Table 1. Fat tissues depending on age and gender.

Transcription

1 EAA Summer School ebook 1: OBESİTY: İN WORLD AND TURKEY. I WANNA LEARN WHİCH THAT HOW OFTEN OBESİTY TO BE SEEN İN THE WORLD AND TURKEY Esra Kurtulus Ankara University, Ankara, Turkey Introduction Obesity is defined as abnormal or excessive fat accumulation as a result of high daily calorie uptake. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed on one hand, and calories expended on the other hand. Once considered a problem only in highincome countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. At least 300 million adults were obese over world and this number is increasing every day. In our country, 1/3 of female and 1/5 of male is obese (totally 8.5 million people). Fat tissue ratio and healthy bodyweight differs person to person. Table 1 summarized fat tissues depending on age and gender (Akgun N, 1986). Table 1. Fat tissues depending on age and gender. Categories Fat Ratio Infants 10% Adult men 10-15% Adult women 15-20% There are many assessment methods to evaluate the body fat ratio: Isotopic compartmentetion Ultrasound Magnetic Resonance Imaging Abdominal and back measurements Skinfold measurements BMI Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying overweight and obesity in adult populations and individuals. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m 2 ; Table 2) Under the 18.5 kg/m2 Between kg/m2 Between kg/m2 Between kg/m2 Over the 40 kg/m2 Table 2. Body mass index. Weak Normal weight High weight Obese Extremely obese BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered as a rough guide because it may not correspond to the same degree of fatness in different individuals. The World Health Organization (WHO) defines "overweight" as a BMI equal to or more than 25, and "obesity" as a BMI equal to or more than 30. These cut-off points provide a benchmark for individual assessment, but there is evidence that risk of chronic disease in population increases progressively from a BMI of 21. Skinfold measurement may be taken at three sites: triceps, subscapular and calf. If the thickness of skinfold obtained from triceps is over 19 mm in the males and over the 30mm in the females, person defines as an obese. From the anthropometric abdominal and back measurements it can be obtained that amount of fat of these sites (Table 3). Table 3. Anthropometric Abdominal and Back measurements. Gender Increased risk High Risk Male over the 94 cm over the 102 cm Female over the 80 cm over the 88 cm Causes of obesity Global increases in overweight and obesity are attributable to a number of factors including: a global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other micronutrients; and a trend towards decreased physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. 175

2 Main factors that cause obesity are: Genetic factors Environmental factors Endocrine factors Neurological factors Psychological factors What are common health consequences of obesity? Overweight and obesity lead to serious health consequences. Risk increases progressively as BMI increases. Raised body mass index is a major risk factor for chronic diseases such as: Cardiovascular disease (mainly heart disease and stroke) - already the world's number one cause of death, killing 17 million people each year. Diabetes This has rapidly become a global epidemic. WHO projects that diabetes death will increase by more than 50% worldwide in the next 10 years. Musculoskeletal disorders especially osteoarthritis. Some cancers (endometrial, breast, and colon). Tratment of obesity Main treatments methods are: Exercise Diet Psychological interventions Drugs Surgical treatment Other mechanical interventions (stomach balloons ect.) Defining Obesity in Children BMI specific for age and gender is used BMI-for-Age Cutoffs: 95th percentile = Obese 85th-94th percentile = Risk of obesity Prevalence of Obesity in Young Adulthood if the child is overweight the risk is... Age No Parents >1 Parent 1-2 8% 40% % 62% % 71% % 79% % 73% 176

3 Obese children are at risk of becoming obese adults Chance of becoming Age Group obese at y of age 1-2-y-olds, no obese parents 8% Normal weight 6-y-olds, no obese parents 10% Obese 6-y-olds 50% Obese y-olds with obese parent(s) 79% The risk of adult obesity at every age interval was significantly greater if either parent was obese. Table 4. Prevalence of overweight* children aged 6 to 8 year old. USA China 1993 Russia South Africa 1994 Brazil 1989 Girls Boys Popkin et al 1996; (*defined as BMI higher than the US reference NHES 85th percentile) Obesity in Turkey Obesity: public health problem across all age and racial or ethnical groups in childhood often tracks into adulthood with well-know adverse effect of obesity on health childhood obesity in Turkey has grown considerably in recent years changing fast life style food habits physical activity (WHO 1993) in children it is important to examine the nature of fat patterning to establish the body fat patterns of Turkish school children aged 7-18 years Material a cross-sectional sample of 684 female and 687 male (total 1371, Table 5) random sampling Turkish children and adolescents aged 7 18 years derived from public and private primary/secondary schools in Ankara, capital city of Turkey SES classes are defined by parental occupation. Table 5. Number of children and adolescents in the different age groups. Age group Boys Girls Total Total Methods Height (mm) and weight (kg): according to Anthropometric Standardization Reference Manual. Through the use of 8 polar electrodes, the BC-418MA (Tanita Bioimpedence Model BC- 418MA) Segmental Body Composition analysed body fat trunk fat right leg fat (kg) left leg fat (kg) right arm fat (kg) left arm fat (kg) Prevalence of overweight and obesity was calculated according to the BMI cut of points (Cole et al. 2000) 177

