Iimpazamo ezibulalayo: Ukuchonga ukuba ngubani otyebileyo kwaye ngubani otyebileyo

Ingxaki yokutyeba kakhulu ifikelele kubungakanani bhubhane, hayi e-US kuphela kodwa kwihlabathi liphela. Inqaku kunyaka ophelileyo nguBoyd Swinburn kunye noogxa bakhe kwijenali laseBritane ILancet ulubize ngokuba "sisifo sehlabathi." E-US kuphela, umzekelo, phantse i-17% (i-12.5 yezigidi!) Yabantwana nakwishumi elivisayo ngoku bathathwa njengabatyebileyo; malunga ne-1/3 yabantu abadala batyebe kwaye enye i-1/3 batyebe kakhulu.

Sibona njani ukuba ngubani otyebileyo kwaye ngubani otyebe ngokugqithiseleyo? Ngokwesiqhelo, kubantu abadala, sisebenzisa isalathiso sobunzima bomzimba (i-BMI), obunzima bethu kwiikhilogram ezahlulwe ngobude bethu kwiimitha eziphindwe kabini. Nguwo umlinganiso, opapashwe ngu-Ancel Keys ngeminyaka yoo-1970, obuyela emva kwisazi sezibalo sase-Belgian senkulungwane ye-19 (kunye noyise wezibalo zale mihla), u-Adolphe Quetelet. Ngokwemigangatho yanamhlanje, esekwe ngasekupheleni kweminyaka yoo-1990, i-BMI engama-25 kg / m ² ukuya kwi-29.9 kg / m ² Ungaphezulu, kwaye i-BMI inkulu okanye ilingana ne-30 kg / m ² utyebe kakhulu, ngokuqhubeka ukwahlulahlula phakathi kwiCandelo I, II, III (ukutyeba kakhulu okanye ukugqithisa kakhulu), kunye neCandelo IV (ukutyeba kakhulu), kuxhomekeke kumanqanaba okwanda kwe-BMI. Njengoko benditshilo ngaphambili, umphandi uJeffrey Friedman, wase Rockefeller University, ucacisa ukuba ukutyeba kakhulu "ngumqobo". Ngamanye amagama, ichazwa xa i-BMI "idlula umda obekiweyo" onje ngokuba "ukwanda okuncinci kubunzima obuphakathi kunefuthe elingalinganiyo kwimeko yokutya kakhulu." I-BMI kuphela komlinganiso wokutyeba, kwaye uninzi lwabaphandi namhlanje lukholelwa ukuba ngumlinganiso ongacacanga, nakubantu abadala, kuba ayibaluleki kwimisipha kunye nobunzima bomzimba. Iimbaleki ezinomthambo obonakalayo zinokuthathwa njengezityebileyo ngelixa umntu osele ekhulile onokudlalisa imisipha (sarcopenia) enokuthathwa njengobunzima obuqhelekileyo xa eneneni etyebe kakhulu okanye etyebe kakhulu.

