People with obesity of internal organs. Detrimental influence. What organs are affected by obesity? Video: Questions of survival. Obesity

The medical term “diabetes mellitus” refers to a disease that is based on a violation of water and carbohydrate metabolism, which provokes malfunctions of the pancreas, which is responsible for the production of a hormone called insulin. This hormone is considered the main component responsible for the absorption of sugar by the body.

The complete absence or lack of insulin gradually leads to the accumulation of excessive amounts of glucose in the blood plasma. The body is unable to cope with such volumes of sugar, so most of it begins to be excreted through urine, which affects the functioning of the kidneys and water metabolism.

Thus, the tissues of a diabetic are not able to retain a sufficient amount of water, so the waste fluid, which is considered inferior, is given to the kidneys. Hyperglycemia in men aged 40, 45, 50 years and so on is considered a reason for more in-depth research.

The disease, which is closely related to metabolism, can be acquired during life or inherited by the patient. The disease affects vision, the nervous system, and teeth. Due to excess sugar, the skin becomes thinner and pustules appear on them. The patient may also develop hypertension, angina pectoris or atherosclerosis.

Varieties

It is immediately worth noting that most often in men whose age ranges from 41 to 49 years and older, type 2 diabetes is diagnosed. This age category belongs to the risk zone, but the disease also occurs among children and adolescents. Statistics show that many children are obese or overweight.

Diabetics of the second type, provided that they adhere to the doctor’s recommendations, can be completely cured. To get better, the patient needs to lead a healthy lifestyle. This need cannot be ignored, since in advanced stages of the disease serious complications begin to develop that negatively affect the functioning of internal organs.

Signs of diabetes in men after 40 are much less common if we consider the first type of the disease. Type 1 diabetes is considered more of a hereditary disease that manifests itself either in infancy or young adulthood. The disease belongs to the category of serious, incurable diseases. The patient's life is maintained by regular insulin injections.

According to research, over the past few years the percentage of sick women and men who were 42–43 years old at the time of diagnosis of type 1 diabetes has increased significantly.

However, despite the change in statistics, it is worth noting that in youth, diabetic disease is much more difficult to bear than in the fortieth year of life, due to the higher rate of metabolic processes.

Signs

There are several main signs of diabetes mellitus in men after 40 years of age, carried by men. They make it possible to diagnose diabetes in a timely manner. However, initially it is necessary to highlight the main causes of the development of the disease:

Genetic predisposition, presence of diabetics in the family. Incorrect, irrational nutrition, non-compliance with food intake. Obesity or a large proportion of excess weight. Low activity, sedentary lifestyle.

Exposure to regular stress. Disruptions at the hormonal level.

The manifestation of diabetes mellitus has a negative impact on the male body as a whole and specifically on the functions performed by the pancreas, which it can no longer cope with over time. For this reason, the level of glucose in the blood increases, that is, diabetes develops.

The primary signs of the disease after 44 years of age include the following symptoms of diabetes mellitus in men:

1. The appearance of pigmentation on the face or body that was not there before.
2. From time to time, inexplicable itching appears in the groin area.
3. Excessive sweating.
4. Significant weight gain or, conversely, weight loss.
5. Increased drowsiness, but sleep is restless and anxious.
6. Increased appetite and thirst.
7. Excessive fatigue even in the absence of physical activity.
8. Delayed wound healing.

However, as practice shows, most often men do not associate these symptoms with the development of diabetes. When a man under 40 years of age and after 46–48 years has at least a couple of the listed symptoms, an immediate examination is required.

The initial stages of diabetes are quickly treatable. To eliminate the problem, a man just needs to start physical therapy (physical activity for diabetes is recommended), correctly adjust his diet, and give up bad habits, if any. Additionally, for effective treatment you should also take a fortified course.

If we consider those cases where it is a man who acts as a diabetic, it is necessary to note several features of the course of the disease. As the disease develops, its clinical signs intensify significantly, and therefore also affect men’s health.

Reproductive and sexual function is greatly affected by diabetes. If measures are not taken in time, a man begins to notice a decrease in potency, sexual desire, as well as frequent premature ejaculation.

On the mucous membranes of a diabetic, as can be seen in the photo, microcracks begin to appear, the skin becomes very flaky and dry. Small wounds remain fresh for a long time and do not heal, which leads to the appearance of fungi, as well as the addition of viral infections.

The patient should pay special attention to the incessant itching, which can only be eliminated by choosing the right hygiene products, for example, gels, shampoos, soaps, and so on. It is best to purchase products that are characterized by minimal alkalinity, that is, those that are suitable for sensitive skin types.

If a 40-year-old man has diabetes, treatment should be timely. If you miss the first signs of diabetes in men, you can allow a rapid drop in testosterone levels in the blood, which entails circulatory failure in the pelvic area. Insufficient nutrition of the genital organs leads to the rapid development of impotence.

Separately, it should be noted that reproductive function is seriously affected. The quality of sperm deteriorates, there is significantly less of it.

In addition, a diabetic runs the risk of damage to DNA, the transmitted hereditary information.

If the disease is not treated

Diabetes mellitus, if considered as an independent disease, does not pose a threat to life, but in the absence of proper treatment, serious complications arise, which often cause death.

Main types of complications:

1. Diabetic coma is the most difficult consequence of diabetes. Symptoms preceding a comatose state occur extremely quickly. If there is clouding of mind, lethargy, and frequent dizziness, the diabetic should be hospitalized.
2. Swelling of a local or widespread nature. Edema is especially common in patients who additionally suffer from heart failure. This symptom often becomes an indicator of renal dysfunction.
3. Sleep disorder. Male patients aged 47 - 49 years and older often suffer from sleep disturbances in diabetes, which is manifested by insomnia, frequent nightmares, awakenings, and so on.

It is worth noting that the treatment of diabetes is subject exclusively to an endocrinologist, who, after conducting a series of studies, will prescribe adequate treatment. However, it is best for men to be prudent. There are several preventative measures that will prevent the disease from developing.

Diabetes is least often diagnosed in men who eat right, devote time to exercise, and regularly monitor their blood sugar. In addition, giving up bad habits is considered an important condition for effective treatment and prevention. The video in this article will tell you about the main symptoms of diabetes.

The most common vascular diseases

The human body is penetrated by a network of arteries, veins, and lymphatic vessels. There is not a single organ independent of the general blood and lymph circulation. Performing the difficult role of a pipeline, the vessels obey the brain and spinal cord and are controlled by its signals, responding to a certain concentration of hormonal substances in the blood and following the instructions of the immune system.

Vascular diseases are not isolated. They are always associated with the manifestation of general failures in the regulation of life support.

Why are vessels needed?

The arteries deliver nutrients to tissues and organs, and supply oxygen necessary to support the required level of energy production and cell function.

Venous vessels must cope with a heavy load, collect waste blood with harmful substances, as well as carbon dioxide, and deliver them upward against gravity to the heart and liver.

An exception is the pulmonary blood vessels: the artery leaves the right ventricle and carries venous blood to the lungs to exchange carbon dioxide molecules for oxygen. And along the venous branches, oxygenated blood collects and enters the left atrium.

From the center to the periphery, the diameter of the vessels decreases, and the structure of the walls changes. The smallest capillaries approach the cells. It is they who have the ability to pass delivered oxygen and nutrients through their shell and take away waste.

The capillaries of the kidneys form the glomerular system and retain everything necessary in the blood, removing unnecessary toxic substances into the urine. Peripheral vascular diseases primarily affect capillary blood flow as the extreme point of blood circulation and communication with tissues. Failure of oxygen supply leads to a state of hypoxia (oxygen starvation), in which cells gradually die without treatment.

What determine the signs of vascular diseases?

Symptoms of vascular pathology indicate the localization of insufficient blood supply. It is customary to distinguish:

• diseases of the central vessels - aorta, coronary arteries, head, neck, spinal cord;
• peripheral vascular diseases - abdominal cavity, vascular diseases of the legs and arms.

Pathology causes:

• violation of the wall structure;
• blockade by nerve fibers regulating tone;
• occlusion (obstruction), spasm, sudden expansion or narrowing of the lumen.

Diseases develop suddenly, are accompanied by acute symptoms, or develop gradually, not making themselves felt for years.

Causes of vascular pathology

The causes of pathological changes in blood vessels include:

• inflammation of an infectious nature (with arteritis, thrombophlebitis);
• congenital disorders and malformations (pulmonary artery stenosis, increased tortuosity of the vertebral artery);
• deposition of atherosclerotic plaques under the inner lining of arteries of the muscular-elastic type;
• thrombosis and embolism;
• changes in strength and elasticity (formation of aneurysms, varicose veins);
• autoallergic inflammatory process (obliterating endarteritis);
• disruption of the structure of the walls, causing rupture and hemorrhage in the internal organs;
• increase or decrease in tone.

The appearance of vascular changes is promoted by diseases:

• widespread atherosclerosis;
• dysfunction of the central nervous system, which regulates vascular tone in neurological diseases, hypertension;
• diabetes mellitus and other endocrine diseases;
• acute and chronic infections;
• heart failure;
• avitaminosis;
• blood diseases;
• hereditary diseases.

Major diseases of the central vessels

The central vessels have the responsible task of supplying blood to the heart and brain. The most common cause of vascular pathology is an atherosclerotic process in the coronary and cerebral arteries or at a short distance (in the aorta, vertebral, carotid and subclavian arteries).

The consequence of the formation of atherosclerotic plaques is narrowing of the artery, a tendency to increased thrombus formation, and tissue ischemia.

Cardiac ischemia

Ischemia of the heart muscle develops in response to insufficient blood flow into the coronary vessels that supply the myocardium. As a result, chronic or acute manifestations are possible.

Symptoms of chronic ischemic disease are:

• attacks of angina pectoris (retrosternal pain), first only during exercise, then at rest, last up to 30 minutes, radiate to the left arm, jaw, throat, shoulder blade, are relieved with nitro drugs;
• dyspnea;
• palpitations and arrhythmias.

In acute myocardial ischemia, infarction (necrosis of muscle tissue) develops. The clinic depends on the following factors:

• prevalence of ischemic zone;
• involvement of pathways in it;
• depth of lesion;
• degree of development of auxiliary vessels.

The pain is very intense (cutting), radiates in the same way as with angina, Nitroglycerin does not help.

Shortness of breath can develop into suffocation and pulmonary edema in case of acute heart failure.

A widespread infarction is accompanied by cardiogenic shock, which causes secondary vascular damage (spasm and thrombosis of the capillary network) and promotes thromboembolism. Therapeutic anti-shock measures are extremely complex and are aimed at preserving the patient’s life.

