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n South African Gastroenterology Review - Obesity : an ever-expanding problem
A review of treatment options : review
Obesity is not a new condition. The associated morbidity and mortality has been known for 2 500 years. What is new is it's growing prevalence. Worldwide there is an increase in the percentage of people that are overweight. It affects both the developed and developing world and South Africa is no exception. In South Africa 29% of men and 56% of women are classified as overweight (BMI >25) or obese (BMI >30). The prevalence is higher than reported in any other African country.
In a sample of 7 726 South African women aged 15-95 years old, a BMI of >25 (overweight and obese) was most prevalent amongst black women (58.5%), followed by women of mixed ancestry (52%), white women (49.2%) and then Indian women (48.9%). A dissimilar pattern was seen in men. In a sample of 5 401 South African men aged 15-95 years, the prevalence of a BMI >25 was highest in white men (54.5%), followed by Indian men (32.7%) and men of mixed ancestry (31%), with the lowest prevalence in African men (25%). Central obesity was found in 9.2% of men and was more prevalent in older men and white men.
There appears to be a changing perception of obesity, as illustrated by a population survey study in which fewer overweight and obese individuals defined themselves as overweight in 2007 when compared to 1999, despite a significant increase in the prevalence of obesity.
Weight control seems so simple. It is a matter of intake versus expenditure. Other factors complicate matters, however. Energy intake has a strong behavioural component, and is influenced by hunger, satiety and nutrient absorption. Energy expenditure has a lesser, but still very important, behavioural component. It is influenced by metabolic rate, thermogenesis and activity. Treatments for obesity either decrease energy intake or increase energy expenditure. Those that decrease energy intake have a greater potential for causing weight loss than those that increase energy expenditure through exercise.
This article will focus on the management of obesity. Before initiating treatment for obesity, the following should be considered. Firstly, the risks of treatment should be evaluated. The risks involved in pharmacological therapy are low, but are more pronounced in bariatric surgery, and therefore risk versus benefit and whether treatment is appropriate in the patient, should be determined. Both overall and central adiposity should be assessed.
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