Ngaba ingxaki yokutyeba kakhulu ngakumbi kunokuba besicinga? Kutshanje u-Shah noBraverman, bebhala kwijenali I-PLoS Inye (2012) bacebise ukuba i-BMI ayichanekanga umlinganiso obukujongela phantsi kakhulu okona kuxhaphaka kokutyeba kakhulu. Kungenxa yokuba ukwanda kwamanqanaba okutyeba kunxulunyaniswa nokugula okukhulu kwezempilo (umzekelo, uninzi lomhlaza, isifo samathambo, uhlobo lwesibini seswekile, idyslipidemias, isifo sentliziyo, ukubetha, ukuphefumla xa ulala, njl.njl.) silinganisa xa sisebenzisa i-BMI. I-BMI iye yathandwa kakhulu kwaye yasasazeka njengesixhobo sokuqonda isifo ngenxa “yokulula, ukhuseleko, kunye nexabiso eliphantsi,” kodwa ukususwa kwayo "akunantsingiselo." Endaweni yoko, u-Shah kunye no-Braverman bacebisa ukuba umlinganiso ochanekileyo kunye nokuthe ngqo kwamafutha omzimba unokufunyanwa ngokusebenzisa i-DXA (i-X-ray ye-X-ray absorptiometry), umatshini ofanayo olinganisa uxinano lwethambo. Kuba lo matshini usebenzisa iX-reyi, ngokucacileyo ayinakusetyenziswa nabasetyhini abakhulelweyo. Bacebisa ukuba inzila yegazi leptin kufuneka isetyenziselwe ukubonisa iipesenti zomzimba. I-Leptin, njengoko benditshilo ngaphambili, yihomoni (ebekelwe bucala kwilebhu kaJeffrey Friedman) efihliweyo ikakhulu ziiseli ezinamanqatha (iadipocyte) naphakathi kwemisebenzi yayo emininzi, ilawula ukulingana kwamandla. Njengabantu abatyebe kakhulu abane-metabolic syndrome, (umzekelo, ukutyeba kakhulu esiswini, amanqanaba eepidid egazi, uxinzelelo lwegazi, kunye namanqanaba eglucose angaqhelekanga) aphezulu, nangona engakhathalelwanga amanqanaba e-insulin (okt imeko ye-insulin ukumelana), ukuze babe negazi eliphezulu amanqanaba e-leptin kunye nemeko ye-leptin insensitivity (okt, ukuxhathisa.)

Kuthekani ngokuchonga ukutyeba kakhulu ebantwaneni? Ukulinganiswa kobunzima kunye namafutha ngokukodwa ebantwaneni "kunzima kakhulu kwaye kuyabhidisa," ngokutsho kwabaphandi uKatherine Flegal noCynthia Ogden, bebhala kwijenali, Inkqubela phambili kwezesondlo kunyaka ophelile. Kubantwana i-BMI iyahluka kungekuphela ngobude kodwa nangobudala ngokunjalo.

I-Flegal ne-Ogden qaphela ukuba omabini la magama "ukutyeba kakhulu" kunye "nokukhuluphala," nangona esetyenziswa kakhulu, "anokungaqondakali" kwaye ngamanye amaxesha asetyenziswe ngokungafaniyo. Ngamanye amazwi, “isigama asikho mgangathweni.” Nangona kukho umahluko, "ukutyeba" kuthathwa njenge-BMI ukusuka kuma-85 ukuya kuma-95 eepesenti ngaphezulu kweminyaka yobudala kunye nesini kunye "nokutyeba" ngaphezulu kwe-95th percentile yabantwana, kodwa "ezi ndlela zokuziphatha azichanekanga ncam." Ezi zibalo, nangona kunjalo, kunokwahlulahlula iklinikhi. Bakwaqaphela ukuba asinayo “nayiphi na imigangatho eyamkelekileyo yokutyeba komzimba” okanye “nkqu nobungqina obunamandla bayo nayiphi na ingcaciso echanekileyo” yabantwana. abantwana basemngciphekweni weziphumo ezibi zempilo zexesha elizayo, nangona, umzekelo, amanqanaba aphezulu e-BMI ebantwaneni enxulunyaniswa nokugula okufana nokunyusa uxinzelelo lwegazi okanye iiprofayili ezingaqhelekanga zeepid, njl. ezinxulunyaniswa nesifo sentliziyo kubantu abadala.

Okukwintsusa : I-BMI kukujonga, endaweni yokuqonda isifo, ukungacacanga kwamanqatha abantwana, abakwishumi elivisayo kunye nabantu abadala, kwaye amanqanaba ayo okusika ayaphikisana kunye neenkcukacha-manani endaweni yeklinikhi. Cinga ngokucela amanqanaba e-leptin egazi kunye nezikena ze-DXA zovavanyo oluchanekileyo lwamafutha omzimba.