CUPRINSCAPITOLUL II. ARGUMENT...............................................................................2CAPITOLUL IIII.1 PREZENTAREA GENERAL A OBEZIT II .........................5Defini ie ..............................................................................................5Clasificare...........................................................................................5Ei!l!"ie..............................................................................................#$i%&!%a!l!"ie.................................................................................#Dia"n!sic &!'ii(...............................................................................)Dia"n!sic *iferen ial ..........................................................................+E(!l, iei &r!"n!sic .........................................................................+Traa%en............................................................................................+C!%&lica ii .......................................................................................12II.2 ROLUL A$I$TENTULUI MEDICAL -N -NGRI.IREABOLNA/ULUI CU OBEZITATE....................................................CAPITOLUL IIIIII.1.PARTEA PRACTIC00.......................................................1#CAZUL I0000000000000000..00...0001#CAZUL II 0000000000000000000..00 21CAZULIII 000000000000000000000. 21CAPITOLUL IVI/.1......EDUCA IA PENTRU $NTATE A PACIENTULUI CU OBEZITATE............................................................................0.. 2)CONCLUZII: ......................................................................................... 38BIBLIOGRAFIE ................................................................................... 391CAPITOLUL IARGUMENTObezitatea ese ! sare &a!l!"ic3 4 *in "r,&,l 5!lil!r *e n,ri ie 4 sa, fi'i!l!"ic3 c, &!en ial &a!l!"ic6 care se refer3 la &ers!anele s,&ra&!*erale.D!%eni,l %e*ical care se !c,&3 *e !5e'iae se n,%e e 7 baiatie8. D,&3 Ga5riela R!%an6 !5e'iaea ese ! 5!al3 cr!nic3 c, ei!&a!"enie %,lifac!rial3i risc "l!5al cresc,6 ceea ce &res,&,ne ,n %ana"e%en clinic sr,c,ra6&rec!cei inensi(6 c, srae"ii era&e,ice eficiene a*resae c9 %ai %,l!r%ecanis%e fi'i!&a!l!"ice i%&licae.-n3rile *e'(!lae inci*en a !5e'i3 ii ese %ai ri*ica3 *ec9 :n3rile %ai &, in *e'(!lae. Pr!fesiai %!*,l *e (ia 3 ;ra*i ie6 !5icei,ri6 facili3 i< =!ac3 ,n r!l i%&!ran. D!,3 rei%i *in &!&,la ia $UAc!ns3 *in s,&ra&!n*erali. O rei%e *in &!