Obesity
Cosmetic Surgery - Plastic Surgery - Aesthetic Medicine - Reconstructive Surgery
The simple definition of obesity, which can be applied to all types of
obesity, is that there is an excess of body fat resulting mainly from
excessive calorie intake associated with a tendency towards decreased
physical activity. Obesity links physical consequences with an
increased risk of mortality and morbidity (disease progression) as well
as psychological and social disadvantages that may affect quality of
life.
The origin of obesity is a problem of care and treatment. Medical
management of excess weight is difficult because several aspects must
be taken into account: genetic determinism, the behavioural component
and the sociocultural dimension.
Current knowledge of the regulation of body fat has improved allowing
better defined therapeutic goals. Obesity results from a complex
mixture of biological, psychological, behavioural, environmental and
economic factors that are intertwined to give a heterogeneous clinical
entity.
The body mass index allows quick diagnosis of obesity before using
more sophisticated methods such as measuring body density, CT scans,
etc. which are not routinely available methods.
The body mass index is just an index. It highlights an increase in
risk factors with excessive body fat, and an increasing risk of
mortality as body mass index increases.
Obesity is the manifestation of an imbalance resulting from the
interaction of biological, primarily genetic factors with behavioural
and environmental factors leading to increased energy storage in the
form of fat in adipose tissue.
The regulation of energy reserves (fat) is complex and unique to each
individual. It is the central nervous system that controls food intake
and energy expenditure by hormonal and nervous means (neuropeptides Y,
ghrelin, leptin, insulin, adiponectin, peptide YY). Obesity leads to an
imbalance in the input and output of energy. Man has the ability to
accumulate reserves but a low capacity to adapt to overeating. Weight
gain leading to obesity is the translation of a fault in the system
regulating the level of energy reserves.
Predisposition to gain weight also has a genetic component.
Obesity develops in several phases:
-the passage from "normal" weight to a little excess weight is the constitution phase called "dynamic";
-the transition to weight maintenance is the static phase;
-the phases of weight loss by therapeutic intervention;
-the phases of weight regain with the succession of failed diets.
The treatment of obese patients must first go through the relief of
physical disorders, correction of psychological and metabolic disorders
and help to support the constraints involved in a long-term diet plan.
The concept of theoretical ideal weight is not tenable because
individuals differ in body mass and size. Individualized weight goals
are needed that must take account of all the biological, psycho
physiological and psychological factors involved in resistance to
restrictive diets.
It is first necessary to increase energy expenditure in daily life.
There is also a dietary regime tailored to each individual, associated
with a psychotherapeutic approach and complemented, in some cases, by
medication.
Gastrointestinal surgery is reserved for severe obesity affecting
health and resistant to previous therapy. Gastrointestinal surgery aims
to reduce gastric volume (gastroplasty, gastric bypass), and is not
risk free. The decision must be discussed by a team of experienced and
qualified specialists: nutritionists, psychologists, anaesthesiologists
and surgeons.
To treat obesity, we need a comprehensive approach at once
psychological, somatic and social. The treatment of obesity is
difficult, but significant results are obtained when the target weight
is associated with improved quality of life and the treatment of
complications.