International Journal of Risk & Safety in Medicine - Volume 7, issue 2
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: We stand today at the threshold of major changes in our policies on the treatment of obesity. These treatments, surgical for severe obesity, behavioral for lesser degrees of obesity, produce predictable weight losses with almost complete safety but poor maintenance of these losses. New findings on the distribution of body fat have profound implications for treatment. It is upper body obesity, particularly the visceral fat depot, that conveys most of the medical risk of obesity, and upper body obesity is a problem primarily afflicting men. Paradoxically, most persons coming for treatment for obesity are women, driven by the merciless stigma…that attacks women for their obesity. Two major changes in our policies on the treatment of obesity are strongly indicated. First, we must encourage men to enter treatment for obesity in numbers commensurate with the serious risks of their obesity. Second, we must make every effort to decrease the stigma of obesity for women. Lay self-help organizations such as OBESITAS can play a key part in this endeavor. It can help to apply legal sanctions against discrimination where such laws exist and advocate such laws where they do not. It can educate the public and it can use its immense creativity to develop new methods of reducing stigma.
Keywords: Obesity, Upper body obesity, Stigma, Discrimination, Obesity treatment policy
Abstract: Obesity (defined as a body mass index >30 kg/m2 ) is common in middle-aged Europeans. The prevalence is notably high in women from Mediterranean and Eastern European countries. cological comparisons show no relationship between obesity and coronary heart disease mortality in men and a weak association in women (which is stronger after adjustment for smoking). Within countries, however, increased BMI is associated with increased cardiovascular risk factors in populations across Europe. In the Netherlands the direct health care costs associated with overweight and obesity (BMI >25 kg/m2 ) have been calculated to be about 1 billion Dutch guilders which corresponds…to about 4% of total costs of health care.
Abstract: Obesity is unique because of the multiplicity of severe complications and the obscure etiology of the disease. Surgical treatment of obesity is also unlike most other surgery. It is neither pathology-oriented nor symptomatic: since the etiology of obesity is not known, the surgery can not have curative intent. Anti-obesity surgery is not a technical exercise, though technique is important, but rather should be seen as a behavioral intervention, requiring extensive preoperative education and life-long follow-up. The risks of most anti-obesity surgery have been reduced to levels significantly below the risk of severe obesity itself. Reduction of comorbidity and improvement…in quality-of-life justify this treatment modality which is much more effective than all non-surgical methods in maintaining medically significant weight loss. Recent developments of minimally invasive techniques, with higher margins of safety and less discomfort, should increase the role of surgery in secondary prevention through earlier intervention.
Abstract: Human obesity is characterized by a series of medical complications, including glucose intolerance, hypertension, dyslipidemia and alterations in haemostasis and fibrinolytic functions. These elements of the so-called syndrome X or polymetabolic syndrome, can easily and prematurely lead to early atherosclerosis. Abdominal obesity, and its visceral component in particular, is the most detrimental aspect of health-related risk. We have shown that hyperlipidemia and hypertension are important consequences of abdominal fat accumulation and they may account for at least a part of the relationship between overweight and coronary heart disease. Despite the fact that some gender differences exist, these results confirm earlier…results of the effect of fat distribution on lipids, lipoproteins and the subsequent risk of ischemic heart disease. The addition of hyperinsulinaemia and insulin resistance completes the cluster of syndrome X, as was shown in previous epidemiological and prospective studies.
Abstract: There is an important relationship between the expression of human appetite and the macro nutrient composition of the prevailing diet. Evidence indicates a correlation between the amount of fat consumed and body weight gain or the degree of adiposity. The pattern of eating behaviour is represented by the size and number of eating episodes (meals and snacks). The size of eating episodes is influenced by the process of satiation and the intervals between episodes by post-ingestive satiety. Protein appears to exert the most potent control over appetite. Carbohydrate also generates strong post-ingestive satiety with the intensity and duration depending upon…the particular structure of the carbohydrate. High fat foods exert weak control over satiation and generate a weak satiety response relative to the proportion of energy ingested. High fat foods therefore have the potential to generate a form of passive overconsumption. The high energy density and potent oro-sensory qualities of high fat foods allows the rate of ingestion to overcome fat-induced satiety signals. This situation suggests behavioural, nutritional and pharmacological strategies to prevent fat-induced passive overconsumption and to improve the effect of fat on appetite control.
Abstract: 635 obese children and adolescents were treated in a dietary programme. They all had an elevated body mass index (BMI) in excess of 130% of the P50 BMI for age. The daily food intake was calculated from a 3-day diary. The children aged 6–12 years (group 1) had a total caloric intake superior to that of the children aged 12–17 years (group 2) in terms of % recommended dietary allowances (RDAs). The fat intake was higher in group 2 and the ratio of polyunsaturated to saturated fatty acids (P/S ratio) was lower. The fibre and the water consumption were too…low, and were comparable in both groups. A hypocaloric balanced diet was proposed with a total energy intake corresponding to 65% of the RDAs, 30% lipids, 50% carbohydrates and 20% proteins. A better long-term follow-up was observed in children of group 1. The rate of success (decrease of the excess BMI) was comparable at 6 months and proportionally superior in group 2 after one year. This simple therapeutic approach could be promoted by general practitioners, pediatricians and dieticians in countering the very considerable increase in juvenile obesity in industrialized countries.
Keywords: Obesity, children, Dietary programme, Body mass index
Abstract: Obesity is an escalating problem in many countries. There is a need to reduce the average body weight of a population, not simply treat the extremes. This requires consideration of societal factors which affect body weight. Weight increases with age, the increase leading to a higher proportion of body fat to lean tissue. Causes include progressive inactivity and dietary fat which often accompany increasing affluence. A body mass index (BMI) of 20–25 is generally advised, but some suggest a BMI of 20–22 for lowest risk of disease. The risk of smoking when thin exceeds the risk of being overweight, so…dietary advice is important on cessation of smoking. Genetic susceptibility to weight gain is strongly influenced by nutrient interactions at all stages of life. Foetal and neonatal nutrition may modify body weight in later life. Familial trends of reduced activity and low metabolic rate need to be addressed, as does the problem of lower metabolic rates and lower food needs after weight loss. Appetite control is poorly understood but dietary fat and energy density of food and exercise are important factors. For those who miss breakfast, the loss of a low fat meal of cereals and toast is significant. The strong influence of dietary fat on obesity and associated disease risks has led to expert committees to develop population nutrient goals which limit dietary fat. An energy discrepancy of only 2% a day can explain an increase in body weight of 5 kg/year. It is easier to understand why people become fat than to tackle the societal issues which affect the prevalence of obesity.