overweight | MY SPECIAL DOCTOR

Body weight: the dangers of fluctuations

22 February 20246 January 2024 by rosanna.feroldi

That repeated drastic diets are bad for your health, and not just your physical health, is a well-known concept and widely reiterated by doctors and nutritionists, although not always given due consideration by message recipients. That is, by people with a few or many extra pounds who would like to improve their fitness and appearance.

The reason is quickly stated: if the overweight is detrimental because it increases the cardiovascular risk, the general inflammatory state, and the risk of developing hormonal disorders and some cancers (such as colorectal and breast cancer in women), slimming down too quickly imposes considerable metabolic stress on the body, which does not make things much better.

If, then, after the weight loss initial failure to maintain the result (as is the case in most cases, if you are not followed by a nutritionist/dietologist), the effect is even worse because you will be back in the initial risk category on the clinical level and you will accumulate more adipose tissue than muscle mass (partly lost along with the fat mass during slimming).

Past studies had already warned that the yo-yo effect is detrimental to overweight or obese people with cardiovascular disease, who can benefit greatly from a weight loss of at least 5-10% of their initial weight, but only if maintained over the long term.

New data from a Korean study involving 3,678 men and women who underwent body weight monitoring and medical evaluations every 2 years for a period of 16 years now report that, even in those without specific diseases, repeated weight fluctuations are to be avoided because they are associated with a significant increase in mortality (as much as more than 50 percent compared with those who maintain a fairly stable weight).

The only category of people who manage to derive some benefit from this metabolically incorrect form of slimming is obese individuals who are free of cardiovascular disease. Indeed, in this subgroup, weight losses, although transient, appear to result in a lower overall risk of developing diabetes with age (reduced by 24 percent on average). On the other hand, it should be pointed out that the benefit would be significantly greater if the weight was lost once and for all and no longer regained.

But beware: the protective effect of weight yo-yoing toward diabetes applies only to those who are obese to begin with. For people who are initially normal weight or with only a few extra pounds, each somewhat pronounced fluctuation in the scale increases the likelihood of losing blood glucose control in later years, rather than decreasing it.

By contrast, in no case does slimming-fat-reduced-fat-reduction, etc., more or less often seem to have, in itself, a significant impact on the risk of going on to acute cardiovascular events such as heart attack and stroke, unless one already suffers from predisposing diseases in this regard.

In view of the hearty meals of the Christmas season, it is best to keep these figures in mind and try not to accumulate too many kilograms, which would then be hard to lose at the beginning of the New Year.

Source

Tae Jung Oh et al. Body-weight fluctuation and incident diabetes mellitus, cardiovascular disease, and mortality: a 16-year prospective cohort study. The Journal of Clinical Endocrinology & Metabolism, 2018; doi1:0.1210/jc.2018-01239

Childhood obesity, are mothers to blame?

22 February 20246 January 2024 by Redazione My Special Doctor

According to an Italian study carried out by researchers at the University of Padua, led by Professor Dario Gregori who works in biostatistics, epidemiology and public health, it is believed that love can somehow affect how parents, particularly mothers, view their child. The analysis on childhood obesity was published in the international journal
“Obesity,
under the title “Does love really make mothers blind? A large transcontinental study on mothers’ awareness about their children’s weight“.

The main objective of the study carried out by Prof. Gregori was to analyze the maternal misperception rate (i.e., the mother’s perception of her child being overweight or underweight). The study looked at 2720 children, ranging in age from 3 to 11 years, of both sexes and from 10 countries (Argentina, Brazil, Chile, France, Mexico, Germany, Italy, the United Kingdom, India and Georgia).
According to the various data, as many as 774 of the 2720 children were found to be obese or overweight, with the largest proportion in India (337 cases, 49%). In other countries, however, the situation is to be monitored, as there are many cases in Latin America, such as in Brazil (124), Chile (54), and Argentina (45). Italy, on the other hand, remains in line with the various European nations, where the proportion of overweight or obese children is 30 out of 774, or 4 percent.

