Nutritional obesity. Alimentary-constitutional obesity: degrees and treatment. Rules for determining BMI

An imbalance between fat intake and low energy expenditure by the body leads to the development of serious disease. Exogenous constitutional obesity has several degrees. In the case of the first stage, you can cope with excessive obesity and avoid serious complications if you start treatment in a timely manner.

General information about exogenous constitutional obesity

Alimentary or primary – these are the names for the type of obesity that is caused by non-hormonal reasons. The exogenous constitutional form of the disease is characterized by a significant increase in the amount of adipose tissue. This occurs as a result of an imbalance between the energy supplied by food and its expenditure. The pathology is distinguished by its progressive nature. Endocrinologists distinguish several degrees of the disease, which have their own characteristics:

	Body fat, % of body weight	Excess weight from normal, %



Fourth

Causes

Experts believe that there are external and internal reasons why exogenous constitutional obesity of degree 1 develops. The disease is often caused by overeating and a sedentary lifestyle. These factors are considered exogenous or external, they also include:

systematic overeating;
increased caloric content of food consumed;
rarely eating large amounts of food;
the habit of eating while lying in front of the TV at night;
national food traditions;
the presence of a food cult in the family;
sedentary work;
the habit of eating stress;
depression.

There are internal or constitutional reasons for the development of first-degree obesity. Endocrinologists include the following factors:

slowing down the rate of lipid metabolism, which is hereditary;
tendency to be overweight in close relatives;
features of the structure of adipose tissue;
active functions of the hypothalamic centers responsible for satiety;
taking hormonal drugs, psychotropic drugs, contraceptives;
pathologies of the central nervous system;
endocrine diseases;
ovarian dysfunction in women;
psychological disorders.

Symptoms

Obesity of the first degree, which has an exogenous constitutional origin, can be determined by a number of signs. These include: shortness of breath, increased sweating, depression, decreased self-esteem, and the appearance of complexes. Symptoms of obesity have characteristics associated with the area where fat deposits accumulate. The following types are distinguished:

There is a technique that helps determine the presence of obesity and its degree. It is necessary to calculate BMI - body mass index. With an exogenous-constitutional form of obesity, which has the first degree, the indicator is 30-34.9 kg/m2. Calculations are carried out according to the formula

BMI = B / P x P, where:

B – weight in kilograms;
P – height in meters.

Treatment

If a patient is diagnosed with stage 1 nutritional obesity, the disease can be managed at home and the development of hypertension, liver and joint pathologies can be prevented. To get rid of excess fat deposits, treatment tactics are used, which include a number of measures. A treatment regimen is proposed containing:

the first stage is dietary nutrition;
regular physical activity;
medications;
correction of the usual lifestyle;
folk remedies for weight loss;
massage.

Normalization of nutrition is one of the important components of the treatment of patients with stage 1 obesity. There are the following diet rules:

Eating fruits and vegetables that have a low glucose content in their raw form.
Introduction to the menu of low-calorie foods.
Use of plant fiber.
Limiting fatty, spicy, smoked, fried foods and spices.
Reducing daily salt intake to four grams.
Exclusion of products made from flour, sweets, sugar, animal fat.
Maintaining daily caloric intake at 1200 kcal.

To restore normal weight and eliminate excess fat deposits, it is advisable to seek help from a nutritionist.

Carry out fasting days once a week.
Introduce split meals with snacks between main meals.
Eat in small portions.
Reduce the amount of fast carbohydrates in your diet.
Drink up to 1.5 liters of water per day.
The last meal is three hours before bedtime.
Avoid alcohol, which stimulates appetite.
Adjust your eating habits.
Take multivitamins.

Drug therapy

For obesity of exogenous constitutional origin, which has the first degree, medications are prescribed in rare cases. Drug therapy is aimed at regulating appetite by affecting the satiety center of the hypothalamus. Medicines have many contraindications. The following side effects often occur:

increased blood pressure;
dizziness;
hyperemia;
insomnia;
headache;
anxiety;
dry mouth;
nausea;
tachycardia;
diarrhea.

Indications for drug treatment for stage 1 disease are a BMI value of more than 30 kg/m2, or data of more than 27 kg/m2 with concomitant diabetes mellitus, hyperlipidemia - high fat content in the blood. The drugs should be prescribed by an endocrinologist. These could be medications like this.

