Obesity is nowadays one of the major health emergencies in the world: in fact, abdominal obesity has reached epidemic proportions and its prevalence is steadily increasing.
The phenomenon involves 1 billion and 200 thousand people worldwide, including over 115 million suffering from other diseases, such as hypertension, cardiovascular disease, dyslipidemia, sleep apnea, and arthritis.
It is obvious that this disorder is associated with excess morbidity and mortality: abdominal obesity, understood as the accumulation of visceral adipose tissue that lead to an increase in waist circumference greater than 102 centimeters in humans and to 88 in women, reached in Italy an incidence of 31.5%.
The adipose tissue is not just a "passive" organ that stores nutrients, but is an active endocrine organ, able to synthesize hormones, cytokines, and other substances that interact with the human body.
Obesity, especially abdominal, is characterized by insulin resistance associated with compensatory hyperinsulinemia: it has been shown that weight reduction improves insulin sensitivity, and that bariatric surgery can in fact resolve type II diabetes and others conditions associated with dyslipidemia.
In our country the main cause of obesity seems to be sedentary lifestyle, rather than overfeeding, thus leading to an important link between obesity and dyslipidemias, in addition to osteoarthritis and vascular dyslipidemia.
In fact, in 2000 the World Health Organization (WHO) has estimated that it would take only a small weight loss of 5-10% of initial weight to reduce cardiovascular risks in patients who are overweight or obese.
Obesity also is part of a more complex picture known as “metabolic syndrome”, characterized by at least three of the following metabolic disorders:
1)Fasting blood glucose above 110 mg/dl;
2)Blood pressure over 130/85 mmHg;
3)Triglycerides greater than or equal to 150
mg/dl;
4)HDL cholesterol below 40 mg/dl in males, and less than 50 mg/dl in females;
5)Waist circumference increased to 102 cm in males and 88 cm in females.
Finally, another type of obesity in which patients have lost their muscle mass (known as sarcopenic obesity), is increasingly gaining ground in the elderly population, and could be a major cause of morbidity and mortality in elderly patients.
For this reason, all subjects that have the objective and clinical parameters for obesity are recommended to reduce their excess weight, and improve insulin sensitivity. Moreover, a change of lifestyle with regular exercise (at least 30 minutes daily), combined with a restricted diet, is strongly suggested. As a matter of fact, exercise (especially aerobic) is the only physiological method for improving insulin sensitivity.
Finally, the treatment of individual cardiovascular risk factors comprising the metabolic syndrome, is very important for a combination therapy that includes the use of drugs that reduce insulin resistance, such as metformin and glitazones (can be prescribed only in cases of diabetes), in addition to statins, fibrates and antihypertensive drugs when necessary.
REFERENCES
Obesity Task Force, Italy (TFOI). Loyal 99. Italian guidelines Obesity: identify, assess, treat. Edizioni Pendragon 1999, Bologna.
Report of WHO Consultation on Obesity. Obesity: Preventing and Managing the Global Epidemic. Geneva, 3-5 June, 1997
Guidelines MTC-MTC The combined approach of obesity-Year 26-2009 - N.3 Editions Paracelsus.
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