Childhood obesity is a phenomenon that needs to be controlled, as Professor Gregori explains, “The proportion of overweight/obese children incorrectly perceived as such by their mothers appears to be very high. Almost all of the overweight children (89%), and half of the obese children (52%) were not perceived as such by their mothers. Stratified analysis by nation shows slight variability among the countries considered in the study. Italy represents one of the countries with the highest proportion of misperception, i.e., 80 percent of overweight/obese children, or 24 out of 30 children, were perceived by their mothers as normal weight“.

These data alarmed Prof. Gregori in no small part, who emphasized that there is a need for public health policies to fight the problem of childhood obesity, especially on parental awareness of their child’s fitness.

Overweight and obesity: if you know them (maybe) avoid them

14 February 20246 January 2024 by rosanna.feroldi

In a world where everyone wants to be thin, one is increasingly overweight, even from childhood. With all that it entails in terms of physical and psychological discomfort and health repercussions, especially after a certain age. What to do? Here are some tips.

When it comes to nutrition and body weight, it opens up a universe of contradictions. You want to stay in shape or lose weight, but also eating what they like without paying too much attention to quantity. Hundreds are spent of euros for the gym, but then you almost never go. A thousand diets, but none are maintained. You buy jumpsuits and sneakers, but you don’t can do without an elevator and a car. The most ironclad healthy living resolutions, but the tomorrow to implement them never comes.

The result is always the same: month after month, the needle of the balance goes in the opposite direction from what is desired or, at best assumptions, remains inexorably fixed on a somewhat round figure. Despair does not help, because it often leads to drowning one’s own frustrations. Resign even less, because it makes people get used to standards of weight and fitness that tend to get progressively worse, almost without realizing it account. So what? As always, the solution lies in the middle, viz. In identifying a healthy balance between actual metabolic needs of the body and pleasures for the palate and spirit.

The origin of the extra pounds

No use cheating or looking for alibis in slow metabolism or the unfavorable constitution: except for a very small proportion of cases in which indeed there may be a significant genetic component or specific pathologies that work against it, if you gain weight or don’t lose weight, the reason goes sought in lifestyle errors, that is, essentially in the combination of a diet that is high in calories relative to individual needs and/or unbalanced and insufficient movement. This rule applies at any age, but in childhood/adolescence can have a metabolic impact particularly negative, which also has unfavorable repercussions on body weight and health In adulthood.

Numerous studies have now indicated that a child in strong overweight or obese will remain so as an adult (or who will slim down with effort), resulting in exposure to an increased risk of cardiovascular disease, diabetes, hormonal disorders and different types of neoplasms (e.g., breast cancer in women and colorectal cancer in both sexes.

For women, then, obesity (as well as being overweight) can impair fertility or cause serious problems during pregnancy and at the time of delivery, not the least of which is to also predispose the child to develop overweight/obesity and diabetes. Not to mention the psychological implications and Relational of the many extra pounds in adolescence and early adulthood adult, when physical appearance plays an important role in the perception of self and in interactions with others.

For women, even those who were initially thin or normal weight, A critical moment on the body weight front is the pregnancy. If you gain too much weight at this stage (i.e., more than the 10-12 kg. physiological, which gynecologists recommend not to exceed), lose weight after childbirth can be difficult, especially if you are over 35-40 years old, if you have a demanding family to care for and/or a job sedentary, leaving little time for physical activity. Residual extra pounds neglected for a long time, in fact, tend to “settle” by constituting the starting point for further increases in subsequent years.

In both sexes, then, the coming of age 40-45 involves. an initial, inevitable metabolic slowdown, which will worsen later: especially after age 50-55 for women, corresponding to the onset of the menopause; and shortly thereafter for men, also due to the reduction of hormones male and muscle mass (which is the one that burns the most calories). If, During and after this transition, you do not revise your habits food (reducing the calories introduced each day and increasing the consumption of vitamins and antioxidants that support metabolism), fattening by a few pounds is practically inevitable.

As mentioned, in a minority of cases, overweight and obesity can arise and persist due to diseases, mainly of endrocrine-metabolic type, or as a side effect of drugs needed to treat a variety of ailments. Among the former include. hypothyroidism, adrenal gland dysfunction, and the ovary polycystic, just to give a few examples.