Primary, or exogenous-constitutional (alimentary) obesity. This type of obesity accounts for up to 97% of all forms of weight gain. The anamnesis of these patients very often contains indications of obesity in close relatives, a stereotype of abundant nutrition that has persisted since childhood, as well as an increase in body weight during periods of recovery from acute diseases; almost everyone experiences a decrease in physical activity.

Persons with I and II degrees of obesity may not have any complaints, and the existing ones are more likely associated with cosmetic changes in appearance. Athletes and artists experience complaints more quickly than others when excess body weight leads to a deterioration in professional and sports performance. Some patients experience malaise, increased fatigue, shortness of breath during normal exercise, palpitations and pain in the heart, in the epigastrium and right hypochondrium, a feeling of fullness in the stomach after eating (especially fatty), dry mouth, and a tendency to constipation. Frequent complaints include headache, decreased sexual potency in men and menstrual cycle disorders in women.

On examination, uniform excess deposition of fat in the subcutaneous tissue, stretch marks on the skin, acne vulgaris, thinning of the hairline, trophic disorders of the skin, and pasty skin on the lower extremities are noted.

Due to the limited excursion of the diaphragm and increased intra-abdominal pressure due to the increased fat content in the abdominal cavity, the function of external respiration is impaired and the diffusion permeability of the lung membranes is reduced. These changes subsequently lead to the formation of cardiorespiratory failure and to the easier occurrence of various inflammatory diseases of the respiratory system. The course of pneumonia in these patients is more severe, and the likelihood of respiratory disorders in the postoperative period is higher. With severe obesity, Pickwickian syndrome can form.

Changes in the cardiovascular system are observed in 80% of obese patients. More often than other vascular changes, arterial hypertension is recorded, less often - electrolyte balance disorders, and sometimes hyperaldosteronism. Compared to people with normal body weight, obese patients are 3 times more likely to experience manifestations of peripheral arterial atherosclerosis and angina pectoris. The vast majority of obese individuals have dysmetabolic myocardial dystrophy.

Increased body weight also contributes to dysfunction of the gastrointestinal tract. Patients often experience gastritis with increased secretory activity, intestinal dyspepsia, flatulence, and constipation. X-rays reveal stretching and prolapse of the stomach. There is no doubt about the connection between obesity and an increase in gallstone disease, fatty hepatosis and cholecystitis. Low-symptomatic disorders of pancreatic function are present in 95% of patients. The frequent combination of hyperinsulinism with impaired glucose tolerance is surprising. Type II diabetes mellitus in these patients can be either latent or overt, but its course is often milder.

Operations performed when necessary in obese patients are more technically difficult and are accompanied by complications. In people with excess body weight, congestive changes in the kidneys, nocturia, and a tendency to form urate stones are noted. Gout is also more common. In obesity, the daily excretion of 17-hydroxycorticosteroids in urine is often increased, and plasma cortisol less often increases. In obese women, early cessation of menstruation and the onset of menopause are common.

With severe obesity, the development of other disorders also accelerates: deforming osteoarthritis, especially of the hip joints, so a “duck” gait becomes characteristic; osteochondrosis of the spine with radiculitis of various locations; varicose veins; thromboembolic complications; ventral and diaphragmatic hernias. At the same time, in assessing the risk of visceral pathology, not only the degree of obesity is important, but also the nature of the body fat distribution. Significant accumulation of abdominal fat entails a high risk of developing dyslipidemia, cardiovascular diseases, type II diabetes mellitus and a resulting increase in mortality.

It seems important to identify the early degrees of exogenous obesity. In case of IV degree obesity, the issue of transferring the patient to disability and changing the nature of work is decided. But in comparison with other forms of obesity, nutritional obesity is a relatively benign and slowly progressive form, it rarely leads to fatal complications.

Diagnostics.

The most important studies in assessing the degree of obesity are anthropometric data, comparison of actual body weight with ideal; It is more difficult to resolve the issue of the nature of obesity, which makes it easier to carry out differential diagnosis with secondary forms of obesity. If a morphological study is possible, it becomes obvious that fat cells in alimentary obesity reach enormous sizes (up to 300 microns 3).

Treatment.

