Obesity – excess fatty deposits in hypodermic cellulose, bodies and fabrics. It is shown by increase in body weight by 20 and more percent from average sizes at the expense of fatty tissue. Brings psychophysical discomfort, causes sexual disorders, diseases of a backbone and joints. Increases risk of development of atherosclerosis, IBS, a hypertension, myocardial infarction, stroke, diabetes, damages of kidneys, a liver, and also disability and mortality from these diseases. Most effectively in treatment of obesity the combined application of 3 components: diets, physical activities and corresponding psychological reorganization of the patient.
Obesity – excess fatty deposits in hypodermic cellulose, bodies and fabrics. It is shown by increase in body weight by 20 and more percent from average sizes at the expense of fatty tissue. Brings psychophysical discomfort, causes sexual disorders, diseases of a backbone and joints. Increases risk of development of atherosclerosis, IBS, a hypertension, myocardial infarction, stroke, diabetes, damages of kidneys, a liver, and also disability and mortality from these diseases. Women are subject to development of obesity twice more often than men, critical age for emergence of excess weight – from 30 to 60 years.
Not only the endocrinology is engaged in studying of obesity and methods of fight against it. By estimates of the international WHO experts obesity is global epidemic of the present covering millions of inhabitants of the planet, is not dependent on professional, social, national, geographical, sexual and age groups. In Russia about 30% of able-bodied population have obesity and another 25% have excess weight.
Patients with obesity are more often by 2-3 times have a hypertension, by 3-4 times – stenocardia and IBS, than persons with a normal weight. Practically any diseases, even such as SARS, flu and pneumonia, at the patients having obesity proceed is longer and it is heavier, have bigger percent of development of complications.
Development of obesity most often is caused by violation of balance between receipt of energy with food and power expenses of an organism. The excess calories which came to an organism and are not spent by it will be transformed to fat which collects in fatty depots of an organism (mainly in hypodermic cellulose, epiploons, a belly wall, internals etc.). Increase in reserves of fat leads to increase of body weight and violation of functioning of many systems of an organism. The overeating leads to obesity more than in 90%, about another 5% of cases of obesity are caused by frustration of a metabolism.
Changes in food behavior result from violation of the gipotalamo-hypophysial regulation which is responsible for control of behavioural reactions. Increase in activity - hypophysial leads systems to increase in production of AKTG, speed of secretion of cortisol and acceleration of his metabolism. There is a decrease in secretion of the somatotropny hormone having lipolitichesky effect, the giperinsulinemiya, violation of metabolism of tireoidny hormones and sensitivity of fabrics to them develops.
Development of obesity is promoted by a number of factors:
- low-active lifestyle;
- genetically caused violations of enzymatic activity (increase in activity of enzymes of a lipogenez and decrease in aktivnosticherepno-brain injuries of the enzymes splitting fats (lipoliza);
- errors in character and a diet (overconsumption of carbohydrates, fats, salts, sweet and alcoholic beverages, meal for the night, etc.);
- some endocrine pathologies (hypothyroidism, gipogonadizm, insulinoma, Itsenko-Cushing's disease);
- psychogenic overeating;
- physiological states (lactation, pregnancy, climax);
- stresses, sleep debt, reception of psychotropic and hormonal drugs (steroids, insulin, contraceptive tablets) etc.
Classification of obesity
In 1997. The World Health Organization offered the classification of degrees of obesity based on definition of an indicator – the body weight index (BWI) for persons from 18 to 65 years. IMT is calculated by a formula: weight in kg/growth in meters in a square. On IMT allocate the following options of body weight and risk of development of the accompanying complications:
- IMT from 18,5 to 24,9 (usual) – corresponds to body weight normal. At such IMT the smallest indicators of incidence and mortality are noted;
- IMT from 25,0 to 29,9 (raised) – demonstrates to the excess body weight or preobesity.
- IMT from 30,0 to 34,9 (high) – corresponds to the I degree of obesity;
- IMT from 35,0 to 39,9 (very high) – corresponds to the II degree of obesity;
- IMT from 40 and more (excessively high) – demonstrates to obesity of III and IV degrees.
IMT from 30 and more indicates existence of obesity and direct threat to health, demands medical examination and development of the individual scheme of treatment.
On comparison of the actual and ideal body weight obesity is divided into 4 degrees: at the I degree excess weight makes no more than 29%, the II degree is characterized by excess of weight for 30-40%, III – for 50-99%, at the IV degree increase in the actual body weight in comparison with ideal in 2 and more times is noted. Calculation of ideal body weight is carried out on a formula: "growth, cm - 100".
On primary localization of fatty deposits on a body allocate the following types of obesity:
- abdominal (top or androidny) – excess adjournment of fatty tissue in the field of the top half of a trunk and a stomach (the figure reminds apple in a form). Develops at men more often and it is most hazardous to health since it is connected with risk of developing of arterial hypertension, diabetes, stroke and heart attack.
