Pejouhesh dar Pezeshki (Research in Medicine)

other افزایش وزن و چاقی مشکل عمده بهداشتی- درمانی حال و آینده Overweight and Obesity the Major Problem of Present and Future بین رشته ای ( مدیریت آموزشی، تحقیقات آموزشی، آموزش پزشکی ) Interdisciplinary (Educational Management, Educational research, Statistics, Medical education پژوهشی Original <div style="text-align: justify;">شواهد کافی وجود دارد که با افزایش تمایه تودن بدن بیش از ۲۵ خطر ابتلا به بیماری های قلبی عروئی و سایر امراض به طور چشمگیری با افزایشی (نمایه توده بدنی بالاتر از ۲۵) فزونی می یابد ، همچنین، هنگامی که تمایه توده بدن به ۳۰ و بالاتر می رسید خطر مرگ بیشتر می شود. با افزایش نمایه توده بدنه متوسط فشارخون و غلظت کلسترول افزایش و HDL کاهش می یابد. مردانی که خیلی چاقی هستند، خطر فزونی فشار خون افزایش کلسترول و یا هر دو آنها، به میزان دو برابر بیشتر از مردانی که وزن طبیعی دارند، وجود دارد. این خطر در زنان بسیار چاق چهار برابر افزایش می یابد. در ایران شیوع افزایش وزن و چاقی در افراد بالای ۳۰ سال در جوامع روستایی از ۴۴ تا ۷۲ درصد و در شهرها تا ۸۲ درصاد گزارش شده است. این عارضه به خصوم در زنان شهر نشین و زنان روستاهای تهران از مردان این نواحی به مراتب شایع تر است. در سال ۱۹۹۸ از سوی انستیتوی ملی سلامت (NIH) رهنمودهای ارائه شده که نتیجه تجزیه و تحلیل مدون محققان آن از مقالات منتشر شده پزشکی است، این رهنمودها برای ارزیابی اضافه وزن و چاقی و اصول کاهش وزن موثر و ایمن فرایند جدیدی که عبارتند از نمایه توده بدنی، اندازه دور کمر و علائم خطری بیمار در ارتباط با امراضی که با چاقی مربط باشند.</div> <div style="text-align: justify;">There are many evidences confirming that a_ BMI more than 25 will significantly increase the risk of cardiovascular problems and related diseases. BMI more than 30 will dramatically raise mortality rate. An increase in BMI will lead to an increase of mean blood pressure and blood cholestrol, and a decrease in HDL levels. In men with morbid obesity the risk of hypertemion and/or elevated cholestrol levels, is 2 times higher than men with normal body weights; respectively, the rates for obese women is 4 times higher. In Iran the prevalence of overweight and obesity among the over 30 years aged group is 44-72 percent in rural and 82 percent in urban areas. This condition was detected with a significantly higher rate among women of rural and urban areas of Tehran district, as compared to men. In 1998 the experts of National Health Institute (NHI) issued guidelines on the basis of the latest medical researches. These guidelines aimed for the evaluation of overweight and obesity and the principles if effective treatment. According to these guidelines evaluation of overweight and obesity is based on 3 indices i.e; BMI, waist circumference and risk factors of obesity related disorders. These guidelines defined overweight by BMI levels at which mortality and morbidity rates increase dramatically. In this regard overweight is defined as a BMI between 25-29.9 and obesity as a BMI more than 30. Reduction of body weight has been seriously recommended in order to lower blood pressure, cholestrol levels, blood sugar and elevate HDL levels. Along BMI assessment, health care personal should evaluate risk factors of obesity related diseases such as, elevated blood pressure, high serum cholestrol and positive family history. Overweight health problems in comparison to the patients without these factors. Therefore these patients should be treated promptly. According to these guidelines the effective ways to reduce body weight are: lowering calorie intake, increasing physical activity and altering behavioral habits in order to improve eating habits and daily physical reduced by 10 percent which markedly decreases the effects of risk factors on obesity related diseases. After this stage more reduction in body weight should be considered. After 6 months of treatment the priority of the protocol will be focused on maintaining the body weight at its decrease level. It should be noted that substituting the fats in the diet by other nutrients without any decrease in calorie intake will not cause a reduction of body weight. Reduction of diet fats will decrease calorie intake which will be beneficial for health conditions. Moderate exercise is recommended for patients at the beginning which afterwards should be raised to 30 minutes or more per day. Before administration of drug therapy, physicians should work on altering patient's life styles for at least 6 months.Approved drugs for the treatment of obesity may be used in a long term comprehensive program which includes diet and physical activities in selected patients. Surgical procedures may be considered in cases of morbid obesity (BMI > 40 or BMI≽35 with other risk factors) who have not responded to other treatments. It is obvious that such patients should be monitored for life time. In conclusion, a national preventional program which aims towards the correction of eating habits and physical activities should be set in order to defeat overweight and obesity related disorders in our country.</div> 69 81 http://pejouhesh.sbmu.ac.ir/browse.php?a_code=A-10-3973-476&slc_lang=other&sid=1 Parvin Mirmiran پروین میرمیران 100319475328460020472 100319475328460020472 Yes Endocrine and Metabolism Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. مرکز تحقیقات غدد درون ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. Fereydoun Azizi فریدون عزیزی 100319475328460020473 100319475328460020473 No Endocrine and Metabolism Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. مرکز تحقیقات غدد درون ریز و متابولیسم و دانشگاه علوم پزشکی شهید بهشتی،تهران،ایران.