Ischemia of cerebral vessels

Ischemia of the cerebral arteries develops not only due to atherosclerosis of cerebral vessels. It is believed that the first manifestations can be found on the walls of the carotid arteries. Blood retention in the vertebral vessels during diseases and injuries of the spine makes the brain dependent on the condition of the cartilage tissue and skeletal system.

Chronic ischemia develops gradually and is detected in old and senile age. Patients experience:

• headaches and dizziness;
• staggering when walking;
• decreased hearing and vision;
• gradual loss of memory and ability to remember;
• insomnia, irritability, change in character.

Acute ischemia manifests itself as ischemic stroke. It occurs more often at night or in the morning, after a short period of warning signs.

Depending on the location of the lesion, the patient exhibits:

• impaired consciousness of varying degrees (from dizziness to coma);
• sensitivity changes in the legs and arms;
• there is no movement in the lower or upper extremities on one side or both;
• speech is difficult;
• have difficulty swallowing;
• mental symptoms appear (suspiciousness, irritability, apathy and depression).

Must be assigned:

• vasodilators;
• agents that promote tissue resistance to low oxygen levels;
• sedatives;
• vitamins and anabolic steroids to support metabolism in damaged cells.

Cardiopsychoneurosis

The disease serves as an example of damage to peripheral arteries due to a malfunction of the leading parts of the central nervous system. An excess of sympathetic influence on the muscle membrane leads to a short-term spasm of the blood vessels of the brain and internal organs. Manifestations of dystonia are very diverse:

• headache;
• slight increase or decrease in blood pressure;
• dizziness;
• tendency to faint;
• palpitations and arrhythmias;
• diarrhea or prolonged constipation;
• nausea and lack of appetite;
• slight increase in body temperature.

The disease affects up to 80% of urban residents. It is detected in children in adolescence after overwork or infection. Treatment consists of a balanced diet, regular physical activity, and medications that calm the nervous system.

Major peripheral vascular diseases

The most common peripheral vascular diseases include:

• obliterating arteritis of the lower extremities;
• atherosclerosis of the arteries of the legs;
• phlebeurysm;
• thrombophlebitis.

Obliteration of the vessels of the legs is caused by nonspecific (without a pathogen) inflammation of the entire wall. Most often this is an autoimmune process that tends to be inherited. Mostly middle-aged men are affected. Great importance is attached to the smoking factor. Nicotine has a toxic effect on the peripheral vessels of the legs. Obliterating endarteritis affects middle-aged men, and atherosclerosis of the leg arteries affects older people. The symptoms are:

• sharp pain in the calves on one or both sides;
• cramps in the lower extremities;
• chilly feet even in warm weather;
• the pain intensifies when walking, so “intermittent claudication” occurs (the person must stop and stand until it goes away);
• trophic changes on the skin - non-healing cracks, ulcers.

Varicose veins of superficial and deep veins begin with loss of tone and sagging of the subcutaneous vessels. This shows up:

• red “spiders” on the skin of the lower leg and thigh;
• increased fatigue of the legs;
• swelling of the feet in the evening;
• aching pain in the calves and feet.

Damage to deep venous trunks leads to more pronounced symptoms:

• pain bothers me constantly;
• feet become bluish;
• thickened venous plexuses are visible under the skin.

A special form of varicose veins is hemorrhoids. This pathology complements bowel movement disorders due to intestinal diseases and a sedentary lifestyle. The expansion of the external hemorrhoidal veins and the internal vascular ring leads to the following consequences:

• bursting pain in the anus;
• constant itching and burning;
• bleeding during bowel movements.

Mild varicose veins are treated by:

• tonics;
• gymnastics;
• wearing compression garments;
• rubbing with ointments.

In severe cases, only surgical techniques help. The doctor selects treatment depending on the depth and diameter of the damaged vessels (sclerotherapy methods, radiofrequency ablation) or offers surgery to remove the entire vein.

Thrombophlebitis complicates the course of varicose veins by the addition of internal or external infection. The inflamed area appears red, swollen, and hot to the touch. Palpation is painful. Thrombophlebitis is most often localized in the superficial veins of the legs and arms. May be accompanied by elevated body temperature and pain.

The disease is associated with dangerous consequences - the separation of part of the blood clot, its transformation into an embolus with the flow of blood into the femoral vein, portal vein, inferior vena cava and right atrium. From here an unobstructed path to the pulmonary artery opens.

Thrombosis of the branches of the pulmonary artery leads to infarction of part of the lung, and blockage of the main vessel causes instant death. A similar complication may occur in the patient in the postoperative period. Therefore, when preparing for surgical interventions, thrombosis prevention is always carried out (tight bandaging of the legs, a course of anticoagulants).

Diseases of the peripheral vessels of the legs in a severe stage are accompanied by gangrene of the toes and overlying parts. Therapeutic measures are designed to prevent tissue necrosis. Vascular pathology is especially severe against the background of diabetes mellitus and atherosclerosis of the femoral artery.

Is it possible to prevent vascular diseases?

To prevent damage to the vascular bed, it is necessary to maintain the tone of the walls, which means that the diet should always contain vitamins from vegetables and fruits.

Dietary requirements for the treatment of arterial atherosclerosis: exclude fatty and fried foods, sweets, and alcohol. Be sure to consume low-fat dairy products and fish.

Smoking should be treated as a serious obstacle to the treatment of the disease. Any, even the most modern treatment, will not be successful if you continue to smoke.

Movement is the key to healthy blood vessels. Daily gymnastics activates blood flow in small capillaries and peripheral veins. You should not engage in strenuous sports or prolonged physical work. Walking, swimming, Pilates are recommended.

Due to the variety of forms of diseases, vascular problems are dealt with by: cardiologists, therapists, surgeons, neurologists, phlebologists, neurosurgeons. If symptoms occur, it is necessary to undergo examination and begin treatment. This will help prevent dangerous complications.

Why does obesity occur in children and why is it dangerous?

Obesity is a chronic metabolic disorder that leads to excessive deposition of adipose tissue in the body. It is often called a disease of civilization. Indeed, overeating and a sedentary lifestyle, characteristic of residents of large cities, are considered to be the main factors in the development of pathology. Today there is a significant increase in the incidence and high prevalence of obesity in children.

The problem of excess weight lies not only in non-compliance with beauty standards: it lies much deeper. The appearance of excess weight in children can have hundreds of causes and as many possible health consequences. You will learn about risk factors for childhood obesity, clinical manifestations of disorders of internal organs caused by excess body weight, and what to do about obesity in boys and girls from our article.

The essence of the problem

Childhood obesity is a condition that is characterized by an excess of the actual weight of the child by 15% or more from the maximum average values. The body mass index is at least 30 kg/m².

There is an increasing trend in the prevalence of the disease throughout the world. More than 60% of adults treated for obesity have weight problems that began in childhood or adolescence. Excess weight in a child can lead to diseases of all body systems in the future:

• cardiovascular;
• endocrine;
• reproductive;
• digestive;
• musculoskeletal;
• respiratory.

Common Causes

Increasingly, concerned parents turn to their doctor with complaints about the appearance of excess weight in their child, the causes of which can be very diverse. Excess body weight is provoked by both exogenous (nutritional) and endogenous (endocrine) factors.

Binge eating

One of the main reasons for the development of the disease is the regular excess of energy entering the body over energy expended. This is achieved by eating a large amount of high-calorie foods:

• confectionery sweets - sweets, cookies, pastries, pies;
• muffins and baked goods;
• fried foods;
• fatty meat, lard;
• cream, sour cream;
• mayonnaise and sauces based on it;
• Fstfood.

Physical inactivity

A sedentary lifestyle significantly reduces the consumption of calories entering the body with food. Obesity in a child often results from:

• sedentary games;
• lying in bed during the daytime;
• watching TV for a long time;
• constant presence at the computer.

Hereditary predisposition and genetic diseases

The role of hereditary predisposition in the development of excess weight in adolescents and children has been proven in several clinical studies. The biochemical features of metabolism, the processes of glycolysis and gluconeogenesis, and the deficiency of enzyme substances in the body are responsible for the gain of excess body weight. There are cases of familial obesity.

A number of genetic diseases are also associated with obesity in adolescents and children. The hereditary nature of the pathology is indicated by the presence of stigmas of dysembryogenesis and accompanying symptoms - muscle hypotonia, visual impairment, mental disability.

Thyroid diseases

Obesity in a child is often a consequence of a violation of the hormonal regulation of the thyroid gland.

For example, congenital hypothyroidism manifests itself immediately after birth. Along with a higher body weight compared to peers, a newborn with low levels of thyroid hormones is lethargic, rarely cries, and has a booming, deep voice. His muscle groups are in a state of hypotonicity, and his stomach is distended.

If the disease is not diagnosed within a few days after birth, the following symptoms develop during the first three to four months of life:

• decreased appetite - the child is reluctant to suck on the mother’s breast or bottle;
• bloating, flatulence;
• constipation;
• pallor, dry skin.

A little later, signs of delayed psycho-emotional and motor development come to the fore: children with congenital hypothyroidism later begin to hold their heads, roll over from back to stomach, sit, and crawl. They take their first steps closer to one and a half years.

Obesity in a child with congenital deficiency of thyroid hormones develops gradually. Despite poor appetite, the baby gains weight and remains larger than his peers. Subcutaneous fat in hypothyroidism is distributed gradually, sometimes obesity is accompanied by myxedema - dense interstitial edema in the face, neck, arms and upper torso.

Acquired hypothyroidism often develops in adolescents during puberty (due to powerful hormonal changes in the body). Excess weight in children with reduced functional activity of the thyroid gland is accompanied by:

• deterioration of memory and concentration processes;
• decreased performance at school;
• various disorders of the digestive system: bloating, flatulence, constipation;
• dry, brittle hair and nails;
• cardialgic pain, heart rhythm disturbances.

Adrenal diseases

Violation of the endocrine regulation of the adrenal glands is also often accompanied by the appearance of excess weight in childhood. Thus, with Itsenko-Cushing's disease, accompanied by increased production of glucocorticosteroid hormones, a sharp increase in body weight is observed.

Against the background of this cause of obesity in children, the distribution of subcutaneous fat occurs according to a special pattern: most of the fat deposits are based on the face and upper torso, while the arms, abdomen and lower limbs remain thin.

Diseases of the gonads

Disorders of the endocrine regulation of sex hormones actively manifest themselves at the time of puberty, adolescents 12-15 years old.

Adipose-genital dystrophy in boys is accompanied by a sharp weight gain, underdevelopment of the internal and external genital organs, gynecomastia (enlarged mammary glands), and the absence of secondary sexual characteristics such as the growth of a beard, mustache, pubic and armpit hair.

Polycystic ovary syndrome in girls, along with obesity, is characterized by menstrual irregularities, excessive hair growth on the face and body, and seborrhea.

