Fatness

Fatness
Obesity — excess fat deposits in subcutaneous tissue, tissues, as well as on the surface of internal organs. Obesity begins with an increase in body weight by 20% or more. This happens due to the accumulation of fatty tissue. Obesity has a negative effect not only on physical health, but also on mental health, causing sexual disorders, various diseases of organs and their systems.

The content of the article:
Causes of obesity
Classification of obesity
Symptoms of obesity
Symptoms of alimentary obesity
The difference between hypothalamic obesity
Features of the endocrine form of obesity
About lipomatosis
Diagnosis of obesity
Complications of obesity
Treatment of obesity
Prognosis for obesity
Prevention of obesity
Fatness
Obesity can lead to the development of atherosclerosis, diseases of the spine and joints, hypertension, diabetes mellitus, stroke, heart attack. Obesity can affect the liver and kidneys, leading to disability and even death. Women suffer from obesity more often than men. The age when the risk of obesity increases is 30-60 years. Endocrinologists and nutritionists are dealing with the problem of obesity.

Today, obesity is a global problem all over the world. Millions of people suffer from obesity, regardless of race, social status or profession. In our country, about 30% of the able-bodied population are obese, and 22% of the population are overweight.

A scientifically proven fact: people with obesity are 2 times more likely to have hypertension and 3 times more likely to have angina pectoris. So it is known that any other disease, including influenza, pneumonia or simply ARVI, in obese people, proceeds much harder and longer than in people without obesity.

Causes of obesity
The onset of obesity is a violation of the balance between the intake of calories (and hence energy) along with food on the one hand, and energy consumption (consumption of incoming calories) on the other.

Those calories that do not have time to be consumed by the body turn into fat deposits that accumulate in the subcutaneous tissue, abdominal cavity, internal organs. An increase in the amount of accumulated fat leads to an increase in body weight, which in turn leads to malfunctions in the functioning of many systems. Most often, overeating leads to obesity (more than 90%), less often it is metabolic failures (5-7% of cases).

Eating disorders occur due to violations of hypothalamic and pituitary regulations, which are responsible for behavioral reactions. If the activity of the hypothalamic-pituitary-adrenal system increases, this will lead to an increase in ACTH products, as well as to an increase in the rate of cortisol secretion and accelerated metabolism.

With obesity, the level of secretion of somatotropic hormone decreases, which usually has a lipolytic effect. Obesity contributes to the development of hyperinsulinemia. In addition, the metabolism of thyroid hormones and the sensitivity of tissues to these hormones is disrupted.

Among other reasons affecting the development of obesity, it is possible to distinguish:

sedentary lifestyle;
deviations in the diet (significant consumption of carbohydrates and fats, abuse of salt and sugar, regular intake of alcohol, dinners at night);
genetic predisposition (disorders of enzymatic activity, including the activity of lipogenesis enzymes, reduced activity of cranial enzymes that act on fat splitting);
endocrine pathologies (insulinoma, hypothyroidism, hypogonadism, Itsenko-Cushing’s disease).
In addition, among the possible causes of obesity are overeating of a psychogenic nature, such natural conditions of the body as pregnancy, menopause or lactation. Stress, lack of sleep and the use of hormonal drugs can also be a possible cause that serves as the beginning of obesity.

Classification of obesity
At the end of the last century, WHO introduced the classification of degrees of obesity, which is based on the definition of the main indicator — BMI (body mass index).

The body mass index is easily calculated if you divide the weight (kg) by the square of height (m). Having received your indicator, you should compare it with the indicators proposed in the WHO classification, where:

A BMI below 18.5 is a low indicator, indicating a lack of body weight and an increased risk of developing various diseases;
A BMI of 18.5-24.9 is a common indicator that indicates that your body weight is normal. In addition, such a BMI guarantees the lowest level of morbidity and mortality among the population;
A BMI of 25.0-29.9 is already an increased indicator indicating the presence of overweight, and as a result, the stage preceding obesity;
BMI 30.0-34.9 is a high indicator, which is classified as grade I obesity;
BMI 35.0-39.9 is a very high indicator, which already corresponds to the II degree of obesity;
A BMI of 40.0 and above is grade III and IV obesity.
If the BMI index is more than 30 units, then this indicates the onset of obesity (obesity of the first degree). In addition, such an indicator is a threat to health, which means that you cannot do without a medical examination here. By contacting a doctor, an individual treatment regimen will be developed for the patient.

