Küresel Sağlık Sorunu ‘Obezite’: Güncel Bir Gözden Geçirme

Abstract

Obezite günümüzde tüm dünyada en önemli halk sağlığı sorunlarından biri olarak kabul edilmektedir. Görülme oranları her geçen gün artan obezite, fiziksel, psikolojik ve sosyal pek çok soruna yol açarak yaşam kalitesini olumsuz etkilemektedir. Dengesiz beslenme ve fiziksel egzersiz eksikliği sonucu diyabet, hipertansiyon ve kardiyovasküler hastalıklara neden olabilmektedir. Bu nedenle obezite ülkelerin sağlık sitemlerine getirdiği yük, sağlık harcamalarında önemli bir yer tutmasının yanı sıra en önemli morbidite ve mortalite nedenlerin başında gelmektedir. Obezitenin gelişiminde genetik yatkınlıklar, çevresel ve psikolojik faktörler arasında karmaşık bir etkileşim söz konusudur. Obezite ile mücadelede yaşamı daha sağlıklı ve kaliteli hale getirmek için yeterli ve dengeli beslenme alışkanlıklarının kazanılması ile fiziksel egzersizin arttırılması gerekmektedir. Obezitenin tedavisinde kişiye özgü tedavi uygulamalarının yanı sıra psikolojik değişkenlerin etkisi dikkate alınmalıdır. Obezitenin tedavisinde kullanılan cerrahi ve cerrahi dışı geleneksel yöntemlerin başarısızlıkları da göz önüne alındığında, psikolojik değişkenlerin anlaşılması ve multidisipliner bir tedavi gerekliliği çok açıktır. Bu derlemede obezitenin etiyolojisi, tanı ve tedavisi güncel literatür bulguları eşliğinde ele alınmıştır.

Keywords

• obezite
• etiyoloji
• tanı
• tedavi

Global Health Problem 'Obesity': A Current Review

Abstract

Obesity is considered one of the most important public health problems all over the world today. Obesity, the incidence of which is increasing day by day, causes many physical, psychological and social problems and negatively affects the quality of life. Unbalanced diet and lack of physical exercise can cause diabetes, hypertension and cardiovascular diseases. For this reason, obesity is one of the most important causes of morbidity and mortality, as well as the burden that countries bring to health systems and an important place in health expenditures. There is a complex interaction between genetic predispositions, environmental and psychological factors in the development of obesity. In the fight against obesity, it is necessary to gain adequate and balanced nutrition habits and increase physical exercise in order to make life healthier and better quality. In the treatment of obesity, the effect of psychological variables should be taken into account, as well as individual treatment practices. Considering the failures of traditional surgical and non-surgical methods used in the treatment of obesity, it is clear that the psychological variables should be understood and a multidisciplinary treatment is required. In this review, the etiology, diagnosis and treatment of obesity are discussed in the light of current literature findings.

Keywords

• Obesity
• Etiology
• Diagnosis
• Treatment

References

1. World Health Organization (1998) Obesity Preventing and Managing the Global Epidemic: Report of a WHO Consultation on Obesity, WHO/NUT/NCD/1998, The World Health Organization, Geneva.
2. WHO.(2015). Obesity and overweight.World health organization. http://www.who.int/mediacentre/factsheets/N311/en/index.html. (Accessed 2015 january)
3. Bray, G.A, Obesity: historical development of scientific and cultural ideas, International Journal of Obesity,1990, 14(11), 909-926.
4. Blüher, M, Obesity: global epidemiology and pathogenesis, Nature reviews, Endocrinology, 2019, 15(5), 288–298.
5. Rosenthal, R.J, Morton, J, et al, Obesity in America, Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, 2017, 13(10), 1643–1650.
6. Borrell, L.N, Talih, M, Examining periodontal disease disparities among U.S. adults 20 years of age and older: NHANES III (1988-1994) and NHANES 1999-2004, Public health reports (Washington, D.C. : 1974), 2012, 127(5), 497–506.
7. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators, Journal of Clinical Epidemiology, 1988, 41(2), 105-140.
8. Devaux, M, Sassi, F, Social inequalities in obesity and overweight in 11 OECD countries, European Journal of Public Health, 2013, 23(3), 464–469.

