DIABETIC & OBE

Many sickness occur depending on unhealthy nutrition in this day and age. The most frequently encountered cases are diabetes and obesity. Just as increasing of the cases of these sicknesses, the health spendings for individuals’ treatment is increasing, too.

Today, 30 million children and adults are being affected by diabetes. This means one out of every eleven has diabetes. 84 million Americans have pre-diabetes and are under the risk of having type 2 diabetes. 90% of the population are not even aware of that they have diabetes. In the USA, one is diagnosed with diabetes in every 21 secs.

The annual amount of spending for treatments of diabetes and pre-diabetes is $322 billion in the USA. 43% of the spending is for the price of treatments for patients, 18% of it is for prescription drugs for treatments, 12% of it is for the supply for diabetic drugs, 9% of it is visit of doctors and 8% of it is for the patients at hospitals.

Between the years 2002-2018, the number of usage of insulin thripled. People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

Most of the cost for diabetes care in the U.S., 62.4%, is provided by government insurance (including Medicare, Medicaid, and the military). The rest is paid for by private insurance (34.4%) or by the uninsured (3.2%). People with diabetes who do not have health insurance have 79% fewer physician office visits and are prescribed 68% fewer medications than people with insurance coverage—but they also have 55% more emergency department visits than people who have insurance.

West Virginia has the highest rate of diabetes at 15 percent. The 11 states with the highest type 2 diabetes rates are in the South. Nationwide, diabetes rates have nearly doubled in the past 20 years — from 5.5 percent (1994) to 9.3 percent in 2012. More than 29 million American adults have diabetes and another 86 million have pre-diabetes. The CDC projects that one in three adults could have diabetes by 2050. More than one quarter of seniors (ages 65 and older) have diabetes (25.9 percent, or 11 million seniors). Diabetes is the seventh leading cause of death in the United States, accounting for around $245 billion in medical costs and lost productivity each year. (Note: The reported diabetes rates are crude rates from 2011-2014 and age-adjusted rates for 2015 and 2016.)

Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States. Currently, estimates for these costs range from $147 billion to nearly $210 billion per year. In addition, obesity is associated with job absenteeism, costing approximately $4.3 billion annually and with lower productivity while at work, costing employers $506 per obese worker per year.

As a person's BMI increases, so do the number of sick days, medical claims and healthcare costs. For instance: Obese adults spend 42 percent more on direct healthcare costs than adults who are a healthy weight. Per capita healthcare costs for severely or morbidly obese adults (BMI >40) are 81 percent higher than for healthy weight adults. In 2000, around $11 billion was spent on medical expenditures for morbidly obese U.S. adults.

Moderately obese (BMI between 30 and 35) individuals are more than twice as likely as healthy weight individuals to be prescribed prescription pharmaceuticals to manage medical conditions.

Costs for patients presenting at emergency rooms with chest pains are 41 percent higher for severely obese patients, 28 percent higher for obese patients and 22 percent higher for overweight patients than for healthy- weight patients. Reducing obesity, improving nutrition and increasing activity can help lower costs through fewer doctor's office visits, tests, prescription drugs, sick days, emergency room visits and admissions to the hospital and lower the risk for a wide range of diseases.

A 2008 study by the Urban Institute, The New York Academy of Medicine and TFAH found that an investment of $10 per person in proven community-based programs to increase physical activity, improve nutrition and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. That's a return of $5.60 for every $1 invested.9 Out of the $16 billion, Medicare could save more than $5 billion and Medicaid could save more than $1.9 billion. Also, expanding the use of prevention programs would better inform the most effective, strategic public and private investments that yield the strongest results.

According to the most recent data, adult obesity rates now exceed 35 percent in five states, 30 percent in 25 states, and 25 percent in 46 states. West Virginia has the highest adult obesity rate at 37.7 percent and Colorado has the lowest at 22.3 percent. The adult obesity rate decreased in Kansas between 2015 and 2016, increased in Colorado, Minnesota, Washington, and West Virginia, and remained stable in the rest of states. This supports trends that have shown overall leveling off of obesity rates in recent years.