Among the latter are insulin used for the treatment of more severe forms of diabetes, cortisone, some antidepressants, the antiepileptics, mood stabilizers, antipsychotics, some hormone therapies used for women’s issues and anti-androgenic drugs Against prostate disorders and cancers in men. In all these cases, the Body weight management must go hand in hand with disease treatment basis and be defined and monitored by the physician.

Healthy diet: better start with children

First, recall that the concepts of normal weight, overweight and obesity are based on the calculation of body mass index or BMI (Body Mass Index), a value that is obtained by dividing the weight expressed in kilograms by the square of the height expressed in meters. So, for example, a person who is 1.70 m tall and weighs 70 kg will have a BMI = 70 kg / (1.70 x 1.70)^{m2 =} 24.22 kg/^m2. This person will be “normal weight,” a category that includes all those with a BMI between 18.50 and 24.99 ^kg/m2. It will be, instead, “overweight” Those with a BMI between 25.00 and 29.99 ^kg/m2 and “obese mild” (class I) those who have a BMI between 29.99 and 34.99 ^kg/m2; with BMI between 35.00 and 39.99 ^kg/m2 you fall into medium obesity (class II), while from 40 ^kg/m2 upwards we speak of severe obesity (class III).

Assuming that overweight and obesity in childhood/adolescence. influence the characteristics of metabolism and health in adulthood, it is crucial that the habit of keeping fit through a healthy diet and exercise regular be promoted to children. This also creates a kind of “imprinting behavioral” that makes it more spontaneous and natural to follow a style of Healthy living and continue to keep body weight under control over the decades Next.

If the child/adolescent is already overweight by several pounds, the advice is to consult the pediatrician and agree with him or her on a regimen age-appropriate diet and exercise, after ruling out any disorders organic not yet diagnosed. If there are many pounds to lose, it is almost imperative to also consult a dietician/nutritionist, whereas if approach to food appears to be influenced by psychological aspects is useful Also consult a psychologist/psychiatrist experienced in eating disorders.

The most important thing, however, is not to trivialize nor dramatize the problem and not nag the child about his or her weight, to what he eats or why he doesn’t move enough. Much better results will achieve by creating a serene and cheerful family environment (where meals become a pleasant time of sharing), filling the pantry and refrigerator with healthy foods (fresh fruits and vegetables first and foremost), cooking light and, above all, setting a good example, both at the dinner table and on the activity front physics.

Many teenagers and young adults are often is tempted from promises of rapid weight loss through diets as curious as they are ineffective, if not downright dangerous to health. Avoid them and recommended to avoid them in any case. If the pounds to be lost are few (3-5 kg), in most cases it is sufficient to make an honest analysis of the their own eating habits (perhaps by compiling a food diary for some days) and correct trivial mistakes (such as regularly taking drinks sugary drinks and alcohol, nibbling while cooking or at aperitifs, exceeding With bread and buns at the table, add too much oil or cheese to salads etc.).

A few suggestions for adults

In addition to the classic advice to reduce intake of the carbohydrates in general and to a minimum that of simple sugars (added or contained in sweet foods), favor proteins from legumes and fish, and Increase fiber consumption (i.e., low-sugar vegetables and fruits), a trick useful for cutting calories without revolutionizing your habits too much food is to gradually reduce portions. It may sound trivial, but by 10-20 g less pasta on your plate you hardly notice (especially if you have shrewdness to start using smaller plates), but week after week week can make a difference on the scale.

On the contrary, it is important to drink more water or other beverages unsweetened (teas, herbal teas, infusions, natural flavored waters, etc.): both because liquids have an immediate satiating effect and help to dampen attacks of starvation; both because it has been observed that many people fail to distinguish well between the stimuli of hunger and thirst and end up with the eat when they should actually drink (the kidneys will also benefit).

When the pounds to be lost are more than 5-10, it is good to consult first their own physician and then a dietitian/nutritionist to set up an eating plan compatible with the needs and characteristics Individuals (age, gender, presence of other conditions and any therapies hired, specific needs, etc.) and establish a “calendar” of the weight loss that has the dual purpose of stimulating adherence to the program dietary and physical activity (which should always be provided in combination) and of allow strategies and goals to be recalibrated, depending on the results via via reached.