&,la ia $UA c!ns3 *in !5e'i. -n an,l 2>>)6 :n Marea Brianie 12>2 cerificae *e *eces %en i!na, !5e'iaea ca fiin* ,n,l *inre fac!rii carea, c!nri5,i la *eces.C!nf!r% ra&!arel!r OM$ R!%9nia ese &e l!c,l rei :n E,r!&a :n &ri(in a !5e'i3 ii la c!&ii. P!ri(i ?e*era iei R!%9ne *e Dia5e6 N,ri iei B!li Infec i!ase6 ,n r!%9n *in &ar, ese !5e'6 iar fiecare al *!ilea r!%9n eses,&ra&!n*eral. A% ales aces s,5iec &enr, s,s inerea &r!iec,l *e a5s!l(ire *a!ri3inci*en ei !5e'i3 ii in ran*,l &!&,la ieii6 %ai ales a cre erii %!r5i*i3 ii aceseia6 fen!%en s!cial ce &!ae fi caal!"a ca ,n fla"el ec!n!%ic!4s!cial.S!"#$% #eze&t$%$i #"ie!t ese ,n &rile= *e a &,ne :n &racic3 c,n!@inAele *!59n*ie &e &arc,rs,l anil!r *e s,*i, &rin i*enificarea &r!5le%el!r s&ecifice *e in"ri=ire la ,n &acien !5e'.Parc,r"9n* ea&ele &r!iec,l,i6 c!la5!ra c, &racica *in insi,Aiile saniare6 a% a=,ns la c!ncl,'ia c3 fiecare &acien re5,ie raa ca ,n ! ,niar6 ca ! eniae6 %ai &recis ca ! fiinA3 ,%an3 care are 11 ne(!i f,n*a%enale6 ,nele *inre ele saisf3c,e6 alele nesaisf3c,e6 iar :n"ri=irile :n*re&ae c3re el re5,ies3 fie &ers!nali'ae6 in ca',l *e fa 36 acesea fiin* a*resae in"ri=irii ,n,i &acien!5e'.P"b%e'e%e &e care le &!ae &re'ena ,n 5!lna( c, !5e'iae @i *e care re5,ie s3 Ain3 sea%a asisen,l %e*ical la :n!c%irea &lan,l,i *e :n"ri=ire s,nB si%3 *e sine sc3',3 4 ! &ers!an3 s,&ra&!n*eral3 sa, !5e'3 (a a(ea ! i%a"ine *e sine ne"ai(3 @i (a fi :nclina3 s34@i eli%ine *isc!nf!r,l &rinr4,n c!ns,% @i %ai %are *e ali%ene. De ase%enea6 e@ec,rile re&eae ale ,n!r re"i%,ri *e sl35ire accen,ea'3 i%a"inea ne"ai(3 f3c9n* @i %ai *ificil3 a&licarea srae"iil!r *e sc3*ere &!n*eral3C &r!5le%e afeci(e 4 s3rile *e sress &siDic6 anEieae sa, afecAi,nile *e i&,l *e&resiei sa, *,rerii cr!nice6 &ers!an3 in*e s3 se s,sra"3 *e la re'!l(area &r!5le%el!r @i ale e%!Aiil!r ne"ai(e &rin ref,"ierea :n %9ncareC 2 ra,%e &siDice 4 e(eni%ene ra,%ai'ane &rec,% a5,',l fi'ic sa, seE,al:n i%&,l c!&il3riei6 *eces,l ,n,i &3rine :n &eri!a*a a*!lescenAei sa, &r!5le%e *e c,&l, ;(i!lenA3 *!%esic3< &! a(ea ,n i%&ac i%&!ran :n ei!&a!"enia !5e'i3AiiC c!ns,%,l *e alc!!l 4 5erea sa, c!cFail4,rile c!n in %,le cal!riii &re*is&,n la a&ari ia !5e'i3 ii *e i& an*r!i*C c!ns,%,l ,n!r %e*ica%ene ;ani*e&resi(ele sa, %e*ica ia"l,c!c!ric!i*3< sa, &re'en a ,n!r afec i,ni &rec,% sin*r!%,l C,sDin"i Di&!ir!i*ia. *i(ersele &a!l!"ii as!ciae !5e'i3 ii ;Di&erensi,nea arerial36 *ia5e,l'aDara i& II6 Di&erli&!&r!eine%iile6 aer!scler!'a c!r!narian36 acci*ene(asc,lare cere5rale6 afec i,ni l!c!%!!rii6 sin*r!%,l *e a&nee in s!