WHAT IS DIABETES?

Diabetes Mellitus is a sickness when hyperglycemia and characterized carbohydrate ruin the

fat and protein metabolism that occurs as a result of a complete or partial failure or deficiency

of insulin hormone secretion which regulates the blood sugar levels released from pancreas.

There are several types of Diabetes which include type 1, type 2 and Gestational diabetes. However, the most common types are type 1 and type 2.

The main issue of type 2 Diabetes Mellitus is the decrease in beta cell function and insulin insensitivity in peripheric tissues. Hyperglycemia is occurred by mainly the lack of insulin and Its resistance in type 2 diabetes pathogenesis. Factors that make it easier to come to exist are inheritance, fatness, pregnancy, long term drug use (diuretic, corticosteroid etc.), infections, physical and psychological traumas and some pancreatic sicknesses.

OBESITY-INSULIN RESISTANCE The effect of insulin on fat individuals don’t look like the ones on physiological conditions. The reason for the insulin resistance and hyperinsulinemia in obesity is due to the decrease of the number of insulin receptors. Abdominal obesity progress parallel with heavy hyperinsulinemia and insulin resistance. Lipolytic activity of the fat cells in stomach is pretty condense. Also, the antilipolytic effect of insulin is more apparent in the fat cells in stomach. When insulin is functionally inadequate, there is a significant increases in lipolysis in obese people: especially in their stomach. The increase of lipolytic response cause the increase of free fatty acid of plasma, the ruin of glucose oxidation in muscle and the change of the speed of lipid oxidation. The increase in free fatty acids indicates the decrease in the amount of insulin in the liver. That means that the decrease of insulin sensitivity, thus the decrease of blood insulin to meet it, in other words, that means being formed of vicious circle of hyperinsulinemia insuin resistant. Type 2 Diabetes Mellitus: level of fasting plasma is either increased or steady. The insulin response against glucose loading is decreased in general. Insulin resistance is common and general feature.

DESCRIPTION AND EFFECTIVENESS OF INSULIN Insulin is released from the pancreas. When the level of glucose rises, the pancreas is automatically warned in a couple of minutes and then releases insulin. Insulin affects the carbohydrate metabolism. It provides glucose in the cells and activates the substances responsible for providing glucose to get into cells. It is responsible for making the glucokinase enzyme which participates in oxidation. It increases the glicogen synthesise and affects the production of protein. It causes the potassium in liquids to maintain steady levels providing potassium to get into cells. Carbohydrate, protein and fat, metabolisms and disorders seen on organisms are shown on the chart.

CLINICAL FINDINGS As a result of getting over the kidney glucose equality of hyperglycemia, glucose is removed out of the body with urine. It increases the out of water with urine. Thirst center which is warned against water loss of the body, makes drinking water more. Feeling of hunger increases. Exhaustion, late recovery on skin scars, often infection, blurred vision, tingle and the other findings.

DESCRIPTION AND CRITERIA OF DIABETES Diabetes, If classical symptom and complications exist, can be easily diagnosed. However, early diagnosis and the correct usage of some lab methods and evaluations based on diagnosis criteria are important. New rules were developed reviewing the diagnosis charts by National Diabetes Data Group (NDDG) in 1979, World Health Organization (WHO) in 1985, American Diabetes Association (ADA) in 1998 and EDPG.

SYMPTOMS +RANDOM PLASMA GLUCOSE ≥ 200mg/dl

In addition to the existence of symptoms specific to diabetes (polyuria, polydypsia and non- explainable weight loss etc.) plasma glucose value measured at any time of day is ≥ 200mg/dl (11,1 mmol/L),

SYMPTOMS + FASTING PLASMA GLUCOSE ≥ 126mg/dl

Value of the fasting plasma glucose 126mg/dl (7.0mmol/L) or higher. (Fasting: The meaning is to have not get any calories for at least 8 hours. Uncertain diagnosis of diabetes is when the fasting plasma glucose is 126 mg/dl or higher.)

