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ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ
Άσκηση και Παχυσαρκία
Η παχυσαρκία ως επιβαρυντικός παράγοντας στην
υγεία – Συνοδές ασθένειες
Σακκάς Γεώργιος PhD
Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού
Άδειες Χρήσης
• Το παρόν εκπαιδευτικό υλικό υπόκειται σε άδειες
χρήσης Creative Commons.
• Για εκπαιδευτικό υλικό, όπως εικόνες, που υπόκειται
σε άλλου τύπου άδειας χρήσης, η άδεια χρήσης
αναφέρεται ρητώς.
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Χρηματοδότηση
• Το παρόν εκπαιδευτικό υλικό έχει αναπτυχθεί στα πλαίσια
του εκπαιδευτικού έργου του διδάσκοντα.
• Το έργο «Ανοικτά Ακαδημαϊκά Μαθήματα Πανεπιστημίου
Θεσσαλίας» έχει χρηματοδοτήσει μόνο τη αναδιαμόρφωση
του εκπαιδευτικού υλικού.
• Το έργο υλοποιείται στο πλαίσιο του Επιχειρησιακού
Προγράμματος «Εκπαίδευση και Δια Βίου Μάθηση» και
συγχρηματοδοτείται από την Ευρωπαϊκή Ένωση (Ευρωπαϊκό
Κοινωνικό Ταμείο) και από εθνικούς πόρους.
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Σκοποί ενότητας
• Η απόκτηση γνώση για τις σχετιζόμενες με την
παχυσαρκία συνοδές ασθένειες και πως αυτές
επηρεάζουν το προσδόκιμο ζωής των ατόμων
αυτών.
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Περιεχόμενα ενότητας - Contents
• Associated Comorbidities (συνοδές ασθένειες)
– Cardiovascular Disease
– Respiratory Complication
– Stroke
– Autonomic Nervous System
– Diabetes
– Dyslipidemia
– Gastroesophageal Reflex
– Arthritis
– Urinary Incontinence
– Non-alcoholic Liver Disease
– Psychological Disorders
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What is Obesity – What is the risk
Overweight is BMI of 25 to 29.9 Kg/m2
Obesity is BMI anything above 30 Kg/m2
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Obesity - Metabolic Syndrome (MetS)
• MetS composed of:
–
–
–
–
–
Insulin resistance
Abnormal fasting glucose levels
Increased cholesterol (total, LDL) and TG
Increased blood pressure
Increased WHR or central adiposity (visceral fat)
• MetS is associated with
– Obesity & Diabetes
– CardioVascular Disease (CVD)
• Optimal BMI for a healthy life from age 18 to 85 is the
23 to 25 (23-30 African American)
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Obesity - Metabolic Syndrome (MetS)
• The life-shortening effect of obesity rises if
(obese) young people stay obese until the
middle and older ages compared to if they
become obese into an older age.
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MetS affects the whole body
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Obesity and Cardiovascular Disease
• Studies have shown that
– adolescence obesity predicts mortality (θνησιμότητα) rates by
80% in male and 100% in female patients
– the risk of death is independent of adult BMI but dependent
of “since when” the adult was obese
• Obesity is associated with reduced life expectancy
(προσδόκιμο ζωής)!
