1. RN, Msc, Laboratory Instructor, Nursing Department A, TEI, Athens, Greece. 2. RN, Msc, Specialized Technician, Nursing Department A, TEI, Athens, Greece. Abstract
Obesity consists a major nutritional health problem in developed and developing countries, which has reached epidemic proportions. Obesity is defined as the condition of excessive fat accumulation to such an extent that affects the individual’s health. Objective: The purpose of the present review was to explore the obesity-related diseases and
the medication for treatment of obesity. Method and material : The method οf this study included bibliography research from both the review and the research literature which carried out mainly internationally over the last five years and referred to obesity. Results: The rapidly increased incidence of obesity is due to environmental factors that influence a genetically pathological predisposition. The body mass index (BMI) is an internationally accepted index to estimate body weight, which allows a comparison of prevalence rates worldwide.
Obesity has been recognized as an important contributing factor in the development of chronic and serious diseases, such as cardiovascular disease, diabetes mellitus type 2, hypertension, stroke, heart failure, dyslipidaemia, uric acid, sleep apnea which is the cause of sudden death in sleep and other diseases. The majority of research studies indicate that weight loss is the main goal of treatment of obesity. Taking medication as an option for the treatment of obesity should be the ultimate therapeutic tool because it is associated with many side effects.
Conclusions: The results of the present review illustrate that obesity is a public health issue
which is rapidly increasing and thus needs to be addressed seriously. Specific diet combined with physical activity can achieve the desired loss of body fat and are the most effective and long-lasting ways to treat obesity. Keywords: obesity-related diseases to obesity- medication-complications Corresponding author: Introduction
O threatens public global health. The because it affects people’s lives negatively
and imposes excessive financial implications
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in every health system. In addition, obesity
Assessment of obesity
focused not only on the prevalence and the
Obesity is defined as the accumulation of
significant consequences on the quality of
required for the normal body function. This
patients’ life. Furthermore, is associated
with increased incidence of type 2 diabetes
disease, arthritis, sleep apnea, and certain
essential and the storage fat. The essential
fat is necessary for the normal functions of
the body and is mainly stored in the bone
Organization (WHO), obesity is classified as
marrow, the heart, the lung, the liver, the
chronic and severe disease in developed and
spleen and the muscle. The essential fat
developing countries, affecting both adults
also includes the female fat, which is stored
and children. Recent research data suggest
in the breasts and hips. Storage fat is the fat
that the global incidence of obesity has
stored mainly in the subcutaneous tissue as a
increased more than 75% since 1980, while
result of the additional energy received
through food. In healthy young adults the
developing countries and particularly, in low-
total body fat represents the 15-20% of total
income countries. -7 More than 1.1 billion
adults are overweight, of which 312 million
are obese. According to estimates of the
International Obesity Task Force, 1,7 billion
people are exposed to health risks related to
type). Central obesity is characterized by
body weight, while the increase in Body Mass
location of the fat in the upper torso and
Index (BMI) is responsible for more than 2.5
million deaths annually, which is expected to
among the male population. Regional obesity
is characterized by deposition of fat in the
significantly among the different women.14-16 geographical regions of the planet. In
The scientific data confirm that central
Europe, higher incidence of obesity occurs in
obesity is associated with greater health risks
compared to the total obesity. In particular,
compared to those of Western and Northern,
it is associated with increased incidence of
diabetes mellitus type II, as well as higher
been carried out report different incidence
The severity of obesity is estimated from
rates of obesity, although all converge at the
distribution in the human body. The accurate
serious obesity problem. Greece ranks in the
measurement of the amount of fat requires
methods and equipment that exist only in
European countries in rates of obesity and
this finding underpins the spread of the
clinical practice, more simple methods are
used, such as the weight - height tables, the
particularly after the formal abolition of the
Body Mass Index (BMI) assessment and the
skin fold measurement.14-16 The weight -
height tables, which are published in many
health, its’ underlying etiology has not been
different versions, indicate an acceptable
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disadvantage in using them, is the fact that
it is not possible to distinguish between fat
and muscle percentage. Consequently, a very
Cardiology classified obesity as an important
muscular person is possible to be described
disease. It is widely accepted that obesity
common, easy and reliable way to classify
cardiovascular risk factors and as it is shown
by the Framingham Heart Study, body weight
Although there is a high correlation between
is classified as the third risk factor for
BMI and fat percentage, it does not provide
developing cardiovascular disease in men,
information about the weight of the muscle
formula that is defined by dividing the body
weight to the second power of the height:
BMI = body weight (Kg) / height cm.2 The
clinical and biochemical disorders of the
normal range is 20-25 kg/cm2. When the BMI
of a person is > 40 kg/cm2, then this person
hyperglaecemia and dyslipidaemia. During
is characterized as severely obese. 14-16
the last two decades two important aspects
Skin- fold measurements technique is the
have been developed about the detrimental
effects of obesity. The first concerns the
importance of visceral fat and the second
the endocrine function of adipose tissue,
which produces a large number of molecules
important information about the that modify the vascular, metabolic, immune accumulation and distribution of the body
and other functions of the cardiovascular
fat. More specifically, it is considered an
system. Fat accumulation is accompanied by
adequate tool for assessing central obesity.