ORAL GLUCOSE TOLERANCE TEST (OGTT) 2nd hour value ≥ 200mg/dl

During the OGTT made by 75gr of glucose, 2nd hour glucose value has to be ≥ 200mg/dl (11.1mmol/L). During the process of diagnosis, there are some feature to pay attention. Test must be repeated in the situation of not being distinct of hyperglycemia and metabolic imbalance. It is recommended that OGTT which is the 3rd criteria needs to be done as a routine. Fasting plasma glucose is identified as normal If it is <110 mg/dl, If It is between 110-126 mg/dl, It is identified as Impaired fasting glucose (IFG). When IFG is identified, OGTT need to be done. During OGTT, 2nd hour plasma glucose is construe with <140 mg/dl as normal, 140-200 mg/dl as IFG.

FASTING GLUCOSE

Normally, the value of fasting glucose is 80-110 mg/dl. If fasting glucose is 126 mg/dl or higher, diabetes can be diagnosed. For the best results, fasting glucose should me measured at least twice a day at different times.

POSTPRANDIAL GLUCOSE

Having plasma glucose concentration more that 200 mg/dl shows the existence of diabetes. Diagnosis of postprandial glucose needs to be done and valued while being on diet concluding at least 150 gr/daily of carbohydrate for min 3 days. Yet, postprandial glucose is prefered for diagnosing.

GLUCOSE MEASUREMENT IN URINE

The most common test in diagnosis is the glucose measurement in urine. Normally, circadian urine has 40-70 mg of glucose.

ORAL GLUCOSE TOLERANCE TEST (OGTT) OGTT is the most sensitive test. For reliable results, should be prepared for it. Before the test, patient needs to be on a limitless carbohydrate diet. Test is on process after 8 hours of fasting. After measuring of fasting glucose, patient should drink 300 ml of water with 75gr of glucose along 3-5 mins. After the diagnosis, If the result is 200mg/dl, that means, diabetes diagnosis is precise.

MEDICAL NUTRITION THERAPY

Nutrition has been on the second plan after the discovery of insulin and oral antidiabetics, but in recent years the importance of the term "Medical Nutrition Therapy (TBT)" has increased and has been used by the American Dietetic Association since 1994, while nutritional therapy constitutes of the main treatment prior to the discovery of insulin in diabetes mellitus (DM) this term has begun to be used.

In order for TBT to be successful, it is necessary to monitor diabetic nutrition habits and socio- economically appropriate nutrition plans, to transfer nutritional education to the patient, and to change the behavior of the patient . TBT is the basis of diabetes management and self- education in diabetes management. In the treatment of diabetes, medical treatment forms corner stones with physical activity and education. For individuals with type 1 diabetes, the goals of the nutrition program are to promote growth and development, to maintain ideal body weight, to prevent obesity or weight loss, to select healthy foods, to improve physical health and health, to maintain blood glucose levels within normal limits, to keep blood lipid levels within normal limits, to prevent acute metabolic complications of diabetes (diabetic ketoacidosis, hypoglycemia, infection, growth retardation ...) and chronic complications (micro and macrovascular) and / if complications have occurred, return to treatment, or at least prevent progression, and take into account individual nutritional therapy, personal and cultural traits, lifestyle and wishes to plan.

ENERGY: Considering that children and young people are in the process of growth and development, the daily energy requirement should be calculated by taking into account age, physical activity, growth and development. It would be erroneous to restrict the energy by thinking that the individual is diabetic. When many individuals with insulin-dependent DM are diagnosed with a disease, a weak and adequate diet will provide normal growth and development of children and adolescents. Rapid growth, severe diseases, daily energy intake during periods after ketoacidosis should be significantly increased. However, insulin resistance develops by increasing energy intake and the amount of insulin used in individuals with normal excess weight, and obesity in these individuals becomes inevitable. To prevent this, a good nutrition story can be used to limit the daily energy intake to 250-500 calories. Providing weight loss in obese patients will reduce insulin requirements and provide better glycemic control.