Central nervous system diseases

Organic and functional lesions of the central nervous system can cause uncontrolled weight gain. If a child suffers from neurogenic obesity, it is most often due to:

• traumatic brain injuries;
• previous meningitis, meningoencephalitis and other inflammatory diseases;
• brain tumors;
• complications of neurosurgical operations.

The most common cause of obesity is damage to the pituitary gland. It is he who controls the processes of growth and weight loss in the body. Additional symptoms of central nervous system diseases include headaches, nausea and vomiting of central origin. Boys may additionally experience gynecomastia, and girls may experience various menstrual irregularities.

Taking certain medications

Some medications that a child has to take for a long time as prescribed by a doctor can also trigger the development of obesity. Among them:

• hormonal anti-inflammatory drugs (glucocorticosteroids);
• estrogen-containing drugs;
• antiallergic drugs (in particular, Ketotifen);
• thyreostatics Mercazolil, Tyrosol;
• drugs used in psychiatry (Amitriptyline, Anafranil).

How is obesity classified?

Despite the fact that the problem of excess body weight is often visible to the naked eye, many parents are interested in how to determine at home whether a child has weight problems.

The classification of obesity in children, based on the definition of BMI, which is successfully used in adulthood, is not without drawbacks. However, its prevalence remains quite high. To determine obesity and its degree, it is necessary to calculate the body mass index - a value that allows you to assess the correspondence of weight to height. BMI = weight (kg)/height² (m²).

For example, if a boy is 8 years old, his height is 125 cm, and his weight is 24 kg, body mass index is calculated using the formula: BMI = 24/1.25*1.25 = 15.36

Normal BMI values ​​for a child are slightly lower than for an adult and range from 15 to 18.5. This is due to the physique of the child’s body.

The interpretation of the results obtained, as well as the degree of obesity in children, is presented in the table below.

Pre-obesity is accompanied by an increase in body weight by 10-29% of the generally accepted norm. The child does not experience much discomfort; parents and others may not notice (not pay attention) to the weight gain.

Obesity of the first degree is characterized by an increase in body weight by 30-49%. For the first time, the baby is faced with certain health problems - shortness of breath, decreased tolerance to physical activity, increased sweating. The external signs of obesity and the growth of the fat layer attract attention.

With grade 2 obesity in children, the total weight is increased by 50-99% of the average. At this stage, fat deposits become stable and difficult to undergo therapeutic correction. In the second degree of obesity, signs of damage to internal organs are observed - hypertension, impaired glucose tolerance (prediabetes), reactive pancreatitis and cholecystitis.

With the third (morbid) degree of obesity, there is a critical increase in weight by 100% or more from the average values. Children with this form of the disease suffer from a variety of pathologies of internal organs. They often have difficulty moving and require constant care. It is possible to adjust their metabolism and start the process of losing weight only with the help of long-term drug correction.

The method associated with calculating BMI in diagnosing childhood obesity is very crude and inaccurate. Therefore, pediatricians and endocrinologists prefer to replace it with a more reliable one, based on the use of centile tables. They take into account not only BMI indicators, but also the age and gender of the baby.

Modern centile tables, created in 2006, are easy to use. They consist of rows corresponding to the child's age and columns that indicate the percentage of children with certain weight indicators.

For example, a boy who is 3 years old has a BMI of 18. We check the table:

1. The Median indicator reflects the absolute norm. According to WHO, most healthy three-year-old boys have a BMI of 15.6.
2. Values ​​that fit into the corridor between columns -1 and +1 are also considered normal BMI indicators. In our example – 14.4-16.9.
3. A BMI value between columns 1 and 2 indicates overweight. For a three-year-old boy – 16.9-18.4.
4. Values ​​between columns 2 and 3 indicate clinical obesity. In the example –18.4-20.0.

Thus, our patient is overweight. He needs to adjust his diet and undergo examination for possible endocrine pathology.

When extra pounds are dangerous

Excess weight has a negative impact on the functioning of all internal organs and systems. These changes are especially dangerous in childhood, when the body is most inactive and reacts sharply to any pathological changes.

The cardiovascular system

Obesity increases the volume of circulating blood and creates additional stress on the heart muscle. This provokes the appearance of symptoms in the child:

• arterial hypertension;
• coronary heart disease;
• atherosclerotic lesions of arterial vessels;
• chronic heart failure.

Diseases that are more typical for older people become a reality for young patients and pose a significant threat to life.

Gastrointestinal tract

Formed negative eating habits, regular consumption of harmful foods and impaired metabolism create the prerequisites for the formation of chronic diseases of the gastrointestinal tract already in childhood. Among them:

• gastritis;
• gastroduodenitis;
• cholecystitis;
• biliary dyskinesia;
• pancreatitis;
• steatosis (fatty infiltration) of the liver;
• liver failure.

Musculoskeletal system and endocrine glands

Excess body weight puts an excessive burden on the child’s incompletely formed bones and joints, often causing the development of synovitis, flat feet, “X” or “O”-shaped deformation of the lower extremities.

Fatty infiltration of functional pancreatic cells leads to impaired glucose tolerance and the development of non-insulin-dependent diabetes mellitus. The activity of the gonads in obesity is also significantly reduced, which causes late puberty and infertility in adulthood.

Nervous system

Excess weight in a child often provokes the development of pathological changes in the nervous system. The most common syndromes include:

• various sleep disorders;
• snoring during sleep;
• dysregulation of breathing processes;
• asthenic conditions;
• neuroses.

Against the background of ridicule from their peers, sick children and adolescents often withdraw into themselves, they develop depression and an inferiority complex. It is very difficult to treat such conditions: often mental and behavioral disorders remain with the patient for life. This causes deviant behavior and can stimulate the onset of alcohol and drug abuse.

Principles of disease diagnosis

Diagnosis of obesity in children is based on a conversation between the child and his parents with a doctor, a general clinical examination, assessment of indicators of physical development (height, weight, BMI) and comparison of them with standardized values. You can diagnose diseases associated with obesity and its possible causes using additional tests:

• clinical blood test;
• clinical urine analysis;
• biochemical blood test (with determination of the level of glucose, cholesterol and its fractions, total protein, bilirubin, liver enzymes);
• hormone tests (T3, T4, TSH to determine thyroid function, adrenal hormones);
• instrumental tests - x-ray examination, computed tomography, MRI, ultrasound.

The diagnosis should reflect the degree of obesity determined in the child, as well as any associated diseases.

Current treatment approaches

Treatment of obesity in children is a long process that requires an integrated approach and careful adherence to medical recommendations. The complex of therapeutic measures includes:

• diet correction: following the principles of a healthy, balanced diet;
• expansion of available physical activity, dosed exercise, regular walks and games in the fresh air;
• drug therapy;
• surgical correction of the condition - according to indications.

In addition, in the treatment of obesity in children and adolescents, an important role is played by identifying and eliminating the causes that caused it.

Treatment of childhood obesity begins with the preparation and selection of an individual nutrition plan. You cannot use standardized recommendations, because when creating a diet, the doctor must take into account not only the weight and initial stage of the disease, but also the age, individual constitutional characteristics, as well as medical contraindications of the child.

1. Fractional (5-6 times a day) meals in small portions.
2. Exclusion from the diet of confectionery, sweets, fast food and other food “garbage”.
3. Regular consumption of vegetables and fruits - sources of fiber, vitamins, and microelements.
4. Sufficient drinking regime.

Complex treatment also includes adequate physical activity. There are also no standard recommendations in choosing it. Some overweight children tolerate active play in the fresh air well, while others like swimming or strength training in the gym. All kids, without exception, benefit from 30-60 minute walks before bed.

Drug treatment is used when other conservative treatment methods are ineffective. The following medications can be used as prescribed by a doctor:

• Orlistat;
• Sibutramine;
• Rimonabat;
• Metformin;
• Exenatin.

The mechanism of action of such drugs is based on suppressing appetite, increasing metabolism and reducing the body’s ability to absorb fats and fat-like substances coming from food.

For obesity in children, treatment based on surgery is rarely used. Bariatric surgeries are prescribed only for health reasons and include:

• gastric banding;
• gastric bypass;
• gastroplasty (various options).

Despite the fact that such operations are designed to treat obesity, they do not have a direct effect on its cause. Therefore, even after successful surgery, the child needs to follow a diet and maintain a sufficient level of physical activity.

Prevention of obesity in children consists of creating correct eating behavior, timely treatment of endocrine, neurological and other diseases that lead to uncontrolled weight gain. Of no small importance is a friendly atmosphere and trusting relationships in the family, the absence of screams, scandals and squabbles.

Obesity has become one of the problems of society in the twenty-first century. The disease is “recruiting” new adherents around the world. This is due to poor nutrition, a sedentary lifestyle, a significant number of chronic endocrine pathologies and many other factors. Literally, obesity means that body weight increases not due to muscle compaction, but due to fat deposits in different parts of the body. Why is obesity dangerous? Looking at people with excess body weight, any doctor will name a dozen reasons, and in the first place will be diseases of the heart, blood vessels, joints and bones, and impaired water-salt metabolism. In addition, this disease makes social life difficult, since modern society is dominated by trends towards sports and a healthy lifestyle.

Etiology

The disease “obesity” can develop for a variety of reasons. The most obvious is physical inactivity, that is, the discrepancy between calories received and energy expended. The second common cause of excess weight is disruption of the gastrointestinal tract. This could be a lack of pancreatic enzymes, decreased liver function, or problems with digesting food. In addition, the risk of obesity can be determined at the genetic level.

There are factors that contribute to weight gain, these include:
- drinking sugary drinks or eating a diet high in sugar;
- endocrine diseases such as hypogonadism, hypothyroidism, pancreatic tumor;
- 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 accumulating nutrients in case there is a sudden shortage of food. And if this was relevant for ancient people, then modern man does not need such “storage facilities”. However, our body is designed in such a way that it reacts stereotypically to both positive and negative influences from the outside. That is why the problem of obesity has become so acute at the moment.

Pathogenesis

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 a mismatch between the cerebral cortex and the hypothalamus. This is where the appetite regulation centers are located. The body requires more food than it expends energy, so everything excess is left “in reserve”, which leads to 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 upbringing. In addition, such problems are sometimes the result of injury, inflammation, or 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, and thyroid gland.

Classification by BMI

It is better to start classifying obesity with one that is known to the general population. As a rule, the primary diagnosis of this disease is carried out based on an indicator such as This is a particular value obtained after dividing body weight in kilograms by height in meters squared. There is the following gradation of obesity according to this indicator:

1. Weight deficiency - if BMI is less than or equal to 18.5.
2. Normal body weight - mass index should be between 18.5 and 25.
3. Pre-obesity - BMI ranges from 25 to 30 points. At this point, the risk of concomitant diseases such as hypertension, bedsores and diaper rash increases.
4. Class 1 obesity is diagnosed if the BMI is between 30 and 35.
5. Obesity 2 degrees - the index is approaching 40 points.
6. Obesity of the 3rd degree is diagnosed when the mass index exceeds 40 points, and the person has concomitant pathologies.

