s specific gravity, can help you accurately measure your body fat percentage by using the specific gravity of your body’s tissues to see which part is fat. But the measuring machine is expensive, and for its operation requires a specialist.

5. Visceral Obesity Diagnosis by Abdominal Fat Computed Tomography (CT)

Abdominal obesity, especially if visceral fat accumulates, increases the risk of obesity-related metabolic diseases. Although the waist circumference reflects the amount of abdominal visceral fat, CT is also used to assess the correct distribution of visceral fat and subcutaneous fat.

Treatments

Many people want to lose weight to treat disease, to improve health, or to beautify. In general, the most effective weight loss treatments are a combination of diet control (meal therapy), increased activity (exercise therapy), and fattening habits (behavioral therapy). If weight loss does not work in this way, medication is combined. Surgery may be done for people who are highly obese, who do not respond to medication.

Studies have shown that dieting alone, such as fasting, can reduce calorie intake in the short term, but it doesn’t lead to weight loss in the long run. For this reason, losing weight should be done in conjunction with weight management by increasing exercise or planning long-term, rather than trying to diet alone.

Although losing weight can significantly reduce health risks and improve quality of life in people who are significantly obese, there is evidence that losing weight in just overweight people can be harmful to health rather than being overweight. In addition, in all people who suffer from yo-yos by repeatedly losing weight, this yo-yo phenomenon can cause secondary health problems by losing more muscle than fat.

There is no easy and quick way to tackle obesity or overweight. Changing your lifestyle by adding exercise and controlling your diet is necessary for permanent change.

1. Diet Therapy

(1) A weight loss of 0.5 kg per week is appropriate for proper weight loss, which requires a reduction in calorie intake of 500 kcal per day.

(2) However, it’s not easy to make a diet like this one by one, so the easiest way to reduce your calorie intake is to reduce your snacks, limit your calorie-rich foods, especially fatty foods. These foods include candies, soft drinks, alcohol, butter, chocolate, margarine, hamburgers, fried foods, donuts and potato chips. Instead, they eat low-fat milk, beans, vegetables, fruits, fish, and lean meats.

(3) By removing high-calorie foods like this, you can reduce weight by half or two-thirds of stocks. If you’re hungry while eating, eat fiber-rich, low-calorie cucumbers, lettuce, corncress, and oil-free fried popcorn. Alcohol consumption is also a major obstacle to weight loss, so be especially careful.

(4) Finally, if you have failed to control your meal for a few days, do not give up everything and continue to practice.

2. Exercise Therapy

The most recommended exercise for obese patients is walking. On the other hand, cycling, swimming, jogging, hiking, 2km walking, 4km biking, and 300m swimming consumes about 150 Kcal. This is only half the air, so even if you exercise, you should try to reduce your meals.

Even if you’re exercising, it’s hard to lose weight without a diet. In the early stages of exercise, weight loss is particularly minor, and appetite may increase, while short-term effects are small, but long-term regular exercise plays a large role in weight loss. This is a decrease in abnormal fat, and the weight going out to the fat is replaced by less bulky muscle, which helps to create elasticity and balance.

Even at the same weight, obesity may look different, and clothing is often different in size. If you are dieting without dieting, you can reduce the muscles and water rather than change fat cells, making it easier to gain weight, and make you look fatter.

3. Diet Diary

It is to keep a journal of what you are eating. It will help you explore ways to cope with various problems, such as situations involving eating out or overeating. It is a great help in keeping up with your diet and is important for both short-term and long-term motivation.

4. Medication

If you want to lose weight more than recommended for the purpose of losing weight or for cosmetic purposes without much effort, you should be careful because it can harm your health. Consider obesity medications by evaluating your obesity and the risk of co-morbidity due to obesity. Since long-term treatment is a principle, proper diet and exercise therapy should be preceded before starting medication.