CARBOHYDRATE: The dietary intake of carbohydrates in diabetic patients' diets varies

according to the dietary habits of the patient, blood glucose and lipid levels. Currently,

carbohydrate restriction is not recommended for diabetic patients. The amount of

carbohydrates should not be less than 50% of the energy. The daily energy requirement is

related to the amount of energy taken more than the amount of carbohydrate taken. The liver

has the ability to form glucose from different nutrients such as protein, fat and carbohydrates.

When dietary intake of carbohydrates is limited, blood lipid and cholesterol levels are elevated

in the patient and thus susceptible to coronary heart disease.

CLASSIFICATION OF CARBON HYDRATES

The Food and Agriculture Organization and the United Nations World Health Organization

have separated three main groups, namely carbohydrates, oligosaccharides and

polysaccharides, according to the degree of polymerisation of carbohydrates.

The consumption of carbohydrates should be similar at meals, the amount of carbohydrate in

meals is important. The increase in blood sugar is caused by the consumption of

carbohydrates on the need, rather than the type of carbohydrate consumed. Sugar is not the

only carbohydrate source we have to control. If sugar-containing foods contain more

carbohydrates, blood sugar levels will rise. For this reason, foods containing sugar should be

consumed with other healthy foods. It should also be noted that rice, pasta, bread, fruit or

other carbohydrate foods consumed in excessive quantities may also increase blood sugar.

The amount of carbohydrates in the meals should remain constant from day to day as much

as possible. Individuals receiving intensive insulin treatment due to the amount of

carbohydrates consumed at meals should adjust their pre-meal insulin dose.

Sucrose (sucrose): Scientific evidence suggests that consuming a certain portion of the meal

as sucrose (tea-meal sugar) does not impair glycemic regulation in insulin dependent DM

(IBD) patients, or in insulin-dependent diabetics. In the research results, 15-25% of the daily

energy was not sucrose, these levels were not found to have a negative effect on glycemic

control. Sucrose can be used instead of other carbohydrate changes at lunchtime. However,

there is a need for the results of long-term and diabetic individuals with diabetes.

Fructose (fruity sugar): Fructose in the diet produces isocaloric sucrose and a lower glycemic

response than many starchy foods. However, consuming too much (2 times the requirement

or 20% of the energy) will increase serum cholesterol and especially LDL-cholesterol levels.

Excessive fructose consumption in diabetics with dyslipidemia should be restricted, but this

should not imply restriction of fruit and vegetables, which are natural sources of fructose

intake in the diet.

Posa: Two groups are separated as pulp; soluble and insoluble pulp, which are defined as

parts of plant-derived food that are not broken down by digestive enzymes in the human

body. The consumption of insoluble pulp (wheat germ, hemicellulose, lignin) is important in

prevention and treatment of many gastrointestinal diseases such as colon cancer. Apple,

grapefruit, lemon, orange, oatmeal, dry legumes and many vegetables contain soluble pulp.

Soluble pulp fermenting gas and short-chain fatty acids in the probe slows the digestion and

absorption of carbohydrates by delaying gastric emptying and has positive effects on serum

lipid levels. There is no scientific evidence to suggest that diabetic pills should be consumed

more. For this reason, fecal consumption recommended for diabetes is like in the general

population. In this context, 20-35 g dietary fiber is recommended to be taken with various

foods today. Instead of white bread, whole wheat or oat bread, rice instead of bulgur, plenty of

salads and a portion of cooked vegetable meals, fruit juice instead of eating with the shell, dry

legumes 3-4 servings per week to increase the content of pulp diet is a practical suggestion to

increase diabetes.

TYPE 1 DIABETIC MEDICAL NUTRITION

Equal amounts of simple sugars or starch increase blood sugar in the same amount. The

nutrient item with the greatest blood-screening effect is carbohydrates. Nutrients containing

different carbohydrates affect blood glucose levels at different levels. Digestible starch passes

into the blood as glucose in 15 min-2 hours after 90-100% of the sugars are secreted. This

method is based on consuming the correct amount of carbohydrate at the main and

intermediate meals. The amount of carbohydrates in the main and intermediate meals should

be adjusted according to the blood sugar measured before meals. Depending on the

measured values, fewer or more carbohydrates should be consumed per day, or insulin may

be adjusted according to the nutrients the individual wants to eat.