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 development of the pathology. According to it, primary and secondary obesity are distinguished. Each of them has its own subclasses.

Thus, 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:

1. Hereditary, with a gene defect.
2. Cerebral, caused by neoplasms, infections or autoimmune damage to the brain.
3. Endocrine, caused by dysregulation of the thyroid gland, hypothalamic-pituitary system, adrenal glands and gonads.
4. 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, we can create the following classification of obesity:

Alimentary-constitutional. Weight gain is associated with excess fat in the diet and lack of exercise. It usually manifests itself in childhood and can 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 its neuroendocrine function.
- Endocrine. Fatness is based on the pathology of the endocrine glands - the pituitary gland, the thyroid gland, and the adrenal glands.
- Iatrogenic. Obesity is caused by medical intervention. This could be taking medications, removing an organ or part of it, damaging the endocrine system during treatment, and much more.

Classification by localization of adipose tissue

After examining overweight patients, it was noticed that not everyone has the same distribution of weight. Therefore, over time, a classification of obesity was developed based on the characteristic location of the fat layer.

The first type, also known as the upper type, also known as the android type, is distinguished by the fact that the upper half of the body, face, neck and arms are enlarged. It occurs more often in men, but can also be seen in women who have entered menopause. A number of authors argue 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, 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 on the shape of a “pear”. It can also develop from childhood if it is aggravated by a violation of the normal diet. in this case there 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 throughout the body, smoothing out the waist, neck, and buttocks.

In order to determine what type of obesity the patient has addressed, it is necessary to determine the ratio of waist and hip circumference. If in women this figure is more than 0.85, and in men more than one, then it can be argued that the person has 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 body as a whole, but also individual organs, tissues and even just cells. Adipocytes (fat cells) can undergo qualitative or quantitative changes. Depending on this, they distinguish:

1. Hypertrophic obesity. It is characterized by a pathological increase in the size of fat cells, while their number remains the same.
2. Hyperplastic obesity, in which adipocytes actively divide. This form occurs in children and is very difficult to treat, since the number of cells can be reduced only by aggressive methods.
3. Mixed obesity, as it is logical to assume, is a mixture of the previous two. 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 excess body weight. Of these, 8.5% are urban residents, and 3.5% are rural residents. Obesity in adolescents and children has become such a common pathology that pediatricians decided to introduce a special section in their educational work with young parents regarding diet. Obesity is considered a condition when a child's body weight exceeds 15% of what it should be for his age. If correlated with BMI, its value will be close to 30 points.

There are two forms of obesity among children: primary and secondary. Primary is usually caused by poor nutrition, early complementary feeding, or refusal of breast milk in favor of cow's milk. But it can also be hereditary if the family is dominated by overweight people. But even in this case, the child is not born fat, he just has a slow metabolism, and with the proper diet and exercise, he will maintain 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 still remain controversial. The following scale was proposed:
- 1st degree - weight is 15-25% more than expected;
- 2nd degree - from 25 to 49% excess weight;
- 3rd degree - the mass is 50-99% more;
- 4th degree - excess weight is two or more times the age norm.

Symptoms

The signs of obesity are basically similar to each other, the only difference is the uniformity of distribution of excess fiber, as well as the presence of concomitant pathologies or their absence.

Most often in patients it occurs that is associated with a violation of the normal diet. Typically, such people have a hereditary predisposition to weight gain, and eating too much food leads to weight gain. Symptoms occur in all family members, as they all eat together. In addition, older women who, due to their poor health, lead a sedentary lifestyle, are susceptible to this type of obesity.

Obesity of the 1st 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.

It 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 changes in diet. Fat appears mainly on the front of the abdomen, thighs and buttocks. Trophic changes may occur: dry skin, stretch marks, hair loss. Such patients complain of insomnia, headaches and dizziness. A neurologist is usually able to identify 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. It’s a completely different matter for patients of an endocrinologist or neurologist. These themselves want to be examined and lose weight for a speedy recovery.

The most commonly used criterion for diagnosing overweight is the body adiposity index. That is, how much greater the actual mass is than the expected one. To determine the severity, it is important not only to prove the presence of excess weight, but also that it is realized through adipose tissue and is not muscle mass. Therefore, they are actively trying to introduce into medical practice methods for determining fat mass, and not the entire body weight.

The norm is determined taking into account statistical data collected by doctors of various specialties over the years of practice. For each gender, age, height and body type, there are tables with already calculated pathology and norm values. Scientists have found that centenarians have body weight that is 10% less than normal. Morbid obesity is diagnosed in the opposite case, when weight is 10% above the upper limit of the permissible limit.

There are several formulas for calculating ideal body weight. All fashionistas know one of them - you need to subtract one hundred from your 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. Measuring the ratio of waist to hip circumference is also of great importance in characterizing obesity, since the location of fatty tissue depends on the reason for weight gain.

Treatment

The fight against obesity is being carried out aggressively and everywhere. Nowadays the media actively promotes a healthy lifestyle and the cult of a beautiful, athletic body. Of course, there is no point in taking the situation to the point of absurdity, but the general direction of the youth movement is preferable to decadent hedonia.

The basic principles of obesity treatment include:
- a diet rich in complex carbohydrates and fiber, vitamins, nuts and greens. Be sure to limit baking, sweets and carbonated drinks.
- physical exercises that should strengthen the body and speed up metabolism.
- medications to reduce weight and appetite;
- psychotherapy;
- surgery.

To achieve long-term results with 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 achieved weight and prevent the disease from returning. The World Health Organization recommends calculating the caloric content of food that the patient normally consumes and gradually reducing the amount of calories. It is necessary to reach the level of 1500 - 1200 kilocalories, provided that the person does not overload himself physically.

Psychotherapy is aimed at strengthening willpower and self-control in relation to food intake and addiction to fast food restaurants and sweet soda. Medications in the process of weight loss help achieve only short-term effects. After stopping taking the pills, the patient returns to the previous lifestyle and does not comply with the recommendations received upon discharge. Despite the fact that now the pharmacological industry can offer a large selection of drugs for excess weight, almost all of them are prohibited 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 speed of food passage becomes higher. The second option is gastric banding. A ring is installed in the cardiac part, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritates 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 weight exceeds the norm, and what concomitant diseases he has.

Several regulatory circuits controlled by the hypothalamus are considered responsible for the regulation of body weight, for example the ventromedial nucleus (satiety center) and the lateral nuclei (hunger center). The regulatory circuit thought to be responsible for long-term lipostatic effects involves body fat mass and is determined by a substance secreted by fat cells (leptin). According to the feedback principle, the amount of fat is maintained at a constant level by changing appetite and physical activity. Therefore, fat that is surgically removed is quickly restored.

Obesity (obesity) is considered a risk factor for hypertension, type 2 diabetes mellitus, hyperlipidemia, atherosclerosis, as well as urolithiasis and cholelithiasis. Excess body weight of more than 40% doubles the risk of premature death. Obesity is partly (poly)genetic (metabolic susceptibility) in origin, partly due to external factors. Two defective genes were found: one in two male mice with extreme obesity and one in type 2 diabetes. If the obesity gene is damaged, the 16 kDa leptin protein encoded by this gene is absent in the plasma. Injecting leptin into mice with a homozygous ob mutation prevents the manifestation of the gene defect. In normal mice, this manipulation causes a decrease in body weight. Mutation of the ob gene damages leptin receptors in the hypothalamus (including in the arcuate nucleus). The hypothalamus does not respond to high plasma leptin concentrations. Some obese people have a defective leptin gene, but many others have high plasma leptin concentrations. In the latter case, the chain of responses to leptin must be interrupted somewhere (red X). The following possible defects are suggested: leptin cannot cross the blood-brain barrier (impaired transport); the inhibitory effect of leptin on the secretion of neuropeptide Y (NPY) in the hypothalamus, which stimulates appetite and reduces energy consumption, is disrupted; leptin does not cause the release of α-melanocortin (α-MSH) in the hypothalamus, which acts through the MCR-4 receptors and causes the opposite effect of NPY.

Three very obese sisters were found to have a homozygous defective leptin receptor gene. Considering that these women did not experience puberty, and the secretion of GH and TSH was reduced, it is possible that leptin plays a role in other endocrine regulatory cycles.

In 90% of cases, eating disorders affect young women. Bulimia nervosa (binge eating followed by self-induced vomiting and/or laxative abuse) occurs more often than anorexia nervosa (weight loss through a very restrictive diet). These eating disorders are characterized by a distorted self-image of their body (patients feel “too fat” even if their body weight is normal or below normal) and an incorrect attitude towards food (the connection between self-esteem and body weight). There is a genetic predisposition (in identical twins there is a 50% coincidence) without established primary genetic defects. Probably, psychological factors are significant, such as disruption of relationships in the family (overprotection, avoidance of conflicts, cruelty), conflicts during adolescence, as well as sociocultural influences (beauty ideals, social expectations).

Eating disorders in anorexia nervosa range from a very strict diet to complete refusal of food; Often these people abuse laxatives. As a result, body weight decreases significantly, even to the point of exhaustion, which may require parenteral nutrition. This condition leads to severe vegetative hormonal disorders, for example, increased cortisone levels and decreased gonadotropin release (amenorrhea; decreased libido, impotence), hypothermia, bradycardia, hair loss, etc. If the condition takes a protracted course, the mortality rate reaches 20%.

Bulimia is characterized by binge eating followed by spontaneous induction of vomiting. Body weight may be normal.

Epidemiology of obesity

Over the past 35 years, the prevalence of obesity has more than doubled. It is especially common in women from many ethnic minorities (African-American, Mexican, Indian, Puerto Rican, Cuban, and Oceanian). Obesity is as harmful to health as smoking: it causes 500,000 premature deaths every year and doubles the mortality rate. Obesity is also widespread among young people and children. Among ethnic minorities, up to 30-40% of children and adolescents are overweight.

One risk factor is weight gain in adulthood. A weight gain of 75 kg or more compared to weight at the age of 12-20 years increases the relative risk of gallstone disease, diabetes mellitus, arterial hypertension and coronary artery disease.

Causes of obesity

Pathoanatomically, in addition to the indicated rare findings in the interstitial medulla or in the endocrine glands, accumulation of fat is found in the usual places of its deposition: in the subcutaneous tissue, omentum, perirenal, mediastinal tissue, in the epicardial region; They also find a high position of the diaphragm, fatty infiltration of the liver, layers of fat between the muscle fibers of the myocardium, and pronounced atherosclerosis.

