L ' obesity a multifactorial : the factors causing it are extremely varied: sometimes they act in isolation but more often in their competition is, in many individual cases it is difficult if not impossible, to identify the factors and mechanisms involved.
It is believed that every person has the physiological regulation ( set point) of body weight of mass fat of muscle mass and other variables related to these, a diencephalic center which modulates the basal metabolic rate, thermogenesis and a whole series of chemical reactions high-cost energy, every shift of weight from this level, involves the activation of a number of corrective mechanisms which tend to return to baseline. The disorders of this regulation or the elevation of its level that controls metabolic responses, would lead to the accumulation fat, and then to 'increase of weight.
This "set-point" would be affected by social factors, endocrine and metabolic, psychological, genetic, personal, from the regime of physical activity, and the development . About the latter must be taken into account that the 'increase of fat mass can result from an increase size (hypertrophic obesity with a majority onset in adulthood) or number (hyperplastic obesity in childhood onset with a majority) of adipocytes, or both situations (hyperplastic-hypertrophic obesity).
The age of onset may therefore provide valuable information on histological type of obesity: When this occurs in childhood or even from birth, is likely to be hyperplastic type of obesity are difficult to treat. The number of fat cells of every individual is, indeed, genetically predetermined, but when they reach the maximum volume is possible, however, the proliferation of new cells from preadipociti.
heritage mobile phone can vary only in the sense of ' increase and never in that of the reduction, for which subjects with an excessive number of adipocytes may obtain a reduction their weight only by reducing cell volume below normal values.
Do not underestimate the role played in causing obesity, since feeding behavior and motor in the early stages of life ; Some have wanted to give importance to even ' over-nutrition in the early months of intrauterine life, which would induce abnormal proliferation of adipocytes number of obesity as a condition of extra-uterine life. Confirmation of this theory is the macrosomia and obesity of mother-infant Diabetic whose hyperglycemia is responsible for an excessive caloric intake to the product of conception.
In adulthood, however, the excess food does not cause an increase number, but rather the size of fat cells.
In summary, in determining obesity play an interactive role, together with the errors dietary , a number of conditions in part related to the environment and partly related to the establishment genetic individual.
All such causal factors of generic, should be added a number of specific diseases - primarily those of the parts and disendocrine - which, by interfering in various ways on energy metabolism, unbalance the normal relationship between the anabolic and catabolic phases, inevitably leading to the gradual increase deposits fat.
The clinical evaluation of obesity in place must be made taking into account the fact that the amount of overweight is only one, though the most conspicuous of the elements to be considered and that between them the metabolic complications and organ assume paramount importance and ceremonial.
This assessment and treatment program to be established therefore include the establishment of a number of elements to be identified through a careful consideration, the diagnostic.
data to be considered are summarized in the mirror and define the following:
KIND AND NATURE
- etiologic criterion: genetic form, hypothalamic, nutrition, etc..
- histological criteria: hypertrophic, hyperplastic, mixed
- morphological criterion: android, gynoid, mixed
- Policy Population: infantile, juvenile, adult
- policy evolution: dynamic, worsening, static or stable
- renal-hepatic bile
- blood chemistry