- femoral and buttock (lower) – primary adjournment of fatty tissue in hips and buttocks (the figure reminds a pear in a form). Meets at women more often and is followed by violations of functions of joints, a backbone, venous insufficiency.
- intermediate (mixed) - uniform distribution of fatty deposits on a body.
Obesity can have the progressing character with increase in volume of fatty deposits and gradual increase of body weight, be in stable or residual (residual after weight loss) stages. On the mechanism and the reasons of development obesity can be primary (alimentary and exchange or exogenous and constitutional, or simple), secondary (hypothalamic or symptomatic) and endocrine.
The alimentary factor connected with the increased power value of a diet at low energy consumption that leads to accumulation of fatty deposits is the cornerstone of development of primary obesity exogenous, or. Such type of obesity develops as a result of prevalence in food of carbohydrates and animal fats or violations of the mode and structure of food (plentiful and rare food, consumption of the main daily caloric content of food in the evening) and quite often carries family predisposition. The calories which are contained in fats promote a body weight increase more, than contained in proteins and carbohydrates. If the fats arriving with food surpass possibilities of their oxidation in an organism, then there is an accumulation of excess of fat in fatty depots. The hypodynamia significantly reduces ability of muscles to oxidation of fats.
Secondary obesity accompanies such hereditary syndromes as Babinsky-Frelikh's disease, Zhelino's syndrome, a syndrome of Lorensa-Muna-Barde-Bidlya, etc. Also symptomatic obesity can develop against the background of various cerebral defeats: tumors of a brain, dissemination of system defeats, infectious diseases, mental disorders, craniocereberal injuries etc.
The endocrine type of obesity develops at pathology of endocrine glands: hypothyroidism, giperkortitsizm, giperinsulinizm, gipogonadizm. At all types of obesity the hypothalamic violations which are or primary, or arising in the course of a disease are to some extent noted.
As specific symptom of obesity serves excess body weight. Excess fatty deposits are found on shoulders, a stomach, a back, on trunk sides, a nape, hips, in pelvic area, at the same time the underdevelopment of muscular system is noted. Appearance of the patient changes: there is the second chin, the psevdoginekomastiya develops, on a stomach fatty folds hang down in the form of an apron, hips take the form of riding breeches. Umbilical and inguinal hernias are typical.
Patients with I and II degrees of obesity can not show special complaints, at more expressed obesity drowsiness, weakness, perspiration, irritability, nervousness, short wind, nausea, locks, peripheral hypostases, backbone and joints pains are noted.
At patients with obesity of the III—IV degree violations of activity of cardiovascular, respiratory, digestive systems develop. Objectively the hypertension, tachycardia, deafs warm tone come to light. High standing of a dome of a diaphragm leads to development of respiratory insufficiency and chronic pulmonary heart. There is a fatty infiltration of a parenchyma of a liver, chronic cholecystitis and pancreatitis. There are backbone pains, symptoms of arthrosis of ankle and knee joints. Quite often obesity is followed by violations of a menstrual cycle, up to development of an amenorea. Increase in sweating causes development of skin diseases (eczema, piodermiya, a furunkulez), emergence of an acne, striya on a stomach, hips, shoulders, hyperpegmentations of elbows, necks, places of the increased friction.
Obesity of different types has similar general symptomatology, distinctions are observed in the nature of distribution of fat and existence or lack of signs of defeat of endocrine or nervous systems. At alimentary obesity body weight increases gradually, fatty deposits uniform, sometimes prevail in hips and a stomach. Symptoms of defeat of endocrine glands are absent.
At hypothalamic obesity obesity develops quickly, with primary adjournment of fat on a stomach, hips, buttocks. Increase in appetite, especially by the evening, thirst, night hunger, dizziness, a tremor is noted. Trophic violations of skin are characteristic: pink or white striya (stretching strip), dryness of skin. At women the girsutizm, infertility, violations of a menstrual cycle can develop, men have a deterioration in a potentiality. There is neurologic dysfunction: headaches, frustration of a dream; vegetative violations: perspiration, arterial hypertension.
The endocrine form of obesity is characterized by prevalence of symptoms of the main diseases caused by hormonal violations. Fat distribution usually uneven, signs of feminization or a masculinization, a girsutizm, a ginekomastiya, skin striya are noted. A peculiar form of obesity is – a good-quality giperplaziya of fatty tissue. It is shown by numerous symmetric painless lipomas, more often observed at men. Also painful lipomas meet ( Derkuma) which settle down on extremities and a trunk, are painful at a palpation and are followed by the general weakness and a local itch.
Except psychological problems practically all patients with obesity suffer from one or a number of the syndromes or diseases caused by excess weight: IBS, diabetes 2 types, arterial hypertension, stroke, stenocardia, heart failure, cholelithiasis, cirrhosis, syndrome sleepy , chronic heartburn, arthritis, arthrosis, osteochondrosis, syndrome of polycystous ovaries, decrease in fertility, libido, violation of menstrual function etc.