a commensurate increase in the volume of
Also, the ratio of Waist to Hip (WHR) is
cardiac cavities and the heart wall, while the
another easy method for assessing central
reduction of body fat is accompanied by a
obesity. WHR is defined as the ratio between
reduction in the adverse effects of cardiac
the lower part of the crest of the iliac ala
function. In addition, the increase of body
and the perimeter of the hips, measured at
fat results in a corresponding increase in
Diseases associated with obesity
causes cardiac hypertrophy, as a result of
Obesity affects all aspects of human life
in a negative way and is associated with
requirements. This increased work of the
many diseases. Scientific data argue that the
heart gradually leads to fatigue and heart
morbidity, while 10 kg of weight loss can
According to the literature, about 75-80%
obesity starts. According to the literature,
of diabetic patients are obese, showing that
the increase in body weight after the age of
obesity is a strong risk factor for developing
18-20 years is associated with statistically
type 2 diabetes mellitus (DM). The risk for
developing type 2 DM increases with higher
disease. Also, the distribution of the fat and
BMI, whereas, in case a person has already
especially the accumulation of fat in the
developed the disease, weight loss reduces
abdomen rather than the obesity itself are
this risk as well as mortality rates. Nine kg
highly associated with the development of
of weight loss reduce type 2 DM associated
weight loss can significantly improve the
disease, obesity is strongly associated with hypertension and atherosclerosis.
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Accumulation and swelling in the artery
among obese men. In consistence to that,
walls, which is made by immune cells and
mortality rates by endometrium, uterine,
consists of lipids (mainly) and connective
cervical, ovarian, breast and gall bladder
women. The two factors that might explain
common disease among people whose weight
the link between obesity and cancer are diet
increases with age, while almost half of
and endocrine disorders. Diet is related to
According to the literature, increase of body
disorders are related to hormone-related
pressure (SBP) by 6 mmHg and diastolic blood
pressure (DBP) by 4 mmHg. The risk is even
play an important role on the morbidity and
mortality in obese patients, although they
predisposition. As a general rule, for every
are usually underestimated. The syndrome
1% reduction in body weight SBP reduces by 1
obesity-hypoventilation is a heterogeneous
Obesity is characterized by a pathologic
situation with increased total cholesterol and
dysfunction and failure of lung function,
hypoventilation of the lung cells and the
night-apnea syndrome. The sleepiness that is
common among obese people and especially
studies have shown that there is a strong
Sometime after they are asleep, the upper
respiratory tract gets blocked and hypoxemia
and hypercapnia occur. This has as a result
increased levels of plasma free fatty acids,
the patient to wake up suddenly, in order to
reduced activity in muscle lipoprotein lipase
be able to breath normally again. This can
especially during the REM phase of sleep,
development of the metabolic syndrome.5,23-
correlation between obesity and endocrine
people with normal body weight, the effect
of obesity on breathing function increases
result in severe hypoxia, cardiac arrhythmia
regardless of fat distribution and studies
weight reverses these abnormalities, if heart
problems have not been permanent yet. 31-34
earlier age in obese girls. Weight loss has
beneficial effects on ovarian function and
load exerted to bones and joints and explains
arthritis, especially in the hip and the knee.
