Obesity: Symptoms and Treatment
Obesity is a condition of the body in which fatty deposits begin to accumulate in excess in its cellulose, tissues and organs. Obesity, whose symptoms consist in increasing the weight from 20% or more when compared with the mean values, is not only the cause of general discomfort. It also leads to the appearance of psycho-physical problems against this background, problems with joints and spine, problems related to sexual life, as well as problems associated with the development of other conditions accompanying such changes in the body.
So, obesity, in addition to the above problems, increases the risk of developing a number of fairly serious diseases in patients. These include, for example, atherosclerosis and hypertension, ischemic heart disease (IHD), stroke, myocardial infarction. In addition, obesity is often a companion of diabetes, which is inextricably linked to it — it is obesity is one of the main reasons predisposing to its development. To diseases that can develop against obesity, you can also add liver and kidney disease. Moreover, considered as obesity-related problems of the disease in obesity can become a cause of disability, determining, moreover, a fairly high percentage of mortality in each of the options. As a supplement to this part, it can also be noted that hypertensive disease in patients with obesity is on average three times more likely than in individuals with a normal weight, while ischemic heart disease and angina, again, in patients with obesity Obesity, is detected up to 3-4 times more often than in individuals with weight within the norm.
Transfer of obesity by patients of any type of diseases, including «normal» ARVI and influenza, occurs in a more severe and prolonged form compared with the course of these diseases in patients with normal weight, in addition, with obesity significantly increases the risk of complications Against the background of the transfer of such diseases. Also, we note that obesity can not only manifest itself as an independent disease, but it can also act as one of the symptoms, respectively, of a different type of disease.
Women are most susceptible to obesity, and this predisposition for them is twice the predisposition to obesity of men. As a critical age interval for the development of obesity, you can determine the age of 30-60 years. Based on the studies on obesity conducted by WHO experts, it is revealed that obesity is practically a world epidemic, and this epidemic is relevant for millions of the population of the world’s population, regardless of their belonging to a specific social, national, professional, age, gender or other group. Only in Russia, obesity is diagnosed on average in 30% of the working-age population, while another 25% of the population is concerned with the problem of overweight.
As the attendant causes of obesity, the following can be considered:
- imbalance between the energy expended and the food consumed (that is, the food is consumed more than the energy is consumed)
- genetic disorders;
- Obesity does not develop on the basis of endocrine disorders (it is the connection with endocrine disorders that is considered for obesity as its main cause), but as a result of disorders of the intestine, liver, pancreas.
In addition, we can identify a number of predisposing factors to the development of obesity:
- genetic factors (reduced enzymatic activity of lipolysis or increased enzymatic activity of lipogenesis)
- Loneliness of a way of life;
- excessive consumption of easily assimilated carbohydrates by the patients (sugared foods, sweet drinks, etc.)
- eating disorders (in this case, eating disorders that cause eating disorders (anorexia, bulimia, etc.) are implied)
- the relevance of a certain type of disease, in particular as such, are considered diseases of the field of endocrinology (hypothyroidism, hypogonadism, etc.)
- use of psychotropic drugs
- frequent stress;
- sleep disturbances, lack of sleep.
Very rarely, the development of obesity is associated with certain types of injuries or with a previous surgical intervention. As a possible variant of the first connection, for example, it is possible to distinguish the pituitary lesion by gunshot wound, as a second, surgical intervention, respectively, one can designate removal of the ovaries.
Individual cases of obesity are associated with conditions provoked by infectious encephalitis, tumor formations of the endocrine glands, for example, a tumor of the adrenal cortex or a pituitary tumor. Also, the cause of obesity, again, in some cases, may be the development of an atrophic process, for example, its development in the thyroid gland, which determines this type of obesity, like endocrine obesity. The pituitary gland in particular contains two main hormones, due to which the regulation of fat metabolism is ensured. In addition, it is closely related to a different type of endocrine glands in our body, which in turn also play an important role in the processes of fat metabolism (here in particular it is necessary to single out the processes of such metabolism with the adrenal cortex and with the sex glands)
In the list of reasons, we have already indicated that metabolic diseases are considered among the factors that provoke the development of obesity, as the main conditioning option, and this is not always due to the defeat of any visceral or endocrine organ. Often obesity is directly associated with violations in the menstrual cycle of women, they, in turn, in particular, often occur when the debut of obesity in the early age. What is noteworthy, full women are faced with a problem early enough in the form of metabolic disorders associated with sex steroids, which causes the release of gonadotropins at an accelerated rate, which in turn leads to anovulation, that is, to the absence of ovulation.