Anorectics of various pharmacological groups (desopimon, amfepromone, isolipan, mazindol (Teranac)), inhibiting appetite. But these drugs have many side effects. Diethylipropine ifenfluramine and the lipase inhibitor Xenical (ormistat) have fewer adverse effects.

When obesity is combined with type II diabetes mellitus, Siofor 500/850, which has a multicomponent effect, is recommended. Thyroid hormones (triiodothyronine and L-thyroxine) increase thermogenesis. General metabolic agents are also used - vitamins C, B6, lipoic acid, statins.

Information sources:

Harrison's Handbook of Internal Medicine
Fedoseev G.B., Ignatov Yu.D. Syndromic diagnosis and basic pharmacotherapy of diseases of internal organs.
Borodulin V.I., Topolyansky A.V. Handbook of a practicing physician.
Roytberg G.E., Strutynsky A.V. Laboratory and instrumental diagnostics of diseases of internal organs.

Good afternoon everyone. Today on our agenda nutritional obesity . Let's talk about what it is , and how to deal with it.

What kind of word is “nutritional”, you ask? To which I will answer you - how about measuring the thickness of the fold on your stomach?

The standard of beauty - yesterday and today

Get acquainted. This is the Venus of Willendorf, whose size of the folds on her stomach speaks for itself. She was probably considered a very beautiful woman by the standards of more than 25,000 years ago. Otherwise, a master unknown to us would hardly have undertaken to make her figurine.

An obese woman with rounded shapes may symbolize the goddess of fertility, but what is certain is that she represents health, well-being and prosperity - something without which it was very difficult to survive in the ancient world. Fatness was previously considered not a misfortune, but a blessing.

It didn’t matter when it came to food, there were no supermarkets built, and the more nutrients a person accumulated in his body, and with it subcutaneous fat, the greater the advantage he had over his fellow humans.

But today are different times. Being slim and fit is in fashion, however, the world is being overwhelmed by an obesity epidemic. Thus, scientists from the research organization NCD Risk Factor, working under the guidance of Majid Ezzati, a professor at Imperial College London, published their sad findings in the Lancet medical journal that at this rate, by 2025, 18% of men and 21% of women worldwide will be obese .

Moreover, more than 6% of men and 9% of women will have severe disease, which means their health will be in mortal danger.

Clinical picture, or how the disease manifests itself

To begin with, let's return to what is it - nutritional obesity?

Obesity occurs when an increase in body weight begins to occur due to the deposition of excess fat. It is divided into 4 degrees , based on the percentage of subcutaneous fat in the body.

Nutritional is its first degree, where the percentage of adipose tissue ranges from 10 to 29% in comparison with lean body mass. In the vast majority of cases, it appears due to eating disorders, lack of adequate physical activity, as well as hereditary predisposition. Doctors also call this form of obesity “nutritional- constitutional."

It is a mistake to consider excess fat in the abdomen or thighs to be an insignificant problem - since 1989, WHO has classified this first stage of weight gain as a disease, removing it from the category of “cosmetic problems.” At this stage, the process of disrupting the vital functions of our body has already begun. And there are other three, and they are much more dangerous.

2nd degree characterized by an indicator of 30-49%

3rd degree – in 50-99%

4th degree – the most dangerous, adipose tissue reaches 100%

Our figure as an indicator

Like any disease, this one has its own types. Primary obesity manifests itself in different ways.

Android type more typical for men. Fat deposits appear in the abdominal area, in the armpits. A subtype of it is abdominal obesity, where fat accumulates mainly under the skin of the abdomen and surrounds the internal organs.
Gynoid type more common in women. Fat is deposited in the buttocks, thighs, and lower abdomen.
Mixed type characterize the symptoms of both of the above. Adipose tissue is evenly distributed throughout the body.

Where do problems come from?

The main reasons for the appearance of extra pounds are known to everyone.

Eating a lot, abusing high-calorie foods
Move a little
Get a predisposition by inheritance
Have diseases caused by disruption of the endocrine glands
Eating depression

Obesity stands out in children . If this is not due to illness or genetics, then most often it begins with the usual “feeding” of a beloved child by their parents. Exhortations such as “eat everything, and then just leave the table” and “a spoon for mom and dad” can lead to serious consequences for the child’s body. And, acquired at a young age, excess weight can accompany the child throughout his life.