Age, cholesterol, triglycerides, microalbuminuria, and hemoglobin A1c (HbA1c) are used to

determine the amount of carbohydrate to be consumed in the meals / meals, weight, paint,

when and how much exercise is taking, drug / values, personal choices, preferences, cultural

habits and lifestyle, other accompanying diseases, weight loss goals.

Advantages of carbohydrate counting: It is easier to learn than change systems. It Provides

diversity and flexibility in food selection. Meal planning is easier with the calculation of

carbohydrate values of foods. It is possible to replace foods containing high sugar (with low

nutritional value and not always recommended to be consumed) with other carbohydrate-

containing foods. Theoretically better glycemic control is provided.

Disadvantages of Carbonhydrate Counting:

It causes more meals to be consumed. It increases the consumption of foods containing high

energy. It can cause enough and balanced eating habits to be forgotten. Frequently, blood

sugar needs to be measured. It is necessary to constantly read the food label and weigh the

food. There is a frequent record keeping requirement. If applied incorrectly it can cause quick

weight gain.

Protein: Proteins are involved in every function and reaction of the organism. Proteins should

be in sufficient quantities in the diet of a diabetic child as they do not raise blood sugar as

much as carbohydrates and absorb as much energy as fat during their absorption.

Protein requirements of diabetic children are similar to those of non-diabetic children of the

same age and sex. Today, to ensure the growth and development of normal diabetic babies,

children and adolescents, it is recommended that 10-20% of energy consumed per day be

consumed by the protein or at least 0.9-2 g / kg protein in the diet, depending on the source.

This amount should be around 15-20% in infants, 12-15% in early childhood and 10-12% in

late childhood. Dietary protein should be provided from both animal and plant sources. Total

protein uptake can be increased if the proteins are plant-derived. Since growth is a matter of

development, at least 50% of the protein supplied must be of animal origin so that the

sufficient essential amino acids can be provided.

Fat: in individuals, the risk of developing atherosclerotic disease with diabetes is significantly

higher than in the general population. In individuals with poorly controlled T1DM, plasma lipid

and lipoprotein concentrations are high and DM increases the risk of coronary artery disease

by 3-4 fold. The main goal of fats in the diet program of people with diabetes is to limit

saturated fat and cholesterol. <10% of the total energy must be provided from saturated fats.

For individuals with LDL-cholesterol ≥100 mg / dL, saturated fat should be limited to <7%.

Dietary cholesterol intake should be <300mg / dL. For individuals with LDL-cholesterol ≥100

mg / dL, it should be limited to <200 mg / dL. The intake of trans fatty acids should be

reduced. 2-3 servings of fish per week should be recommended because sufficient n-3

polyunsaturated fatty acid (MDA), ie omega-3, is available. Total RDA (polyunsaturated fatty

acid) intake should be up to 10% of the energy.

Vitamins and minerals: In certain populations, multivitamin preparations may be injured in

elderly, pregnant, lactating, vegetarian and energy-restricted individuals. Diabetes mellitus in

normal condition does not require such supportive treatment. There is insufficient evidence to

support vitamin-mineral (other than folate and calcium) in diabetics with no disability and no

specific status. However, studies have shown that antioxidant vitamins and mineral

supplements provide various benefits in treatment. Studies have shown that vitamin C has

potential benefits in the prevention of protein glycosylation. In addition, energy from protein

and fat may also increase the need for B-group vitamins, especially thiamin and riboflavin and

nicotinic acid. Carbohydrates can not be fully metabolized in group B vitamins. Therefore, it is

recommended that group B vitamins also be given to diabetic patients. If fat intake is

restricted in diabetic patients and vitamin D supplementation is needed. Because of its

antioxidant properties, it also reduces the hyper coagulability and aggregability of

erythrocytes, reducing the risk of atherosclerotic plaque formation and preventing the

development of diabetic complications. However, since long-term efficacy and safety of

antioxidants are unknown, long-term support is not recommended.

