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Obesity

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					Obesity is a common problem in our contemporary society. Modern life has
made high energy food more accessible while we are spending less and less
time to exercise and spend this energy. Obesity is a higher level of
weight gain which is considered when body weight reaches 120% of our
expected ideal body weight. Obesity is more common in women in particular
at a certain stage of the woman' reproductive life, when they are
pregnant. As we advance in age we tend to put on more weight as our
metabolism gets slower and our energy needs get less and we spend more
time in less active state. Obesity is more widespread in lower and middle
social classes.Obesity is the commonest nutritional eating disorder in
the world. It is commoner in lower social class. It is also commoner in
middle age and in later life due to slowing of metabolism as we advance
in years. Women are more likely to get obese due to hormonal changes
during pregnancy and after the menopause. More than half of the middle-
aged people in particular in lower social classes are obese.Simply
stated, obesity is a result of increase of food intake in excess of
energy requirements of the person. However, some people who are
physically inactive may increase in weight in spite of normal food
intake. Others may lose weight while eating normally due to some
metabolic cause which leads to excess need for energy as in the case of
hyperactive thyroid gland. Abnormal eating habits in childhood have an
effect on body weight in later life and perhaps due to increase in the
number of fat cells in the body during the development stage.Obese people
are liable to have poor judgment about how much they have eaten. Eating
is more related to external stimuli such as smell and sight of food and
time of the day when it is usual to have their meal rather than internal
stimuli such as hunger feeling or gastric motility. Some eat more in
response to stress and emotional state as a way of comfort eating. This
is a habit which may go back to childhood when food was given by parents
at time of stress and as food carries the meaning of giving love. There
are certain medical conditions which may lead to obesity. Obesity is
known to run in families and this is may be either related to genetics
and inheritance or due to some environmental influences of the family.
How to manage obesity?Dieting:The usual approach to deal with obesity is
calorie reduction. A careful programmed diet with total calories not
exceeding 1000 calories per day would achieve a weight loss of 1-2
kilograms every week. Dieting may result in irritability and a sense of
depression and sadness in some people and this may be the actual cause of
relapse in many cases.Psychotherapy in the form of group psychotherapy or
support groups are helpful and effective. The person's life style and
circumstances may need to be examined and problems such as marital
conflict or any other cause of distress leading ton overeating may need
to be dealt with.Behaviour techniques are used to overcome obesity
problems. One way is self monitoring and keeping a diary of food intake
and calorie content of each item. It is also significant to control the
environmental cues which lead to excessive eating. It is significant to
modify the eating habits and behaviour as these may be causal to the
faulty eating behaviour. Groups as those run by Weight Watchers help to
reinforce weight loss through self-reinforcement and group reinforcement.
Obese people may have to manage the usual pattern of guilt and feeling of
failure as these feelings in themselves may lead to relapses.Drugs may
play a limited role as they may cause a number of side effects and they
are used as the last resort . Some of these are stimulants which are
derived from amphetamines, and they are used for short-term use. They are
less constructive for patients who are extremely obese.1. Orlistat
(Xenical) reduces absorption of fat in the intestine.2. Sibutramine
(Reductil or Meridia) is an anorectic or appetite suppressant, which
reduces the desire to eat. Sibutramine has been withdrawn from the market
in many countries due to the risks of stroke and myocardial infarction3.
Rimonabant (Acomplia) is a cannabinoid (CB1) receptor antagonist that
acts centrally on the brain thus decreasing appetite and increasing body
heat production and energy expenditure. It has not received approval
yet.4. Metformin (Glucophage): can reduce wieght in people with Diabetes
mellitus type 2.5. Exenatide (Byetta) is a long-acting analogue of the
hormone GLP-1. GLP-1 is secreted in the intestine in response to the
presence of food. GLP-1 delays gastric emptying and promotes a feeling of
satiety. Byetta is currently available as a treatment for Diabetes
mellitus type 2. It must be injected subcutaneously twice daily, and it
causes severe nausea in some patients, especially when therapy is
initiated.6. Pramlintide (Symlin) is a synthetic analogue of the hormone
Amylin, which in normal people is secreted by the pancreas in response to
eating. Amylin delays gastric emptying and promotes a feeling of satiety.
Symlin is only approved to be used along with insulin by Type 1 and Type
2 diabetics. Symlin must be injected at mealtimes.Surgical treatment
Sometimes the only remaining option for management of obesity is surgical
intervention. Dental splinting, truncal vagotomy, gastric bypass or
partitioning and intestinal bypass are effective in considerable obesity.
Liposuction is also another surgical approach in considerable obesity.

				
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