The right balance is important in everything

It is worth noting here that fat in itself is not terrible, since it gives our body energy, saves the body and internal organs from the cold, and protects from internal damage. Nature itself has a certain fat content; being too thin is no less harmful to health.

The difficulty lies elsewhere. Excessive body weight is inextricably linked with various diseases, especially

cardiovascular,
diabetes mellitus type 2,
obstructive sleep apnea (difficulty breathing),
some types of cancer
osteoarthritis
depression.

But in general, extra pounds reduce life expectancy and have a detrimental effect on our body. Their load on the joints, heart, and liver is especially noticeable when the weight exceeds the norm by 20%.

Measure and weigh

Well, what's with the fold on the stomach? (By the way, you can “pinch” yourself not only on the stomach, but in other parts of the body, and measure the resulting fold everywhere). It is believed that if it is around 2.5 cm, then your weight is still fine. Bye.

Because with age, extra pounds inevitably add on. At least 1.5-2.5 every ten years. This is considered a physiological norm, but as we have seen, there are a number of factors that significantly increase this already unpleasant norm.

Popular formula

The most common way to understand how things are is to determine your body mass index (BMI).

To do this, weight in kilograms is divided by height in meters squared.

BMI = weight (kg) / height (m) x height (m)

For example, height 170 cm (1.7 m), weight 75 kg

75 / (1.7x1.7) = 25.95

Unless you're from some of the Southeast Asian countries like Japan, which use lower values. And not a professional athlete, for whom there are their own requirements, then

A normal body mass index (BMI) should be between 18.5 and 25.
Overweight is considered overweight if the BMI reaches 29.9
A BMI above 30 poses an increased health risk.

To confirm the “diagnosis”, you can also pick up a measuring tape and measure your waist circumference. If in women it is more than 88 cm, and in men 102 cm, then fat deposits are evident.

Solving weight problems

What if your BMI did not show the result you hoped for?

First, consult your doctor, even if you are sure you are healthy.
Well, secondly, take care of yourself. Start doing gymnastics, take an interest in special sets of physical exercises for obesity.
And of course, serious changes are needed in diet . Your menu can be improved by reducing the consumption of high-calorie foods, those containing a lot of sugar and fat. And also by increasing the consumption of foods with dietary fiber, which include fresh vegetables, herbs, berries and fruits, oatmeal (but not cereal), and beans. Your doctor may also prescribe medications to reduce your appetite or reduce fat absorption.

What to remember

Obesity is dangerous even at its very first stage
You can determine which stage you have using the BMI calculation formula
To adjust your weight you need diet, exercise and advice from a doctor who is not overweight himself.

And since the disease, as we know, is better to prevent than to treat, it is better to take care in advance to avoid unwanted weight gain.

At the same time, the decision to eat less and buy yourself a plate for this with the inscription “Liuba, eat less” will not be a solution to the problem. Only a rational, balanced diet, coupled with regular physical activity, can maintain our weight at normal levels and avoid falling into the ranks of those who become obese.

See you again in new articles!

Alimentary obesity (exogenous-constitutional) is a type of metabolic pathology in which hereditary factors do not play a significant role. External causes play a leading role in the development of this disease, but the influence of the initial state of the body on the process should not be excluded.

All factors contributing to the development of nutritional obesity can be divided into external and internal. External symptoms include regular overeating, the presence in the diet of large amounts of food rich in fats and simple carbohydrates (baked goods, sweets, pasta, fatty meat dishes, etc.), incorrect eating habits (not eating according to the schedule, eating high-calorie and heavy foods at night) . Today, the problem of a sedentary lifestyle as one of the key links in the pathogenesis of obesity is particularly relevant. Internal factors include metabolic diseases (diabetes mellitus, etc.). A special group consists of hormonal imbalances with excessive or insufficient function of the gonads that occur during pregnancy and lactation, and during menopause in women. In the anamnesis of almost every obese person there are relatives suffering to one degree or another from metabolic pathology, which indicates the invariable role of genetic predisposition to the disease.

According to UN estimates, the countries with the highest percentage of obese populations include the United States (32.8%), Mexico (31.8%) and Syria (31.6%). Russia occupies 28th place in this ranking, the level of the population with excess body weight is 24.9%.

Existing classification

Excess body weight is 10-29%.
Excess weight - 30-49%.
Excess weight - 50-99%.
The actual body weight of a person exceeds the norm by 100%.