Regarding the comparison of a person’s body weight with an ideal body weight, obesity can be divided into 4 degrees:

I degree of obesity — when excess body weight is no more than 29% of the total body weight;
II degree of obesity — an increase in body weight by 30-40%;
III degree of obesity — overweight — not less than 50% and not more than 99%;
The IV degree of obesity is the most severe when the body weight increases by two or more times relative to the usual one.
The ideal body weight is the result obtained if the number 100 is subtracted from the growth index (measured in centimeters).

As for the classification of obesity relative to the location of fat deposits, there are three types:

Abdominal (android) — excessive fat deposition in the upper half of the trunk, as well as in the abdomen (such a figure often resembles the shape of an apple). This type of obesity is most often inherent in men and is very dangerous to health, since it represents a direct risk of diseases such as diabetes mellitus, stroke, heart attack, arterial hypertension.
Femoral-gluteal — excess fat is concentrated in the lower part of the body — in the area of the hips and buttocks, while the figure resembles the appearance of a pear. This type of obesity is often inherent in women, accompanied by impaired functioning of the spine and joints, as well as possible venous insufficiency.
Intermediate is a type of obesity when fat is evenly distributed throughout the body.
Obesity is often progressive, which means a gradual increase in body fat, leading to a constant increase in body weight. Obesity can be in a stable stage or residual, that is, residual, observed after weight loss of the body. Regarding the mechanism of obesity development , there are two types of it:

Primary (simple): alimentary-metabolic or exogenous-constitutional, which is based on an exogenous (or alimentary) factor, which is associated with an increase in the level of incoming calories in a modified diet and an unchanged energy—low-cost lifestyle, which leads to the accumulation of fat. The reason for this type of obesity is usually the predominance of carbohydrates and fats in the diet, as well as a violation of the usual diet and food quality (for example, a meager breakfast, lack of lunch and the adoption of a daily meal for dinner). Often primary obesity may have a genetic predisposition. You should know that the calories contained in fatty foods contribute to obesity more often than those that enter the body with carbohydrates and proteins. If more fat comes from food than it has time to oxidize, then the remaining fats accumulate in fat depots. A sedentary lifestyle reduces the ability of muscle tissue to oxidize fat deposits.
secondary: hypothalamic or symptomatic: secondary obesity often accompanies a number of hereditary syndromes, including Babinsky-Frolich disease, Lawrence-Moon-Bardet-Bidl syndrome or, for example, Gelino syndrome. In addition, this type of obesity often occurs as a background of a cerebral lesion, which may be a brain tumor, dissemination of infectious diseases or lesions of systemic organs. Often mental disorders or traumatic brain injuries are also the cause of secondary obesity.
endocrine obesity is formed in the presence of malfunctions in the endocrine glands (hypercorticism, hypothyroidism, hypogonadism and hyperinsulinism).
With any type of obesity, hypothalamic changes can be noticed, initial and those that occur during diseases.

Symptoms of obesity
The main symptom of obesity is overweight. Excess fat deposition is clearly noticeable on the abdomen, torso, sides, back, hips, nape, and pelvis. The second characteristic symptom of obesity is underdevelopment of muscle mass.
A change in the appearance of a person: the appearance of a second and even a third chin, the development of pseudogynecomastia, the appearance of an “apron” (fat folds on the abdomen) and “breeches” on the hips — typical for the diagnosis of “obesity”. In addition, with obesity, an umbilical or inguinal hernia is often also found.
People with obesity of I or II degree may not particularly complain about health problems.