%nJ. O5e'iaea n, ese n,%ai ! &r!5le%3 eseic3 ci :n &ri%,l r9n* ! ,l5,rare *e n,riAie caraceri'a3 &rin s&!rirea "re,3Aii c!r&!rale %,l &ese ni(el,l "re,3Aii i*eale6 c, a%&le c!nsecinAe as,&ra s3rii *e s3n3ae. A&ariAia !5e'i3Aii infl,enAea'3 as&ec,l fi'ic al &ers!anei *ar @i sarea ei &siDic3. EEces,l&!n*eral "enerea'3 n,%er!ase c!%&licaAiiB *ia5e 'aDara6 afecAi,ni car*iace @i cere5r!4(asc,lare6 Di&erensi,ne arerial36 a&nee *e s!%n6 ,l5,r3ri l!c!%!!rii. De@i !5e'iaea ese c!nsi*era3 ! afecAi,ne c!%&leE3 n,riAi!nal4%ea5!lic3 eEis3 n,%er!ase %!*ali3Ai *e raa%en. Ese c!nsi*era3 !5e'3 acea &ers!an3 al c3r,i In*ice *e Mas3 C!r&!ral3 ;IMC< *e&3@e@e 2>. IMC ese ,n insr,%en *e e(al,are a "re,3Aii ra&!ra3 la :n3lAi%e. Un IMC cresc, re&re'in3 ,n fac!r *e risc &enr, !5e'iae. De ase%enea6 &enr, a&recierea eEces,l,i &!n*eral ese ,ili'a3 circ,%ferinAa a5*!%inal3. A&recierea !5e'i3Aii se &!ae face *,&3 ra&!r,l *inre "re,ae @i :n3lAi%e6 sa, *,&3 %3s,rarea &li,l,i c,ana. D,&3 in*icele Br!ca6 "re,aea i*eal3 eseBG 3 T4055in care G ese "re,aea in Fil!"ra%e6 iar T inali%ea in ceni%eri.De eEe%&l,B ,n in*i(i* :nal *e 16)> % re5,ie s3 ai53 ! "re,ae *e )> *e K". $e acce&a %ici (aria ii care n, re5,ie sa *e&3 easc3 1>415J. Mai eEac ese f!r%,la &r!&,s3 *e L!ren'BG 3 T4 05567T40859 : 5;$ete%et re&re'in3 ! %3s,ra!are saisic3 care c!%&ar3 "re,aeai :n3l i%ea ,nei &ers!ane. De i n, %3s!ar3 &r!cen,l *ees, a*i&!s ese ,il &enr, a esi%a "re,aeac!r&!ral3 n!r%al3 :n f,nc ie *e c9 *e :nal3 ese &ers!ana. Da!ri3 , ,rin ei calc,l3riii a %3s,r3rii sale IMC4,l ese cea %ai f!l!si3 %e!*3 *e *ia"n!sic a &r!5le%el!r *e "re,ae *inr4! &!&,la ie6 incl,'9n*B L s,5&!n*era5iliaea6 L s,&ra&!n*era5iliaeai? !5e'iaea. $e &!ae calc,la *,&3 ! f!r%,l3B "re,aea :n F"O:n3lAi%ea :n %2 sa, *,&3! Dar3 care c,&rin*e linii !ri'!nale c!res&,n'3!are "re,3Aii @i linii (ericale c!res&,n'3!are :n3lAi%ii @i linii c!n,rae &enr, *iferiele (al!ri ale IMC. Penr, c!&ii IMC4,l se calc,lea'3 la fel *ar ese c!%&ara c, (al!rile i&ice &enr, (:rsa res&eci(3. Disri5,Aia Aes,,l,i a*i&!s :n c!r& ese i*enifica3 *,&3 *!,3 i&,ri *e !5e'iaeB L an*r!i*3 si ? "in!i*3. Ti&,l an*r!i* *e !5e'iae ese le"a *e f!r%a 7ca *e %3r8 a c!r&,l,i. Esei&,l %asc,lin :n care ,%erii6 5raAele6 ":,l6 &ie&,l @i a5*!