Echilibrul energetic si obezitatea – care sunt principalii determinanti

Mai 30, 2017 | 1 comment | Obezitate, Serban Damian, determinanti, echilibru, energetic, nutritionist

In cele ce urmeaza o sa discut putin despre un subiect tot mai frecvent dezbatut, cel al obezitatii. E normal sa fie un subiect popular, atat timp cat rata obezitatii este intr-o continua crestere.

Un articol foarte recent (februarie 2017) publicat in Cancer Causes & Control prezinta concluziile unui grup de lucru format din experti, care sub umbrela International Agency for Research on Cancer, au trecut in revista dovezile stiintifice privind asocierea dintre echilibrul energeti si obezitate. Focusul a fost pe tarile mediu si subdezvoltate.

Articolul este interesant si amplu, iar eu vreau sa comentez doar concluziile acestui grup de lucru, care desi nu aduc noutati spectaculoase, sunt valoroase prin faptul ca intaresc informatii pe care le stim deja. In contextul in care apar tot felul de ipoteze si afirmatii care incearca sa contrazica ce stim deja, e important sa stim pe ce ne bazam si in ce directie trebuie sa mergem.

Asadar concluzii:

The global epidemic of obesity and the double burden of malnutrition are both related to poor quality diet; therefore, improvement in diet quality can address both phenomena.

E o concluzie evidenta, insa aici cuvantul cheie este „calitate”, nu cantitate. Atarna mai greu faptul ca o persoana mananca prost, decat faptul ca mananca mult (obezitate) sau putin (malnutritie).

The benefits of a healthy diet on adiposity are likely mediated by effects of dietary quality on energy intake, which is the main driver of weight gain….  The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms.

Aportul energetic este principalul determinant al cresterii in greutate, insa acesta este in stransa legatura cu calitatea regimului si in consecinta cu nivelul de adipozitate. Legatura se face prin influente asupra secretiilor hormonale si asupra cailor neurologice, care influenteaza satietatea. Practic o alimentatie de proasta calitate induce modificari endocrine si neurologice care afecteaza capacitatea organismului de a recunoaste starea de satietate si de aici aportul mai crescut de energice ce duce la instalarea obezitatii.

Dietary patterns characterized by higher intakes of fruits and vegetables, legumes, whole grains, nuts and seeds and unsaturated fat, and lower intakes of refined starch, red meat, trans and saturated fat, and sugar-sweetened foods and beverages, consistent with a traditional Mediterranean diet and other measures of dietary quality, can contribute to long-term weight control.

Solutia e la indemana: aport mai mare de fructe si legume, leguminoase, cereale integrale, nuci si seminte, grasimi nesaturate, plus reducerea aportului de glucide rafinare, carne rosie, grasimi saturate si trans, dulciuri si bauturi indulcite. Toate acestea contribuie la controlul greutatii pe termen lung.

Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control.

Bauturile indulcite trebuie limitate. Punct. Sau eliminate complet, ca sa fim mai siguri.

In weight loss trials, existing evidence does not support the role of the reduction in the percentage of energy from fat on weight loss, though the reductions in fat may not have been low enough for the outcome and the effects of single macronutrients cannot be adequately captured without specifying replacement/comparison sources of energy.

O afirmatie transanta despre dietele low-fat, lucru de asemenea cunoscut de ceva timp (in acest sens am scris si eu aici).

Genetic factors cannot explain the global epidemic of obesity.

Aici probabil ca se vor revolta oameni care se pricep mai bine decat mine la genetica si nutrigenomica, insa intotdeauna mi-am pus intrebarea cum de putem vorbi de un determinism genetic puternic in conditiile in care obezitatea a luat amploare doar in ultimii cativa zeci de ani.

It is possible that factors such as genetic, epigenetic and the microbiota can influence individual responses to diet and physical activity.

In schimb, da, la nivel de individ, probabil ca profilul genetic influenteaza felul cum reactioneaza la un anumit tip de dieta si de activitate fizica. Tocmai de aceea intalnim oameni care slabesc foarte usor, altii care se ingrasa aparent din nimic etc.

Short-term studies have not provided clear benefit of physical activity for weight control, but meta-analysis of longer term trials indicates a modest benefit on body weight loss and maintenance. The combination of aerobic and resistance training seems to be optimal.

O veste in acelasi timp proasta si buna. Proasta pentru cei care sunt dornici sa faca sport si isi imagineaza ca asa vor rezolva problema excesului ponderal, insa in acelasi timp buna, pentru cei mai multi supraponderali care nu au nicio dorinta sa faca miscare. Da, e adevarat, beneficiile sunt modeste, insa totusi exista. Si iata, combinatia cardio + exercitii de forta reprezinta lozul castigator.

Long-term epidemiologic studies also support modest benefits of physical activity on body weight. This includes benefits of walking and bicycle riding, which can be incorporated into daily life and be sustainable for the whole population. Physical activity also has important benefit on health outcomes independent of its effect on body weight.

E suficient sa mergem pe jos si sa pedalam zi de zi, ca sa obtinem beneficii, nu doar in ceea ce priveste greutatea corporala, ci sanatatea in general (iar efectele sunt independente unele de altele, conform studiilor epidemiologice pe termen lung).

Long-term epidemiologic studies show that sedentary behavior (in particular TV viewing) is related to increased risk of obesity, suggesting that limiting sedentary time has potential for prevention of weight gain.

Sedentarismul… e rau. Parca nu stiati asta. Iar reducerea sedentarismului poate preveni cresterea in greutate.

The major drivers of the obesity epidemic are the food environment, marketing of unhealthy foods and beverages, urbanization, and probably reduction in physical activity.

Principalii determinanti ai epidemiei de obezitate sunt: hrana si bauturile nesanatoase, urbanizarea si reducerea activitatii fizice. Nimic nou, poate doar ideea de urbanizare, care este un fenomen ce a luat amploare in ultimul secol.

In utero and early childhood, environment has important implications for lifetime adiposity.

Nu avem nicio scuza daca ne condamnam copiii la obezitate, prin lipsa de atentie la mediul in care acestia se formeaza si traiesc, in special in copilaria timpurie.

Gaining control of the obesity epidemic will require the engagement of many sectors including education, healthcare, the media, worksites, agriculture, the food industry, urban planning, transportation, parks and recreation, and governments from local to national.

Pe scurt, suntem condamnati (cel putin aici in Ro si alte tari din lumea 3-a).

We now have evidence that intensive multi-sector efforts can arrest and partially reverse the rise of obesity in particular among children.

Doomed.

 

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Comments (1)

  1. Sigina Pop, ND
    mai 31, 2017

    Foarte faina sinteza. Ei, in nutrigenetica ne intere mult microbiomul, care influenteaza expresia genica.
    Legat de sport, da, benefuciile sunt modeste… dar scaderile in greutate sunt mai spectaculoase si durabile + sport. Diferenta aia in care in loc de slabit 4 kile, slabesti 7. Mie mi se pare fenomenal sportul in moderarea poftelor, mai ales de dulce. Din modesta mea experienta (personala+pacienti), poftele sunt muuuuult diminuate cand e asociat sportul.

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