As already reported for children/adolescents, also for the adults psychological/psychiatric support can be very helpful, if we realizes that he attributes to food valences that have little to do with hunger (e.g., compensation for frustrations and nervousness). In cases of severe obesity or Very severe, the doctor may prescribe certain appetite-reducing drugs or support weight loss, or consideration may be given to the bariatric surgery, weighing its pros and cons well.

Absolutely to be avoided, however, is any kind of Supplement or “miracle” remedy touted online or by centers aesthetics, gyms, clinics of dubious reputation: experience has shown that they do not serve no purpose and can damage health, at great cost.

Slimming down after the “hip”

Given that metabolism physiologically slows down starting from age 40 and increasingly in later years, slimming down will require more commitment and time after this age. But one should not be discouraged or give up because it is precisely after “age” that eliminating (or reducing) pounds of Too much becomes more important to prevent cardiovascular disease and diabetes Type 2 or help keep them under control.

Numerous studies have shown that a weight loss of equal to at least 10% of the initial one significantly reduces the risk global cardiovascular and may even reverse type 2 diabetes in early stage. In addition, at any age, losing weight helps to snore less, to alleviate (or resolve) gastroesophageal reflux disease, to avoid many sore back, not to put too much stress on the hip and knee joints, and to maintain satisfying sexuality for longer.

Of course, to achieve this and get these benefits, you need a some good will and be convinced that it is a good right thing. The suggestion is to start trying hard, without wait until you are too old, but remembering that losing the excess weight is possible and useful at any age.

Sources:

National Heart, Lung and Blood Institute – NIH (https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity)
National Institute of Diabetes and Digestive and Kidney Diseases – NIDDK (https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight)
World Health Organization – WHO (https://www.who.int/nutrition/topics/5keys_healthydiet/en/; https://www.who.int/en/news-room/fact-sheets/detail/healthy-diet)
Arnold M et al. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women’s Health Initiative: A Longitudinal Study from the United States. PLoS Med 2016;13(8):e1002081 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987008)
Johnson RJ et al. Perspective: A Historical and Scientific Perspective of Sugar and Its Relation with Obesity and Diabetes. Adv Nutr 2017;8:412-422
Gardener H et al. Diet Soda and Sugar-Sweetened Soda Consumption in Relation to Incident Diabetes in the Northern Manhattan Study. Curr Dev Nutr 2018;2:nzy008

So much effort, but the belly doesn’t drop? Here’s why

15 February 20246 January 2024 by Redazione My Special Doctor

You try hard to make it go away, but the “bacon” remains virtually unchanged. Why? First of all, it is good to be honest with oneself. themselves and evaluate whether they are really making an effort to follow a healthy diet (eating less high-calorie foods and drinking less alcohol and soft drinks. sugary) and to engage in more physical activity. Then, if indeed these two premises are met, other enemies of the form must be considered physical that specifically promote the accumulation of the so-called “fat visceral”: the most dangerous for heart and artery health and for the development of metabolic diseases such as type 2 diabetes. Check which ones are and which ones there directly affect. So take action!

Artificial sweeteners: the position of US pediatricians

12 February 20246 January 2024 by rosanna.feroldi

As Italy prepares to introduce the “Sugar tax,” not only to balance the state budget but also with a view to discouraging the intake of beverages (and foods) containing excess sugar and calories, U.S. pediatricians are wondering about the possible health effects of the growing number of artificial sweeteners used as substitutes by the food industry and consumed in increasing quantities by children. Consumption of which, often, parents are not fully aware, since sweeteners are listed by law only in the list of ingredients (which not everyone reads and in any case written in microscopic characters), while the “reduced sugar content” that everyone likes is always made explicit in clear letters on the packaging and in advertising claims, leading to an interpretation, if not fallacious, at least partial and somewhat distorted of the characteristics of the product being purchased.

