One of the problems of society in the twenty-first century has become obesity. The disease "recruits" new adherents around the world. This is due to malnutrition, a sedentary lifestyle, a significant number of chronic endocrine pathologies and many other factors. Literally, obesity means that body weight does not increase due to muscle compaction, but due to fat deposits in different parts of the body. Why is obesity dangerous? Looking at overweight people, any doctor will name a dozen reasons, and in the first place there will be diseases of the heart, blood vessels, joints and bones, a violation of water-s alt metabolism. In addition, this disease makes social life difficult, as modern society is dominated by sports and he althy lifestyle trends.
Etiology
The disease "obesity" can develop for a variety of reasons. The most obvious is physical inactivity, that is, a discrepancy between the calories received and the energy wasted. The second common cause of excess weight is a violation of the gastrointestinal tract. This may be a lack of pancreatic enzymes, a decreaseliver function, problems with digestion of food. In addition, the risk of obesity may be determined at the genetic level.
There are factors that contribute to weight gain, these include:
- drinking sugary drinks or a diet high in sugar;
- endocrine diseases such as hypogonadism, hypothyroidism, pancreatic tumor glands;
- psychological disorders (eating disorders);
- permanent stressful situations and lack of sleep;- taking hormonal or psychotropic drugs.
Evolution of 2 million years has provided a mechanism for the accumulation of nutrients in case there is a sudden shortage of food. And if for ancient people this was relevant, then modern man does not need such "stores". However, our body is designed in such a way that it stereotypically reacts to both positive and negative external influences. Therefore, the problem of obesity is now so acute.
Pathogenesis
The regulation of the deposition and mobilization of fat depots is carried out as a result of a complex interaction between the nervous system and the endocrine glands. The main reason for the accumulation of a large amount of lipids is the mismatch of the cerebral cortex and the hypothalamus. It is there that the centers are located, the regulation of appetite. The body requires more food than it expends energy, so all the excess is left "in reserve", which leads to an increase in body weight and the appearance of excess adipose tissue.
Such a violation of coordination by the center can be both congenitalstate, and acquired as a result of education. In addition, such problems are sometimes the result of trauma, inflammation, chronic endocrine pathology.
When the pituitary gland, adrenal cortex and - pancreatic cells begin to show pathological activity, and the amount of growth hormone drops sharply, then almost all the fat and glucose that enter the body are deposited in tissues and organs. This leads to morphological disorders of the liver, kidneys, thyroid gland.
Classification by BMI
Classification of obesity is better to start with the one that is known to the general population. As a rule, the primary diagnosis of this disease is carried out based on such an indicator as the body mass index (BMI). This is the private value obtained by dividing the body weight in kilograms by the squared height in meters. There is the following gradation of obesity for this indicator:
- Underweight - if BMI is less than or equal to 18, 5.
- Normal body weight - mass index should be between 18.5 and 25.
- Pre-obesity - BMI ranges from 25 to 30 points. At this point, the risk of comorbidities, such as hypertension, bedsores and diaper rash, increases.
- Obesity 1 degree is set if the BMI is from 30 to 35.
- Obesity 2 degrees - the index is approaching 40 points.
- Obesity 3 degrees is diagnosed when the mass index exceeds 40 points, whilea person has comorbidities.
Etiopathogenetic classification
The following classification of obesity is one of the most detailed in this area, as it takes into account the causes and mechanism of the development of pathology. According to it, primary and secondary obesity are distinguished. Each of them has its own subclasses.
So, primary obesity is divided into:
- gluteal-femoral;
-abdominal;
-caused by eating disorders;
- stressful; - provoked by metabolic syndrome.
In secondary, symptomatic obesity, four subtypes can be derived:
- Hereditary, defective gene.
- Cerebral, provoked by neoplasms, infections or autoimmune brain damage.
- Endocrine, caused by dysregulation of the thyroid, hypothalamic-pituitary system, adrenal glands and gonads.
- Medication associated with taking steroid drugs, hormonal contraceptives and cytostatics.