• Central Nervous System Drugs
  • Noradrenaline Drugs: Noradrenergic drugs cause appetite suppression and weight loss through the adrenergic or dopamine receptors.
    • Phentermine (Phentermine): An amphetamine-based drug that stimulates the secretion of norepinephrine. Central nervous stimulation effects can cause side effects such as blows, dizziness and headaches. Currently not used.
    • Pendimetrazine: It is believed that the appetite suppressant effect is stimulated by stimulating the secretion of norepinephrine.
    • Mazindol: The chemical structure of amphetamine and other imidazoline drugs acts to block norepinephrine resorption. There are no long-term studies, and 9% of weight loss has been reported in one year of open clinical trials.
  • Serotonin Drugs: Serotonin is a neurotransmitter involved in controlling appetite, especially the desire to eat carbohydrates. Serotonin drugs contribute to weight loss by increasing appetite suppression by increasing low serotonin levels in the brain’s central region.
    • Fluoxetine: Increases serotonin concentration by preventing reabsorption of serotonin secreted at the nerve junction ends. The appetite suppressant effect is due to an increase in serotonin levels in the nerve junctions, especially in obese patients with depression. Side effects can include headache, anxiety, insomnia, nervousness, drowsiness, nervous system symptoms such as drowsiness, gastrointestinal symptoms such as nausea, vomiting, and diarrhea, and skin symptoms such as rashes and pruritus.
    • Lorcarserin: A drug that suppresses appetite by selectively stimulating serotonin receptors distributed in the brain’s edible center. As a side effect, no side effects of cardiovascular risks such as palpitations or increased blood pressure, which were previously found in appetite suppressants, were reported, and blood pressure appears to drop somewhat due to weight loss. Headaches are also reported as a common side effect, which requires caution for patients with usual headaches.
    • Contrave: A combination of Bupropion and Naltrexon, both drugs are already being used as an addiction treatment.
• Peripheral Acting Drugs
  • • Orlistat: A compound that reduces the absorption of fat from the digestive system. The drug combines with lipase, an enzyme that breaks down fat in the digestive tract and inhibits the breakdown of fat. Thus, about 30% of the fat you eat is not absorbed into the digestive tract and is excreted with the stool. Side effects may include diarrhea, stool incontinence (fatty stool), and bloating. This is not a side effect, but rather the pharmacological action of the medication itself, which can be avoided by reducing the amount of fat you eat.

5. Surgical Treatment

Surgical procedures have been developed to help people with severe obesity. High obesity is a life-threatening and poor quality of life, accompanied by a variety of complications, but is not effective with non-surgical therapies such as medication or diet. Even if weight loss is successful, the risk of relapse is very high. Therefore, advanced obesity surgery may be necessary if your body mass index is greater than 32 kg / m² and you have obesity-related diseases (severe sleep apnea, obesity-related heart disease, diabetes, etc.). Surgery results in a weight loss of about 30% of your initial weight in the standard procedure. However, complications such as electrolyte imbalance, poor absorption of nutrients, gallstone formation, hernia and mechanical intestinal obstruction, sagging skin, and hair loss can occur. In addition, diet adjustment training is required for about three months after surgery, and active management is needed for nutritional supplements including vitamins and minerals.

Prevention

1. Exercise

Exercise must be combined to prevent obesity. Exercise is generally recommended to start 20 to 30 minutes a day, 3-4 times a week. However, to maintain your weight loss, it is most effective to take one hour a day five times a week. In general, this week of exercise can help you burn out 700-1000 calories. Since we need to burn off 3500 calories to lose 0.45 kg of weight, the sole effect of exercise on weight loss is to lose about 2 kg of weight every five weeks. Exercise is a must-have program for anyone who wants to lose weight.

2. Behavioral Modification

Observing obesity-related behaviors by yourself is a way to identify your own habits and identify the causes of gaining weight to effectively prevent and control obesity.

1) Diet Diary

Keeping a meal diary as well as during and after medication can create regular eating habits and prevent overeating and overeating, which can have the effect of preventing obesity.