Obesity: features of pathogenesis
The pathogenesis, that is, the peculiarities of the processes that determine the development of obesity in the patient, can not be unequivocally determined. In particular, the cause of the development of pathological obesity can not be identified only by the discrepancy (imbalance) of the energy expended by the body with the food consumed (and its caloric value in particular). The main issue in this case is reduced to a discrepancy in the effect of autoregulatory mechanisms that ensure the constant normal weight indices in healthy people for many years. After all, if we consider situations, for example, with forced rest (trauma) or with compulsion to take food (overfeeding), the excessive appearance of fat often becomes a result of a temporary, that is, it is actual until a recovery occurs or until the diet is stabilized (It will not change under individually regulated needs). For this reason, it can be noted that persistent obesity develops precisely as a result of the functions of the cerebral cortex due to the formation of conditioned reflex connections and a complex of other processes.
Thus, as a basic variant for the development of obesity, it is possible to consider the disorders that arise in the functions of the main central mechanisms, namely, the hypothalamus and the cerebral cortex, namely, in those centers where the appetite is regulated. Returning to the connection between consumed food and energy consumption, it can be assumed that the peculiarities of this relationship are due precisely to the functional features of these centers. They, in turn, can be both congenital and acquired (there are options that are conditioned by the nature of nutrition, upbringing, the way of life of the family, etc.). In case of injuries that directly affect the area of such centers, with or without accompanying inflammation, obesity can occur, caused by a violation of the functions of the centers that regulate appetite.
WHO in 1997, based on the comparison of studies and the study of relevant criteria, a classification was developed, in which, respectively, the degree of obesity was indicated. This classification is based on the allocation of a specific indicator, as such, BMI is the body mass index calculated for persons aged 18-65 according to the formula for dividing the weight (kg) by the height (m) in squared. For example: 65 / 2.89, where 66 weight, 2.89 — the number in square for growth of 1.70 m; The finished value is 22.49, (the finished number corresponds to specific indicators — below).
Based on the consideration of many examples, it is revealed that such a calculation accurately reflects the actual situation in terms of indicators. The maximum permissible figure of the BMI norm is 25 kg / m according to such calculations. Based on this, we can distinguish the following picture:
- BMI within the range below 18.5 — the figure corresponds to a weight deficit, determining for the patient the risk of developing another type of pathological conditions against this background
- BMI between 19-24.9 — corresponds to the usual weight, that is, the normal weight, these figures determine the lowest indicators for disease susceptibility and mortality
- A BMI within 25-29.9 corresponds to an increased body weight, which is also defined as pre-fatigue with corresponding risks for further prognosis
- BMI in the range of 30-34,9 is a high index, in this case we are talking about a state such as the 1st degree of obesity of the patient (from this interval, one can speak of obesity as such, moreover, it is from this period that it determines Significant risks for the overall health status, necessitating the conduct of appropriate medical examination in the subsequent development of methods aimed at normalizing the state of health)
- A BMI within the range of 35-39.9 is a very high index, a second degree of obesity of the patient
- A BMI with a value of 40 and above is an excessively high index, determining for patient III and, respectively, IV degree of obesity.
The classification described above is the most common in use for calculating the weight compliance of growth and a specific interval that determines a health risk or a norm.
Besides this, there is another calculation formula, it is also simple in the calculus: Mu = P — 100, as the ideal body mass, the value Mu is considered, P in the formula — growth in centimeters. Based on the calculation of this formula, the degrees of obesity are also distinguished, in all there are four. Thus, the I degree of obesity in this variant corresponds to values exceeding the ideal body weight by an average of 15-29%, then, II degree of obesity, corresponds to values at which the excess reaches 30-49%. Similarly, the III and IV levels of obesity are calculated, for which the excess corresponds to the values 50-99 (III), 100 and more (IV).
There are some types of obesity, which are determined on the basis of the main areas of body fat concentration:
- Abdominal type of obesity (android, upper type of obesity). This type of obesity determines the main areas of fat tissue concentration from the upper part of the trunk, as well as in the abdominal region, on the basis of which it is possible to determine the analogy of this constitution with the apple. Mostly men are predisposed to this obesity, in addition, there are high enough risks to affect the general health, which is caused by the frequent occurrence of diabetes mellitus, hypertension, heart attack and stroke on the background of obesity.
- The femur-buttock type of obesity (the lower type of obesity). Already on the basis of the title of this paragraph, the reader can understand that the regions of the buttocks and thighs are the primary regions for localization of fat deposits, in general consideration, we can give an analogy of the figure type with a pear. Primarily, this type of obesity is diagnosed in women, as concomitant with it, venous insufficiency, various diseases of the spine, joints can be designated.
- Mixed type of obesity (intermediate type). This type of obesity corresponds to a uniform distribution throughout the body of fat deposits.
