Obesity, new public health problem

Obesity is now considered a real disease just like hypertension. Recent studies have shown that excess weight and obesity affected more than half the adult population in many countries. Common in rich countries, obesity is increasing rapidly in many emerging countries.

The French are too big or they do they tend to become? Are we equal before the food or are there any genetic predisposition to obesity? What is the relationship between diet and obesity, and between obesity and disease? Why obesity becomes a problem of public health? Can we prevent obesity by identifying individuals at risk particularly in disadvantaged populations? How to fight against weight gain or regain normal weight?

Understanding obesity

Around the world, the kilos accumulate …

In the U.S. one in three adults is obese (33% against 21% in the 60s) and in some minority communities such as African and Latin American. South America, Asia, India, Thailand and China are not spared especially in large cities and their suburbs. This affects not only the rich countries but also emerging countries. In Europe, obesity is also gaining ground and now affects 15-20% of middle-aged adults: 10% on average in northern Europe but up to 50% of the female population in Eastern Europe.

According to a recent survey (1997) of the Sofres, France would count 37% of adults overweight, including 8% obese. Young people are also more likely to be large and are becoming heavier. The number of obese people is increasing steadily, although this increase is slower than in the USA, Canada, Great Britain, Germany. So France is still relatively untouched, perhaps through its cuisine but for how long?

The most threatening obesity among poor

In the occurrence of obesity, there are differences related to early socio-economic. The survey reveals that SOFRES obesity is more common than the family has limited financial resources. The occupations most at risk are farmers and laborers. The over-representation of obesity among the poor is predominantly female (5% of women, 3% of men). The barometer CFES-CERIN reveals that the percentage of obese women varies between 17% (income less than 6600 F) and 5% (income above 16 000 F). The results of the study SU-VI-MAX also show that obesity is more about the unemployed, pensioners, manual workers (11% against 4% for managers), confirming the apparent relationship between socioeconomic status and obesity . This relationship found in France as in other rich countries may be explained by social inequalities in health and differences in dietary habits. Difficult access to health care system makes random the early care and facilitates the occurrence of massive obesity complicated with hypertension, diabetes … Moreover, the means to fight against excessive weight – health, cure, diet, sports and gymnastics – increase with the level of household life. Finally, the low-income households are the biggest consumers of television and various studies have shown a correlation between weight and time spent watching TV, at least in children.

A low level of education increases the risk of obesity especially in women

The level of education appears to be a predisposing factor to obesity: the study Fleurbaix-Laventie women who have an education level lower than the CAP or BEP, after adjusting for other factors (number of children, activity physical, diet, smoking, alcohol) have a higher weight than women with a higher level of study. In Finland, the authors of the draft European MONICA found the same trend. According to the Nutrition Barometer 1996, CFES CERIN, we also observed that obesity is two to three times more common among people with low educational attainment. The time spent each day watching television is also higher among those with primary school education.

Ideal weight for obesity: early identification drifts

Obesity is defined by an excessive increase in body fat in proportion as it may harm the health of the individual. The concept of risk is part of the definition of obesity. The Body Mass Index or BMI assesses body fat and the importance of overweight. The BMI is simple to make: the ratio of weight (kg) on the square of height (in meters). As someone measuring 1.60 meters and weighing 65 kg has a BMI of 25 [65 / (1.6 x 1.6)]. Monitor BMI identifies early excesses of weight and early treatment:

- Between 19 and 25, normal weight.
- Between 25 and 30, there are overweight.
- From 30, we talk about obesity.
- Beyond 35, severe obesity.

Too many kilos … Less health

We rarely dare say that a person is fat and even less that is obese … We prefer to call a woman “a little high or coated, or a man” beefy “. This cautious language show that excess weight is primarily related to notions of aesthetics. Even if they vary at different times and civilizations, few women today would like to be compared to models of Rubens …

But excess weight, and a fortiori obesity represents a risk to the health of the individual. Obesity is responsible for cardiovascular complications, respiratory, osteoarticular because the extra kilos weary heart, makes breathing difficult, overwhelming the joints. Obesity is often associated with diabetes, gout, high blood pressure. Obesity is often linked to an increased number of work stoppages, the latest in disability and overall decreased quality of life. The psychological consequences of obesity, feelings of abnormality, social rejection and injustice of the system constraints are the cause of social isolation increased further by the social discrimination that raises obvious obesity.

Inform the obese to better treat obesity

Successful treatment of obesity is based on the active and motivated person. Grounds under strain it is necessary to know to analyze the failures and accompany the person in his care. Social, personal and family combine to dissuade him from his goal. Social factors are particularly represented by the constraints of working life, many people have lunch at their workplace, which does not facilitate a proper diet. However they should not settle for a sandwich or worse, skip lunch, thinking and promote weight loss faster.

Remember that 50% of obese eat too much but not necessarily evil. Family factors are also involved, since the establishment of a regime change and its follow family customs. In some families of obese, who decides to lose weight is a traitor to his face which clan, temptations to mockery, nothing will be spared. Finally, personal factors are equally important: the system must be lived as a penance to atone for the excesses of the past. Taking into account the personality of the subject is important to establish an effective regime thus personalized. On the other hand, dieting does not live in deprivation. It is always better to speak of food as recommended forbidden foods and preventing a dietary pattern should be followed for life not to resume the road to obesity …

The drugs against obesity: the pill that melts away the pounds is not yet available

Drug treatment of obesity is considered only when other measures failed. It is reserved for significant obesity, often complicated and high risk. These are the anorectics that cut hunger and particularly the desire for sweet foods. Orlistat, a prescription medicine available to physicians is a molecule that decreases the intestinal absorption of dietary fat intake. Fats and evacuated faeces can cause diarrhea greasy uncomfortable. Currently the cost of this treatment is about 600 GB per month not reimbursed by social security. In all cases, regular medical supervision and strict control is necessary for the effectiveness of treatment and the scheme and to monitor the safety of these drugs.

The story of genes for obesity

Obesity is a family heirloom at least in part. A child with a father or a mother obese at greater risk of becoming homeless. In the late 60s that the genetic nature of obesity has been demonstrated in mice. But not until 1994, we isolated the gene. If genetically obese mice, a single gene is responsible, in humans, however, a score of genes involved in obesity and so much remains undiscovered. In 1997, the discovery of a genetic defect blocking the production of leptin confirms the role of genetics in some human obesity. Leptin “satiety hormone” in informing our brain’s level of reserves of body fat induced a decrease in food intake.

Another hypothesis is being validated: that of receptors on the surface of fat cells. They are involved in the degradation of fats by the body’s needs. Some obese receptor unable to function and fat cells store fat without ever being able to release it.

Other genes are probably involved in controlling body weight which has not yet yielded all its secrets …

Invoice of obesity in the United States: 50 billion dollars per year

U.S. researchers have estimated that 50 billion dollars in health costs the cost of obesity and diseases related to it. Statistics from the study reveal that the average health expenditure is increased by 25% among overweight and 44% in the obese. The average annual number of days of hospitalization for obese is 74% higher than people of normal weight.

The economic cost of obesity in France was estimated at 2% of health spending in 1992 with one third attributable to hypertension. It is comparable to that of Australia and less than that of the Netherlands (4%) and USA (5-7%). This comparison must be qualified because of differences in health system according to the country.

The social cost of obesity, unemployment, disability pensions, sick … has not been evaluated.

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