%en,l s,&eri!r s,n %3rie *e (!l,%. La acese &ers!ane !r"anele inerne cele %ai afecae s,n ini%a6 fica,l6 rinicDii @i &l3%9nii. Ti&,l an*r!i* *e !5e'iae are ,n risc cresc, *e afecare &,l%!nar3 @i car*iac3 &rin ni(el,l :nal *e c!leser!l. Ti&,l "in!i* *e !5e'iae ese cel caraceri'a *e f!r%a 7ca *e &ar38 a c!r&,l,i6 :n care "r3si%ea se *e&!'iea'3 %ai ales :n &area inferi!ar3 a c!r&,l,i.Ese :n:lni la a%5ele seEe *ar cele %ai afecae s,n fe%eile. Or"anele cele %aiafecae s,n rinicDii6 ,er,l6 inesinele6 (e'ica ,rinar3 @i c!l!n,l.Eti"%".ieEi!l!"ia !5e'i3Aii ese %,lifac!rial3.Aceasa c,&rin*e ,r%3!arele afecAi,ni care &re*is&,n la !5e'iae @is,&ra&!n*eraliaeB fac!rii %ea5!lici6 fac!rii "eneici6 se*enaris%,l6 sil,l *e(iaA36 fac!riien*!crini6 rasa6 seE,l6 (9rsa6 fac!riienici@i c,l,rali6 sa,,ls!ci!4ec!n!%ic6 !5icei,ri ali%enare6 ren,nAarea la f,%a6 sarcina @i%en!&a,'a6 fac!ri &siD!l!"ici6 *ia5e,l "esaAi!nal.Si'#t"'at"%".ieA fi !5e' ese ,n l,cr, %,l %ai seri!s *ec9 a a(ea ce(a %ai %,le Fil!"ra%e &ese "re,aea n!r%al3. Cele %ai i%&!rane si%&!%e :n ca',l !5e'i3 ii s,nB L Def!r%area c!r&,l,i *a!ra3 *e&,neril!r eEcesi(e *e "r3si%e. Ma=!riaea "r3si%ii :n eEces (a fi :n =,r,l alieii &e &ie& ;f!r%a *e %3r< 6sa, &e!l*,rii fese ;f!r%a *e &ar3412J la fe%ei. Grsimea de depozitare re&re'in3 ac,%,larea "r3si%ii :nes,,la*i&!s care &r!e=ea'3 !r"anele inerne. Caniaea eEac3 *e "r3si%e :n &r!cene a ,nei &ers!ane &!ae fi esi%a3 &rinBTestarea la infraro u &rin care se rans%ie ! l,%in3 infrar! ie :n%, cDi,l 5ice&s6 aceasa ese refleca3i a5s!r5i3 *e c3re "r3si%e. Me!*a ese ra&i*3i , !r *e f!l!si. Absorb iometria cu raze X (DEXA) ese %e!*a san*ar* *e esare a c!%&!'i iei c!r&!rale. D!,a i&,ri *iferie *e ra'e P scanea'3 c!r&,l6 ,na care*eecea'3 !aees,,rilei cealal3 care n, *eecea'3 "r3si%ea. Un c!%&,er (a s,5sra"e *!ar frac ia *ees, a*i&!s. Msurarea mediei densit ii corporale. De!arecees,,l "ras are !*ensiae sc3',3 fa 3 *e %, cDii !ase se &!ae esi%a c!n in,,l :n "r3si%e. $e f!l!sesc a&!i ,na *inre f!r%,lele Br!'eF sa, $iri &enr, a calc,la &r!cen,l *e "r3si%e. Analiza prin impedan a bioelectric. Princi&i,l ac i,nii sale &res,&,nea&licarea a *!i c!n*,c!ri &e c!r&i ri%ierea ,n,i c,ren elecric &rin c!r&.Re'isen a *inre c!n*,c!ri (a &er%ie %3s,rarea "r3si%ii c!r&!rale6 *e!arecere'isen a elecrici3 ii (aria'3 :nrees,,l a*i&!s6 %,sc,lari scDeleic. es,,rile f3r3 "r3si%e s,n 5,ne c!n*,c3!are *e elecriciae6 *e!arece c!n in a&3 %,l3 fa 3 *e cele "rase care s,n anDi*rei n, c!n*,c elecriciaea. 82ia.&")ti! ,i+ee& ia% O5e'iaea sec,n*ar3Obezitatea e&,"!i&@: Gi&erc!ri'!lis%C Ins,lin!%C O(ar &!licDisicCObezitatea Ai#"ta%a'i!@: T,%!ral3C Infla%a!rieC P!s4ra,%aic3 /asc,lar3 ;ane(ris%J *inre !5e'i a=,n" la (9rs3 *e )> *e ani.$e :nAele"e c3 &r!"n!sic,l f!r%,la *,&3 c,n!sc,a eE&resie &!