Foot pain is reported to be the second most common musculoskeletal symptom in children who are obese. Even adults who are overweight and obese report foot pain to be a common problem. Psychological consequences
Body fat can impact on an individual mentally, for example high levels of android fat have been linked to poor mental wellbeing, including anxiety, depression and body confidence issues. On the reverse, psychological aspects can impact on body fat distribution too, for example women classed as being more extraverted tend to have less android body fat. Waist–hip ratio
See gynoid fat distribution
Central obesity is measured as increase by waist circumference or waist–hip ratio. Increase in waist circumference > 102 cm (40 in.) in males and > 88 cm (35 in.) in females. However increase in abdominal circumference may be due to increasing in subcutaneous or visceral fat, and it is the visceral fat which increases the risk of coronary diseases. The visceral fat can be estimated with the help of MRI and CT scan. In females, measures of Waist to Hip ratio have been observed as an evolutionary sign of attractiveness and reproductive success. A females waist being smaller than her hips by a ratio of 0.7 is considered most attractive as it indicated readiness to give birth to offspring, and overall health to ensure survival of offspring. Waist to hip ratio is determined by an individuals proportions of android fat and gynoid fat.
Pharmacology
Rifaximin is a semisynthetic broad spectrum antibacterial drug, derived through chemical modification of the natural antibiotic rifamycin. It has very low bioavailability due to its poor absorption after oral administration. Because of this local action within the gut and the lack of horizontal transfer of resistant genes, the development of bacterial resistance is rare, and most of the drug taken orally stays in the gastrointestinal tract where the infection takes place. Mechanism of action
Rifaximin interferes with transcription by binding to the β-subunit of bacterial RNA polymerase. This results in the blockage of the translocation step that normally follows the formation of the first phosphodiester bond, which occurs in the transcription process. This in turn results in a reduction of bacteria populations, including gas-producing bacteria, which may reduce mucosal inflammation, epithelial dysfunction, and visceral hypersensitivity. Rifaximin has broad spectrum antibacterial properties against both gram positive and gram negative anaerobic and aerobic bacteria. As a result of bile acid solubility, its antibacterial action is limited mostly to the small intestine and less so the colon. A resetting of the bacterial composition has also been suggested as a possible mechanism of action for relief of IBS symptoms. Additionally, rifaximin may have a direct anti-inflammatory effect on gut mucosa via modulation of the pregnane X receptor. Other mechanisms for its therapeutic properties include inhibition of bacterial translocation across the epithelial lining of the intestine, inhibition of adherence of bacteria to the epithelial cells, and a reduction in the expression of proinflammatory cytokines.