Weight is influenced by both heredity and environmental factors. Heredity can explain up to 40% of differences in human weight. However, the marked increase in the prevalence of obesity over the past 20 years cannot be explained by genetic factors - rather, it is caused by changes in environmental factors, including lack of sleep, constant stress at work and at home, irregular meals and dietary patterns (fast food instead of diet, rich in vegetables, fruits and fish).

Excess calories taken in are stored as fat. Even a small but long-term difference between calorie intake and calorie expenditure can lead to significant fat deposition. So, taking in just 5% more calories than you burn can lead to the accumulation of about 5 kg of fatty tissue over a year. If you consume 7 kcal/day more than you burn over the course of 30 years, your body weight will increase by 10 kg. This is what Americans gain on average between 25 and 55 years of age. Technological progress is leading to lifestyle changes that promote a positive energy balance.

The foods and drinks favored by modern Americans are high in calories and fat, but low in many essential nutrients. According to various estimates, from 60 to 90% of Americans are malnourished in the sense that, despite excess calories, their diet does not meet the daily requirements for certain nutrients. In addition, only 9% of men and 3% of women regularly and vigorously move or play sports in their free time.

There is no doubt that the origin of persistent obesity is determined precisely by the cerebral cortex due to easily formed conditioned reflex connections, etc.

One cannot think that what is common to all forms of morbid obesity is a decreased need for calories and a decreased basal metabolic rate. On the contrary, the basal metabolism in states of extreme exhaustion, such as in severe enteritis, cancer cachexia, pituitary cachexia, often falls, but in obesity it remains normal (except for rare cases of hypothyroid obesity). All of the above confirms the complexity of the pathogenetic mechanisms of obesity.

Based on the participation of various parts of the regulatory system in the pathogenesis, the following forms of obesity are clinically distinguished:

1. Cerebral, or diencephalic (hypothalamic) obesity, which includes clinical cases of obesity after encephalitis of a wide variety of etiologies, for example, after epidemic encephalitis, encephalitis with typhus, scarlet fever, rheumatic chorea, etc. (as well as experiments with damage to the tuber cinereum and etc.).
2. Pituitary obesity, close to diencephalic and essentially representing a variant of the same diencephalic-pituitary form, and the pituitary gland is predominantly affected, and not the neuro-vegetative centers, as in the first variant. Fat is deposited on the chest, abdomen, pubis, thighs; characterized by a decrease in the specific dynamic effect of food. Dystrophia adiposo-genitalis is characterized by underdevelopment of the genital organs and general infantilism, along with signs of a tumor of the pituitary gland or interstitial brain. In Itsenko-Cushing's disease - basophilic adenoma of the pituitary gland, in addition to obesity with characteristic striae distensae on the abdomen, there are a number of symptoms common to hyperfunction of both the anterior lobe of the pituitary gland and the adrenal cortex and dysfunction of the gonads, such as: hirsutism (hair growth in women according to the male type), severe hypertension, apoplexy, as well as diabetes, osteoporosis and signs of a pituitary tumor. Close to this form is adrenal obesity with tumors of the adrenal cortex.
3. Hypogenital obesity, which develops in women during menopause, natural or artificial, as well as during lactation, in men with underdevelopment of the gonads (eunuchoid obesity). Prepubertal obesity in boys may also depend on a lack of sex hormones.
   Hypoovarian obesity is characterized by the location of fat in the form of leggings or the hanging of the abdomen in the form of an apron. However, the distribution of fat often occurs according to a general type, or fat is deposited mainly on the legs, etc.
4. Hypothyroid obesity, observed with insufficient thyroid function, sometimes without other symptoms of myxedema; characterized by a fat neck and moon-shaped face. A decrease in basal metabolic rate is pathognomonic.
   These and other special forms of obesity are observed very rarely; Thus, in one of the summary works on 275 obese patients, only 2 cases of cerebral and 5 cases of endocrine obesity were noted.

The largest number of cases is due to obesity of the usual form - a neurodystrophic process without sharp anatomical changes in the nervous and endocrine systems, often attributed to the exogenous type of obesity from overeating, but accompanied, however, by a violation of regulatory and metabolic processes, creating a vicious circle in the clinic of the disease and thus causing the persistent course of the disease. With a certain amount of persistence, this trend can be overcome by purposefully changing the influence of external factors.

Symptoms and signs of obesity

Patients do not tolerate heat well, especially on humid days. Massive fatty tissue represents a constant additional load, restricts the movements of the diaphragm, disrupts blood circulation and breathing. The heart is mechanically constrained, myocardial fibers atrophy from the pressure of fatty infiltration; At the same time, patients often develop coronary sclerosis and hypertension, which further disrupt the activity of the heart. Infectious and allergic bronchitis, atelectasis, hypostatic pneumonia, emphysema, often observed in obese patients, create further difficulties for the functioning of the heart. Therefore, it is clear that over time, cardiac complaints, along with impaired peripheral circulation (brain, kidneys, limbs), acquire leading importance in the clinical picture. Obese patients are predisposed to cholelithiasis and acute necrosis of the pancreas.

Diagnosis of obesity

• Waist circumference.
• In some cases, body composition analysis.

BMI is a crude screening tool and has limitations for many subgroups. BMI varies by age and race; its use is limited in relation to children and the elderly. In children and adolescents, overweight is defined as a BMI >95th percentile or based on age- and gender-specific growth charts.

Asians, Japanese and many Aboriginal populations have lower minimum levels for overweight. In addition, BMI may be high in muscular athletes who do not have excess body fat and may be normal or low in previously overweight people who have lost muscle mass.

The risk of metabolic or cardiovascular disease caused by obesity is more accurately determined by the following factors:

• other risk factors, in particular, having a family history of type 2 diabetes or early cardiovascular disease;
• waist circumference;
• serum triglyceride levels.

Waist circumference, which increases the risk of obesity-related complications, varies depending on:

• White men: > 93 cm > especially > 101 cm > 39.8.
• White women: > 79 cm > especially > 87 cm > 34.2.
• Indian men: >78 cm > especially > 90 cm > 35.4.
• Indian women:>72 cm>especially>80 cm>31.5.

Body Composition Analysis. Body composition - the percentage of fat and muscle - is also taken into account when diagnosing obesity. Although probably unnecessary in routine clinical practice, body composition analysis may be useful if clinicians are wondering whether an elevated body mass index is due to muscle or excess fat.

Body fat percentage can be calculated by measuring the thickness of the skin fold (usually over the triceps) or determining the circumference of the muscle at the mid-upper arm.

Bioimpedance body composition analysis (BIA) allows you to estimate your body fat percentage in a simple and non-invasive way. It directly determines the percentage of total fluid in the body; The percentage of body fat is determined indirectly. BIA is the most reliable method for healthy people and in people with only a few chronic diseases that do not change the percentage of total body fluid. It remains unclear whether BIA poses a risk in people with implanted defibrillators.

Underwater (hydrostatic) weighing is the most accurate method of measuring body fat percentage. Being expensive and labor intensive, it is used more often in research than in clinical work. In order to accurately weigh a person during a dive, he must exhale completely beforehand.

Diagnostic imaging, including CT, MRI, and dual-energy X-ray absorptiometry (DXA), can also assess fat percentage and distribution, but is generally used for research purposes only.

Other types of research. Obese patients should be screened for obstructive sleep apnea using a tool such as the Epworth Sleepiness Scale and often the Apnea-Hypopnea Index. This disorder is often underdiagnosed.

Blood glucose and lipid levels should be measured regularly in patients with a large waist circumference.

Ignoring the disease by doctors

This occurs especially often with excess body weight or stage I obesity. The reason for ignoring it is often that the patient visits the doctor in connection with other problems and does not want to receive recommendations for weight loss. However, the doctor and the patient must be aware that even such a relatively small excess body weight is a risk factor for many diseases (hyperlipidemia, arterial hypertension, diabetes mellitus, etc.).

Therefore, the doctor must draw the patient’s attention to the harm caused by excess body weight and the importance of reducing it. With a discussion of the question of whether there is excess body weight and whether it is harmless, the patient begins to move towards accepting recommendations on how to regulate body weight.

Overexamination of the patient

In more than 90% of cases, excess body weight is an independent (primary) problem, and not a consequence of another disease.

Secondary obesity can be a consequence of a number of endocrine diseases (hypothyroidism, Cushing's disease/syndrome). Less commonly, the cause of excess body weight is congenital genetic defects (Prader-Willi syndrome, etc. - relevant in children and young patients), the consequences of immobilization, head injuries, tumors of the hypothalamic zone, therapy with antipsychotics, etc.

Many of these causes of secondary obesity are easy to diagnose based on history and physical examination.

During a laboratory examination of an obese patient, it is necessary to determine the following indicators:

• TSH level;
• daily excretion of free cortisol in urine (with clinical suspicion of hypercortisolism - stretch marks, arterial hypertension, hyperglycemia, “Cushingoid” appearance, etc.);
• to assess the metabolic consequences of obesity: glucose levels, lipid profile, uric acid.

Often, redundant and expensive examinations are carried out to determine all known hormones or evaluate indicators that, although they play a role in the genesis of obesity, do not affect the choice of treatment methods (leptin level).

On the other hand, without a thorough history and proper laboratory testing, you can miss an endocrine (or other) disease that led to the development of secondary obesity.

When evaluating an obese patient, it is possible to perform appropriate tests to exclude hypogonadism in men and hyperprolactinemia in men and women, although this is not part of the generally accepted examination plan.

A common, but not beneficial practice is to conduct an OGTT with measuring, in addition to glucose, also the level of insulin and/or C-peptide.

Based on the increased level of these indicators, the presence of insulin resistance can be stated (for the correct interpretation of increased insulin levels, see Chapter 10). In this case, medications that improve insulin sensitivity (usually metformin) are often prescribed. But the doctor and the patient must understand that:

• the use of metformin by itself does not cause weight loss;
• The effect of metformin on tissue sensitivity to insulin is reversible and disappears after discontinuation of the drug. In this regard, the drug should be taken for life,5 which can be justified only in rare cases, for example, with a high risk of type 2 diabetes in the near future.

Underestimation of eating disorders and depression

A significant proportion of obese patients have eating disorders (such as bulimia) and depressive disorders. Without eliminating these problems, standard recommendations for changing diet are ineffective, and therefore many patients need the help of a psychotherapist (psychiatrist).

In everyday practice, these problems often go undetected in obese patients.

Obesity forecast

Obese patients die at an earlier age than thin people. The immediate cause of death is most often heart failure, myocardial infarction, cerebral hemorrhage, lobar pneumonia and other infections, consequences of cholelithiasis, surgery, etc.