Types of obesity based on the location of adipose tissue:

Android (male) obesity is sometimes called central obesity. This type is characterized by the deposition of fat masses in the abdomen, armpits, lower back and back.
Gynoid (female) obesity - fat deposits occur in the chest, buttocks and thighs, and lower abdomen.
Mixed - relatively equal distribution of fat throughout the body.

The deposition of adipose tissue in the body is a genetically determined process that is controlled by sex hormones. With hormonal dysfunction in men or women, redistribution of adipose tissue may occur according to the type of the opposite sex.

Particular attention should be paid to the process of obesity of internal organs. With a slight excess body weight, its percentage is low, but the higher the degree of obesity, the more fat is distributed around the internal organs. Pathologies of fat metabolism may develop, leading to inclusions of fat drops between the functional cells of organs, which leads to the development of dystrophies of the latter (“tiger” heart, fatty liver, etc.). Any dystrophy is accompanied by disruption or insufficiency of the organ, which leads to the appearance of concomitant diseases.

Clinical picture

In addition to fat deposits, nutritional obesity is characterized by some secondary symptoms. These include shortness of breath and respiratory failure, palpitations during exercise, and increased sweating. They arise due to an increase in the volume of circulating blood along with adipose tissue, but the heart has difficulty coping with such a load and requires the activation of compensatory mechanisms. Shortness of breath may be partly due to the increased size of the internal organs and the greater omentum, which press on the diaphragm from below, thus compressing the lungs. Against the background of a constant excess of lipoproteins in the blood, atherosclerotic vascular lesions develop, which underlies the development of coronary heart disease. Excess fat tissue can lead to the development of type 2 diabetes. Every fat person is a potential diabetic.

Striae may appear on the skin (white or red stripes, similar to scars, appear when a person recovers quickly, but the elasticity of his skin does not allow him to accommodate the sharply increased volume of tissue). Excessive sweating creates favorable conditions for the proliferation of pathogenic bacteria in the folds, which leads to pustular skin diseases. Constant excess pressure on the spine can lead to deformations and curvatures.

Diagnosis of obesity

The international standard for diagnosing obesity is body mass index. It is calculated using the formula: BMI = body weight (kg)/height² (m), (kg/m).

This indicator is very subjective, since it does not take into account the weight of a person’s muscle mass. Based only on body mass index, one can mistakenly assume that an athlete with well-developed muscles is overweight.

During inspection, the following indicators are determined:

The thickness of the skin fold on the abdomen, at the angle of the shoulder blade, and shoulder (the norm is up to 1.5-2 cm).
Waist circumference. For a man this figure should be less than 101-102 cm, for a woman - less than 87-88 cm.
Type of constitution (hypersthenics - people with a strong, stocky build) are most prone to obesity.

Necessary treatment

In order to reduce or get rid of obesity, a complete reorganization of lifestyle is required. The nutritionist prescribes such a patient a strict diet with limited fats and carbohydrates, gradually reducing the calorie content of the daily diet. Nutritional obesity is by no means cured by fasting. Meals are fractional, in small portions, up to 5-6 times a day. The patient is recommended to have moderate physical activity: walks in the fresh air, therapeutic exercises and physical education. If you feel well, the load can be increased.

There are various types of obesity, in which the appearance of a person already suggests its probable cause of development. For the most part, these people look different because fat is deposited unevenly due to hormonal levels. In women, deposits often appear in the lower part of the body, and in men - in the upper part.

Types of obesity

Depending on the cause, there are the following types of obesity:

exogenous (alimentary) – the result of systematic overeating and decreased mobility;
endogenous (pathological) – develops due to the presence of various ailments.

Obesity is a chronic progressive disease that, if left untreated, causes severe pathologies. When you are overweight, the body works to the limit, and organs wear out much faster. As a result, both life expectancy and its quality decrease.

If treatment is possible, the following types of obesity are distinguished:

adjustable – removed by diet and increased physical activity;
irreversible - extremely rare.

Types of obesity that differ in the dynamics of the disease:

stable – when excess weight does not increase, but does not decrease;
dynamic – the patient’s weight continues to increase.

Constitutional obesity

Constitutional obesity is a chronic disease caused by physical, biochemical and metabolic factors. It provokes a number of complications, leads to disability and increased mortality among patients due to the development of cardiovascular diseases.

