Article Index

Obesity: epidemic of the third millennium

Obesity is the most common chronic disease of the Western world. There are about 300 million obese in the world, an epidemic for which has been coined the Anglo-Saxon neologism "globesity" well that makes the idea of the phenomenon. It is a complex disease due to genetic, environmental and individual, that determine a change in the energy balance, resulting in increased body weight caused by excessive accumulation of adipose tissue in the body. Weight gain can be realized only if there is a positive balance between calorie intake and energy consumption, due to a condition of overeating associated with reduced physical activity. These conditions are typical of the lifestyle of the industrialized countries, where the abundance of food is accompanied by a lifestyle that will gradually but surely reduce the chances of movement. (D'Amicis A et al., 2006)
The treatment of obesity and the paradox of the diet

The therapeutic approach to the problem of obesity has always been largely prescriptive, aimed at weight loss by decreasing calorie intake (dietary restriction). In the natural history of the obese subject, at least in the early stages of treatment, weight loss is an event relatively easy to reach, whatever the type of applied diet. Problems arise in prolonged treatment, particularly in long-term maintenance of weight lost. As I described in a now classic study of 1959 by Stunkard and McLaren 2/3 of people who lose weight regain it within one year and after five years most dieters undergo patients recover the initial weight. (Stunkard AJ et al., 1959) The caloric restriction is for the organism a stressful situation, with the activation of a complex neuro-endocrine-metabolic chain, followed by a number of alarm signals indicating the need of energy. iI most important is represented by the feeling of hunger. You can have psychoemotive changes such as anxiety, hostility, anger, irritability, low mood, often associated with episodes of craving and binge eating. In this situation of precarious balance, the loss of control on caloric restriction is an event all the more likely, especially in situations of particular emotional commitment. In the remainder of dietary restriction, the defaillance episodes multiply and often the patient definitively abandoned their therapist (eclipse phenomenon). During this period, which is absent any form of dietary control, weight inevitably increases, often exceeding the initial one, configuring the so-called Weight Cycling Syndrome. And 'now unanimously it accepted that repeated caloric restrictions, and the consequent weight fluctuation cycles, involving a gradual increase in weight. Paradoxically, it could be argued that "diets lead to obesity." (Bosello O et al., 1998) The international scientific community is now agrees that no prescription (dietoterapica and / or pharmacological) has, by itself, the ability to permanently reduce weight in obese subject, if at the same time is not changed the dietary behavior and lifestyle. (Melchionda N, 1996) Recent studies show that dietary restriction, if not supported by an adequate psychological support, pharmacotherapy, and why not, acupuncture, seems to be doomed to failure.