In addition, obesity can be progressive, resulting in a gradual increase in body fat volume with accompanying (also gradual) increase in body weight. Can obesity correspond to a stable stage (residual stage of obesity, considered as a residual stage, marked after weight loss).
In accordance with the peculiarities of the causative factor of obesity, as well as in accordance with its own peculiarities, obesity can manifest itself as primary (simple obesity, exogenous constitutional obesity, alimentary-metabolic obesity), as secondary (symptomatic obesity or obesity hypothalamic), As well as endocrine obesity.
The basis of primary obesity is the alimentary or exogenous factor caused by an excessively high energy saturation with respect to a diet that is relevant to the patient at the same time with a low energy consumption, against which the excessive mass begins to accumulate. The development of this type of obesity in particular is caused by a significant amount of carbohydrates in food, as well as the presence in it of an excess of animal fats. In addition, the cause of this variant of obesity may be a violation of the composition and diet (rare eating, abundant food intake, and evening meals in the amount of daily intake), it is often caused by family predisposition. The calories included in the fats contribute more to weight gain than the calories of carbohydrates and proteins.
As for secondary obesity, it acts as a concomitant factor in a number of syndromes, for example, Gelino syndrome, Babinsky-Frohlich disease, etc. In addition, symptomatic obesity, which is considered this variant, may accompany a number of cerebral lesions, Such as brain tumors, infectious diseases, craniocerebral trauma, mental disorders, etc.
And, finally, endocrine obesity. Its development is accompanied by the presence of pathologies in the area of endocrine glands. As pathological conditions that cause obesity on this background, you can identify such diseases as hyperinsulism, hypothyroidism, hypogonadism, etc.
There are some forms of obesity, which are isolated on the basis of participation in the pathogenetic process of various links related to the regulatory system:
- Diencephalic (cerebral, hypothalamic) obesity. This group includes such clinical variants of obesity that develop against the background of previous encephalitis (regardless of the nature of their origin). As such variants of encephalitis, one can consider the transfer of encephalitis accompanying scarlet fever, typhus, as well as epidemic encephalitis, etc.
- Hypogenital obesity. This form of obesity develops in women during the onset of menopause (artificial or natural), during lactation. Men can also face this form of obesity, which is accompanied by the underdevelopment of their sexual glands (the so-called eunuchoid obesity). The lack of a sex hormone in boys can also lead to the development of prepubertal obesity. The hypoovarian obesity associated with this group is characterized by the concentration of fat in such a way that it resembles the trousers, and also when its concentration determines the analogy with the apron (concentration of fat deposits in the abdominal region). In general, it can be indicated that fat is distributed in frequent cases in a generalized manner.
- Pituitary obesity. This form of obesity is close in type to obesity diencephalic, the pituitary gland is also affected here (mainly). The deposition of fat takes place along the abdomen, chest, hips, pubic area. Actual is the underdevelopment of the genitals, the general type of infantilism of patients.
- Hypothyroid obesity. This type of obesity is accompanied by a deficiency in the functioning of the thyroid gland. Characteristic features of this type of obesity: moonlike face, thick neck.
As the main symptom corresponding to obesity, as is understandable, overweight is considered. The concentration of fatty deposits can be very different, which, therefore, determines for them the localization in the abdomen, hips, shoulder region, back, etc. In addition, the formation of fat deposits accompanies such a symptom as the development of the muscular system. There are also characteristic changes in the appearance of patients. So, they have a second chin, a pseudo-gynecomastia (enlargement of mammary glands) is noted, the hips form similar to a riding breeches, the characteristic fat folds start to hang like an apron. Often against a background of actual changes in obesity, a hernia (inguinal, umbilical) develops.
I and II degrees of obesity may not be accompanied by any characteristic complaints, while at more «serious» stages of the development of obesity within the limits of these degrees, where it manifests itself in a more pronounced form, there is increased sweating, drowsiness and Weakness, shortness of breath, swelling, constipation, pain in the joints and in the spine.
Symptoms of obesity of III and IV degree are accompanied by much more serious violations of the functions of the whole organism. In particular, there are violations of the respiratory, cardiovascular and digestive systems in it. When objective examination of patients is determined by changes in heart tones, tachycardia and hypertension. Against the background of the changed state of the dome of the diaphragm against obesity, respiratory failure develops, besides this, a pulmonary heart becomes a frequent companion of these degrees of obesity. «It suffers» from obesity at these stages and parenchyma of the liver (its external surface, in particular, it is prone to fatty infiltration), pancreatitis, holitsestit (its chronic form) also develops. Again, there are complaints of pain in the spine, there are often signs that indicate the development of arthrosis of knee and ankle joints.
