Diet and overweight management in obesity

Obesity is excess weight, defined as a body mass index (BMI) greater than 30 kg / m2. Complications include cardiovascular pathologies (especially in subjects with excess abdominal fat → android profile), diabetes mellitus, certain cancers, gallstones, fatty liver, cirrhosis, osteoarthritis, reproductive disorders in in men and women, psychological disorders and, for the subject with a BMI ≥ greater than 35, premature death.

The diagnosis is in fact based on the body mass index. Treatment includes lifestyle modification (diet, physical activity and behavior) and, in some special cases, weight loss surgery.

What are the causes of obesity?

The causes of obesity are probably multifactorial and may include a genetic predisposition. Ultimately, obesity is caused by a long-standing imbalance between energy intake and energy use, including energy expenditure for basic metabolic needs and activity-related energy expenditure. physical. However, many other factors appear to increase the predisposition to obesity, including endocrine disruptors, gut microbiome, wake / sleep cycles, and environmental factors.

Overweight, obesity … Focus on eating disorders

Weight gain linked to obesity is associated with 2 main eating disorders:

• Binge eating disorder:

It corresponds to the impulsive consumption of large quantities of food with, in particular, a subjective feeling of loss of control during the episode and guilt during the course of the episode. This disorder does not, however, involve compensatory behaviors, such as vomiting. Binge eating occurs in about 3.5% of women and 2% of men during their lifetime and in about 10-20% of people who participate in weight loss programs. Obesity associated with these disorders can be significant and therefore often characterized by weight fluctuations as well as psychological difficulties.

• Nocturnal polyphagia syndrome:

It includes morning anorexia, evening binge eating and insomnia, including eating in the middle of the night. In this situation, more than 25 to 50% of the daily food intake takes place after the evening meal. As a result, approximately 10% of people who seek treatment for severe obesity have this disorder in the United States.

Other eating disorders, similar but less marked, probably contribute to weight gain in a greater number of subjects. For example, eating after the evening meal contributes to excess weight gain in many people who do not have night feeding syndrome.

What are the risks of complication of obesity?

Complications of obesity include:

• Diabetes mellitus:

Insulin resistance, dyslipidemia, and high blood pressure (metabolic syndrome) can develop, often predisposing to diabetes mellitus and coronary artery disease over time. These complications are, however, more frequent in cases of abdominal adiposity, high triglycerides, a family history of type 2 diabetes or premature cardiovascular disease or a combination of these risk factors.

• Obstructive sleep apnea:

Obstructive sleep apnea can also occur if there is excess fat in the neck compressing the airways during sleep. Apnea is manifested by repetitive pauses in breathing during sleep. This disorder, often undiagnosed, can however cause loud snoring and excessive sleepiness during the day and increase the risk of hypertension, cardiac arrhythmias and metabolic syndrome. Obesity can also lead to obesity-hypoventilation syndrome (“Pick Wick syndrome”).

• Skin disorders (intertriginous infections):

Dermatoses are indeed frequent; sweat and skin secretions retained in the thick folds in particular promote bacterial and fungal growth, frequently responsible for infections (intertrigo).

• Social, economic and psychological issues:

Obesity can generate social, economic and psychological problems, due to prejudice, discrimination and stigma and a poor self-image. For example, obese people face difficulties in hiring and paying.

Complications of obesity also include:

• Reproductive system disorders, including infertility, low serum testosterone levels, in men, and polycystic ovary syndrome in women
• Many cancers (especially colon cancers and breast cancer)
• Osteoarthritis
• Tendon and facial disorders
• Metabolic syndrome

The importance of body composition analysis in managing overweight

Body composition, the percentage of fat mass and non-fat mass, gives a more precise definition of excess fat, and therefore obesity. Body composition analysis can be helpful in determining whether an increase in BMI is due to excess fat or muscle mass.

Body fat percentage can be estimated by measuring the thickness of the skinfold (usually above the triceps) and the midbrachial muscle area.

Bioelectrical impedancemetry makes it possible to estimate the percentage of body fat, simply and non-invasively. Bioelectrical impedance analysis directly estimates the percentage of the total amount of body water; the calculation of the percentage of body fat is derived indirectly from this. However, bioelectrical impedancemetry is more reliable in people in good health or who have a limited number of chronic pathologies which can thus modify hydration (moderate obesity, diabetes mellitus).

Some naturopathic tips to help manage overweight in obesity:

A balanced diet is particularly important for weight loss and weight maintenance.

The strategies include the following actions:

• Eat small meals while avoiding or choosing snacks carefully
• Replace refined carbohydrates and processed foods with fresh fruits, vegetables and salads
• Replace with water, sugary drinks or fruit juices
• Limit alcohol consumption to moderate levels
• Include fat-free or low-fat dairy products that are part of a healthy diet and help provide sufficient amounts of vitamin D
• Low-calorie, high-fiber diets that modestly limit calories (600 kcal / day) and incorporate lean protein appear to work best in the long term. Foods with a low glycemic index and marine fish oils or monounsaturated fatty acids of plant origin (olive oil) reduce the risk of cardiovascular pathologies and diabetes
• Meal replacements help to lose weight and stabilize it; these products can be used continuously or intermittently
• Diets that are too restrictive are unlikely to be followed or to cause lasting weight loss. Diets that limit caloric intake to <50% of baseline energy expenditure, known as very low calorie diets, may only contain 800 kcal / day
• Exercise increases energy expenditure, basal metabolism, and meal-induced thermogenesis. Physical activity also seems to regulate appetite towards caloric consumption more appropriate to needs.

Sport side:

Exercises, including endurance (resistance), increase muscle mass. Muscle tissue burns more calories at rest than fat tissue, so increasing muscle mass leads to lasting increases in basal metabolism. Interesting and enjoyable exercise is more likely to be done with intensity. A combination of aerobic and resistance exercises is in fact preferable to these exercises performed alone. The guidelines, however, suggest physical activity of 150 min / week for health benefit. 300 to 360 min / week to achieve weight loss and maintenance. Developing a more physically active lifestyle can indeed make it possible to lose weight and maintain it.

Other benefits associated with physical activity additionally include increased insulin sensitivity, improved lipid profile, reduced blood pressure, increased aerobic capacity, psychological well-being, risk breast and colon cancer decreased and increased life expectancy.

Sources:

• Ajslev TA, Andersen CS, Gamborg M, et al. Childhood overweight after establishment of the gut microbiota: The role of delivery mode, pre-pregnancy weight and early administration of antibiotics. Int J Obes 35 (4): 522–529, 2011. doi: 10.1038 / ijo.2011.27.
• Heindel JJ, Newbold R, Schug TT: Endocrine disruptors and obesity. Nat Rev Endocrinol 11 (11): 653–661, 2015. doi: 10.1038 / nrendo.2015.163.
• Williamson DF, Thompson TJ, Anda RF, et al: Body weight and obesity in adults and self-reported abuse in childhood. Int J Obes Relat Metab Disord 26 (8): 1075-82, 2002. doi: 10.1038 / sj.ijo.0802038.
• Anda RF, Felitti VJ, Bremner JD, et al: The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci 256 (3): 174-86, 2006. doi: 10.1007 / s00406-005-0624-4.