&,lar3 Qc, c9 ese %ai l,n"3 c,rea,a6 c, a9 %ai sc,r3 (ia 386 ese f!are real3. Tata'e&t$c3*erea :n "re,ae a ,n,i !5e' :nce&e &rin sa5ilirea *e la :nce&, a ,nei5,ne c!la5!r3ri :nre %e*ic @i &acien. -nr4! &ri%3 ea&3 se (a &,ne accen,l &e :%5,n33Airea s3rii *e s3n3ae @i n, &e !5Ainerea ,nei "re,3Ai c!r&!rale i*eale Diea re&re'in3 ele%en,l *e 5a'3 al raa%en,l,i. C,ra *e sl35ire &r!&ri,4'is3 ;*ie3 @i scDi%5area %!*,l,i *e (iaA3>41H>> cal!rii la 53r5a iC ? Diea &rin a&!r cal!ric f!are re*,s 4 H>>412>>calO'i. Aces raa%en esere'er(a &enr, ca',rile *e !5e'iae eEre%3 care a, ne(!ie *e ! sc3*ere a "re,3 ii ra&i*3i ese a&lica *!ar s,5 srica s,&ra(e"Dere %e*ical3. Aceas3 *ie3 se &!ae a&lica &e ! &eri!a*3 sc,r3 *e i%&6 *e re",l3 *e 2 l,niL -nr4,n re"i% Di&!cal!ric s,n &er%ise ,r%3!arele ali%eneB4 la&e s%9n9ni6 ia,r *e"resa6 5r:n'3 *e (aci *ieeic36 ,r*34 carne sla53 *e (ac36 (i el6 &as3re ;&,i< 4 &e e sla5 4 !,3 fiere ari6 al5, ,l *e !, 4 le",%eB r! ii6 ri*icDi6 sala3 (er*e6 ar*ei "ra i6 casra(e i6 c!n!&i*36 *!(lecei6 (ar'3 al536 fas!le (er*e6 &re&arae caB salae6 s!e6 fiere :n53, ie. 4 fr,ceB %ere cre esi6 l3%9i6 "rea&fr,i6 &!r!cale6 %an*arine6 (i ine6 cire e. 4 "r3si%iB ,lei,ri (e"eale6 %ar"arin36 ,n :n caniae re*,s34 53,,riB sif!n6 s,c,ri *e le",%e6 fr,ce6 la&e ecre%a4 sareB :n %e*ie 5 "O'i.$e (!r *a 54# %eseO'i6asi",r9n*,4se asfel ! %ea5!li'are %ai 5,na a cal!riil!r reali'ae6 :%&ie*ic9n* ac,%,larea l!r s,5 f!r%a *ees, a*i&!s.Re.i' #e&t$ " zi:L ;cca 1>> cal!rii6 )5" &r!eine6 1>>" "l,ci*e6 25"li&i*e>" la&e rece sa, cal*Ora !:L ! cDifl3 ;5>"< sa, ! felie *e &9ine ;5>"< c, 5r9n'3 *e (aci10L ! cafea nea"r3 c, 'aDarin3"r#nz:?el,l IBL salae *e cr,*i3 i *in 2>>" (ar'3 al53 sa, r!sie sa, ri*icDi *e l,n3 sa,an*i(e6 sala3 (er*e sa, casra(e i6 sala3 *e r! ii6 ar*ei "ra i6 &ra' c, ! lin",ri 3 *e ,lei6 l3%9ie sa, ! e L se &! f!l!si 142 farf,rii *e s,&3 sa, ci!r536 &re&arae *in acelea i le",%ei acelea i cani3 i ca cele in*icae &enr, sala3. Ne&,9n* f!l!si ri*icDiilei an*i(ele6 le",%ele &enr, s,&e sa, ci!r5e se (!r c!%&lea c,l!5!*36 s&anac6 *!(lecei sa, c!n!&i*3.?el,l IIBL 1>>" carne sla53 *e (ac36 %9n'a6 &asare fiar36 fri&36 !ca3i fiar3 sa,fri&36 :n35, i36 c!nser(e *e carne sla53 &re&ara3 ras!l L sa, 15>" &ese sla56 sra(i*6 c!*6i,c36al3, ;c!n"ela sa, &r!as&3" 5r9n'3 *e (aci?el,l IIIBL ,n %3r ;1>>"" car!fi fier i :nn35, i i sa, 2>>" s!e,ri *in fas!le (er*e si 2>>" *!(lecei c, 2 lin",ri e ia,r ?el,l IBL 1>>" carne sla53 fri&3 sa, 15>" &e e sla5 ;a*ica s!r,l care s4a c!ns,%a la &r9n'