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Cardiovascular Impact of Increased Fat Mass
Adipose Tissue Circulation
• Increased Adipose tissue leads to edema
• Adipose tissue has an extensive capillary network
• Resting blood flow is 2-3ml/min/100g fat
• Increased after meal to 20ml/min/100g fat
• In obesity, perfusion is reduced in 1.5ml/min/100g
fat meaning that the water between the fat cells
(interstitial space) is not accessible leading to
increased edema
• In addition, 30% of the circulated IL6 (Interleukin-6)
comes from the adipose tissue
• IL6 modulates CRP – marker of chronic inflammation –
that can trigger acute coronary syndrome
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Left Ventricular Hypertrophy
(υπερτροφία της αριστερής κοιλίας)
• At any given level of activity,
the cardiac workload and
peripheral resistance are
greater for obese subjects
• Due to increased left
ventricular filling pressure and
volume – chamber dilation –
there is a high risk for Left
Ventricular Hypertrophy (LVH)
• In weight reduction a decrease
in central blood volume gives
relief from edema and
dyspnea
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Lipid Deposition in Organs
•
Lipid deposition can impair tissue or organ function in
three ways:
• Fat around organs can modify function due to
• increased pressure (compression)
• periorgan fat cells secreting various acting
molecules
• Lipids accumulation may lead to cell dysfunction
or cell death – known as Lipotoxicity
• Fat deposition in cardiac muscle (epicardial fat)
could lead to cardiomyopathy
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Vascular Disease in Obesity
• Venous Stasis (φλεβική στάση), lower leg edema and
cellulitis (κυτταρίτιδα) due to venous valvular
incompetence
• Venous thrombosis and pulmonary embolism – 2.5 times
more risk with waist circumference >100 cm
• Abnormal endothelial function due to decrease NO (nitric
oxide) meaning increased oxidative stress
• Decrease in NO function leads to increased
vasoconstriction and increased vascular resistance
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What is Hypertension?
Hypertension or high blood pressure is a condition in which the
blood pressure in the arteries is chronically elevated.
Blood pressure is the force of blood that is pushing up against
the walls of the blood vessels.
If the pressure is too high, the heart has to work harder to pump,
and this could lead to organ damage and several illnesses such as
heart attack, stroke, heart failure, aneurysm, or renal failure.
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What is Hypertension?
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Hypertension in Obesity
(υπέρταση)
• The majority of hypertensive patients are
overweight
• Hypertension is 6 times more frequent in obese
than in lean subjects
• Weight gain in a previously lean subject is a
potent risk for developing hypertension
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Hypertension in Obesity
• A 10 kg increase in body weight is associated
with 3 mmHg higher systolic and 2.3mmHg higher
diastolic blood pressure
– This is translated into 12% risk for Coronary Heart
Disease (CHD) and 24% for stroke
• Blood Pressure = Cardiac Output * Systemic
Vascular Resistance
– C.O. is increased due to oxygen demand from the
excess fat tissue, SVR is increased due to endothelial
dysfunction (NO etc)
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Peripheral Vascular Resistance in Obesity
(περιφερεική αγγειακή αντίσταση)
• Obesity is associated with inflammation
• Strong correlation between IL6, CRP and obesity
• IL6 stimulates CRP from the liver
• Increased IL6 is correlated with systolic and diastolic
blood pressure
• Obesity is considered a
“low-grade systemic inflammation”
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Respiratory Complications in Obesity
(αναπνευστικές διαταραχές)
• Obese subjects have
–
–
–
–
Increase demand for ventilation
Increased breathing workload
Respiratory muscle inefficiency
Decreased functional reserve capacity
and expiratory reserve volume
– Closure of peripheral lung units
• Ventilation-Perfusion mismatch
(supine position)
• Obesity is a classic cause of alveolar
hypoventilation (κυψελιδικός
υποαερισμός)
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Apnea in Obesity
(υπνική άπνοια)
• Obesity is by far the most important
risk factor for sleep disorders
• Sleep Apnea – repeated episodes of
obstructive apnea and hypopnea
during sleep, together with daytime
sleepiness or altered
cardiopulmonary function
• Hypertension rises with sleep
disorders
• Sleep apnea is associated with
increased levels of CRP
• Sleep Apnea – Hypertension –
Atherosclerosis
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Pulmonary Hypertension in Obesity
(πνευμονική υπέρταση)
• 15-20% of Sleep Apnea patients suffer from
Pulmonary Hypertension
• MetS is associated with Pulmonary Hypertension
• Mechanism: Obesity relates to sleep apnea –
relates to alveolar hypoventilation – relates to
