Autor(es): Francesco Perrotta
From OMS-World Health Organization-out is a worrying sign: in the’ European Health Report 2002, report on health in Europe in 2002, published by ‘Regional Office for Europe, obesity is defined as an epidemic that extends throughout the European Region. “In many European countries more than half of the adult population is” overweight “and about 20-30% of adults and ‘accordingly obese (clinically obese). The illness of the’ obesity in subjects in ‘evolution is in increasing in European countries, one child in five is obese and / or overweight. negatvo A signal is represented by a continued increase in childhood obesity in adulthood with serious risks to health. Another negative indicator is the psychological fallout In fact, childhood obesity often leads to a dizzying set of self-esteem with syndromes depressive.
The Conference held in Copenhagen on 11 and 12 September 2002, obesity, a challenge for the European Union, the theme has been addressed in its extreme gravity with this overview of data: · about 300 million people are obese in the world • The number already ‘high’ is intended to increase still more and more, with serious consequences for the health · Reality ‘ is more serious in North America and Europe, but has spread to areas where, in the past, was not present except in very small quantities (Asia, India, China, Japan and even parts of Africa and South America, including as well as some countries in the developing world); • in recent years the number of people with obesity has doubled in many countries; ° in Europe has increased by 10-50% in the last 10 years; • According to a study by the International Obesity Task Force, about 4% of all children in Europe and obese and this number is markedly increased · It is estimated that between 2-8% of overall costs for health care is linked to obesity.
The dimension of the problem in the U.S. is double in Europe, but the rate of increase is higher in European countries, · The key elements for the prevention and treatment of obesity and is ‘now clear that key elements are identified in’ Proper nutrition, the role of families and physical activity; COUNTRYSIDE information widely distributed media, school, family, and sports are considered necessary to raise awareness of the problem in all sectors of society, including the medical staff who often is not sufficiently prepared to deal with the problem and patients are less willing to seek help
The research, at present, aims to eliminate the environment that some factor has changed from the war years on ensuring that the potential diabetic, genetically speaking, are transformed from potential to reality. ‘S hypothesis is related to increased caloric intake, a time our ancestors ate much less. New research, for the treatment of diabetes, are represented by the artificial pancreas, portable insulin pumps and transplants. Those at risk for diabetes type 1 (the infant-juvenile, which requires insulin) are those who have a family history of diabetes behind. for type 2 diabetes, however, adversely affect the sedentary hypokinesia and increased body weight. In particular, the mode of distribution of adipose tissue on the abdomen appears to play a dangerously heightened role of risk.
Childhood obesity is the result of a prolonged positive energy balance over time in practice for a long time you introduce more calories than you consume.
The definition of overweight / obesity in children is more complex than in adults, whose ideal weight is calculated based on the BMI (Body Mass Index or Body Mass Index)
the subject’s weight in Kg
the height in meters squared
Waiting to find the most appropriate benchmark, the BMI has also been proposed for children by applying the correction tables that take into account gender and age (range 2-18 years). after applying the correction is defined as:
Overweight: a BMI between 25 and 30
The degree of obesity: a BMI between 30 and 40
Grade III obesity: a BMI greater than 40
Alternatively, knowing that
the growth of children is assessed by reference to the tables of the percentiles, charts, bringing together the percentages of weight and height of children, broken down by sex and age.
Tables of Percentiles
weight boys 0-24 months
and 2-14 years
Tables of Percentiles
height males 0-24 months
and 2-14 years
Then define a child:
Overweight when their weight exceeds the ideal of 10-20% reported at
as a child and ‘obese when his weight exceeds by more than 20% than the ideal
The infant-juvenile obesity is widespread and growing in Western countries, such as to be regarded as a real social disease. Obesity in childhood predisposes the adult. The obese child has an almost doubles the risk of becoming an obese adult, compared with normal-weight peer. Obesity is a condition that can expose the body to the onset of degenerative diseases such as cardiovascular and metabolic disorders.
It is therefore essential to know the extent of the problem in schools for the purpose of a preventive intervention aimed to reduce it and to be carried out especially in children.
According to statistical studies conducted by the International Obesity Task Force, the prevalence of overweight and obesity is growing proportions “epidemic” is reaching alarming proportions in developed countries than in developing countries.
In the U.S., representing the country just a symbol of obesity, the prevalence has increased dramatically since 1998. To date, in fact, 24 of 50 states have an obesity rate of around 20-24%.
In Europe, the prevalence of obesity has increased by 10-50% in most countries over the past 10 years: males 10-20% of the population, females 10-25% of the population.
Childhood obesity affects an age ranging between 6 and 13 years with interest to the male.
Italy is one of the European countries with the highest number of overweight children (20%) and obese (about 4%).
The causes are many, and it covers the bad food habits, physical inactivity, genetic factors, inheritance or predisposition and environmental factors.
The consequences for obese children are fatigue, joint and skeletal abnormalities (varus or valgus deformity of the limbs, flat feet), gastrointestinal disorders and inevitably psychological problems (difficult relationship with his own body, easy isolation, difficulty to socialize).
Regardless dall’eziopatogenesi overweight is always a consequence of a positive energy balance. The intake of energy nutrients exceeds the caloric expenditure resulting in an increase of the body reserves.
The predisposing factors can be divided into:
= genetic factors that predetermine the number of fat cells and alterations in feeding behavior;
Environmental factors = drug use, ethnic and socio-cultural, dietary factors, physical inactivity, psychological factors.
The survey methods and protocols related
Obesity as a health problem, it begins to attract interest from the early years of last century with the studies of American insurance companies.