Clinical and pathogenetic classification
If we take as a basis the mechanisms that lead to the appearance of overweight, then we can make the following classification of obesity:
- Alimentary-constitutional. Weight gain is associated with excess fat in the diet and inactivity. It manifests itself, as a rule, in childhood and may be associated with a hereditary predisposition.
- Hypothalamic. An increase in adipose tissue occurs due to damage to the hypothalamus and, as a result, a violation of itsneuroendocrine function.
- Endocrine. Fatness is based on the pathology of the endocrine glands - the pituitary gland, thyroid gland, adrenal glands. - Iatrogenic. Obesity is caused by medical intervention. This can be medication, removal of an organ or part of it, damage to the endocrine system during treatment, and much more.
Classification by location of adipose tissue
After examining overweight patients, it was noticed that not everyone has it distributed equally. Therefore, over time, a classification of obesity was derived based on the characteristic location of the fat layer.
The first type, also known as the upper, or android type, differs in that the upper half of the torso, face, neck and arms are enlarged. It occurs more often in men, but it can also be seen in women who have entered the menopause period. A number of authors claim that there is a link between this type of obesity and the risk of developing diabetes mellitus, as well as the pathology of the cardiovascular system.
The second type, lower or gynoid, is an accumulation of adipose tissue on the thighs and buttocks, and is more common in the beautiful half of humanity. The figure of such women takes the form of a "pear". It can also develop from childhood, if aggravated by a violation of a normal diet. Concomitant diseases in this case will be pathologies of the spine, joints and vascular network of the lower extremities.
The third type is mixed or intermediate obesity. In this case, excess weight is more or less evenly distributed overbody, smoothing the line of the waist, neck, buttocks.
In order to determine which type of obesity a patient applied for, it is necessary to determine the ratio of the circumference of the waist and hips. If in women this indicator is more than 0.85, and in men it is more than one, then it can be argued that a person has the first variant of the distribution of adipose tissue.
Morphological classification
In the process of obesity, changes affect all levels of life organization, not only the whole body, but also individual organs, tissues and even just cells. Adipocytes (fat cells) may undergo qualitative or quantitative changes. Depending on this, they distinguish:
- Hypertrophic obesity. It is characterized by a pathological increase in the size of fat cells, while their number remains the same.
- Hyperplastic obesity, in which adipocytes are actively dividing. This form occurs in children and is treated very poorly, since the number of cells can be reduced only in aggressive ways.
- Mixed obesity, as it is logical to assume, is a mixture of the two previous ones. That is, the cells not only increase, but there are more of them.
Classification of obesity in children
According to statistics, in Russia now about 12% of children suffer from overweight. Of these, 8.5% are urban residents, and 3.5% are rural. Obesity in adolescents and children has become such a common pathology that pediatricians have decided to introduce a special section into their educational work with young parents.regarding diet. Obesity is considered a condition when the body weight of a child exceeds 15% of the due at his age. If correlated with BMI, then its value will approach 30 points.
There are two forms of obesity among children: primary and secondary. Primary is caused, as a rule, by malnutrition, early complementary foods, or the rejection of breast milk in favor of cow's. But it can also be hereditary if overweight people predominate in the family. But even so, the baby is not born fat, he just has a slow metabolism, and with proper diet and exercise, he will keep his weight within normal limits. Critical for primary obesity are the first three years of life and puberty.
Secondary obesity is associated with the presence of acquired endocrine pathologies. The criteria by which the degree of overweight gain is determined are still debatable. The following scale was proposed:
- 1 degree - weight more than 15-25% of the due;
- 2 degree - from 25 to 49% of excess weight;
- 3 degree - weight more by 50-99%;- 4 degree - overweight is two or more times the age norm.
Symptoms
Signs of obesity are basically similar to each other, the difference is only in the uniform distribution of excess fiber, as well as the presence of concomitant pathologies or their absence.
Most often, patients have alimentary obesity, that is, associated with a violation of the normal diet. As a rule, such people have a hereditarypredisposition to weight gain, and excessive eating leads to weight gain. Symptoms occur in all members of the family, as they all eat together. In addition, this type of obesity affects older women who, due to their poor he alth, lead a sedentary lifestyle.
