UNIVERSITA’ DEGLI STUDI DI FIRENZE
FACOLTA’ DI MEDICINA E CHIRURGIA
Corso di laurea specialistica in “Scienze della Nutrizione Umana”
Corso di “Medicina dello sport” Prof. Giorgio Galanti
Professore Ordinario in Medicina Interna Azienda Ospedaliera Careggi Firenze; Cattedra di Medicina dello Sport
Relazione di :
dott.ssa Simona Sampirisi
“l’obesità child "is one of the problems is steadily increasing and, in many European countries, one child in five is obese or overweight. A worrying fact is the persistence of childhood obesity in adulthood, leading to increased risk for salute1. The pediatric obesity is a worrying situation and difficult clinical management, which is characterized by the high prevalence and the occurrence of complications (diabetes mellitus, hypertension, dyslipidemia) ever earlier and important, about 25-50% of children maintains the obese overweight in old age adulta2 leading to increased health risks and inevitable ripercussione psicologica: infatti, l'obesità infantile comporta spesso una diminuzione dell'auto-stima e persino sindromi depressive".
Il fenomeno ha una rilevanza sia da un punto di vista epidemiologico che da un punto di vista economico inquanto l’umento degli individui in sovrappeso determina un continuo aumento dei costi sociali dovuti per il controllo delle complicanze che comporta tale patologia.
La prevenzione risulta essere oggi più importante che mai, bisogna comunicare e insegnare l’importanza della salute partendo da un’educazione alimentare associato allo sport e quindi un sano stile di vita. Le scuole sono l’ambiente più vicino ai bambini e ai genitori, la base di una buona educazione nasce dalla conoscenza and an awareness of what one meets with a disease like obesity ...
... For Obesity is defined as a generalized and excessive accumulation of fat in the subcutaneous tissue but also in other tissues and may be associated with alterations of metabolic parameters with physical problems of overload and psychological discomforts sociali3.
The World Health Organization warns that in the 'European Health Report 2002, report on health in Europe in 2002, published by WHO European Region, obesity is defined as a real epidemic that extends throughout the European Region. "In many European countries - it says - more than half of the population adult is above the threshold for "overweight" and about 20-30% of adults fall into the category of obese ("clinically obese ")...
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Obesity in childhood as a risk factor
Obesity is a major risk factor for a variety of diseases and medical conditions that include:
- and metabolic factors: hypertension, l ' hyperinsulinemia, glucose intolerance to type 2 diabetes, cardiovascular diseases, neurological disorders, some forms of cancer, gallstones
- Physical Factors: orthopedic conditions, asma.
- Fattori Psico-sociali: conseguenze emozionali, sociali e psicosociali immediate per il bambino e l’adolescente. Tra queste, anche quelle legate al bullismo in ambito scolastico, a sua volta associato a rischio di depressione e ansia. Inoltre, i bambini sovrappeso godono di autostima più bassa e sono riconosciuti e meno accettati tra i compagni di giochi e a scuola (aspetto determinante, questo, per il loro sviluppo sociale e psicologico). Infine, i bambini in sovrappeso-obesi, proprio per il ridotto livello di autostima, saranno maggiormente suscettibili a comportamenti negativi per la salute: consumo di alcol, fumo di sigaretta (Lobstein et al, 2004)9,10....
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periods at risk of developing childhood obesity
There are at least three times during the life of a subject in which there is a greater likelihood that obesity will arise: the first year of life, the aged between 4 and 6 years and puberty. Three are also periods of hyperplasia adipociti11. The adipose tissue may be increased by hyperplasia (increased number of fat cells) and / or hypertrophy (increase in the volume of them). In fact, excess food consumption determines, in the long run, an excess of body fat and the appearance of phenomena such as overweight and obesity ....
is ... dimostrato che uno stile di vita sedentario nell’infanzia favorisce lo sviluppo di malattie cardiovascolari , diabete e obesità in età adulta26. Una moderata attività fisica, come camminare o andare in bicicletta offre sostanziali benefici per la salute: secondo l'Organizzazione Mondiale della Sanità, bambini > 2 anni dovrebbero impegnarsi in un’attività fisica moderata- intensa per almeno 30 minuti , tutti i giorni o più giorni alla settimana. Per attività fisica moderata-intensa, s'intende l’intensità degli esercizi che è stata definita in base alla frequenza cardiaca e che in generale quella moderata consiste in 30 minuti di jogging ad una andatura controllata, mentre quella intensa consiste in 30 minutes of running or shooting.
sedentary habits after school (abuse of television and computers), diminish the effectiveness of education in physical activity during school hours.
