One of the problems of society in the twenty-first century was obesity. The disease is recruiting new followers 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 tightening, but due to deposits of fat in different parts of the body. Why is obesity dangerous? Looking at people with overweight, 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-salt metabolism. In addition, this disease complicates social life, as in modern society the tendency to sport and a healthy lifestyle prevails.
Etiology
Obesity can develop for a variety of reasons. The most obvious is physical inactivity, that is, a mismatch between the calories received and the energy spent. The second common cause of excess weight is a violation of the gastrointestinal tract. This may be a lack of pancreatic enzymes, decreased liver function, problems with digestion of food. In addition, the risk of obesity can be determined at the genetic level.
There are factors that contribute to weight gain, these include:
- use of sugary drinks or a diet containing a lot of sugar;
- endocrine diseases, such as hypogonadism, hypothyroidism, pancreatic tumor;
- psychological disorders (eating disorder);
- permanent stressful situations and lack of sleep;
- taking hormonal or psychotropic drugs.
A 2-million-year-long evolution has provided a mechanism for the accumulation of nutrients in case a food shortage occurs. And if for ancient people this was relevant, then modern man does not need such "storage". However, our body is structured in such a way that it responds stereotypically to both positive and negative influences from the outside. Therefore, the problem of obesity at the moment has become 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 large amounts of lipids is the mismatch of the cerebral cortex and hypothalamus. This is where the centers of appetite regulation are located. The body requires more food than it consumes 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 either a congenital condition or acquired as a result of education. In addition, such problems are sometimes the result of trauma, inflammation, chronic endocrine pathology.
When the pituitary gland, the adrenal cortex and pancreatic cells begin to show pathological activity, and the amount of growth hormone decreases 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.
BMI classification
The classification of obesity is best started with that which is known to the general population. As a rule, the initial diagnosis of this disease is carried out based on an indicator such as body mass index (BMI). This is a particular value obtained after dividing body weight in kilograms by height in meters, squared. There is the following gradation of obesity for this indicator:
- Mass deficit - if BMI is less than or equal to 18.5.
- Normal body weight - the mass index should be in the range from 18.5 to 25.
- Obesity - BMI ranges from 25 to 30 points. At this point, the risk of concomitant diseases such as hypertension, pressure sores and diaper rash is increased.
- Obesity of 1 degree is set if the BMI is from 30 to 35.
- Obesity 2 degrees - the index approaches 40 points.
- Grade 3 obesity is diagnosed when the mass index exceeds 40 points, while a person has concomitant pathologies.
Etiopathogenetic classification
The following classification of obesity is one of the most detailed in this area, since it takes into account the causes and mechanism of development of pathology. According to her, primary and secondary obesity are distinguished. Each of them has its own subclasses.
So, primary obesity is divided into:
- buttock-femoral;
- abdominal;
- caused by an eating disorder;
- stressful;
- provoked by metabolic syndrome.
In secondary, symptomatic obesity, four subtypes can be derived:
- Hereditary, defective gene.
- Cerebral, provoked by neoplasms, infections or autoimmune damage to the brain.
- Endocrine, caused by dysregulation of the thyroid gland, hypothalamic-pituitary system, adrenal glands and gonads.
- Medication associated with the use of steroid drugs, hormonal contraceptives and cytostatics.
Clinical and pathogenetic classification
If we take as a basis the mechanisms that lead to the appearance of excess weight, then we can compile the following classification of obesity:
- Alimentary-constitutional. Weight gain is associated with an excess of fat in food and lack of exercise. It manifests itself, as a rule, in childhood and can be associated with a hereditary predisposition.
- Hypothalamic. The increase in adipose tissue occurs due to damage to the hypothalamus and, as a result, a violation of its neuroendocrine function.
- Endocrine. The basis of fatness is the pathology of the endocrine glands - the pituitary, thyroid, and adrenal glands.
- Iatrogenic. Obesity is caused by medical intervention. This may be taking medication, removing an organ or part thereof, damage to the endocrine system during treatment, and much more.
Classification of fat localization
After examination of patients with overweight, it was noticed that not everyone has the same distribution. Therefore, over time, a classification of obesity was derived based on the characteristic location of the fat layer.
The first type, it’s the upper one, it’s the android one, differs in that the upper half of the body, face, neck and arms increase mainly. It occurs more often in men, but it can be seen in women who have entered the menopause period. A number of authors claim that there is a connection between this type of obesity and the risk of developing diabetes mellitus, as well as pathology of the cardiovascular system.
The second type, the lower or gynoid, is an accumulation of adipose tissue on the hips and buttocks, and is more common in the fair half of humanity. The figure of such women takes the form of a “pear”. It can also develop from childhood, if exacerbated 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 over the body, smoothing the line of the waist, neck, buttocks.
In order to determine what type of obesity a patient has faced, it is necessary to determine the ratio of the waist and hips. If in women this indicator is more than 0.85, and in men more than one, then it can be argued that in humans the first variant of the distribution of adipose tissue.
Morphological classification
In the process of obesity, changes affect all levels of the organization of life, not only the whole organism, but also individual organs, tissues, and even just cells. Adipocytes (fat cells) may undergo qualitative or quantitative changes. Depending on this, there are:
- 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 actively divide. This form is found in children and is very poorly treated, since it is possible to reduce the number of cells in extremely aggressive ways.