Without treatment, obesity tends to progress. The likelihood and severity of complications is proportional to the absolute amount of fat, fat distribution and absolute muscle mass. After weight loss, most people return to their pre-treatment weight within 5 years, and obesity therefore requires a lifelong management program similar to any other chronic disease.

Complications of obesity

Obesity worsens the quality of life and is a significant risk factor for a number of diseases and premature death.

Complications of obesity include:

• Metabolic syndrome.
• Diabetes mellitus type 2.
• Cardiovascular diseases.
• Non-alcoholic steatohepatitis (fatty infiltration of the liver).
• Gallstone disease.
• Gastroesophageal reflux.
• Obstructive sleep apnea syndrome (OSAS).
• Reproductive system disorders, incl. infertility.
• Many types of malignant neoplasms.
• Deforming osteoarthritis.
• Social and psychological problems.

Obesity is also a risk factor for non-alcoholic steatohepatitis (which can lead to cirrhosis of the liver) and reproductive disorders such as low serum testosterone in men.

Obstructive sleep apnea can occur when excess fat in the neck compresses the airway during sleep. Breathing stops momentarily hundreds of times a night. It is a disorder that often goes undiagnosed.

Obesity can lead to obesity-related hypoventilation syndrome (Pickwick syndrome). Impaired breathing leads to the development of hypercapnia, decreased sensitivity to carbon dioxide in stimulating respiration, and hypoxia.

Osteoarthritis and tendon and fascial diseases can occur as a result of obesity. Excess weight probably predisposes to the development of gallstones, gout, pulmonary embolism, and some types of malignancies.

Obesity treatment

General principles. Americans spend more than $70 billion annually on commercial “weight loss products.” In most cases, people manage to lose weight with their help, but, alas, after 1-5 years the lost kilograms come back in abundance. Obesity is a chronic disease, and long-term maintenance of normal weight requires equally long efforts. For a sustainable change in lifestyle, the patient needs to change his behavior. It is also very important to have an understanding of the basics of proper nutrition. Patients should be encouraged to systematically, gradually lose weight. At the same time, sensitivity to insulin increases, blood pressure and lipid levels in the blood decrease, and fatty infiltration of the liver decreases.

Reducing caloric intake should take into account the patient's age and associated risk factors. Below is a formula that, if followed, allows you to lose about 0.5 kg per week. Daily calorie intake = (Current weight in kg x 28.6 kcal) - 500 kcal.

Reducing the amount of fat in the diet- an important part of any weight loss program. Many patients are helped by reducing the amount of fat in the diet to 10-20% of its daily calorie content (about 20-30 g of fat per day). In most commercial weight loss programs, the daily calorie intake is 800-1200 kcal. If you follow it consistently, this program allows you to lose from 200 g to a kilogram per week for 30 weeks.

From amateur diets Most of them are of little use, and some of them are simply harmful. In addition, a decrease in calorie intake can lead to micronutrient deficiencies and disrupt metabolic processes.

That is why it is recommended to lose weight under the supervision of a nutritionist. The nutritionist should recommend that the patient eat three times a day, avoid snacking between meals, eliminate fatty and high-calorie foods from the diet, and eat more vegetables and fruits.

Physical activity important not only for long-term maintenance of normal weight, but also for general health. You need to increase the load gradually. According to research, once you reach a normal weight, 80 minutes of daily moderate physical activity, such as brisk walking, or 35 minutes of vigorous physical activity, such as brisk cycling or aerobic exercise, is enough to maintain it. However, you don't have to join an organized exercise program; a consistently active lifestyle can help you maintain your weight just as well as aerobic exercise. Recent research shows that weight training is best for weight loss and maintenance. By increasing muscle strength and muscle mass, this type of exercise thereby speeds up metabolism and enhances the oxidation of fats as a source of energy. This makes it much easier to maintain normal weight for a long time.

If a patient constantly hears from doctors words about the need to lose weight, but they are all limited to only general phrases (“you need to eat less and move more”), he develops a denial of these recommendations and a belief in the ineffectiveness of the diet in his case (“this is not me - I eat little”; “I tried it many times, but it doesn’t help me”). The reason may be the patient’s ignorance of many important aspects of weight loss (the need to limit vegetable fats, such as olive and sunflower oil, which have the highest calorie content among all products).

The same applies to physical activity: clear recommendations are needed on how often, for how long and with what intensity to exercise.

At the same time, providing such detailed recommendations to the patient only makes sense at the stage when he seriously wants to lose weight and is ready to change his diet and lifestyle (not always pleasant for him) to achieve this goal. Detailed recommendations at earlier stages (for example, “denying the problem”) are ineffective and only waste time for the doctor.

“The main sources of calories are flour and sweets”

When reducing body weight, limiting the consumption of these foods first is a common misconception among patients, and sometimes among doctors.

Often such a diet turns out to be ineffective, because the most high-calorie foods rich in fat are consumed in the same quantity. It is important to explain to the patient that the “champions” in terms of calorie content are fats and alcohol, and:

• when losing body weight, you have to limit your fat intake (sunflower and olive oil, including in salads, when cooking and heating food);
• A common “trap” for patients trying to lose weight is eating foods rich in “hidden” fats and temporarily prescribing diet therapy.

A common mistake is relatively short-term adherence to so-called unbalanced diets (for example, a carbohydrate-free diet such as the Atkins diet or a similar “Kremlin” diet). Due to severe caloric restriction and the ketogenic effect (which reduces appetite), these diets provide fairly rapid weight loss, but this diet does not last long. After returning to the previous diet, body weight is likely to return to its previous level or even higher (“yo-yo syndrome”).

The so-called very low calorie diet has very limited use in the treatment of obesity. Sometimes it is used at the initial stage of weight loss, followed by a transition to a low-calorie diet (1200-1800 kcal/day) on a permanent basis. This provides a greater overall result than using only a low-calorie diet, but this method is only useful in the hands of an experienced nutritionist. Otherwise, there is a risk of weight gain upon completion of a very low-calorie diet (the above-described “yo-yo syndrome”). Fasting treatment also has all the disadvantages described above, and it is also contraindicated in patients with diabetes.

Physical activity

Increasing physical activity is no less important a component of treatment than changing diet.

The effect of diet on the “weight” indicator itself may be more pronounced than that of physical exercise. At the same time, the latter provide favorable changes in body composition (for example, with a decrease in fat tissue by 1 kg and an increase in muscle tissue by 1 kg, body weight does not change, but the body becomes healthier).

Therefore, properly selected moderate-intensity physical exercises of at least 2-4 hours per week are considered an essential component of a weight loss program.

A sharp change in the usual diet and lifestyle, including the introduction of intense physical activity without a preparation stage

The recommendations that the patient receives must be realistic: if they are too aggressive and impossible to implement in his daily life, this will most likely lead to refusal of treatment and cause stress.

Targets set for weight loss should also be realistic. Even if body weight remains formally overweight, such a reduction significantly improves metabolic parameters, well-being, and the condition of the cardiovascular and musculoskeletal systems. At the same time, the achieved body weight is easier to maintain, and the risk of relapse is lower than with a more significant reduction in body weight. More impressive results, especially in the short term (for example, under the motto “lose weight by summer”), are usually achieved either by a diet with a very low calorie content (see its disadvantages above), or through drugs or diets with a diuretic effect. However, the latter, although they move the needle on the scale, do not reduce the amount of adipose tissue, and therefore do not bring benefit in the treatment of obesity (and can be harmful, in particular increasing the risk of cardiac arrhythmias when combined with CNS stimulants).

Intense physical activity in an inactive, detrained patient can also cause deterioration of the condition (especially in old age). Therefore, the intensity of physical activity must be increased gradually. Participation in the treatment of a doctor - a specialist in physical therapy is considered optimal.

Supplements

Dietary supplements, including “dietary supplements for weight loss,” are substances with an unproven clinical effect and little-studied safety (since they have not undergone high-quality clinical trials). Of course, there are no dietary supplements in domestic and international recommendations for the treatment of obesity and the doctor should not prescribe these drugs.

With all the variety of herbal products available on the market for weight loss, they can be divided into four main types:

1. drugs that reduce appetite due to psychostimulating effects;
2. means that provide a feeling of fullness by filling the stomach with indigestible cellulose derivatives;
3. drugs with a diuretic effect;
4. laxatives.

Often several substances with different mechanisms of action are combined in one drug.

These agents are not useful in treating obesity for two main reasons.

1. When using many of them, weight loss occurs due to the diuretic effect. In addition, the combination of diuretics with psychostimulants carries a serious risk of life-threatening arrhythmias.
2. Even when herbal preparations cause weight loss by reducing calorie intake, their effect is reversible. Therefore, their use would only make sense long-term, but the safety of such use has not been tested, is highly questionable and is not recommended by the manufacturers of these dietary supplements.

Prescribing drug therapy only to patients with morbid obesity or completely refusing it. Use of medications in short courses (1-3 months)

Today in Russia, drugs are available that block the absorption of fats in the intestines - orlistat (Xenical, Orsoten) and reduce appetite - sibutramine (Meridia, Lendaxa, Reduxin)6. However, the effect of these drugs is reversible, therefore, for a lasting effect, they should be used for several years (in the future, it is possible to consolidate the acquired eating patterns and maintain the effect after discontinuation of the drug). Using these drugs in short courses is a mistake.

These drugs are indispensable primarily for grade III obesity (morbid) due to the fact that in a number of such patients, after losing body weight using non-drug methods, significant excess body weight remains. Reducing body weight from 145 to 125 kg (-14%) is a good result, but a body weight of 125 kg can also cause big problems. In this situation, drug therapy can improve treatment results. But even with less severe obesity (for example, stage II), the use of these drugs is advisable if non-drug therapy has no effect.

The indication for drug therapy is currently considered to be a BMI > 30 kg/m2.

Surgeries on the gastrointestinal tract have their own area of ​​application in the treatment of morbid obesity.

Diets for obesity

Diets with severe calorie restriction or protein diets serve as a safe alternative to fasting as a way to achieve significant, sustainable and permanent weight loss. The daily calorie intake for such diets is 400-800 kcal. Effective and safe programs include 0.8-1 g of protein per kilogram of desired weight or 70-100 g of protein per day and at least 45-50 g of carbohydrates to minimize nitrogen losses and avoid ketoacidosis, respectively. In general, rapid and permanent weight loss occurs over a period of weeks or months. After about six months, this process slows down, then stops, and further weight loss is very difficult to achieve. Unfortunately, once a person gives up a low-calorie diet, maintaining the achieved weight is also very difficult. A more active lifestyle and regular exercise can help with this. Promising results are obtained by alternating the use of diets with severe calorie restriction and “meal replacements” (for example, special cocktails that replace part of meals) simultaneously with food restrictions.