Since then, many researchers have done their utmost to realize detection methods based on height-weight indicators, defining for each method, the limit beyond which a person was considered obese and at risk to health.
Among these, the anthropometric indices were used in between the past and still play an important role in epidemiological studies, both for the high reproducibility of the measures for their ease of detection.
The most important are: The relative weight percentage and body mass index.
It is based on the calculation of the ratio between the actual and the ideal weight, calculating it on the tables of the growth curves, as the value given by the percentile weight corresponding to that of the stature of the subject. According to some methods, the child with an excess weight of 20% or 30% over ideal weight is defined as obese.
However, the validity of this index is influenced by the standard of reference, some of which are based on growth data of a group of children lived in 60 years. Another problem is that the relative weight percentage of this index is overly influenced by the stature of the subject.
Body mass index
Another index of weight that avoids the limits of precedent is the BMI or Body Mass Index (BMI) or Quetelet index, named after Belgian anthropologist who proposed the use, which is scarcely influenced by the stature.
It is calculated using the formula: BMI = weight (kg) / height (m2).
Normal weight> = 18.5 <25
Overweight> = 25 <30
Obese> 30 =
The determination of body composition
The methods previously handled are not able to quantitatively define the concept of obesity appears to be physiologically dependent on the concept of lipid present in each adipose cell and the total number of fat cells. According to some studies, obese subjects were compared with their normal weight peers, a greater number of adipocytes with increased lipid content.
For these reasons in recent years are being adopted into clinical practice those methods which, considering separately the various parts of the body, allowing a more direct estimate of the percentage of fat.
These methods are based on a model called “two-compartment model, whereby it is assumed that the human body is composed of two compartments of different composition: fat mass (Fat Mass) and the mass alipidica (Fat-Free Mass). The latter is formed from the apparatus and skeletal muscle, blood and other organs.
The anthropometric measures
Among the anthropometric measures, a simple method for determining the percentage of fat in the body is to measure the circumference of some of its parts (abdomen, buttocks, thighs and right calf, right arm and forearm).
Appropriate conversion tables, broken down by sex and age, then allow to determine the percentage of body fat through simple mathematical calculations.
This method is widely used in sports, in conjunction with the skinfold thickness to determine the level of muscle from different tissues of the athlete.
A good compromise between the anthropometric measures is the skinfold thickness is a simple, non-traumatic, not only the evaluation of body composition analysis but also for the total district subcutaneous fat. the thickness of subcutaneous fat is measured using the calipers (Harpenden, Holtain) by lifting the skin and subcutaneous tissue with the thumb and index finger, excluding the underlying muscle tissue. The seats are more standardized in the triceps skinfold, subscapular, suprailiac and calf.
In Italy is available for the pediatric age percentile curves for the triceps and subscapular skinfold, by which obesity is defined as the triceps skinfold measurement exceeds the 85th percentile.
In addition to the predictive value of the percentage of fat, have been established on the benchmarks for defining obesity. According to Lohmann fact, when the percentage of adipose tissue of subjects in pre-pubertal, pubertal and post-pubertal, exceeds 25% and 32% in males and females the subject is considered obese. This method also has its limitations, first of all, it is operator dependent. Also it can be difficult to detect folds in a very obese person, because the mantle subcutaneous fat can be so abundant as to prevent correct measurement, and the fact that the locations chosen for measuring skin, do not necessarily reflect the average thickness of the coat fat.
Prevention and treatment
The lifestyle and a sedentary lifestyle, in addition to the various factors considered, appear to have a significant importance in determining the causes of obesity. In this regard, an important research was conducted by the Institute of Sports Science CONI in 1993, a young population aged between 9 and 14 years attending the school in all countries, namely dell’Agroromano Roccagorga, Sezze Romano, Bassano and Privett.
The sample consisted of 864 students, divided in 444 males and 420 females. To evaluate obesity has used the skinfold at triceps and subscapular. It was considered as a benchmark for the determination of obesity, the actual body weight exceeding 20% of that ideal. The objective of this study was to identify a possible incidence of obesity among the sedentary compared to sports. From our observations this is not shown. It resulted in a rather high percentage of obese subjects in all groups considered.
To not have overweight children, the only real weapon is prevention, about the Italian Society of Pediatrics has highlighted the following ten commandments so as to prevent the risk of overweight and obesity:
· Be a good breakfast;
· Take regular meals and avoid the “fuoripasto”;
· Consumption fruits and vegetables;
· Drink plenty of water by limiting sweetened drinks;
· Reduce the fat in food, particularly meats, fried foods, condiments and desserts;
· Avoid using food as a “bonus”;
· Focusing on outdoor play, possible at least one hour per day;
· Walk walk on all possible occasions;
· Apply a sport regularly. It does not matter at all costs to be champions, but to exercise and have fun;
· Limit the “videodependence” during leisure time (up to 2 hours a day).
An analysis of Italian literature, related to obesity in school-age shows how the phenomenon has grown since the war. The lack of homogeneity of data, unfortunately, prevents us from determining exactly what the growth of the phenomenon.
This variability is attributable to the different definitions of obesity, methods, protocols and tables Auxologico reference used by the studies reviewed.
However, the results of all the works are to be consulted in establishing agreed that obesity is already present in significant proportion of students in early grades of elementary school. It grows steadily with age reaching its peak in the lower secondary school students and decreases in later ages.
In this regard, the Ministry of Education could endorse a discovery protocol only at the national level to be managed by the teachers of Physical Education within their jurisdiction with regard to assessment of physical abilities of pupils. In so doing, the unique nature of the results would allow the creation of a database which better reflects the true extent of the phenomenon and thus a more effective monitoring of the entire school population Italian
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