9. Gallus, S, Lugo, A, et al., Overweight and obesity in 16 European countries, European Journal of Nutrition, 2015, 54(5), 679-689.
10. Ural, D, Kılıçkap, M, Göksülük, H, et al, Türkiye’de obezite sıklığı ve bel çevresi verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme, meta-analiz ve meta-regresyonu [Data on prevalence of obesity and waist circumference in Turkey: Systematic review, meta-analysis and meta regression of epidemiological studies on cardiovascular risk factors], Turk Kardiyoloji Dernegi Arsivi , 2018, 46(7), 577–590.
11. Sağlık Bakanlığı, Türkiye Beslenme ve Sağlık Araştırması 2010: Beslenme durumu ve alışkanlıklarının değerlendirilmesi sonuç raporu. Ankara: Sağlık Bakanlığı Sağlık Araştırmaları Genel Müdürlüğü, 2014.
12. Satman, I, Yilmaz, T, ve ark, Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish Diabetes Epidemiology Study (TURDEP) 2002, Diabetes Care, 25, 1551-1556.
13. Satman, I, Omer, B, ve ark, Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults, Europen Journal of Epidemiology, 2013, 28,169-180.
14. Wright, S.M, Aronne, L.J, Causes of obesity, Abdominal Imaging, 2012, 37(5), 730–732.
15. Conway, B, Rene, A, Obesity as a disease: no lightweight matter. Obesity reviews: an official journal of the International Association for the Study of Obesity, 2004, 5(3), 145–151.
16. Archer, E, Lavie, C.J, Hill, J.O, The Contributions of 'Diet', 'Genes', and Physical Activity to the Etiology of Obesity: Contrary Evidence and Consilience, Progress in Cardiovascular Diseases, 2018, 61(2), 89–102.
17. Naukkarinen, J, Rissanen, A, Kaprio, J, Pietiläinen, K.H, Causes and consequences of obesity: the contribution of recent twin studies, International Journal of Obesity, 2012, 36(8), 1017–1024.
18. Loos, R.J, Genetic determinants of common obesity and their value in prediction, Best Practice & Research, Clinical Endocrinology & Metabolism, 2012, 26(2), 211–226.
19. Silventoinen, K, Rokholm, B, Kaprio, J, Sørensen, T.I, The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies, International Journal of Obesity, 2010, 34(1), 29–40.
20. Deveci, E, Obezite cerrahisi adayı olan ve olmayan obez bireylerde yeme özellikleri, beden bölgesinden hoşnutsuzluk, tedavi motivasyonu ve psikopatolojinin değerlendirilmesi. İstanbul Üniversitesi, Yüksek Lisans Tezi, İstanbul.2013.
21. Balani, R, Herrington, H, Bryant, E, Lucas, C, Kim, S.C, Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity, Journal of the American Association of Nurse Practitioners, 2019, 31(9), 502–510.
22. Doğan, N, Toprak, D, Demir, S, Afyonkarahisar ilinde obezite prevalansı ve ilgili risk faktörleri, Turkiye Klinikleri Journal of Medical Sciences, 2011, 31(1), 122-32.
23. Beyaz, F, Koç, A, Antalya’da obezite yaygınlığı ve düzeyini etkileyen sosyo-ekonomik değişkenler, Akdeniz İİBF Dergisi, 2011, 11 (21), 17-45 .
24. Faith, M. S, Butryn, M, et al, Evidence for prospective associations among depression and obesity in population-based studies, Obesity reviews : an official journal of the International Association for the Study of Obesity, 2011, 12(5), e438–e453.
25. Monda, V, La Marra, M, et al, Obesity and brain illness: from cognitive and psychological evidences to obesity paradox, Diabetes, metabolic syndrome and obesity: targets and therapy, 2017, 10, 473–479.
26. Düşgör, B, Ergenlikte obezite ve beden: psikanalitik bir inceleme, Turkiye Klinikleri Journal of Psychology-Special Topics, 2016, 1(2), 29-34.
27. Sarwer, D.B, Grilo, C.M, Obesity: Psychosocial and behavioral aspects of a modern epidemic: Introduction to the special issue, The American Psychologist, 2020, 75(2), 135–138.
28. Shen, C, Sambamoorthi, U, Rust, G, Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness, Disease Management, DM, 2008, 11(3), 153–160.
29. Wang, L, Liu, W, et al, Association of overweight and obesity with patient mortality after acute myocardial infarction: a meta-analysis of prospective studies, International Journal of Obesity, 2016, 40(2), 220–228.
30. Scott, K.M, Bruffaerts, R, et al, Obesity and mental disorders in the general population: results from the world mental health surveys, International Journal of Obesity, 2008, 32(1), 192–200.
31. Crisp, A.H, McGuiness, B, Jolly fat: relation between obesity and psychoneurosis in general population, British Medical Journal, 1976, 1(6000), 7–9.
32. Simon, G.E, Von Korff, M, et al, Association between obesity and psychiatric disorders in the US adult population, Archives of General Psychiatry, 2006, 63(7), 824–830.
33. Rhew, I.C, Richardson, L.P, et al, Measurement matters in the association between early adolescent depressive symptoms and body mass index, General Hospital Psychiatry, 2008, 30(5), 458–466.
34. McLaren, L, Beck, C. A, et al, The relationship between body mass index and mental health. A population-based study of the effects of the definition of mental health, Social Psychiatry and Psychiatric Epidemiology, 2008, 43(1), 63–71.