One of the minerals that contribute to glucose homeostasis is magnesium. Magnesium

insufficiency occurs in insulin resistance, carbohydrate intolerance, hypertension, cardiac

arrhythmia, retinopathy, mineral homeostasis and dyslipidemia. If hypomagnesemia has been

detected, magnesium supplementation is recommended. Chromium supplementation has

been reported to have beneficial effects on glycemic control in patients with chromium

deficiency. However, chromium deficiency is not reported in most diabetic patients, so

chromium supplementation is not required. Although sodium (Na) is an extraordinary

electrolyte for the human body, Na taken with daily nutrients is usually on the

recommendation. Table salt, containing 40% Na, is added to many foods during processing,

thus increasing daily Na consumption.

It is suggested that diabetic individuals should avoid consuming low or moderate Na

consumption, consuming salt with foods they consume, eating excessively salty foods and

salty ready-to-eat foods, especially if the risk of developing hypertension is higher in patients

with IBD than in general population. The recommended Na intake is 1000 mg / 1000 kcal and

this value should not exceed 3000 mg / day. Diabetic patients with both mild and moderate

hypertension 2400 mg / day and below, both hypertension and nephropathy, are

recommended to consume 2000 mg / day or less of Na. In patients with diabetes, blood

pressure should be monitored carefully and standardized blood pressure values should be

determined to determine persistent blood pressure. It has been reported that even in the

presence of moderate hypertension, Na-reduced diet should be used with aggressive

antihypertensive drugs. Potassium loss is highly prevalent in patients with diabetes.

Hypercalcemia also occurs in patients with renal insufficiency who are receiving ADE

inhibitors.

Artificial Sweeteners and Diet Products:

Artificial sweeteners are divided into 2 groups as energy-containing ones (fructose, sorbitol,

mannitol, xylitol) and energy-free ones (saccharin, cyclamate, aspartame and acesulfame-K).

Sugar alcohols (polyols) such as sorbitol, mannitol and xylitol are sweeteners that produce a

lower glycemic response compared to sucrose. However, it has no distinct advantages over

the use of other sweeteners, and on the contrary, there is a laxative effect of excessive

consumption. In particular, the sweeteners containing diabetic sweet products sold under the

definition "diabetic" should be examined and diabetics should be trained in this respect.

Because sugar alcohols and fructose are normally used to achieve sweetness in the

production of such products, when they are consumed by diabetics who believe that they are

safe, the risk of neuropathy is increased by excessive fructose intake and dyslipidemia and

excessive sorbitol intake. It has been reported that non-energy sweeteners (artificial

sweeteners) approved by the FDA are safe for use by saccharin, aspartame, acesulfame

potassium and sucralose and diabetics. The recent reports on the harmful effects of

aspartame are completely unfounded and do not rely on any scientific evidence.

Number of Meals: In order to prevent the fluctuation of blood sugar and the balanced

distribution of the energy and food items consumed daily by individuals with type 1 diabetes,

nutrition is recommended for 6 diets including 3 main and 3 intermittent meals, but this type of

insulin used by the entire diabetic individual depending on the shape of life. Because of the 6-

hour effect of regular insulin in diabetic patients treated with short-acting regular insulin does

not lead to hypoglycaemia, 3 intermedia meals are recommended in medical nutrition therapy.

With the introduction of fast-acting insulin analogues, intermittent meals may not be

consumed for diabetic individuals. Individuals with a desire to consume snacks are

recommended to eat foods with low glycemic index at intermediate times.

Hypoglycemia: One of the most common and most feared acute complications in the

treatment of type I diabetes. Blood sugar falls below 55-65 mg / dl. The causes of

hypoglycemia are as follows: insulin dose or oral antidiabetic dose, delayed meals or meal

times, inadequate food intake at meals, excessive exercise and severity, diarrhea and

vomiting, gastrointestinal distress, delayed gastric emptying, and alcohol intake.

2.OBESITY

Chronic hypertension is the most important cause of obesity (1). Along with that; Other factors

may also play a role, such as genetic predisposition, sedater life, and deterioration of

mechanisms that protect the individual against excessive storage of oil.