At obesity the probability of developing of breast cancer, ovaries and a uterus at women, a prostate cancer at men, a colon cancer increases. The risk of sudden death against the background of the available complications is also increased. Mortality of men aged from 15 up to 69 years having the actual body weight exceeding ideal for 20% is one third more, than at men with a normal weight.
Diagnosis of obesity
At inspection of patients with obesity pay attention to the anamnesis, family predisposition, find out indicators of the minimum and maximum weight after 20 years, duration of development of obesity, the held events, eating habits and a way of life of the patient, the available diseases. For clarification of existence and degree of obesity use a method of definition of the body weight index (BWI), ideal body weight (Mi).
The nature of distribution of fatty tissue on a body is determined by calculation of the coefficient equal to the relation of the waist circle (WC) to the circle of hips (CH). Existence of abdominal obesity is demonstrated by the coefficient exceeding value 0,8 - for women and 1 - for men. It is considered that the risk of development of associated diseases is high at men with FROM> 102 cm and at women with FROM> 88 cm. For assessment of extent of adjournment of subcutaneous fat carry out determination of the size of a skin fold.
The most exact results of definition of localization, volume and percentage of fatty tissue receive from the lump of a body by means of auxiliary methods: Ultrasonography, nuclear magnetic resonance, computer tomography, radiological densitometry, etc. At obesity consultations of the psychologist, the nutritionist and the physiotherapy exercises instructor are necessary for patients.
For identification of the changes caused by obesity define:
- indicators of arterial pressure (for detection of arterial hypertension);
- hypoglycemic profile and the tolerance test to glucose (for detection of diabetes of the II type);
- level of triglycerides, cholesterol, lipoproteid of low and high density (for assessment of violation of lipidic exchange);
- changes according to the ECG and EHOKG (for identification of violations of work of the blood circulatory system and heart);
- level of uric acid in biochemical blood test (for detection of hyper uraemia).
Treatment of obesity
Each person having obesity can have the motivation of decrease in body weight: cosmetic effect, reduction of risk for health, working capacity improvement, desire to wear clothes of the smaller sizes, the aspiration to look good. However, the purposes in the relation of weight reduction and its rates have to be real and directed, first of all, to reduction of risk of emergence of the complications accompanying obesity. Begin treatment of obesity with purpose of a diet and physical exercises.
To patients with IMT
At observance of a hypohigh-calorie diet there is a decrease in the main exchange and conservation of energy that reduces efficiency of a dietotherapy. Therefore the hypohigh-calorie diet needs to be combined with the physical exercises increasing processes of the main exchange and metabolism of fat. Purpose of medical starvation is shown to the patients who are on hospitalization at the expressed obesity degree for short term.
Drug treatment of obesity is appointed at IMT> 30 or inefficiencies of a diet for 12 and more weeks. Effect of medicines of group of amphetamine (, , phentermine) is based on braking of feeling of hunger, saturation acceleration, anorektichesky action. However, side effects are possible: nausea, dryness in a mouth, sleeplessness, irritability, allergic reactions, accustoming.
In some cases purpose of zhiromobilizuyushchy medicine of an adipozin, and also antidepressant of the fluoxetine changing food behavior is effective. Today in treatment of obesity medicines and , not causing the expressed collateral reactions and accustoming are considered the most preferable. Action of a sibutramin is based on acceleration approach of saturation and reduction of amount of the consumed food. Orlistat reduces processes of absorption of fats in intestines. At obesity symptomatic therapy of the main and associated diseases is carried out. In treatment of obesity the psychotherapy role (conversations, hypnosis) changing stereotypes of the developed food behavior and a way of life is high.
Methods of bariatrichesky surgery - expeditious treatment of obesity are applied in cases of permanent deduction of weight at IMT> 40. In world practice operations of a vertical gastroplastika, bandaging of a stomach and a gastroshuntirovaniye are most often performed. As a cosmetic measure local removal of fatty deposits – liposuction is carried out.
Forecast and prevention of obesity
In due time begun systematic actions for treatment of obesity bring good results. Already at decrease in body weight by 10% the indicator of the general mortality decreases> than by 20%; the mortality caused by diabetes> than for 30%; caused by the oncological diseases accompanying obesity,> than for 40%. Patients with I and II degrees of obesity keep working capacity; with the III degree – become disabled III group, and in the presence of cardiovascular complications — the II group of disability.
For prevention of obesity with a normal weight it is enough to person to spend calories and energy it is so much how many he receives them within a day. At hereditary predisposition to obesity, aged after 40 years, at a hypodynamia restriction of consumption of carbohydrates, fats, increase in a diet of proteinaceous and vegetable food is necessary. Reasonable physical activity is necessary: pedestrian walks, swimming, run, visit of gyms. If there is a discontent with a body weight, for its decrease it is necessary to address the endocrinologist and the nutritionist for assessment of extent of violations and drawing up the individual program of weight loss.