Weight loss has as a result pain relief from
testosterone. In addition, glucocorticoid
decrease in bone mass, which increases with
levels change with increased levels of plasma
The majority of the data relating obesity
and overall mortality risk, indicate that the
predisposing factors increase the incidence
higher the BMI (> 30) the higher the risk of
of certain types of cancer. Mortality rates by
mortality. In contrast, more than 9 kg weight
loss in obese women is associated with 25%
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reduction in risk of mortality from all causes,
food, the ones that inhibit the absorption of
food from the gastrointestinal tract and the
cardiovascular disease and cancer. Also, in
case the patient has already developed an
The drugs that reduce desire for food or
obesity-related disease, intentional weight
suppress the appetite lead to a reduced food
loss still reduces mortality risk by 20%,
According to their effect in the Central
reduction) and type 2 diabetes mellitus (30-
Nervous System, they are classified in three
40% reduction). It is important to distinguish
additional categories: the ones that work
between intentional weight loss and weight
amphetamines), those that work through the
Pharmaceutical treatment of obesity
serotonergic receptors and those that work
Proper diet and physical exercise is the
ideal method for creating a negative energy
Simbutramin (Reductil). Simbutramin inhibits
the binding of serotonin and nor-adrenaline
Medication, as a method of treating obesity,
should be chosen only when the nutritional
treatment has been shown to fail. Although
reducing the calorie intake as a result of
medication helps in weight loss and prevents
saturation while the increase in energy cost
relapse, it has many side effects and the
due to an increase in thermogenesis. 35-38
patient still needs to follow a certain diet
absorbed by the gastrointestinal tract and
has a long half-life, which allows daily
medication must meet the following criteria:
metabolized in the liver and is excreted
diseases related to obesity such as diabetes
(together with the metabolites), mainly by
the kidneys. The main side effects include
disease, night-apnea syndrome, degenerative
arthritis, etc. should have been developed
constipation. The drug is not recommended
for people with a history of cardiovascular
3) At least two risk factors such as age ≥
disease and tachycardia, and in patients with
non-regulated arterial hypertension. Studies
hypertension, high LDL cholesterol, low HDL
have shown that simbutramin increases heart
cholesterol, high levels of fasting plasma
rate by 4-5 beats/min and blood pressure by
glucose or family history of early coronary di
3 mmHg. The increase in blood pressure is
rarely the cause for stopping the specific
4) No beneficial results after following
certain diet and physical exercise program
that inhibit the absorption of food from the
gastrointestinal tract and are divided into 2
further categories: a) the drugs that inhibit
treatment of obesity starts back in 1893
gastric emptying and b) the drugs that inhibit
intestinal absorption, like orlistat (Xenical).
increase thermogenesis. Since then, there
Orlistat inhibits the action of gastric and
have been many drugs, which aimed either
triglyceride hydrolysis and therefore inhibits
energy costs. Many of them used only for a
short period of time and almost all were
reduction of absorption of dietary fat can
reach up to 30%. The maximum activity is
severe side effects. Today, the drugs for
daily or immediately after meals. It has been
categories; the ones that reduce desire for
shown that the orlistat leads to a moderate
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decrease in total cholesterol, 10% reduction
of LDL-cholesterol, 10% reduction of fasting
2. Heseker H., Schmid A. Epidemiology of
administration. Orlistat has also been tested
as a drug of diabetes type II prevention,
3. Sichieri R., do Nascimento S., Coutinho
gastrointestinal disorders are the main side
which occur in 15-30% of the patients who
use the drug, are usually mild and subside
metabolism. This category includes thyroid
obesity in France. Presse Med. 2007;36(6
hormones, caffeine, nicotine, drugs that act
as the sympathetic NS such as ephedrine, the
hormone and human gonadotropin that give
positive results in the treatment of obesity.
obesity internationally are orlistat and
Simbutramin. The choice of medication is
based on family history, the accompanying
10. Berghöfer A., Pischon T., Reinhold T.,
diseases and the diet, and should not be
Conclusions
Obesity is a severe pathologic situation that
causes both morphological and functional
associated with a high risk of morbidity and
individual's life and has deleterious effects,
not only on health and self-esteem but also
on the socio-economic status of the patient.
At the same time, each government spends a
huge amount of money for the treatment of
the different diseases caused by obesity.
Seeking medical help is an essential step
because it helps to reduce morbidity and
mortality rates among obese individuals.
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Nausea and vomiting of pregnancy (NVP) is a common event that affects 70-85% of pregnant women. Approximately 35% of pregnant women consider their symptoms severe enough to limit their activities of daily living which extends to loss of time at work. While a single etiology of NVP has not been identified, elevated levels of estrogen and human chorionic gonadotropin (hCG) have been shown to
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