Drug treatment of obesity

Without drug treatment or diets with a sharp restriction of caloric intake, it is extremely difficult to achieve weight loss and fat loss, and then maintain the result. Drug treatment can help some patients maintain a normal weight for a long time, but it cannot be used for rapid weight loss. Obesity is a chronic disease, and as soon as the patient stops taking medications, the excess weight usually returns. In addition, the effectiveness of drug treatment may decrease over time, so it is very important that it is combined with proper nutrition, lifestyle and behavior changes.

Sibutramine is a relatively new drug approved by the FDA for long-term use in 1997. It is a monoamine reuptake inhibitor (serotonin, dopamine, norepinephrine), originally developed as an antidepressant. In most cases, it leads to dose-dependent weight loss. Sibutramine is available in capsules for once daily use. In one study, 39% of patients receiving sibutramine for a year lost 10% of their baseline weight (only 9% of those receiving placebo). Based on clinical studies, sibutramine is safe.

Orlistat approved by the FDA for the treatment of obesity in 1999. It inhibits gastric and pancreatic lipase, preventing the formation of free fatty acids from dietary triglycerides. Orlistat causes weight loss and a decrease in the mass of fatty tissue in internal organs, regardless of diet. The drug does not reduce the feeling of hunger and does not cause a feeling of satiety. Side effects include cramping abdominal pain, loose stools, increased release of gases; however, reducing the amount of fat in the diet to 60 grams or less will relieve most of these side effects. There was also a slight decrease in serum levels of fat-soluble vitamins A, D and beta-carotene, but they remained within normal limits. The drug is contraindicated in chronic malabsorption and cholestasis. Orlistat is available in capsules of 60 mK for taking 2 capsules 3 times a day.

Olestra is a fat substitute, which is an ester of sucrose and 6-8 fatty acid residues. In appearance and taste, olestra resembles butter, but it is not hydrolyzed by gastrointestinal lipases and is excreted unchanged in the feces. Olestra is used in the production of potato chips and is produced as a butter substitute. The drug allows the patient to reduce the intake of fats from food without depriving himself of the taste of the oil.

Surgical treatment for obesity

Surgery. The condition of patients should allow them to undergo surgery and subsequent long-term treatment.

The purpose of surgical treatment of obesity- reduce the volume of the stomach or create a bypass for incoming food, bypassing the stomach and part of the small intestine. In the first case, the patient will be satisfied with a small amount of food, in the second, part of what is eaten will not be absorbed.

Operations. Surgical interventions used for obesity can be divided into three categories.

Surgeries that reduce the volume of the stomach. In this case, the anatomy of the stomach changes to limit the flow of food, but the absorption process is not affected. This includes operations such as vertical gastroplasty with strengthening of the outlet with a polypropylene mesh or silicone ring, horizontal gastroplasty, gastric banding, including adjustable ones.

Operations that interfere with absorption. At the same time, the anatomy of the gastrointestinal tract changes in such a way as to reduce the absorption of nutrients and the intake of calories.

Operation technique

Gastrobypass surgery. In the upper part of the stomach, staple sutures are placed horizontally or vertically, thereby separating a pocket with a volume of 15-25 ml with access to the small intestine. The operation is reversible and can be performed laparoscopically or through open access. A Roux-en-Y anastomosis is performed with the afferent portion of the small intestine (where bile and pancreatic juice enter). The small intestine is divided at a standard distance of 75 cm from its origin. The length of the section of the small intestine between the stomach and the anastomosis site is 150 cm, and with distal gastric bypass - more than 150 cm. Weight loss is achieved due to early satiety (since the gastric “pocket” is quickly filled with food) and slight malabsorption. If sufficient weight loss cannot be achieved, you can lengthen the section of the intestine that is excluded from digestion.

Laparoscopic mini-gastrobypass surgery- This is a variant of gastric bypass with a longer tube formed along the lesser curvature of the stomach.

Gastric banding, including adjustable (laparoscopic). Gastric banding is often performed laparoscopically. In this case, a ring is placed on the upper part of the stomach, limiting its size to 15 ml, without removing the rest. Repeated operations to reduce the volume of the stomach have to be performed up to 6 times a year.

With an adjustable gastric band, the ring can be removed; You can also perform additional intervention by performing one of the operations that impair absorption.

results

Complications. Early complications are the same as after any surgical intervention.

Late complications include "ulcer and stenosis of the anastomosis, bleeding, increased certain gastrointestinal symptoms, such as diarrhea. Deficiencies of certain vitamins and microelements, neurological and mental disorders are possible. Patients should be under medical supervision; in case of deficiency of vitamins and microelements, appropriate nutritional supplements are prescribed additives.

Treatment of persistent forms of obesity is a difficult task.

Weight loss can be achieved by reducing the caloric intake of food. However, patients, who often experience an increased feeling of hunger, do not tolerate a stricter regime well. It is also not easy to ensure increased combustion through physical exertion, which causes increased shortness of breath and various other complaints.

It is especially important to begin systematic treatment as soon as a tendency towards weight gain is detected.

In the treatment of obesity, it is now often considered advisable to sharply reduce calories (to 1,200-1,000 calories and below) with a normal amount of protein, but a sharp reduction in carbohydrates (up to 100 g) and fats (up to 30 g). Salt intake is limited to 2-3 g per day. A general massage is prescribed, and later, when the patient gets stronger, walks and light exercise. Thyroidin is prescribed at 0.05-0.1 per day for a long period or in large doses for 1-2 weeks. Rapid weight loss is achieved by prescribing regular doses of Mercusal. For hypoovarian obesity, folliculin and sinestrol are beneficial. In addition to treating obesity itself, it is necessary, depending on concomitant diseases or complications, to treat cardiosclerosis, cholelithiasis, diabetes, etc.

Good results for obesity are obtained from treatment in Essentuki, where patients, along with alkaline salt waters and baths, receive various types of mechanotherapy and use a general regimen, as well as in Kislovodsk, where they are prescribed dosed walks, carbon dioxide baths, etc.

Diet therapy for obesity

When compiling a diet, rely on the above-described method of compiling a physiological diet, determining the calorie content of selected food products for preparing various dishes, use tables of product interchangeability; Thus, you will be able to diversify your diet as much as possible, and your nutrition will be complete and reasonable. End each day with a glass of kefir, but no later than 2 hours before bedtime.

If it seems to you that you will eat too often, then do not forget that the portions should be small. Using small dishes can also help; For this purpose, you can even use plates for first and second courses intended for children. After all, as many people say, he himself is full, but his eyes are not. This is because the plate was half empty, but with a child’s plate it will be easier.

It must be said here that if you want to lose weight and follow the above tips, you should drink more water (up to 1.5-2 liters per day). It will be even better if you take a glass of water before meals: this will reduce your appetite.

When eating according to a prescribed diet, it is imperative to gradually reduce the consumption of simple or easily digestible carbohydrates in the diet; reduce the consumption of sausages, replacing them with game meat and skinless poultry. Soups should be prepared in vegetable or weak meat or fish broths; reduce the content of table salt in dishes: if you do this gradually, you can quickly get used to slightly under-salted food. You should cook using gentle methods of cooking food (without oil, you can use a double boiler or grill, bake or stew food).

Having quickly achieved results, you can just as quickly “relax” and forget about the diet, and as a result, gain more.

Physical therapy for obesity

Another factor contributing to weight loss is physical activity. You can start by developing the habit of doing morning exercises, which, even if they consist of simple exercises, will allow you to warm up and tone absolutely all the muscles of the body.

Before starting physical therapy exercises, you must consult a doctor of the appropriate specialty. Only he, taking into account the state of the cardiovascular system of a particular patient, will be able to select the optimal physical activity for him.

You should walk whenever possible. So, if work is located several stops from home, then you can leave earlier and walk to it. In winter it is useful to ski, in the cool season you should walk more, ride a bike, and in summer you should swim more, walk barefoot on the sand or on the grass. People suffering from obesity can be advised to play more outdoor games with their children or grandchildren: this will be good physical activity, and children will also be delighted to communicate with adults.

When choosing a sport, pay attention to swimming, which allows you to spend up to 12 kcal per minute.

In swimming pools, aqua training has now become very fashionable, i.e. doing exercises in water. Here are some sample exercises in water. Performing them to maintain general tone, good mood and as a suitable physical activity is enough 1-2 times a week.

Obesity prevention

Daily caloric intake is calculated in accordance with the normal weight of a person, determined by the above formula. Systematic weighing is necessary to take into account the effectiveness of preventive measures, and in case of weight gain, additional dietary restriction.

Preventive measures against obesity are especially necessary for people engaged in sedentary work, aged 40 years and older.

Obesity is not so much a matter of appearance, but rather a matter of healthy and proper functioning of the whole body. In this article, we will look at which organs are the first to suffer from excess fat and how to determine whether you have extra pounds.

Scientists constantly say that obesity is a problem in modern society. It is as global as melting glaciers, ozone holes and carbon dioxide emissions into the atmosphere. But its main differences are the focus and speed of progress. We cannot control natural phenomena, but it is our responsibility as a species to try to help humanity survive.

However, what do you know about obesity? Most people have only superficial knowledge of this problem. Usually their knowledge boils down to the fact that a person with such a disease looks fat. Moreover, everyone has their own understanding of “fat,” so many are not even aware of the existence of such problems among their family and friends.

Obesity has several stages, and its main danger is not loss of shape and difficulty moving, but damage and failure of the functioning of internal organs.

And even losing weight does not guarantee that the body will restore its natural processes, since it is much easier to destroy cells and tissues and affect them with diseases than to treat them.

Which organs are most affected by obesity?

1. Liver

Contrary to popular belief, the heart and blood vessels are not the first on the list of things that are in danger from regular overeating. The work of the liver is most quickly disrupted, since it is this organ that is involved in the processing of fats. It is the so-called filter of the whole body, therefore, with an abundant and frequent supply of macroelements, constant surges in glucose and insulin caused by fast carbohydrates, the liver simply cannot cope with the task. The main problem is that there are no pain receptors in this organ. A person will not feel any deviation until he reaches the extreme point: nausea and vomiting when eating food, pain in the right side under the ribs.

To monitor the condition of the liver, it is necessary to take annual blood tests for glucose, insulin, testosterone and cholesterol levels. It is also recommended to pay close attention to the functioning of the thyroid gland.

