Obesity is a chronic disease that is defined as an excess of fatty tissue that causes an increase in body weight.
Among its etiopathogenesis, several factors are considered, both genetic and environmental, the final result being an energy imbalance between caloric intake and expenditure.
Genetic factors actually represent a very low percentage, around 1-2 %. The most important are lifestyle and eating habits, which often result in excessive caloric intake, sedentary lifestyles, etc.
In recent decades there has been an exponential increase in obesity worldwide, constituting a true pandemic. Spain is at an intermediate level between the Nordic countries, France and Australia, where the percentage is lower, and the USA and Eastern countries, where the prevalence is much higher.
Diagnosis of obesity
The diagnosis is established in the clinic on the basis of various anthropometric data, the body mass index (BMI) being the one that defines the pathology. This index is the quotient between weight and height squared.
- A normal value is between 18 and 24.
- Above 25 and up to 29 is considered overweight.
- From 30 onwards it is obesity, with grades 1, 2 and 3.
- From 40 onwards it is morbid obesity.
The detection of fat can also be established in the clinic by bioelectrical impedance. We can also use other diagnostic imaging methods but they are expensive and do not provide a higher yield.
From a physiological point of view, there are a number of substances that regulate appetite, many of which are secreted in the fat tissue itself. For many years this tissue has been considered as a mere reservoir, but its function is becoming increasingly better understood. Nowadays it is considered, practically, as a true endocrine organ.
It is precisely many of the products synthesized by this tissue that cause part of the morbidity associated with obesity, since it generates chronic low-grade inflammation, which in turn will favor the excess cardiovascular risk presented by these patients and probably also the associated oncological pathology.
Obesity-related diseases include type II diabetes mellitus, cardiovascular disease and some types of cancer. The visceral or abdominal distribution of fat is more closely related to the risk of ischemic heart disease than the amount of total fat. Thus, a waist circumference greater than 102 cm in men and 88 cm in women would imply an exponential increase in morbidity and mortality independent of BMI.
On the other hand, the increase in fat tissue would cause a restriction in the volume and distensibility of certain organs, hindering their function. Compression due to overweight in joints can cause early osteoarthritis and alterations of various kinds, in the digestive system it could lead to hiatal hernia, reflux disease, etc.
Therapeutic attitude
The basis of therapy is to produce a negative energy balance so that caloric intake is less than total expenditure. The pillars of treatment are diet, exercise and change of habits.
In terms of diet, it is essential to eliminate the intake of carbohydrates provided by flour, refined sugars and especially those associated with sugary drinks. The aim is to have a balanced Mediterranean-style diet with a predominant intake of vegetables, legumes and fruits, with a quality protein intake and a schedule adapted to the patient’s activity. In general terms:
- Educate the patient in the acquisition of healthy dietary and physical activity habits:
- We must teach them to recognize which foods provide a high biological value and which ones are empty calories and detract from their health.
- Encourage the patient to do some physical activity appropriate for his or her age, condition and possible associated pathologies.
- To make a periodic follow-up with which the patient feels supported.
- Complementary aesthetic medicine treatments.
- Surgical treatment is indicated in BMI > 40 or BMI > 35 when there is associated pathology, after multidisciplinary assessment.
Complementary aesthetic medicine treatments
Aesthetic medicine can be an important adjuvant that also increases patient motivation due to the faster disappearance of subcutaneous fatty tissue.
Mesotherapy: there are many substances that can be applied by mesotherapy and that produce a reduction of the adipose panniculus by lipolysis. Others also collaborate in the formation of collagen, firming the tissue. Homeopathy offers a large therapeutic arsenal that is also used in a protocolized way in both directions, lipolytic and firming.
Mesotherapy is generally applied in areas of cellulite, where the fatty tissue is not very thick. It can be accompanied by pressotherapy, draining massages and other techniques that help to mobilize fat and interstitial fluid accumulation.
Hydrolipoclasy is basically applied in the subcutaneous fatty tissue of the abdomen, flanks and gluteal region. It consists in the administration of low osmolarity substances capable of breaking the adipocyte wall. It can also be performed with lipolytic products. It is applied alone or associated with ultrasound cavitation.
In short, the aim is to instill in the patient a series of habits that help to generate a negative energy balance, providing professional support and help with aesthetic therapies that facilitate the elimination of subcutaneous fatty tissue.
Given the health implications of obesity and overweight, we believe it is important to address this pathology as soon as possible in order to avoid tissue deterioration and the chronification of the various associated pathologies. We must also consider that with adequate treatment we will improve the quality of life and self-esteem of these patients.