To reduce weight, you must follow an antidiabetic diet and increase physical activity.

With ordinary constitutional obesity, the following types are distinguished:

1. The female type of obesity (gynoid) is considered relatively favorable, since it poses little threat to health. With it, the figure takes on the shape of a pear: fat is deposited on the hips, buttocks and lower abdomen. It is typical for endocrine-healthy women. Most fat deposits form under the skin.

2. The male type of obesity (android) is associated with high levels of androgens. The figure takes on the shape of an apple: fat is deposited on the shoulders, chest and abdomen. In advanced cases, it develops into metabolic syndrome and abdominal obesity, and is also accompanied by severe health consequences. With it, the deposition of fatty accumulations in the abdominal cavity and internal organs predominates. Therefore, it is more dangerous and unfavorable.

3. Mixed type of obesity is the most common and normal for children. It is expressed by the uniform distribution of fat deposits throughout the body.

Endogenous and exogenous obesity

The endogenous type of obesity is the result of hormonal imbalance in the body and various diseases. Frequently encountered representatives:

Cushingoid type – characteristic of Itsenko-Cushing’s disease and tumors of the adrenal glands or pituitary gland. Patients' arms and legs are unnaturally thin, and all the fat accumulates on the torso and face. Accompanied by hypertension and diabetes;
cerebral type – occurs with developmental anomalies and brain tumors. Characterized by uniform deposition of fat throughout the body, uncontrolled eating behavior and other neurological disorders. Leads to psycho-emotional and autonomic disorders, disruptions in the hormonal system, especially in the sexual sphere, which leads to impotence and infertility;
lipomatous – caused by the genetic type (mainly heart disease) and is accompanied by benign tumors (lipomas) in adipose tissue;
eunuchoid type - more common in men and is caused by a violation of testosterone production. Fat accumulates on the abdomen, thighs, buttocks and chest area. Stubble stops growing. If it develops in childhood or adolescence, then underdevelopment of the genital organs and gigantism (very tall stature) often occur, and the voice remains boyishly high;
spongy type - develops in people with diseases of the circulatory system (lymphatic vessels, heart, veins), caused by fluid retention in adipose tissue;
monstrous is the prohibitive 4th degree of obesity, excess weight is 2 times higher than one’s own (over 60-70 kg), and the skin forms sagging giant folds. The mortality rate in this case is very high, mainly from heart failure.

Exogenous obesity occurs only due to external factors (overeating, sedentary lifestyle) and is not associated with heredity or acquired diseases. It is considered primary (ordinary) and is often found in children, office workers, housewives, fast food lovers and those who spend a lot of time at the computer or on the couch.

Exogenous obesity is easier to cure than others, namely with the help of diets, proper nutrition, a healthy lifestyle and intense sports training. Massage sessions and all kinds of wraps will help remove cellulite and sagging skin.

Abdominal and visceral obesity

Abdominal obesity is the localization of excess weight under the skin in the abdominal area. It is more common in men (beer belly), and more recently in children and adolescents. It is mainly caused by hereditary factors, decreased serotonin levels, disruption of the food center, systematic overeating and low physical activity.

Symptoms of abdominal obesity:

in all patients, regardless of gender, under the age of 40 years, the waist circumference is more than 100 cm, and after the age of 40 years – more than 90 cm;
swelling;
thirst;
irresistible craving for sweets;
depression.

Complications of abdominal obesity:

high insulin levels;
disturbance of urination, as well as fat and carbohydrate metabolism;
arterial hypertension;
decreased blood clotting;
enlargement of the left ventricle of the heart.

Visceral obesity (internal) is the localization of excess weight in the abdominal area, but not under the skin, but in and around the internal organs. In this case, an excess amount of free fatty acids enters the bloodstream through the portal vein of the liver. As a result, a number of metabolic disorders occur.

Visceral obesity develops in people who already have abdominal obesity, but have neglected it. In terms of the degree of impact on health, it is the most dangerous and is almost always accompanied by metabolic syndrome and type 2 diabetes. Death is also not uncommon.

Both men and women suffer from visceral obesity. Very often it is caused by regular stressful situations, increased nervousness, insomnia and chronic lack of sleep. Getting rid of it is the most difficult, but quite possible.