In frequent cases of any degree and form of obesity, there are violations of the menstrual cycle, which can reach the state of amenorrhea (that is, the complete absence of menstruation).
Due to excessive sweating caused by obesity, skin diseases such as eczema, furunculosis often develop. Appear acne (acne), there is a presence of striae (ie stretch marks) in the region of the hips, abdomen, on the shoulders (inner surface). In areas of increased friction, areas of hyperpigmentation are formed, they also appear on the neck and on the elbows. Depending on the specific type of obesity, meanwhile, is characterized by common for the varieties of symptoms, the existing differences relate mainly to the distribution of fatty deposits, as well as signs indicating the defeat of the nervous and endocrine system (this type of symptoms may also be absent during the course of the disease).
So, alimentary obesity is characterized by the predominant relevance of such a factor as a hereditary predisposition to fatness / obesity. The development of such obesity is important in case of high caloric content of food and reduced energy consumption of the body, basically this type of obesity is diagnosed in the family at once for several people. The main group of people who develop alimentary obesity are women, leading a sedentary lifestyle, middle / old age. When questioned, it turns out that frequent overeating is also overeating. Weight gain occurs in a gradual manner, the distribution of fat mass occurs in a uniform manner, the largest accumulation of fat in the region of the hips and abdomen. Signs indicating a concomitant defeat of the endocrine glands, no.
The next option is hypothalamic obesity. This form is relevant for concomitant pathologies of the central nervous system, accompanied by a defeat of the hypothalamus (against the background of infection, trauma, in tumor formations). This form of obesity is accompanied by a general obesity of the patients, the fat is mostly deposited by the type of apron in the abdomen, as well as on the hips and on the buttocks. Often the trophic lesions are in this case the skin, it becomes dry, pinkish or white stripes of striae appear on it (as we noted above, these are stretch marks). Based on the clinical manifestations associated with obesity, such as sleep disorders, headaches, etc., as well as on the basis of data obtained from a neurological examination, it becomes clear that there is a pathology of the brain. As additional manifestations, associated with this type of obesity, you can identify high blood pressure, increased sweating.
This form of obesity, like endocrine obesity, , is diagnosed in patients with actual endocrine diseases, we previously listed them (this is hypothyroidism, etc.), the actual symptomatology of such Diseases is in the general picture of obesity prevailing. Fat deposits focus unevenly, there are signs indicating hormonal disorders (gynecomastia (increase of mammary glands in men), feminization (the appearance of somatic and mental signs in men, generally inherent in the female sex), etc.). On the surface of the skin in different areas it is also possible to determine the presence of stretch marks.
Lipomatosis (otherwise this type of obesity is also defined as Derkum’s disease), is a peculiar form of the disease under consideration, accompanied by the emergence of characteristic fatty nodes, which show pain when sensed. Diagnosed mainly in men, concentration — the trunk, limbs. Additional symptoms: itching of the nodes, general weakness.
In addition to obesity-related psychological problems, almost all obese people face a common number of diseases and syndromes developing against the background of excessive body weight. In particular, these are the following already noted diseases: diabetes mellitus, IHD, arterial hypertension, angina pectoris, heart failure, myocardial infarction development, stroke. There is also chronic heartburn, arthritis, osteochondrosis, arthrosis, colon cancer.
Current «female» pathologies, such as polycystic ovary syndrome (polycystosis), breast, uterus, ovarian cancer. Men with obesity can develop prostate cancer. Obesity complications often cause sudden mortality of patients precisely against their background.
Diagnosis and treatment
Diagnosis of obesity can be performed primarily on the basis of the above calculations of ideal body weight and BMI. The degree of sedimentation of subcutaneous fat is made on the basis of the study of the skin fold. The most accurate results by volume, percentage and localization of adipose tissue can be obtained with the following auxiliary diagnostic measures: ultrasound, computed tomography, nuclear magnetic resonance, X-ray densitometry, etc. In addition, studies aimed at identifying associated changes provoked by obesity .
Obesity is treated in a comprehensive way, given that it takes time. In order to achieve the corresponding results in terms of weight, to fix them and to avoid the option that the weight after treatment will return in double volume, you should correctly approach the selection of diet and necessary physical exertion, namely such basic methods of treating obesity are realized in the practice of combating obesity . In addition, drug therapy can be prescribed, the selection of medications takes place on an individual basis. In the medical diet, in particular, they are guided by the «table number 8» with the restriction of the consumption of fats, proteins and carbohydrates to certain values and with the achievement of a total caloric content of the diet in the range of no more than 1800 kcal.
If symptoms appear that indicate obesity, it is necessary to visit the endocrinologist, in addition you may need to consult a psychotherapist and a nutritionist.