4 Results Table 6. SES Classification - Occupation of the parents. Father Mother Occupation n % n % Professional, Administrative and managerial and Self employment high level Government employee, Military and Police Forces Retired Sales, self employment medium level and technicians and related service Transportation and Farmer Handlers, helpers, labourers Unemployment Housewife Dead Unknown Table 7. Prevalence of overweight and obesity. Girls Boys Overweight Obese Overweight Obese Age N % N % N % n % Total Discussion Present study provides descriptive information on the prevalence of overweight and obesity in Turkish children and adolescents Correlation with body fatness and BMI in children was found to be in the ranges from 0.79 to 0.96 obesity rate for boys (6.86%) was higher than for girls (3.95%) reports out of the US suggest that obesity doesn't not vary by sex but longitudinal studies on Canadian children suggest that obesity is modestly higher in boys (38% vs. 35%, NLSCY) our sample showed high sexual dimorphism with having greater obesity values for boys where the girls showed higher fat values increased central body fat in girls former study show that increased central body fat in children is related to adverse changes in lipid profiles (Freedman et al., 1989), insulin metabolism (Freedman et al., 1987) and blood pressure (Shear et al., 1987). prevalence of obesity among Turkish children is not high yet compared with the industrialized countries to prevent further increases in prevalence of overweight and obesity, population-level strategies must be applied. population specific new longitudinal studies are needed for a better estimation of children and adolescent obesity and body fat status. Acknowledgements We would like to thank to the authorities of the schools for providing permission to carry out the work. 178

5 References Akgün N. (1986) Egzersiz Fizyolojisi (Şişmanlığın Tedavisinde Egzersizin Yeri). İzmir: Ege Üniversitesi Basımevi. ( ) Coleman, D.L., 1978, "Obese and diabetes: two mutant genes causing diabetes-obesity syndromes in mice", Diabetologia 14: Coleman, D.L., and Eicher, E.M., 1990, "Fat (fat) and tubby (tub): two autosomal recessive mutations causing obesity syndromes in the mouse", J. Heredity 81: Demirtaş N., Kavlak Y. ve Efe B. (2000) Obezitede Kardiyovasküler Yanıtlar. Ankara: Türkiye Fizyoterapistler Derneği Yayınları. Ersoy G. (1996) Beslenme, Fiziksel Aktivite ve Sağlık. Bilim ve Teknik Dergisi (343): Hamann et al., 1996, "Decreased brown fat markedly enhances susceptibility to diet induced obesity, diabetes, and hyperlipidemia", Endocrinol. 137: Haseloff and Gerlach, 1988, "Simple RNA enzymes with new and highly specific endoribonuclease", Nature, 334: Herberg, L. and Coleman, D.L., 1977, "Laboratory animals exhibiting obesity and diabetes syndromes", Metabolism 26: McFarlane-Anderson, 1992, "Levels of G-proteins in liver and brain of lean and obese (ob/ob) mice", Biochem. J. 282: Özata M. (2002) Obezite ve İnsan Genomu Çalışmaları. Bilim ve Teknik Dergisi (419): Platt, 1989, "Obesity-linked regulation of the adipsin gene promoter in transgenic mice",proc. Natl. Acad. Sci. USA 86: Sarver et al., 1990, "Ribozymes as potential anti-hiv-1 therapeutic agents", Science 247: Simopoulos, A.P. & Childs B., eds., 1989, "Genetic variation and nutrition in obesity: approaches to the molecular genetics of obesity", in "Genetic Variation and Nutrition in Obesity", World Review of Nutrition and Diabetes 63, S. Karger, Basel, Switzerland. Timur Gültekin Prevalence of Obesity at Turkish school children: Changing Life Style, Ankara University,Faculty of Letters, Department of Anthropology, Ankara, TURKEY Tunca H. (1984) Sağlık Kondüsyonu Kilo Sorunu. Bilim ve Teknik Dergisi (200): Zülal A. (2002) Sağlık İçin Hareket Edin. Bilim ve Teknik Dergisi (417): Mailing address: Esra Kurtulus Ankara University, Sihhiye Ankara, Turkey 179