2) Positive Thought

The idea of ​​success or failure or unrealistic perfectionism, such as ‘Never, always, always,’ is frustrating and self-confident, and there is a danger of breaking all the achievements that have been made. This attitude is necessary because flexible thinking and positive thinking can make diet and behavioral changes easier.

3) Stress Management

Managing stress is an important part of losing weight and preventing obesity. To prevent stress binge or giving up weight loss itself, you need to think about alternative actions you can take instead of eating during stress. For example, it is necessary to overcome the crisis of the moment through alternative actions such as watching movies, listening to music, cleaning or walking, bathing, or washing the car.

Behavioral therapy is the process of finding problems with weight gain, clearly setting goals, and solving problems, and providing appropriate compensation for success can help correct wrong habits and ways of thinking.

Personalized Information

1. Advice for those considering weight control

Many people who try to control their weight take drugs such as appetite suppressants or use fasting indiscriminately for fast weight control. The weight loss effect of this method is temporary, and if you stop it, you will easily gain weight, and your dependence on drugs or fasting will increase your risk of misuse of this method, leading to nutritional imbalances that can harm your health. Failure to control your weight in this way can also lead to eating disorders such as depression, anorexia nervosa and bulimia nervosa.

Therefore, obese people should consider the following when trying to lose weight:

• Decide if you really need to lose weight.
• Analyze your diet and activity and make a weight loss plan. Start by recording all the food you eat for two weeks to find out how much you eat.
• If you decide to lose weight, plan specific ways of eating and exercising. Do not try to lose too much weight in a short time. Then, when is the time to start implementing the plan.

There are many ways to lose weight, but the following ads may not be true, so you need to be careful before you believe them.

• It is not hard and does not require exercise diet ads
• Ads that significantly reduce weight in a short time
• Program ads that rely on artificial foods or drugs
• Food ads that promote a mysterious effect on weight control
• Ads that selectively reduce the flesh of parts of the body (for example, buttocks or jaws)

2. Different Types of Diet

Observing obesity-related behaviors by yourself is a way to identify your own habits and identify the causes of gaining weight to effectively prevent and control obesity.

1) Low Fat Diet

These types of diets have been known for their ability to lower fat balance and sugar balance to help health and extend their lifespan. It is also consistently recommended by important medical organizations as one of the longest-researched results.

However, many argue that it is difficult to practice and that the effect is not sufficient. They insist that they eat very low-fat meals to gain weight, and they need to get rid of 10% of their calories in order to get rid of diseases like coronary artery disease.

2) High Protein Diet

There are many kinds of this popular diet. Examples include “protein powder”, “mayonnaise diet”, “Zone diet”, “soldier diet”, and “Scarsdale diet”. The creators of this diet suggest that the low-fat diet, recommended by the American Heart Association, replaces fat with carbohydrates, and that increasing carbohydrate intake causes many problems in processing sugars, and changes in insulin concentrations lead to more eating. It is also pointed out that in some patients it leads to worsening of metabolism.

On the grounds of this argument, in some cases cholesterol or triglycerides have begun to deteriorate with very low fat diets. Another study found that despite the decrease in the consumption of fat-containing foods in the United States, average weight gain and obesity have continued. This is probably due to increased carbohydrate intake. Converse opponents of the protein diet, on the other hand, point to a large amount of weight loss in a short time because it enhances the reduction of sodium and water. It also says fat intake in the protein diet is increasing the mortality rate of heart disease. The protein diet is pointing out that there are generally less fiber, which is important for other aspects of health. These are problems that are hard to understand for the general public. Because this diet has been used satisfactorily by millions of Americans, I think it is a good initial program for weight loss. The protein diet has not yet been established for comparison with other diets.

Protein diets seem to be particularly helpful for those who are looking for a definite and tasty diet. Protein diets also make it easier to control your diet than low-fat diets and high-carb diets. However, it is emphasized that most people should not eat this diet for as long as possible.