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Inactivity is a factor that greatly contributes to maintaining the child obesity
recommendation of the sports best suited to the age and IBM
In children of school age a kind of exercise program provides structured:
- BMI 17-20: Children (3-11 aa) overweight. Are recommended aerobic activities against gravity, such as walking, stair climber or treadmill exercise, participate in sports such as tennis, martial arts, skiing, indoor gym, swim, dance, dance aerobics.
- BMI 19-24: Children (3-11 aa): obese. Recommended aerobic activities: first, not against gravity, like swimming, bicycling, or aerobic training load (strength), aerobic dance specifically for the upper limbs, the arm ergometer (crank), bicycle and gear lying interspersed with frequent rest . BMI ≥ 24.1: Children (3-11 aa): severely obese. May be given a weekly specialist supervision.
- BMI ≥ 24.1: Children (3-11 aa) severely obese. May be given a weekly specialist supervision.
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Nutritional intervention:
The diet therapy is only one component of obesity treatment, even in childhood. The goal of treatment is to change the bad behavior of the lifestyle, improve diet, increase physical activity and decrease inactivity, ensuring growth fisiologica34, 35.36.
The nutritional intervention should be performed in patients with:
- Overweight in the presence of complications or risk factors
- Obesity, with or without complicanze37
And 'take priority a diet therapy program only when the children and family appear willing to make the necessary changes in the style of vita38.
approach started early (between 2-3 years old) seems to give longer lasting results (American Academy of Pediatrics, 40).
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The therapeutic strategy includes:
1) in the presence of a single mistake detected food: the correction of the same without necessarily changing the overall eating pattern;
2) in the presence of excessive caloric intake: l ' adopting a balanced eating pattern normocaloric age with gradual reduction of foods high caloric density and high fat content.
3) in the presence of a lifestyle characterized by physical inactivity: the development of appropriate physical activity can rebalance the energy balance;
4) in the presence of established clinical complication, usually associated with obesity in middle-high grade : the adoption of a moderately low-calorie, balanced diet pattern, given in line with the recommendations dietetiche39, 40,41,42,43: for low-calorie balanced diet means a pattern characterized by: a lower energy intake (30% reduction calories than the recommended energy requirements) and distribution of calories among macronutrients similar to normal, distributed among 5 meals, giving preference protein (15-20%), especially with reduction of lipid proportion (25-30%). The relatively high protein portion tends to maintain a normal intake in grams per kilogram of protein to prevent negativity of nitrogen balance. The purpose of this diet is to gradually reduce the weight of the boy, but manifestly, used to a proper diet. The distribution of the meals must be made in 5 events with food, and includes: 15% of calories at breakfast, in the presence of fruit and vegetables a day, two small snacks that provide energy to 10-15%, 35-40% at lunch , 30% at dinner.
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dietary recommendations to prevent obesity Infant
The Royal College of Paediatrics in 2002 published the following dietary recommendations in the prevention of child obesity scolare53:
1) healthy and balanced diet, not monotonous, which alternate daily food since all active adequate to prevent deficiencies of nutrients, with a contribution of 10-15% protein, 28-30% fat and 60% carbohydrates.
2) Avoid excessive calorie intake, but eating in relation to what you consume and give the child time to eat with confidence to foster a sense of satiety. The energy requirement varies according to age, sex, the physical shape, height and type of activity taking place.
3) Give a proper distribution of the meals and calories in the day with a breakfast in the division by 15%, 5% in the snack, lunch 40%, 10% and 30% in the tea with the meal, and avoid foods out more meal.
4) Give a proper distribution of nutrients through the rotation of the different foods with the reduction of protein and animal fat, simple carbohydrates with an appreciation of complex carbohydrates. It is also recommended adequate intake of fiber through the use of fruits, vegetables and legumes, presented in a visually pleasing (at least 5 servings per day) a lower salt intake, the use of plain water rather than sugary drinks and cooking methods that require little fat.
5) Proper nutrition education can not be separated from the reduction of sedentary behavior and the increase in exercise, particularly those carried out in the open air, with a reduction, then, sedentary lifestyles, and especially the hours spent watching TV.