Obesity 1 degree is observed in most people who systematically transmit, especially in the evening. This happens because there is no time and desire for breakfast and lunch. Hungry people consume their daily calorie intake at dinner and go to bed.
Hypothalamic obesity is characterized not only by weight gain, but also by the presence of symptoms of disorders of the nervous system and endocrine regulation. Obesity develops very quickly and is usually not associated with a change in diet. Fat appears mainly on the front surface of the abdomen, thighs and buttocks. Perhaps the appearance of trophic changes: dry skin, stretch marks, hair loss. Such patients complain of insomnia, headaches and dizziness. The neurologist is usually able to identify the pathology in his area.
Diagnosis
People with obesity have extremely reduced criticism of their condition, so to persuade or force them to go to the doctor even for a simple consultation is not an easy task. It is quite another matter for patients of an endocrinologist or a neuropathologist. These themselves want to be examined and lose weight for a speedy recovery.
The most commonly used criterion for diagnosing overweight is the Body Obesity Index. Thatthere is how much the actual mass is more than the due. To determine the severity, it is important not only to prove the fact of excess weight, but also the fact that it is realized at the expense of adipose tissue, and is not muscle mass. Therefore, in medical practice, they are actively trying to introduce methods for determining exactly the fat mass, and not the entire body weight.
The norm is determined based on statistical data collected by doctors of various speci alties over the years of practice. For each gender, age, dew and physique, there are tables with already calculated pathology and norm values. Scientists have found that centenarians have a body weight of 10% less than normal. Pathological obesity is diagnosed in the opposite case, when the weight is 10% over the upper limit of the permissible.
There are several formulas for calculating ideal body weight. All fashionistas know one of them - one hundred must be taken away from height in centimeters. The resulting number will be the desired value. But this is a very conditional and unreliable study. More accurate is the BMI or Quetelet index, which was given above. The measurement of the ratio of the circumference of the waist and hips is also of great importance in the characterization of obesity, since the location of fatty tissue depends on the cause of the weight gain.
Treatment
The fight against obesity is vicious and widespread. Now the media is actively promoting a he althy lifestyle and the cult of a beautiful, athletic body. Of course, it is not worth bringing the situation to the point of absurdity, but the general direction of the youth movement is more preferable thandecadent hedonism.
The basic principles of treating obesity include:
- a diet rich in complex carbohydrates and fiber, vitamins, nuts and greens. Be sure to limit baking, sweet and carbonated drinks.
- physical exercises that should strengthen the body and speed up metabolism.
- drugs for weight loss and appetite;
- psychotherapy; - surgical treatment.
To achieve long-term results of any type of treatment, you need to change your diet and frequency of meals. There is an opinion that diets are useless in the fight against obesity, but they help to consolidate the weight achieved and prevent the disease from returning. The World He alth Organization recommends calculating the calorie content of the food that the patient consumes normally and gradually reducing the number of calories. It is necessary to reach the mark of 1500 - 1200 kilocalories, provided that the person does not overload himself physically.
Psychotherapy focuses on strengthening willpower and self-control in relation to food intake and addiction to fast food restaurants and sweet soda. Medicines in the process of weight loss help to achieve only a short-term effect. After stopping the pills, the patient returns to the previous lifestyle and does not follow the recommendations received at discharge. Despite the fact that the pharmaceutical industry now has a large selection of drugs for excess weight, almost all of them are banned due to the side effects they cause.
Surgical methods include suturing the stomach,popular in the sixties of the last century. The essence of the operation is that the organ is divided into two unequal parts and the small intestine is sutured to the smaller one. Thus, the volume of the stomach decreases, and the rate of passage of food becomes higher. The second option is gastric banding. A ring is installed in the cardial part, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritates the satiety center, allowing the patient to eat less.
What type of obesity is the most dangerous? Perhaps everything. No one can say that typing is good for a person. The level of danger depends on how much the actual weight exceeds the norm, and what comorbidities he has.