In developed countries, 40% of the population is overweight while 20% is obese. In some

countries, up to 3/4 of the adult population has weight gain. In developed countries, this rapid

increase in obesity, unchanged genetic background, is caused by excessive energy intake

and decreased activity

Nowadays obesity is classified according to BMI (Body Mass Index). Although the obesity is

defined as BMI> 30, the increase in health risk progressively increases when body weight

exceeds the BMI of 25. Morbid obesity (> 40) is a serious disease and patients usually live

less than 60 years. The ideal BMI for life expectancy seems to be between 20 and 22. As a

measure of obesity, the use of VKI has been accepted all over the world and is used as an

indicator for life expectancy and obesity related complications.

The qualitative difference between Android (abdominal) and gynecoid (hip and baseline)

obesity is also important. Because it is the android type which is accompanied more by

metabolic complications including the development of diabetes and atherosclerosis. Although

the waist circumference is better correlated with the amount of organ fats, the ratio between

waist and hip circumference (BCC) is> 1, which is used as the index of the android obesity.

The risk of metabolic complications, such as the tendency to develop android type obesity, is

related to the waist circumference and is usually classified as mild or severe. (Table 1).

Table 1. Metabolic risk of waist circumference and obesity.

Metabolic risk according to waist circumference

Woman man

Ha f

> 80 (cm) & gt; 94 (cm)

Heavy

& Gt; 88 (cm) & gt; 102 (cm)

Although obesity is used as the main source of fat energy, it is also affected by the pattern of

the substrate taken. Obese people spend more energy depending on their increased fat-free

mass and the effort required to move their heavier bodies. In obese individuals, the oxygen

consumption corresponding to each kg of body weight is normally lower. Because fat tissue

has less metabolic rate than lean tissue. Some obese people have lower dieteion-related

thermogenesis.

Eating disorders can increase the progression of obesity. Night-eating syndrome is defined as

a nightly intake of more than 50% of the total daily intake and is associated with an

abnormality, depression and sleep apnea syndrome in the serotonin system. Overeating is

defined as periods of uncontrolled overeating, especially at nights, and at the same time the

plant is associated with lack of serotonin.

OBESITANE TREATMENT

5 different methods used in obesity treatment:

• Diet

• Psychotherapy • Mode of physical activity • Pharmacotherapy • Surgery

The first 3 methods are the cornerstones of any weight loss program because the treatment

takes the goal of achieving energy balance. These initiatives include:

- Regular food intake; daily food intake is divided into 3-6 alimines. Food should be healthy,

suitable for food norms and have antiatherogenic properties, adequate vitamins, minerals and

fiber. Must be varied and contain daily vegetables, fruit, whole grain products, potatoes and

pulses.

- Reduction of oil intake; It is the most important part of weight loss. Although the patients

have a great deal of information about the diet, they often take their place. They repeat that

they do not take the sugar all the time, but 5 g of cube sugar contains 20 kcal, while 5 g of oil

contains 45 kcal.

- Changing the lifestyle involves emphasizing psychotherapy, changing habits in leisure time,

and increasing all-round activity. Simple changes in diet habits rarely succeed.

- Prevention of dietary errors should be encouraged by the new lifestyle. It is often seen that

the patient is completely embarrassed after a one-time recording and totally relinquishes the

effort.

- Adequate intake of low calorie drinks is important.

Alcohol intake should be reduced (alcohol = 7.5 kcal / g) reducing the calorie intake should be

life goal. At the same time you need to change your whole lifestyle, including the eating and

exercise routine. Short cycling dietary precautions (600 kcal to 2500 kJ) for several days or

weeks are also known as very low calorie diets (VLDC) and are only effective in very specific

circumstances. These regimens usually last between 7 and 30 days and should be done

under the supervision of a physician as they may be dangerous. When all the diet measures

in the short or the long term have lost motivation, rebound and re-weight gain problems. This

should be demonstrated by long-term training and oversight. Pharmacological treatment of

obesity is also effective and can be applied intermittently or continuously for years. Orlistat is

the most commonly known drug and can be used for long periods, months or years, but it is

usually prescribed several months at a time.