Obesity , Weight Management &Control –Medcrave Online Publishing

Obesity is a world-wide epidemic considered to be the fifth leading risk for global deaths. Obesity and its associated conditions such as insulin resistance, type 2 diabetes, Dyslipidemia and steatosishepatis, termed as a metabolic syndrome, represent major challenges for basic science and clinical research. Obesity is defined as abnormal or excessive fat accumulation that may impair health. The World Health Organization (WHO) defines obesity with BMI (body mass index):

a. A BMI greater than or equal to 25 is overweight
b. A BMI greater than or equal to 30 is obesity [1].
 
Obesity is considered to be the disease of the modern and the urbanization world, the consequences of which may be fatal. Every year millions of people die as a result of being overweight or obese. According to the WHO 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens (endometrial, breast, colon) are due to obesity [1].
 

 Obesity and overweight are considered as a high-income country problem, even though there is a rise in low and middle-income countries. This makes about 10% of all the population worldwide suffering of obesity. Most worrying is the fact that children even under the age of 5, who live in developing or developed countries, have overweight problems or obesity [1,2].
Obesity is caused by an energy imbalance between calories consumed and calories expended. The high-fat food consumption and the low physical activity results in excessive fat accumulation, which increases the risk of noncommunicable diseases such as: 
a. Cardiovascular diseases- mainly heart disorders and stroke- the leading cause of death in 2008.
b. Diabetes
c. Musculoskeletal disorders- especially osteoarthritis
d. Some cancers- endometrial, breast, colon [1]
At least 2.8 million people die each year as a result of being overweight or obese. In fact, the mortality increases with the increasing of the BMI. In the WHO European Region, the Eastern Mediterranean Region and the Region of the Americas, over 50% of women are overweight. The highest prevalence of overweight among infants and young children is in upper-middle-income populations, while the fastest rise in overweight is in the lower-middle-income group [1,3-5].
 
 In order to maintain good health, individuals need to stay within the range of 18.5- 24.9 kg/m2 BMI. There is increased risk of co-morbidities for BMIs in the range of 25.0 to 29.9 kg/m2, very high risk of co-morbidities for a BMI greater than 30 kg/m2. In the year of 2008, more than 205 million men and 297 million women worldwide were estimated with the condition of obesity. In high income countries there is almost no difference between the number of men and women suffering of obesity, while in lower-middle-income countries or in upper-middle income countries, obese women are more than double than obese men [6-10].
A research conducted in the Netherlands, Spain, Sweden and the United Kingdom, have shown an inverse relationship between education and either BMI or obesity among both men and women. Other research shows that obesity has relation with the socioeconomic status of men, women and children in medium – and low-income countries. In 2008 there were 40 million pre-school children with weight more than double than the normal at that age. Gaining weight depends on the socioeconomic status in different countries. In the lower and middle- income countries the number of children with obesity rises within the rising of incomes. On the other hand, in high-income countries, such as the United Kingdom and the United States, lower socioeconomic status is associated with a higher prevalence of obesity [11]
 Globalization- consequence of increased urbanization and industrialization, including international trade and shared communications, and the lack of active lifestyle, results in rapidly spreading obesity and turning it into a worldwide problem.
Before 1980, obesity rates were generally much lower than 10%. Since then, rates have doubled or tripled in many countries and nowadays the database shows that 50% or more of the population is overweight [12-14].
 
In many countries the threat of spreading the obesity and becoming a national problem is rapidly growing and increases many concerns. It is in the leading positions of non-communicable diseases and recently replaces more traditional problems such as under nutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnea.
 The main problem in gaining weight comes from the prevalence intake of energy fats and the lack of active lifestyle. Eating food rich in saturated fats and refined sugar, coupled with the lack of sporting activity, inevitably leads to increasing the body mass index [1,9,15].
 Methodology Identification of relevant studies
The literature was searched to identify relevant manuscripts, as well as meta-analyses. Four electronic databases were searched to identify reviews of relationship between obesity and vascular dysfunction (Google Scholar, Research Gate, EMBASE, PubMed) published until May 2014. Broad search terms were used that related to obesity factors such as physical activity, exercise, diet, nutrition, eating, food, diabetes, weight, etc). Criteria for inclusion of papers were that they reported a systematic review or meta-analysis and were published in English. Reviews of intervention studies were also included. Identified papers were first screened for inclusion based on the title, followed by a screening of the abstract, and then the full text. The reference lists of included papers were screened for further relevant studies. Any duplicate papers were removed.
 Quality rating
The included reviews were rated for methodological quality based on the following criteria 
a. Inclusion of an explicit and clear statement regarding subject of the study.
b. Comprehensiveness of the methodology.
c. Clarity of the description of inclusion and exclusion criteria.
d. The quality assessment included ratings of at least two of the following aspects: study design, sampling, outcome measures and follow-up assessment.

 

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