Abdominal obesity – the disease which is followed by adjournment of excess fat in a trunk and internals. The main signs – the circle of a waist is more than 100 cm, a systematic overeating, thirst for sweet, the increased thirst. Quite often arterial hypertension, a syndrome in a dream, apathy, drowsiness, bystry fatigue, chronic locks and other violations of digestion is defined. The endocrinologist is engaged in diagnostics, clinical poll, survey with measurement of a circle of a waist, calculation of IMT is applied. Treatment includes observance of a diet, regular physical load, medicamentous therapy is in addition appointed.
Abdominal obesity also call central, visceral, obesity on men's type and obesity like Yabloko. In MKB-10 it is referred to category "Diseases of Endocrine System, Frustration of Food and Metabolic Disorder". The problem of excess weight is known since the time of Hippocrates, however progress in treatment of this disease is very modest, and epidemiological indicators gradually increase. The last fact is connected with development of the food industry, unhealthy habits in food and low-mobility of people. According to WHO data, 30% of the population of the planet have excess body weight. Men are more subject to abdominal type of obesity, in the last decades prevalence of this pathology among children and teenagers increases.
Reasons of abdominal obesity
On an etiologichesky sign obesity happens alimentary and constitutional and symptomatic. The first option meets much more often, is caused by heredity and a way of life of the person. By clinical experience of doctors, a set of excess weight on the basis of endocrine and other pathology – less widespread phenomenon. The list of the reasons of abdominal obesity includes the following items:
- Constitutional features. Genetic predisposition is one of etiologies in 25-70% of cases. Characteristics of exchange processes, factors of development of a metabolic syndrome and diabetes are inherited.
- Food type. Obesity is promoted by the excess caloric content of food, the use of its large number in evening and night time, transition from traditional national food to industrial. In a diet of patients fats, light carbohydrates, alcohol prevail.
- Food frustration. Food addictions are defined by family and national stereotypes concerning food and a condition of mental health. At emotional frustration exchange of endorphins and serotonin is broken, the use of sweets and alcohol becomes "dope", dependence is formed.
- Hypodynamia. Increase in amount of fat quite often is caused by low-mobility in everyday life – insufficient power consumption, arriving with food. The fats and carbohydrates which were not dissipated by an organism for physical activity are processed and laid in "depot".
- Endocrine violations. Lead a giperkortitsizm, an insulinom, a gipogonadizm and a hypothyroidism to obesity. The disease is provoked by change of secretion of hormones, appetite as a result increases, the habit to overeat is formed, slowed down .
In most cases abdominal obesity on the mechanism of an origin is exogenous and constitutional. Diseases are the cornerstone hereditary factors, a regular overeating and insufficient physical activity. Excess consumption of food leads to increase in concentration of glucose in blood and to development of a giperinsulinemiya – to strengthening of production of insulin, stimulation of appetite, activation of a liposintez. Thus, the vicious circle promoting increase in consumption of food is formed.
Emergence of feeling of hunger and saturation depends on activity of ventrolateralny and ventromedialny hypothalamic kernels. Activity of the center of hunger is controlled by dofaminergichesky system, the center of satiety functions according to adrenergichesky regulation. At development of abdominal obesity primary or secondary (exogenous) deviations in all links of neuroendocrine regulation – in a pancreas, a hypothalamus, a hypophysis, a thyroid gland, adrenal glands and gonads are defined.
In practice of communication of doctors and patients there is a spontaneous division of abdominal obesity on primary, alimentary and secondary, provoked by endocrine or other disease, drug intake. The first type is more widespread, caused by food and the nature of physical activity of the patient, demands application of strong-willed efforts for recovery. In the second case treatment of the main disease is necessary, responsibility for a positive outcome is shifted by the patient to the doctor, effect of medicines. There is also more difficult kliniko-pathogenetic classification according to which allocate 4 forms of obesity:
- Abdominal and constitutional. It is connected with features of a diet, a hypodynamia and hereditary conditionality of accumulation of fat. IMT usually does not exceed 40 points.
- Hypothalamic. Develops at hypothalamus pathologies. It is based on strengthening of feeling of hunger, obtusion of feeling of saturation.
- Endocrine. Arises as result of hormonal failure. It is characteristic of a hypothyroidism, a giperkortitsizm, a gipogonadizm. The coefficient of IMT is higher than 40-50 points.
- Yatrogennoye. Medicamentous form of obesity. Its development is provoked by application of drugs – corticosteroids, antidepressants, anti-psychotics, contraceptive medicines.
Symptoms of abdominal obesity
Key symptom of a disease – an excess congestion of fatty deposits around a stomach, the top half of a trunk. The silhouette of the patient becomes roundish, the name of this kind of obesity from here distributed – apple. The grasp of a waist of men exceeds 94 cm, women – 80 cm. At this IMT can remain within norm because in other parts of a body a fatty layer normal or gipotrofirovanny, muscular tissue underdeveloped. The diet consists of high-calorific products. The food behavior is characterized by frequent having a snack, plentiful dinners, meal of night, abuse of sweets, smoked and fried dishes, low alcohol drinks. Quite often patients do not notice or incorrectly estimate the high caloric content of food: do not consider casual having a snack, addition of fat sauces, a way of cooking (hot fan, usual frying).
Other characteristic of patients – revaluation of the daily activity. Many have a low tolerance to physical activities – insufficient fitness of an organism, inability to carry out exercises on development of endurance and muscular force. It promotes formation of the energy saving mode of activity. People with obesity refuse walking in favor of movement on transport, do not participate in team games or remain in them inactive, avoid the homework demanding physical efforts (mopping, cleaning).