In the case of obesity of the III or IV degree in a person , it is noted:

drowsiness;
sweating;
weakness;
nervousness;
irritability;
frequent shortness of breath with minimal physical work;
nausea;
constipation;
pain in the spine and problems in the joints.
In addition, patients with obesity of the III or IV degree often suffer from diseases of the cardiovascular system, have problems with the digestive and respiratory systems. The presence of hypertension, tachycardia and the presence of deaf heart tones are characteristic accompaniments of obesity.
Obesity causes high standing of the diaphragm, which causes respiratory failure and pulmonary heart syndrome. In addition, the occurrence of fatty infiltration of the liver parenchyma, as well as the occurrence of pancreatitis or chronic cholecystitis, is not excluded.
Painful sensations in the spine, symptoms of arthrosis of the knee or ankle joints are obvious manifestations of obesity. Obese women have a problem with the menstrual cycle, which can subsequently lead to the onset of amenorrhea.
Such a symptom as sweating leads to the development of a number of skin diseases, including furunculosis, eczema and pyoderma. The appearance of acne, striae in the hips, abdomen and shoulders, as well as hyperpigmentation on the neck, elbows and in areas of increased friction — all these can be additional symptoms of obesity.
Obesity of different types and degrees has similar symptoms. As for the differences, they are inherent in the nature of the distribution of body fat, as well as the fact of the presence (or, conversely, absence) of disorders of the endocrine and nervous system.

Symptoms of alimentary obesity
In the case of alimentary obesity, the increase in body weight will be gradual, while fat deposits are uniform or with a rare predominance of fat in the abdomen and thighs. The symptoms of the endocrine system disease were not found.

The difference between hypothalamic obesity
Hypothalamic obesity is characterized by a rapid increase in body weight with a characteristic deposition of fat mainly in the abdomen, thighs and buttocks. Among other manifestations of this type of obesity:

increased appetite (mainly in the evening);
thirst and hunger at night;
white striae (stretch marks on the skin);
dry skin.
Women are characterized by the development of hirsutism and infertility with a characteristic menstrual disorder. An additional symptom of men will be impaired potency. In addition, neurological dysfunctions such as headache, insomnia, hypertension, sweating and other autonomic disorders may occur.

Features of the endocrine form of obesity
The endocrine form of obesity is characterized by symptoms that are caused, first of all, by failures in the hormonal sphere. With this type of obesity, the distribution of fat occurs unevenly. Fat is distributed taking into account the signs of masculinization and feminization, there are skin striae, hirsutism and gynecomastia.

About lipomatosis
A special form of obesity is considered to be lipomatosis (hyperplasia of adipose tissue of a benign nature). Lipomatosis often manifests itself in the form of numerous painless lipomas, and is often inherent in men. However, there are also painful lipomas observed in the area of the limbs and trunk. They are characterized by soreness at the time of palpation, which is accompanied by weakness of the body and itching of a local nature.

Diagnosis of obesity
First of all, when examining a person with obesity, specialists study the anamnesis and predisposition of the body at the level of genetics. Doctors determine the minimum and maximum weight that a person should have after 20 years, the duration of developing obesity, the methods of treatment that were previously used by the patient, his diet and lifestyle in general. The doctor also draws attention to the presence of other diseases and their connection with obesity.

The body mass index (BMI) and the ideal body mass index (MI) are determined by physicians in order to calculate the degree of obesity.

As for the nature of the distribution of adipose tissue throughout the body, it is determined by calculating the coefficient, which will be the result of the ratio of the waist circumference to the hip circumference. If such a coefficient among women is more than 0.8, and for men it is equal to one, then this indicates the development of abdominal obesity. According to statistics, the risk of concomitant diseases is high when the waist circumference index is more than 88 cm in women and more than 102 cm in men.

The most accurate diagnostic results, including the determination of the localization of fat deposits, their volume and ratio to the total body weight, can be obtained as a result:

Ultrasound;
nuclear magnetic resonance;
CT;
X-ray densitometry.
People with a diagnosis of “obesity” need to be regularly consulted by a nutritionist, a neuropsychiatrist and a physical therapy instructor.