2. Cardiovascular system

There are two types of fat: subcutaneous and visceral. Obesity is characterized by the predominance of the second type, which is deposited on the walls of blood vessels and internal organs, preventing their proper and stable functioning. Essentially, fatty compounds clog the channels for blood flow, and the heartbeat slows down. And the predominance of simple carbohydrates in the diet leads to constant jumps in sugar levels. This, in turn, causes the heart to pump blood faster. But how can she move faster if the blood vessels have narrowed? The first symptoms are hypertension, frequent pressure surges.

There is no need to completely give up fast food, since any prohibitions are a temporary measure that will last until your first breakdown. Gradually introduce vegetables rich in fiber, magnesium, potassium, and iron into your diet, for example, broccoli, other types of cabbage, and greens.

3. Respiratory system

Shortness of breath is a constant companion for people suffering from obesity. It is also accompanied by snoring, stopping breathing during complete relaxation of the body, and lack of sleep. The reason again lies in visceral fat, since it puts pressure on the internal organs, making the trachea narrower. If you already have some degree of obesity, then try to get rid of at least additional “contributions” to deteriorating health: give up alcohol, smoking, do breathing exercises daily so that the body does not feel a lack of oxygen.

4. Genitals

The genitals play a huge role in metabolic processes and the processing of fats into active energy. With obesity, the amount of lipids for breakdown significantly exceeds the ability of the reproductive system to produce the optimal amount of estrogen. The result is a decrease in sexual desire.

In this matter, it plays a decisive role, since no dietary supplements or other medications or folk remedies will solve the problem, they will only remove the symptoms.

5. Kidneys

Excess weight is the cause of the development of urolithiasis. This is what American scientists from Johns Hopkins University say. It is not yet fully known how these two processes are connected, but in theory the kidneys suffer because through them the body seeks to get rid of toxins and other unnecessary substances in the body. However, with obesity, the resulting mass also puts pressure on internal organs and interferes with metabolic processes. Simply put, the body ceases to understand what exactly needs to be removed and what needs to be left in.

To normalize the water-salt balance, it is recommended to consume pumpkin, since it contains pectin, potassium, vitamins A, C, E and beta-carotene. In addition, try to drink more pure, non-carbonated water - 30 ml is required daily for 1 kg of weight.

6. Brain

Obesity reduces the level of oxygen in the blood, therefore, less of the substance responsible for the proper functioning of cells is delivered to the brain. In addition, a person’s cognitive capabilities largely depend on the speed of blood flow to the cerebral cortex and the elasticity of blood vessels, and they, as we know, are narrowed due to visceral fat.

If you want not to lose the ability to think sensibly, then train your own memory and body. Physical activity has a positive effect on the brain: cardio work is aimed at creating hyperventilation and saturating the body with oxygen, and strength work is aimed at stabilizing the functioning of neurons. Fatty fish rich in Omega-3 and phosphorus should be included in the diet.

7. Leather

Unlike all of the above organs, the skin is the quickest to show any signs of malnutrition and hormonal imbalance. The very first signs of health problems are sudden rashes on the face, peeling of certain areas, rough skin on the elbows and knees. You should also think about your own weight if you have constant swelling, even without much physical activity, brittle nails and hair loss.

To restore the skin, it is necessary to include protein foods in the diet, especially poultry. Of course, it is also necessary to use creams and shampoos, but they mostly remove the symptoms, but not the cause of the disease.

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Do you have excess fat?

Only a specialist can diagnose you with obesity after conducting comprehensive tests. At home, you can only find out approximate numbers and decide whether it’s time to go to a nutritionist or not. For this, there are online calculators that will calculate how much you should weigh based on your height, age, and level of exercise. Their readings are not very accurate, since they do not determine the body mass index and do not take into account body type, but if you see a deviation of 10 kg, then this is a reason to think about it.

The second option is volume measurements. The waist should not exceed 90 cm. If more, it’s time to lose weight. This rule applies to both men and women. Discomfort when bending over and tying shoelaces, shortness of breath while climbing stairs - all these are also signals for action to combat extra pounds.

The third method is more accurate. It requires a caliper (or caliper) and a table of values ​​(they are available on the Internet). In a relaxed standing position, with your left hand, pinch as much skin and fat on the abdomen as possible, just above the pelvic bone and 5-7 cm from the navel. Measure this distance with a tool and compare the results with the table. This way you can roughly determine the mass fraction of fat in the body.

Bioimpedance analysis performed in the clinic is the most accurate. This is a painless, inexpensive and quick procedure, after which you will be given a piece of paper. On it you will see the weight of your own body and its components: bones, muscles, fat. It is performed in specialized weight loss clinics, but sometimes the device is also available in the offices of ordinary hospitals.

Remember that obesity affects more than just your appearance. The inability to wear size XS is the least of the problems that arise when you are overweight. Try to control your diet and move more often. No one convinces you that you need to spend all your time in the gym and eat only chicken and buckwheat. If you are obese, you will have to try and actually attend training. If you just want to avoid such a problem, then walk more often, sometimes run, dance in front of a mirror, climb stairs and agree to any active recreation. Think of food not as a way to reward yourself for something or to eat away stress, but simply as a means of satiation. In this case, you are not at risk of obesity.

Obesity of internal organs, especially the pancreas, leads to a serious disruption of its normal functioning. Fatty infiltration of the pancreas or steatosis, as this pathology is otherwise called, develops as a result of the accumulation of fats in the cells of the organs.

Fat cells interfere with the normal functioning of healthy cells. The reasons, first of all, should be sought in the disruption of metabolic processes. Despite the seriousness of the disease, with timely initiation of treatment, its progression can be stopped and organ function restored.

Reasons for the development of pathology

The essence of the disease is that healthy pancreatic tissue is replaced by fat cells. The process of obesity is characterized by slow development and can last for years. In most cases, pancreatic obesity is not an independent disease, it is the result of the development of other disorders in the body, i.e. it is a secondary pathology.

Pancreatic obesity occurs for various reasons, but in most cases it is associated with metabolic disorders. Against this background, normal organ cells die and are replaced by fat cells. The occurrence of the disease can be triggered by the following factors:

• alcohol abuse;
• acute or chronic pancreatitis;
• hereditary predisposition;
• diabetes;
• chronic hepatitis;
• excess body weight;
• thyroid diseases.

Symptoms

There are no symptoms of the disease in the initial stages due to the fact that fat cells, located in separate areas of the pancreas, are not yet able to compress nearby organs and therefore their functionality is not temporarily affected.

As the disease progresses and fat cells accumulate in the gland, the following signs appear:

• nausea and vomiting;
• abdominal cramps;
• increased gas formation;
• feeling of heaviness;
• frequent stools with fatty admixtures;
• diarrhea;
• pain in the right hypochondrium.

Symptoms of the disease appear when a third of the organ is replaced by fatty tissue. As a result, the functioning of the pancreas itself is disrupted and other surrounding organs are compressed. Since the complete digestion process is ensured by enzymes secreted by the gland, if its functioning is impaired due to obesity, fatty and protein foods are especially difficult to digest.

Depending on the extent of damage to the gland by fat cells, there are 3 degrees of such obesity. The first degree is characterized by damage to 1/3 of healthy gland cells, the second degree 2/3 and the third more than 60%. The crowding of fat cells and the location of their accumulation also affect the severity of the disease.

Why is excess weight dangerous?

Diagnostic and treatment methods

Any disruption of the pancreas affects the functioning of other nearby organs, in particular the stomach and, as well as the spleen and kidneys. In addition, the endocrine and cardiovascular systems are affected. All this necessitates the need to take therapeutic measures to restore normal functioning of the pancreas.

Treatment methods for pancreatic obesity are determined after diagnostic procedures. To identify this disease, ultrasound is used, which makes it possible to identify foci of increased echogenicity in the tissues of the pancreas. In addition, magnetic resonance imaging of the abdominal cavity is used, which can be used to accurately determine where in the organ fatty areas are located. The patient is also prescribed urine and blood tests.

For pancreatic obesity, treatment is carried out mainly using conservative medicine methods and following the principles of proper nutrition. Surgical treatment is used only in advanced and complex cases of the disease. But surgical methods are rarely used. In general, pancreatic obesity can be successfully treated, provided that adequate measures are taken in a timely manner and a special diet is followed.

Obesity of the pancreas is characterized by a slow course and therefore the patient has time to normalize the problems that have arisen in the functioning of the organ. For treatment to be successful, the patient must completely stop taking any types of alcohol and adhere to a diet. If a patient with pancreatic obesity takes any medications that affect the diseased organ, they should be discontinued or replaced with others.

The goals of treatment are to reduce the load on the pancreas and stop the process of cell death. Therapy is long-term and complex. It is selected individually in each specific case. For the treatment of pancreatic pathologies, the following groups of drugs are prescribed:

• eliminating pancreatic insufficiency and stimulating digestion - Pancreatin, Festal, Mezim;
• antispasmodics that relieve pain - Platyfillin or No-shpa;
• drugs that normalize hormonal levels and metabolism.

Nutritional Features

Since the pancreas plays a key role in the digestion process, to get rid of obesity it is necessary to reduce the load on it. A special diet is provided for this. It will help improve metabolic processes and prevent further fat deposition in the pancreas tissue.

Strict control over nutrition will help correct any disturbances in the functioning of the pancreas. Diet is necessary not only after the acute phase of the disease has been eliminated, but also during the period of remission, to prevent relapses.

The main point in such a diet is the exclusion or minimal consumption of foods that slow down digestion and increase inflammatory processes in the gland. This applies primarily to spicy, fried, salty and sweet foods and alcohol. Meals should be frequent and small.

The therapeutic diet involves drinking large amounts of fluid, at least 3 liters per day. You can drink any water. It is useful to include dried fruit compote in your drinking regimen, but without adding sugar. You should not drink carbonated drinks, coffee or cocoa, or grape juice. Weak tea with lemon is allowed. Allowed drinks include decoctions of herbs and berries diluted with water.

It is recommended to include more fermented milk products in your diet - yogurt, yogurt, kefir. Food should be chopped or pureed. Preference should be given to boiled, baked or steamed foods. Avoid eating too hot or cold foods. The last meal should be 2 hours before bedtime.

According to the diet for pancreatic obesity, the following products are allowed for consumption:

• dried bread made from wheat flour of not the highest grade, crackers, unleavened dry biscuits;
• curd products and milk;
• soups and dishes made from boiled and stewed vegetables with the addition of a small amount of butter or sour cream;

• porridge from rice, oatmeal, buckwheat and semolina;
• boiled pasta;
• lean meats and fish, chicken eggs;
• soft and sweet berries and fruits, baked apples.

In case of obesity of internal organs, high-fat dairy products and broth-based soups, fatty meats, canned foods and offal should be excluded from the diet. Wheat, barley, pearl barley and corn porridge are prohibited. You should not eat fruits and vegetables with a high content of coarse fiber.

Video: Abdominal obesity