35. Özdel, O, Sözeri-Varma, G, ve ark, Obez kadınlarda psikiyatrik tanı sıklığı, Klinik Psikiyatri Dergisi, 2011, 14, 210-217.
36. Eren, İ, Erdi, Ö, Obez hastalarda psikiyatrik bozuklukların sıklığı, Klinik Psikiyatri Dergisi, 2003, 6, 152-157.
37. Yanıkkerem, E, Obezitenin kadın sağlığına etkileri, Journal of Health Sciences of Kocaeli University, 2017, 3(1), 37-43.
38. Lin, H. Y, Huang, C. K, et al. Psychiatric disorders of patients seeking obesity treatment, BMC Psychiatry, 2013, 13, 1.
39. Değirmenci, T, Kalkan, O.N, ve ark. Obezitede psikolojik belirtiler ve ilişkili etmenler, Nöropsikiyatri Arşivi, 2015, 52, 42-46.
40. Karagöl, A, Özçürümez, G, ve ark, Beden kitle indeksinin depresyon ve aleksitimi ile ilişkisi, Anadolu Psikiyatri Dergisi, 2014, 15,207-213.
41. Kolotkin, R.L, Binks, M, et al, Obesity and sexual quality of life. Obesity (Silver Spring, Md.), 2006, 14(3), 472–479. Rowland, D.L, McNabney, S.M, Mann, A.R, Sexual function, obesity, and weight loss in men and women, Sexual Medicine Reviews, 2017, 5(3), 323–338.
42. Rastrelli, G, Lotti, F, et al., Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility, Expert Review of Endocrinology & Metabolism, 2019, 14(5), 321–334.
43. Jackson, V. M, Breen, D.M, et al., Latest approaches for the treatment of obesity, Expert Opinion on Drug Discovery, 2015, 10(8), 825–839.
44. Dalle Grave, R, Sartirana, M, Calugi, S, Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures, BioPsychoSocial Medicine, 2020, 14, 5.
45. Cooper, Z, Doll, H.A, et al, Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up, Behaviour Research and Therapy, 2010, 48(8), 706–713.
46. Munsch, S, Biedert, E, et al, A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder, The International Journal of Eating Disorders, 2007, 40(2), 102–113.
47. Werrij, M. Q, Jansen, A, (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity, Journal of Psychosomatic Research, 2009, 67(4), 315–324.
48. Gade, H, Hjelmesæth, J, et al., Effectiveness of a cognitive behavioral therapy for dysfunctional eating among patients admitted for bariatric surgery: a randomized controlled trial. Journal of Obesity, 2014, 127936.
49. Rodriguez-Hernandez, H, Morales-Amaya, U.A, et al, Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects, The British Journal of Nutrition, 2009, 102(12), 1847–1853.
50. Cooper, Z, Fairburn, C. G, A new cognitive behavioural approach to the treatment of obesity, Behaviour Research and Therapy, 2001, 39(5), 499–511.
51. Lo Presti, R, Lai, J, et al, Psychological treatments for obesity in youth and adults, The Mount Sinai Journal of Medicine, New York, 2010, 77(5), 472–487.
52. Oğuz G, Karabekiroğlu A, ve ark. Obezite ve bilişsel davranışçı terapi, Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry, 2016, 8(2), 133-144.
53. Yardımcı, B, The effectiveness of cognitive-behavioral group psycho-education in the treatment of obesity, Yayınlanmamış yüksek lisans tezi, İstanbul Bilgi Üniversitesi Sosyal Bilimler Enstitüsü, 2011, İstanbul.
54. Ünal, G.Ö, Obezitenin psikiyatrik yönü, tedavisinde davranışçı ve bilişsel davranışçı terapi, Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 2018, 7(1),31-41.
55. Phillips, B.T, Shikora, S.A, The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy, Metabolism: Clinical and Experimental, 2018, 79, 97–107.
56. Garvey, W.T, Mechanick, J.I, et al., American Association of Clinical Endocrinologists and American College of Endocrinology, Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity, Endocrine practice:official journal of ithe American College of Endocrinology and the American Association of Clinical Endocrinologists, 2016, 22 Suppl 3, 1–203.
57. Ribeiro, G, Giapietro, H.B, et al, Depression, anxiety, and binge eating before and after bariatric surgery: problems that remain, Arquivos Brasileiros de Cirurgia Digestiva: ABCD = Brazilian archives of digestive surgery, 2018, 31(1), e1356.
58. Bauchowitz, A.U, Gonder-Frederick, L.A, et al, Psychosocial evaluation of bariatric surgery candidates: a survey of present practices, Psychosomatic Medicine, 2005, 67(5), 825–832.
59. Sevinçer, G.M, Coşkun, H, ve ark, Bariatrik cerrahinin psikiyatrik ve psikososyal yönleri, Psikiyatride Güncel Yaklaşımlar, 2014, 6(1), 32-44.
60. Rahman, R, Azagury, D.E, Novel technologies and techniques in bariatric surgery, Minerva chirurgica, 2017, 72(2), 125–139.
61. Buchwald, H, Buchwald, J.N, Metabolic (Bariatric and Nonbariatric) Surgery for Type 2 Diabetes: A Personal Perspective Review, Diabetes Care, 2019, 42(2), 331–340.
62. Chang, S.H, Stoll, C.R, et al., The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012, JAMA Surgery, 2014, 149(3), 275-287.
63. Douglas, I.J, Bhaskaran, K, et al., Bariatric surgery in the United Kingdom: a cohort study of weight loss and clinical outcomes in routine clinical care, PLoS Medicine, 2015,12(12).
64. Öcal, H, Aygen, E, Obezitenin cerrahi tedavisi, Fırat Tıp Dergisi, 2018, 23, 78-87.