Il “problema obesità” visto dall’internista


Maria Teresa Guagnano, Maria Rosaria Manigrasso, Fabio Capani, Giovanni Davì

Ann. Ital. Chir., 2005; 76: 407-411

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The prevalence of obesity has reached epidemic dimension in industrialized countries and it is known that obesity is
associated with increased risk of cardiovascular morbidity and mortality.
Commonly, obesity is defined by the Body Mass Index (BMI). However, BMI fails to consider body fat distribution. The
relationship between the risk of metabolic-cardiovascular diseases and body fat distribution indices such as the waist-tohip
ratio (WHR) and the waist circumference, rather than measures of the degree of body fatness as expressed by BMI,
has long been recognized. Recently, clinical and epidemiological research has found waist circumference to be the best
anthropometric indicator of both total body fat and intra-abdominal fat mass. Android or visceral obesity is associated
with metabolic syndrome and increased cardiovascular morbidity and mortality through a variety of molecular mechanisms
possibly linking the metabolic syndrome to hemostatic and vascular abnormalities.
Obesity guidelines suggest the need for weight reduction using behavioural change to reduce caloric intake and increasing
physical activity. A realistic goal for weight reduction is to reduce body weight by 5% to 10% over a period of 6
to 12 months.
Combined intervention of a low calories diet, increased physical activity, and behaviour therapy provides better outcomes
for long-term weight reduction and weight maintenance than programs that use only one or two of these modalities. The
drugs used to promote weight loss have been anorexiants or appetite suppressants. All classes of anorexiant drugs affect
neurotransmitters in the brain. The new agent sibutramine has norepinephrine and serotonin effects. Another new agent,
orlistat, has a different mechanism of action, the reduction of fat absorption. Weight loss drugs approved by the FDA
for long-term use may be useful as an adjunct to diet, physical activity and behaviour therapy for patients with a BMI
of > 30 with no concomitant obesity-related risk factors or diseases, and for patients with a BMI of > 27 with concomitant
obesity-related risk factors or diseases.