- Mixed obesity, as it is logical to assume, is a mixture of the previous two. That is, the cells not only increase, but also there are more of them.
Classification of obesity in children
According to statistics, in Russia now about 12% of children are overweight. Of these, 8.5% are urban residents, and 3.5% are rural. Obesity in adolescents and children has become such a frequent pathology that pediatricians decided to introduce a special section in their educational work with young parents regarding diet. Obesity is 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 usually caused by malnutrition, early feeding or refusal of breast milk in favor of cow. But it can be hereditary, if overweight people prevail in the family. But even in this case, the child is not born fat, he just has a slow metabolism, and with proper diet and physical activity, he will keep his weight within normal limits. The first three years of life and puberty are critical for primary obesity.
Secondary obesity is associated with the presence of acquired endocrine pathologies. The criteria by which the degree of excess weight gain is determined are still debatable. The following scale was proposed:
- 1 degree - the weight is more by 15-25% of the due;
- 2 degree - from 25 to 49% of excess weight;
- 3 degree - the mass is more by 50-99%;
- 4 degree - overweight is two or more times higher than the age norm.
Symptoms
Signs of obesity are mostly similar to each other, the only difference is the uniform distribution of excess fiber, as well as the presence of concomitant pathologies or their absence.
Most often, patients experience alimentary obesity, that is, associated with a violation of a normal diet. As a rule, such people have a hereditary predisposition to weight gain, and excessive consumption of food leads to weight gain. Symptoms are found in all family members, as they all eat together. In addition, older women are subject to this type of obesity, who, due to their shaken health, lead a sedentary lifestyle.
Obesity of 1 degree is observed in most people who systematically transmit, especially in the evening. This happens because there is no time or desire for breakfast and lunch. Hungry people at dinner consume a daily calorie intake and go to bed.
Hypothalamic obesity is characterized not only by weight gain, but also by the presence of symptoms of a nervous system disorder and endocrine regulation. Obesity is developing very quickly and, as a rule, is not associated with a change in diet. Fat appears mainly on the front surface of the abdomen, hips and buttocks. The appearance of trophic changes is possible: dry skin, stretch marks, hair loss. Such patients complain of insomnia, headaches and dizziness. A neurologist usually manages to identify a pathology in his area.
Diagnostics
People with obesity have extremely reduced criticism of their condition, so persuading or forcing them to go to the doctor even for a simple consultation is not an easy task. The patients of an endocrinologist or neuropathologist are quite another matter. These themselves want to be examined and lose weight for a speedy recovery.
The most commonly used diagnostic criterion for overweight is the body obesity index. That is, how much the actual mass is more than necessary. To determine the severity, it is important not only to prove the fact of excess weight, but also that it is realized due to adipose tissue, and is not muscle mass. Therefore, in medical practice, they are actively trying to introduce methods of determining precisely the fat mass, and not the whole body weight.
The norm is determined taking into account the statistical data collected by doctors of various specialties 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 long-livers have 10% less body weight than normal. Pathological obesity is diagnosed in the opposite case, when the weight is 10% exceeded the upper limit of acceptable.
There are several formulas for calculating the ideal body weight. One of them is known to all fashionistas - a hundred should be taken away from growth 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. 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 adipose tissue depends on the cause of weight gain.
Treatment
The fight against obesity is carried out maliciously and everywhere. Now the media is actively promoting a healthy lifestyle and the cult of a beautiful, athletic body. Of course, it is not worth bringing the situation to absurdity, but the general direction of the youth movement is more preferable than decadent hedonia.
The basic principles for treating obesity include:
- A diet rich in complex carbohydrates and fiber, vitamins, nuts and herbs. Be sure to limit baking, sugary and carbonated drinks.
- physical exercises that should strengthen the body and speed up the metabolism.
- medicines to reduce weight and appetite;
- psychotherapy;
- surgery.
To achieve long-term results of any type of treatment, you need to change your diet and the frequency of food intake. There is an opinion that diets are useless in the fight against obesity, but they help to consolidate the achieved weight and prevent the disease from returning. The World Health Organization recommends calculating the calorie content of food that the patient eats normally and gradually reduce the number of calories. It is necessary to reach the mark of 1500 - 1200 calories, provided that the person does not physically overload himself.
Psychotherapy is aimed at strengthening the willpower and self-control in relation to food intake and dependence on fast-food restaurants and sweet sparkling water. Medications in the process of weight loss help to achieve only a short-term effect. After stopping the pill, the patient returns to his previous lifestyle and does not follow the recommendations received at discharge. Despite the fact that now the pharmaceutical industry can offer a large selection of drugs for overweight, almost all of them are prohibited due to side effects.
Surgical methods include gastric suturing, 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 hemmed to a smaller one. Thus, the volume of the stomach decreases, and the speed of passage of food becomes higher. The second option is bandaging the stomach. A ring is installed in the cardial part, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritating the saturation center, allowing the patient to eat less.
What type of obesity is the most dangerous? Perhaps that's all. No one can say that typing is good for a person. The level of danger depends on how much the actual mass exceeds the norm, and what kind of concomitant diseases it has.