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Obesità patologica

L’Obesità è un’epidemia mondiale

Fino ad alcuni anni fa, l’obesità era considerata una condizione legata, in particolar modo, agli abitanti dei Paesi industrializzati o meglio ad una Società in cui il troppo benessere aveva facilitato, nel corso del tempo, ripetuti eccessi alimentari uniti ad uno stile di vita rigorosamente sedentario. Negli ultimi venti anni, invece, questo fenomeno si è diffuso, in modo progressivo, anche nei Paesi emergenti. 

Nel 1997, l’Organizzazione Mondiale della Sanità, il massimo organo di controllo della Salute internazionale e della Sanità pubblica, ha riconosciuto la natura epidemica “globale” dell’obesità definendola “… una condizione caratterizzata da un eccessivo peso corporeo per accumulo di tessuto adiposo, in misura tale da influire negativamente sullo stato di salute”. In pratica la medicina moderna inquadra l’obesità come una vera e propria malattia in quanto ad essa sono associate diverse condizioni patologiche a carico di vari organi ed apparati. 

CICCIONE-BICI-300x224Dal punto di vista epidemiologico, l’obesità patologica costituisce un problema rilevante per la società odierna: La WHO ha previsto che nel 2015 il numero di adulti in sovrappeso raggiungeranno i 2,3 miliardi, mentre gli obesi saranno più di 700.000. Il problema sta assumendo proporzioni francamente epidemiche, la cosiddetta globesity, e secondo i dati pubblicati dall’ International Obesity Task Force ad oggi oltre 1miliardo di persone adulte sono in sovrappeso e circa 310 milioni sono obese. Nei bambini/adolescenti le stime rispettive sono di circa 160 e 40milioni. In Europa la prevalenza dell’obesità è aumentata di tre volte nelle ultime due decadi ed è destinata a raddoppiarsi nei prossimi trent’anni se non si interviene efficacemente (secondo i dati della Conferenza ministeriale europea per la lotta all’ obesità, Istanbul 2006).  Attualmente si stima che la metà della popolazione sia in sovrappeso; la percentuale dei soggetti francamente obesi invece varia dal 10 al 20% negli uomini, e dal 15 al 25 % nelle donne. Anche in Italia l’obesità rappresenta un problema sanitario di crescente e pressante gravità; la percentuale di soggetti in sovrappeso è di circa il 35 %, con una prevalenza nel sesso maschile, mentre quella di soggetti francamenti obesi è di circa il 10% , con una piccola prevalenza per il sesso femminile e per le regioni meridionali.  L’andamento è in preoccupante aumento se si considera che il numero di obesi dal 1994 ad oggi è cresciuto del 25% , che ad aumentare non è tanto il numero dei soggetti in sovrappeso quanto quello dei pazienti obesi e che, infine, si registra il record europeo di bambini / adolescenti in sovrappeso, 36%, ed obesi, 10-15%. Infine l’ultimo rapporto dell’Istituto Auxologico Italiano, pubblicato nel 2007, indica un ulteriore significativo peggioramento. Il dato più allarmante è costituito dal fatto che in soli 4 anni la popolazione dei soggetti in sovrappeso sia aumentata di circa 6.000.000 di unità.

Un argomento quindi di particolare rilevanza, dalle dimensioni medico-sociali ed economiche preoccupanti anche per le numerose patologie degenerative e di organo, che possono determinare effetti negativi sulla qualità e sulle aspettative di vita di un individuo.

Dati ISTAT mostrano che in Italia c’è stato un incremento  percentuale del numero di adulti obesi del 9% dal 2000 al 2005; inoltre a 6-9 anni un bambino su tre è sovrappeso, mentre lo è uno su quattro a 10-13 anni. Secondo uno studio europeo, nel  2002 in Italia ci sono state 57000 morti  attribuibili a sovrappeso e obesità.  L’eccesso ponderale è infatti correlato ad una aumentata morbosità e mortalità.Il rischio di mortalità aumenta proporzionalmente con l’incremento del peso. L’eccesso di peso corporeo non solo riduce l’aspettativa di vita, ma ne peggiora la qualità. Il costo socio economico dell’obesità incide in maniera cospicua sulla spesa sanitaria: tra costi diretti ed indiretti è stato stimato che il peso economico si aggira tra il 2% ed l’8%, di quello totale.