alveolar hypoxia = pulmonary vasoconstriction
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Stroke & Obesity
(εγκεφαλικό επεισόδιο)
• Many studies have shown association between BMI –
WHR – Stroke
• Obesity is a potential risk factor for stroke
independently from cholesterol levels, hypertension &
diabetes
• Overweighted men (25 – 29.9 BMI) had 1.32 times
higher risk for Total Stroke, 1.25 for Hemorrhagic
Stroke and 1.35 for Ischemic Stroke
• If your BMI increases by 1 unit your risk increases by
– 4% for Ischemic Stroke
– 6% for Hemorrhagic Stroke
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Coronary Artery Disease in Obesity
(στεφανιαία νόσο)
• Obesity is associated with advanced
atherosclerosis in the Right Coronary Artery &
Abdominal Aorta
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Coronary Artery Disease in Obesity
• Central adiposity is more
important for atherosclerosis
than total body fat
• The levels of HDL , LDL,
hypertension, diabetes,
smoking and glycohemoglobin
accounted for the 15% of
atherosclerosis found in obese
patients…the rest is explained
by central fat (visceral fat)
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Arrhythmias in Obesity
(αρρυθμίες)
• “Sudden death is more common in those who are naturally
fat than in the lean” Hippocrates
• Obese subjects have an increased risk of arrhythmias and
sudden death even in the absence of cardiac dysfunction
• Abnormal prolonged QT interval found in obese patients
• QT abnormalities are associated with central adiposity or
insulin resistance
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Autonomic Nervous System & Obesity
(αυτόνομο νευρικό σύστημα)
• ANS regulates cardiovascular system and energy
expenditure
• 10% increase in body weight = decline in parasympathetic
tone = increase in resting heart rate
• Increase of resting HR is associated with high mortality
rates
• 10% reduction in body weight in severely obese subject
resulted improvement in cardiac function
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Diabetes in Obesity
(διαβήτης)
• More than 95% type 2
diabetes is attributed
to obesity
• The risk of type 2
diabetes increases with
weight gain
• With weight loss, type
2 diabetes and insulin
resistance is improved,
diabetes medication is
reduced
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Dyslipidemia in Obesity
(δυσλιπιδαιμία)
• Obesity is associated with increased total
cholesterol, increased LDL, decrease HDL and
increased TG levels
• With weight loss, lipidemia is improved by
40% and stays there until weight is regained
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Gastroesophageal Reflux in Obesity
(γαστρο-οισοφαγική παλινδρόμηση)
• Obesity is a major risk
factor for
gastrointestinal reflux
disease (γαστροοισοφαγική
παλινδρόμηση)
• Improvement of these
symptoms have been
found in the majority of
the patients who lost
weight
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Degenerative Joint Disease in Obesity
(ασθένειες του κολλαγόνου)
• Obesity is clearly a cause of large joint
degeneration (ασθένειες του κολλαγόνου) and
arthritis
• With weight loss, obese patients have found
relief from pain in hips, knees, feet and lower
back
• Arthroplasty is safe when the patients are within
the normal weight range
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Urinary Incontinence in Obesity
(ακράτεια ούρων)
• Obesity appears to be an important etiologic
factor in stress urinary incontinence (ακράτεια
ούρων), probably through the mechanism of
increased abdominal pressure
• With weight loss, studies have shown
decrease in intra-abdominal pressure,
decrease in sagittal abdominal diameter and
decrease in stress urinary incontinence
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Non-alcoholic Steatohepatitis in Obesity
(μη αλκοολική στεατοηπατίτιδα)
• Nonalcoholic Liver Disease and Nonalcoholic
SteatoHepatitis are strongly associated with
obesity and type 2 diabetes
• NASH may result in cases of cirrhosis and liver
failure
• Deposition of fat in the liver is the primary
suspect but the pathophysiology is unknown
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Psychiatric and Social Disorders in Obesity
(ψυχιατρικές διαταραχές)
• The morbidly obese frequently suffer from poor self-image
and social stigmatization
• They are at special risk for affective disorders, anxiety and
substance abuse (drugs)
• Repeated diets could lead to depression, anxiety and food
preoccupation
• After weight loss, patients have been shown to have better
mood, self-esteem and to become more socially active
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Summary
• Obesity is always followed by something else…
• From metabolic syndrome and urinary
incontinence to psychiatric disorders
• The years that somebody has been obese, highly
related to the risk of death
• Reduction of body mass (kg) results in a
significant improvement in total health
• The combination of exercise and diet is the
optimal way to loose weight and keep it away
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