3) Vegetarian Diet

It is high in fiber but is a typical low fat, high carb diet that includes low calorie foods. Only vegetarians (no eggs, cheese, milk, etc.) should be supplemented with enough protein and vitamin B12. The diet effect is hopeful but not popular these days.

4) Mediterranean Diet

Scientists studying characteristic diets around the world have reported that people who consume the least fat have the lowest incidence of heart disease. Nevertheless, this did not work was the Mediterranean region. The Mediterranean diet runs in this region without any restrictions. Even more noteworthy is that most of the calories come from fat. (The American Heart Association recommends 30 percent of the calories eaten from fat. And in fact, Americans eat 40 percent of the calories from fat. By comparison, the percentage of calories in fat in the Mediterranean diet is about 35%)

Saturated fatty acids are relatively low at around 10% and contain a lot of unsaturated fatty acids found in olive oil. It also contains a large amount of “omega-3” fatty acids. It is a balanced diet compared to protein and carbohydrate diets. Complex Carbohydrate-High fiber content is emphasized and fish is used as a source of protein. The amount of calories blends well and benefits your health.

5) Drinking Diet Therapy

There are many types of diets you can drink, and if you have significant risks, you should follow your doctor’s instructions. Liquid diets contain about 400-800 calories and consume 2-3 calories a day, low calorie drinks, the effect of which is proportional to the price. Therefore, the price is quite expensive. This diet can lead to increased gallstones, so be sure to consult with your doctor before using it.

3. Diet Related Drugs

Weight loss is followed by weight gain. This is a natural phenomenon and, in fact, all of the weight lost by the drug returns to normal within seven months of stopping the drug. Diet pills are a risk. This is certainly phenomenal if it will result in weight loss in the long run, while noticeably alleviating many health risks. Weight loss should not be stopped for compensation. The drugs used here should be consulted first.

1) Phentermine

It works by increasing neurotransmitters in the brain called norepinephrine.

2) Sibutramine

Stimulates the sympathetic nerve to reduce the amount of food eaten, and to some extent promote metabolism. It appears to increase blood pressure and pulse, putting a strain on the heart. Manufacturers do not recommend taking people with symptoms of high blood pressure, coronary artery disease, congestive heart failure, arthritis, or stroke. Do not take people with severe liver, kidney disease, anorexia nervosa, stroke, pregnant or taking certain medications.

3) Orlistat

A compound that reduces the absorption of fat from the digestive system. The drug combines with lipase, an enzyme that breaks down fat in the digestive tract and inhibits the breakdown of fat. Thus, about 30% of the fat you eat is not absorbed into the digestive tract and is excreted with the stool. Side effects include diarrhea and bloating.

4. Exercise therapy: Does exercise make you eat more?

Exercise is obscure in weight loss. It is difficult to lose weight if you don’t diet while exercising. But in the long run, regular exercise plays a big role in weight loss, even if there is no short-term weight loss. This is the reduction of abnormal fat, which makes our body stronger by replacing weight with fat with strong muscles.

Exercise is generally recommended 3 to 4 times a week, 20-30 minutes a day. However, to maintain your weight loss, it is most effective to take one hour a day five times a week. In general, this week of exercise can help you burn out 700-1000 calories. Since we need to burn off 3500 calories to lose 0.45 kg of weight, the sole effect of exercise on weight loss is to lose about 2 kg of weight every five weeks. Exercise is a must-have program for anyone who wants to lose weight.

5. Surgical Method

Surgical procedures have been developed to help people with severe obesity. This may be the case with a body mass index of 37 kg / m² or above, or with a body mass index of 32 kg / m² and having two or more comorbidities. Surgery results in a weight loss of approximately 30% of your initial weight in standard procedures. However, complications such as electrolyte imbalance, poor absorption of nutrients, and gallstone formation may occur, requiring meal adjustment training for about 3 months after surgery, and active management of nutritional supplements including vitamins and minerals.