Come si misura l’obesità                                                                                                                             L’obesità è misurata, solitamente, mediante l’ Indice di Massa Corporea (body mass index, BMI o IMC), calcolato dividendo   il peso corporeo in chilogrammi per l’altezza in metri quadri (kg/m²).In base al B.M.I., vengono solitamente definiti diversi gradi di obesità:

imc-255x300

  • SOVRAPPESO  un BMI ≥25 kg/m²,
  • OBESITÀ DI I, II E III GRADO: valori di  BMI compresi rispettivamente tra 30-34.9 kg/m²,   tra 35-39.9 kg/m²  e  ≥40 kg/m².
  • OBESITÀ CLINICAMENTE SEVERA O PATOLOGICA: valori di BMI che rientrano nella Classe III (BMI>40 kg/m²) e  nella Classe II (35<BMI>39.9 kg/m²), con associate comorbosità (coestistenza di due, o più, patologie diverse, in uno stesso individuo).

 

 

 

L’obesità è una patologia cronica                                 

L’obesità è una patologia cronica, ad eziologia multifattoriale, che nasce dallo squilibrio tra la spesa energetica e l’introito calorico. Essa è influenzata da numerosi fattori che agiscono contemporaneamente, comprese le cattive abitudini alimentari, lo scarso esercizio fisico (incidenza del 60-80%) e, anche, la predisposizione genetica (incidenza stimata intorno al 20-40%). Sono molteplici gli studi che hanno dimostrato come il paziente affetto da  obesità patologica,  sia maggiormente colpito da numerose patologie croniche ed invalidanti, come il diabete (90% dei pazienti diabetici sono in sovrappeso e/o obesi), l’ipertensione arteriosa (70%), l’insufficienza respiratoria, spesso associata ad apnee notturne (60-90%), l’artrosi delle articolazioni (gonartrosi:1.45%) e diverse neoplasie come carcinoma del colon retto(40-50%), dell’endometrio (34%), e della mammella (11%).

Conseguenze delle patologie, che possono essere correlate all’obesità                                                   Le conseguenze delle patologie anzidette, oltre a determinare sofferenza e  ridurre, nel tempo, le capacità lavorative e sociali dell’individuo, comportano, purtroppo, anche un aumento del rischio di morte.

La mortalità nei pazienti con obesità patologica risulta, infatti, 2-3 volte più alta, rispetto alla popolazione in normopeso.

Innumerevoli studi, inoltre, hanno dimostrato come le diverse patologie obesità-correlate subiscano un sensibile miglioramento, fino alla completa remissione, qualora il paziente riesca a riportare il proprio peso nell’ambito della normalità, oppure riesca a ridurlo significativamente e stabilmente nel tempo.

Le Metodiche non chirurgiche                                                                                                                        Ad oggi, le metodiche non chirurgiche, per ottenere la riduzione del peso corporeo, sono risultate inefficaci nel produrre un significativo calo ponderale a lungo termine – come è stato dimostrato dallo  studio –  Swedish Obesity Subjects (SOS)  –  dove il calo ponderale, mantenuto al termine di un follow-up di 10 anni, nel GRUPPO CHIRURGICO di 2000 PAZIENTI,  corrispondeva in media al 16.1% del peso iniziale, in contrasto con il GRUPPO MEDICO di 2000 PAZIENTI,  che mostrava, invece, un aumento del 1.6% del peso iniziale. 

La CHIRURGIA BARIATRICA si dimostra essere una valida alternativa terapeutica per tutti i pazienti affetti da obesità patologica, ove tutti gli altri presidi terapeutici di tipo conservativo, siano risultati inefficaci. 

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