But is there really anything to fear when it comes to artificial sweeteners approved for food use by the Regulatory Agencies (i.e. the Food and Drug Administration – FDA in the United States and theEuropean Food Security Agency – EFSA in Europe) responsible for ensuring the safety and wholesomeness of substances used to produce food of any kind? In principle, no, because only compounds for which no indications of possible harm to the human body have emerged are allowed for food use. But it is precisely on this point that theAmerican Academy of Pediatrics – AAP does not agree much and would like a little more caution from everyone, institutions, manufacturers and parents. According to the Position statement published on this matter in the scientific journal Pediatrics, in fact, while for some sweeteners that have been in use for a longer time (saccharin, aspartame, acesulfame, sucralose) health criticalities from moderate consumption can be reasonably ruled out, for others of more recent introduction (such as stevia) the evidence supporting their total harmlessness is considered insufficient, especially with regard to the effects from prolonged use and especially in children.

Not only that. One aspect that the JPA believes should be investigated further concerns quantities because, as is known, any substance can result in extremely different effects in the human body depending on how much is taken in a single day and repeatedly on successive days for varying periods of time. This is also true of common sugar, which is a harmless and valuable source of ready-to-use energy for the muscles and brain when taken in low doses, but becomes an enemy of metabolic and cardiovascular health when consumed in excessive amounts, promoting-as is well known-conditions of overweight/obesity, insulin resistance and diabetes. Unfortunately, unlike other nutrients in foods, artificial sweeteners are not required to be labeled with quantities (absolute or percentage) per 100 grams or per serving of product, which prevents (the consumer and those who have to assess individual/population exposure levels) from knowing how much they are taking in through their usual diet.

Add to this that, contrary to what was initially assumed and touted, studies to date have indicated that consumption of artificial sweeteners in place of common sugar is not necessarily associated with weight loss unless their use is part of an overall healthy, balanced diet aimed at weight loss. Thus, opting for “low-sugar” or “zero-sugar” beverages or foods, per se, does not help counter the growing prevalence of overweight and obesity, either among adults or children.

Given these considerations, while not wishing to generate unreasonable alarmism, U.S. pediatricians believe that more in-depth studies need to be conducted to assess the long-term effects of different artificial sweeteners, including on children’s intake levels, and which parents should be better informed about the properties and, more importantly, the amounts of artificial sweeteners in commercially available industrial food products to support informed choices and avoid excessive intakes.

Source:

CM Baker-Smith et al. The Use of Nonnutritive sweeteners in Children – American Academy of Pediatrics (AAP) Policy Statement. Pediatrics 2019;114(5):e20192765; doi:10.1542/peds.2019-2765(www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Looks-at-Use-of-Nonnutritive-Sweeteners-by-Children.aspx; pediatrics.aappublications.org/content/early/2019/10/25/peds.2019-2765)

Obesity: dietary therapy

7 February 20246 January 2024 by Alessia Giannino

Obesity is defined as “malnutrition by excess, with marked increase in fat mass, of greater magnitude than overweight.” Based on excess body fat and using BMI as a reference, obesity is considered grade 1 for values between 30 and 34.9 kg/m², grade 2 if between 35 and 39.9, and grade 3 if values exceed 40 kg/m².

Excess body fat is influenced by certain factors such as familiarity for other chronic diseases, fat distribution, age, and the presence of complications and/or morbid associations.

Dietary advice

Dietary therapy for obesity is based on a balanced diet, which should ensure adequate intake of macronutrients and micronutrients, taking into account the individual’s excess body fat, energy expenditure, and body composition. Typically, low-calorie diets range from 1200 to 1500 kcal daily. Carbohydrates should be taken mainly as complex carbohydrates and account for 55 percent of Total Energy. Fats, on the other hand, should consist of monounsaturated fatty acids and account for 25-30% of Total Energy.

In addition, the diet should contain 5 servings of fresh fruits, vegetables and greens per day. It is necessary to limit consumption of energy-dense foods, such as those high in simple fats and sugars and alcoholic beverages.

Diet should always be combined with regular muscle exercise, mainly aerobic exercise.

Source: Handbook of Dietetics and Clinical Nutrition by Franco Contaldo et al.