Often at patients violations from other systems of an organism are observed. Obesity is accompanied by an arterial hypertension, coronary heart disease, diabetes 2 types and its complications, a syndrome obstructive a dream, cholelithiasis, locks, a syndrome of polycystous ovaries, an urolithic disease, osteoarthrosis. Frustration of nervous system are shown by apathy, drowsiness, bystry fatigue. Patients complain of a depression, the increased uneasiness, problems in communication, feeling of uncertainty and the inferiority complex connected with excess weight.
At people with the central form of obesity the probability of diabetes of the second type which results from violation of tolerance to glucose, emergence of a stable giperinsulinemiya, an arterial hypertension increases. The majority of complications are connected with a metabolic syndrome of which are characteristic a hyperglycemia, the wrong carbohydrate exchange, a dislipidemiya. Against the background of exchange violations atherosclerotic plaques on walls of blood vessels are formed. At women abdominal obesity provokes hormonal dysfunction, in particular – leads to strengthening of activity of the adrenal glands developing androgens. It is shown by growth of hair in the face, a breast and a back (men's type). At late stages of obesity infertility is diagnosed, men have a deterioration in a potentiality, violation of reproductive function.
Examination of patients is conducted by the doctor-endocrinologist. In the course of differential diagnosis and detection of associated diseases other experts – the cardiologist, the neurologist, the doctor of functional diagnostics, laboratory assistants take part. The complex of procedures includes:
- Collecting anamnesis. The expert finds out existence of obesity, diabetes of the II type, resistance syndrome to insulin among the immediate family. Asks on features of food, physical activity of the patient. As patients are inclined to underestimate the caloric content of the diet and to overestimate the volume of loadings, maintaining diary entries within a week with their subsequent analysis is appointed.
- Survey. The expert visually and by means of a kaliper estimates existence of excess of fat, the nature of its distribution (in the top part of a trunk, area of a waist). Patients have quite often a hyperactivity of sweat and sebaceous glands that is shown by gloss of skin, greasiness, pustulous rashes, furunkulezy, a piodermiya.
- Measurement of volumes, weighing. Measurement of weight, growth, a circle of hips and a waist is performed. At abdominal obesity at girls and women FROM exceeds 80-84 cm, a ratio FROM/ABOUT more than 0,85; at young men and men FROM over 94-98 cm, an indicator FROM/ABOUT more than 1,0. On the basis of data on growth and weight of the patient the body weight index pays off. IMT more than 30, for endocrine – more than 40 is characteristic of alimentary obesity.
- Laboratory tests. For diagnostics of complications of obesity, identification of causes of illness the research of a lipidic profile is appointed. Increase in plasma of level of triglycerides (≥ 150 mg/dl) and glucose level (> 5,6 mmol/l), decrease in concentration of lipoproteid of high density is characteristic (
- Tool researches. Assessment of quantity and an arrangement of a fatty layer is carried out by method of a computer tomography and a magnetic and resonant tomography of abdominal area, a two-power x-ray absorbtsiometriya. The area and volume of fatty tissue pays off. The area of visceral fat most often is located at the level of 3 and 4 or 4 and 5 lumbar vertebras.
Treatment of abdominal obesity
At secondary or symptomatic obesity therapy of the main disease is required. A considerable part of patients has alimentary and constitutional type of a disease at which correction of a way of life – change of eating habits, introduction of regular physical activity is most important. The scheme of treatment is formed individually the endocrinologist, the nutritionist, the sports instructor. Obesity degree, presence at the patient of heavy somatic pathologies is considered (IBS, osteoarthrosis, diabetes and others). The program can include:
- Diet. The basic principle of clinical nutrition – reduction of caloric content of a diet: for women to 1200-1500 kcal, for men to 1400-1800 kcal. The use of fats and simple carbohydrates is minimized, the menu join products with the content of proteins and celluloses. The plan of food is formed the nutritionist, for control of its performance maintaining the diary of food is recommended.
- Increase in physical activity. Degree of loading and the mode of occupations depend on the general physical training, the state of health of the patient. At heavy degree of obesity of occupation begin with increase in duration of walking, at the second stage complexes of gymnastics and swimming, on the third – visit of fitness studios, run, other sports of average and high intensity are appointed.
- Medicamentous correction. Drug intake is shown at heavy obesity, inefficiency of a diet, existence of the complications which are not allowing to increase physical activity. Treatment is directed to decrease in process of splitting and absorption of fats, increase in activity of receptors of serotonin and adrenaline (saturation acceleration, appetite oppression, strengthening of thermoproduction). Therapy is carried out by GMG-KOA-reduktazy inhibitors (statins), fibrata, APF inhibitors.
- Bariatrichesky surgery. Expeditious treatment can be used at severe forms of obesity, lack of the general contraindications for the procedure. The positive result manages to achieve by formation of a small stomach, roundabout shunting of a stomach, a resection of a part of intestines.
Forecast and prevention
Respect for two basic purposes of the doctor – a diet and strengthening of physical activity – allows to cope with abdominal obesity in the majority of clinical cases. Prevention includes visit of dispensary inspections, the moderate use of food, regular trainings by sport. People with predisposition to completeness are recommended to limit high-carbohydrate and greasy food, to increase amount of vegetables, fruit, fast meat and dairy products, to refuse food in 3 hours prior to a dream, to daily allocate time for foot walks, morning exercises, and 2-3 times a week – for sports activities.