The diagnosis of obesity also includes the determination of blood pressure indicators in order to detect hypertension; hypoglycemic profile and glucose compatibility test (in order to detect diabetes mellitus); cholesterol, triglyceride and lipoprotein levels of various densities in the blood. In addition, an ECG or ECHOCG can detect a violation of the circulatory system or a deviation of the heart. A biochemical blood test is designed to determine the level of uric acid.

Complications of obesity
In addition to the psychological deviations that obesity leads to, overweight people may suffer from the following diseases:

diabetes mellitus;
stroke;
heart failure;
cirrhosis of the liver;
gallstone disease;
sleep apnea syndrome;
arthritis;
arthrosis;
polycystic ovary syndrome;
decreased libido;
menstruation disorder.
This is not the whole list of complications that obesity provokes. Obesity is the cause of oncological diseases: breast, uterus and ovarian cancer in women, prostate cancer in men. In addition, obesity increases the risk of sudden death.

According to statistics, the mortality rate among obese people aged 15-70 years is three times higher than among people with normal weight.

Treatment of obesity
The goal to treat obesity in different people arises due to the desire to look good, achieve the desired cosmetic effect, reduce the risk to health, improve performance, and so on. However, medical treatment of obese patients has one goal — to reduce the risk of a number of obesity-related diseases and complications.

Treatment of any type and degree of obesity begins with the appointment of a certain diet and exercise.

Patients with grade I obesity (and a BMI below 35) are prescribed hypocaloric nutrition, which implies a reduction in the daily caloric intake of food by 500 kcal, as well as increased exercise. This restriction of daily calories is achieved by reducing the consumption of fats and carbohydrates (especially refined). The diet provides for the consumption of a sufficient amount of protein with fiber. It is best to eat food boiled, eat no more than 5-6 times a day in small portions. Spices, alcohol and sugar should be removed from the patient’s diet.

In the case of a hypocaloric diet, there is a decrease in metabolism and energy conservation, which leads to a decrease in the effectiveness of the diet. To avoid the latter, the diet is combined with physical exercises that can increase the metabolic processes of the body, speeding up metabolism. Therapeutic fasting can be prescribed only under the supervision of doctors during inpatient treatment, not for a long time.

Drug treatment will be in the case of grade II obesity with an index of more than 30 units, as well as if diet therapy was ineffective in case of grade I obesity.

The main drugs prescribed for the treatment of obesity:

drugs of the amphetamine group (regenone, dezopimone, fepranone and mirapront): their action is based on the inhibition of hunger, a rapidly arising feeling of satiety and anorectic effect. Drugs of this group also have side effects: nausea, dry mouth, excessive irritability, allergies and insomnia;
combining adiposine (a fat-immobilizing drug) with the antidepressant prozac, which can correct eating behavior;
preparations of meridia (for example, sibutramine) and xenical — do not cause serious side effects, accelerate the arrival of saturation, reducing the amount of food consumed. In addition, xenical helps to reduce the absorption of fat components.
Symptomatic therapy of the diseases present in obesity will be necessary. Psychotherapy in the form of conversations or hypnosis may also be prescribed in order to change the attitude to food and correct the patient’s eating behavior.

Surgical treatment will be prescribed only in the case of grade III or IV obesity. Most often, gastric banding or vertical gastroplasty, as well as liposuction, are performed.

Prognosis for obesity
If the treatment of obesity is started in a timely manner, then its prognosis will be positive. According to statistics, a 10% reduction in body weight reduces the mortality rate by more than 20%. In addition, the number of deaths due to diabetes (by more than 35%) and cancer associated with obesity (by 40%) is decreasing. Usually, patients with I or II degree of obesity are able-bodied, while people with III degree of obesity are registered and receive group III disability.

Prevention of obesity
The best prevention of obesity for people with normal weight is spending the amount of calories that was received during the day. In the case of a genetic predisposition, people with a sedentary lifestyle need to consume fewer carbohydrates and fats, increasing the amount of protein food and fiber.

Regular exercise, including running, swimming, hiking, will be beneficial for everyone, preventing the development of obesity. If you notice a sharp or gradual increase in your own body weight, you should go to a nutritionist and an endocrinologist to prescribe an individual weight loss program that will help to cope with the problem in its early stages.

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