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Obesity

In Roman times, a beautiful woman was considered to be well proportioned and rounded in the style of Venus de Milo (plus arms of course!). During the Renaissance, voluptuous females of Junoesque proportions were appreciated. Today the tall, skinny, anorexic fashion model is considered to be in vogue. It is possible that those overweight by today's standards were merely born in the wrong era.

Two centuries ago the average person walked twelve kilometres a day, getting adequate exercise and burning off excess weight. As a result, obesity was a sign of wealth as the person did not need to walk long distances for work, or had access to a carriage rather than a horse (horse riding also uses energy).

Up to 40% of people in developed countries are overweight, but only 5% are considered to be obese by medical standards. Obesity is medically defined as being more than 40% over the ideal weight for sex, height and age. Men tend to develop 'apple' obesity (fat around the middle of the body) while women are 'pears' (fat deposits around the buttocks). The 'apple' form has a far higher risk of heart complications.

Those whose weight is within 20% of their recommended weight have little to fear health-wise. Those who exceed this limit are more likely to develop strokes, heart disease, diabetes, arthritis and liver disease.

The causes of obesity can be simply listed (in order of importance) as:-

•  inherited tendency

•  too much food eaten

•  too little exercise

•  metabolic (body chemistry) disorders

The vast majority of cases of obesity are due to excessive food and physical inactivity, but if your parents were obese, your chances of also being obese are greatly increased. Some people have very efficient bodies (like a efficient car), and require remarkably little energy in the form of food to remain healthy and active. If the amount of energy used(calories /kilojoules) in exercise and normal b(function exceeds the amount of energy taken in as food and drink, the person will always: lose weight. If the reverse is true, weight will increase. It should be remembered that c alories and kilojoules are a measure of the energy content of food, and not the fat content.

Middle age spread occurs as the metabolic rate of the body (the rate at which all organs in the body function) slows with age, at the same time that exercise levels tend to reduce, and food intake increases with more security. Many women gain weight after the menopause due to a slowing of the body's metabolic rate when oestrogen levels, This effect may be slowed by hormorne replacement therapy.

Other metabolic causes of obesity include disorders of the pituitary gland under the brain (caused by a tumor, cancer, stroke, infection injury or other disease), an under active thyroid gland (hypothyroidism), Cushing syndrome (over production of steroids, or taking large doses of cortisone), poorly controlled insulin dependent diabetes, the chromosomal defect of Prader- Willi syndrome, syndrome X (also known as Reaven syndrome insulin resistance syndrome), Stein-Leventhal syndrome (multiple cysts in the ovaries), Frohlich syndrome (late onset of puberty, thin wrinkled skin, scanty body hair) and the Laurence-Moon-Biedl syndrome (night blindness, mental retardation, obesity, small geniIals and sometimes extra fingers or toes).

The metabolic cases of obesity must have the underlying condition treated, and not the obesity itself.

Obese men and women tend to spend an incredible amount of money in their attempts to become thin by buying special foods and medicines. The cheapest and most effective way to lose weight is to spend less, by buying less food, particularly less of the expensive processed foods. If you willpower is lacking, or the craving for rich foods becomes unbearable, doctors can prescribe tablets that are designed to reduce your appetite (anorectics). These drugs are expensive, and should not be used for long periods, but they are effective.

Orlistat (Xenical) is a drug that reduces the body's ability to absorb fat, and is quite successful in assisting obese people to lose weight, but it must be used in conjunction with a diet program, and some degree of diarrhoea is an almost invariable side effect.

Sibutramine (Reductil) is a medication that was released in 2002, that acts on the brain to reduce appetite. A weight reduction of 5% can be expected in three months in most patients. Patients who are on certain antidepressants and patients with heart disease or high blood pressure cannot use it, blood pressure must be monitored regularly, and the medication is quite expensive. Many other groups should not use this medication, including those over sixty-five years. Its use should be carefully discussed with a doctor.

The long term success rate for those who are truly obese and try to lose weight is very discouraging. Most have yo-yo weights, which fluctuate up and down over the years by 20Kg. or more as they try different diets and exercise programs. This weight fluctuation can be more harmful than staying fat.

Overall, less than one in twenty of obese people manage to return to within normal weight limits and stay there for more than five years. If you do manage to stay on a diet for about five years, and maintain your weight constantly within the desired range, the body will adapt to its new shape, and the metabolic rate may also adjust, so that you may suddenly find after years of dieting that you can relax a little, and still maintain the new weight.