What is obesity
Obesity is a chronic disease characterized by excessive accumulation of fat in the subcutaneous layer and internal organs. The diagnosis poses a huge threat to the patient and carries with it a number of negative processes in the body: from minor hormonal disorders to oncology.
The American Society for Metabolic and Bariatric Surgery Updates defines obesity as a chronic, relapsing, multifactorial neurobehavioral disease in which an increase in body fat contributes to the dysfunction of adipose tissue and the biomechanical effect of adipose tissue on surrounding tissues with the development of metabolic and psychosocial health outcomes.
To assess the stage of obesity, use the body mass index (BMI), which is calculated as the ratio of body weight (in kilograms) to height (in meters) squared. Obesity is diagnosed when a person’s body weight exceeds the norm by more than 20%.
Reasons for being overweight
Obesity is a multifactorial disease, so it can occur for completely different reasons:
- Overeating or imbalance between calories consumed and expended. As a result of an unreasonably high caloric content of the diet, the predominance of simple carbohydrates and saturated fats, there is an imbalance between the amount of calories consumed and expended.
- High carbohydrate or any other unsystematic diet. Strict restrictions in eating behavior very often lead to a breakdown, a set of extra pounds and walking in a vicious circle of “restriction – breakdown”.
- Sedentary lifestyle – hypodynamia. Limited physical activity involves very little energy expenditure. This leads to a weakening of vascular tone, a decrease in muscle activity, a deterioration in lymph and blood flow. A sedentary lifestyle plays a huge role not only in the development of obesity, but also in the occurrence of cardiovascular diseases, as the intensity of metabolic processes decreases, cholesterol levels increase, and the formation of atherosclerosis.
- Stress. Evolution at a subconscious level laid the following equality in the human brain: “Food = safety”. Eating negative feelings blocks the feeling of fullness, as a result of which a person begins to absorb food uncontrollably.
- Endocrine factor. Works in 5% of the total number of cases of obesity. The cause of endocrine overweight can be various conditions of hormonal imbalance, including polycystic ovary syndrome, menopause, hyperandrogenism, Cushing’s syndrome, growth hormone deficiency, hypothyroidism.
The increase in body weight can also be due to age-related changes. Between the ages of 50 and 60, 60-65% of women experience weight gain of 2 or more kilograms.
In particular, this is due to a decrease in estrogen levels and an increase in androgen levels. This shift in sex steroids affects metabolism, which leads to the development of abdominal obesity (in the abdomen).
Hypothalamic obesity also refers to the endocrine factor. The trigger is organic and functional lesions of the hypothalamus.
The work of this organ can be disrupted by congenital anomalies, infectious diseases of the central nervous system (for example, encephalitis), trauma and surgical interventions of the head, aneurysm, histiocytosis, sarcoidosis.
As a result of damage to the hypothalamus, appetite is stimulated (due to an increase in the production of neuropeptide Y) and a decrease in sensitivity to the hormone leptin.
In some cases, a person’s gene can fail, as a result of which he will receive a hereditary disease and a tendency to be overweight from early childhood. These include: Prader-Willi syndrome, Bardet-Biedl syndrome, Kuchen’s syndrome, Alström’s syndrome, Frohlich’s syndrome.
Genetics also influence the ratio of fat to lean mass.
Additional clinical symptoms
The range of complaints of obese patients cannot be called small. Obesity delivers not only aesthetic and psychological discomfort, but also causes symptoms such as:
- Apathy, drowsiness, fatigue
- Tendency to constipation
- Joint pain
- Decreased muscle mass
- Increased blood pressure
- loud snoring, sleep apnea
- Decreased libido and potency
- dry mouth
- Violation of the menstrual cycle
- “Second” chin, fat “apron” on the stomach
There are three types of obesity:
Gynoid (according to the female type, conventionally called “pear”).
The accumulation of excess fat occurs in the area of the thighs, buttocks and in the lower abdomen. Unlike the abdominal type, it is considered less dangerous, especially in the initial stages, since the hormonal background does not suffer, and fat is deposited under the skin, and not viscerally (around the organs).
Abdominal (according to the male type, conventionally called “apple”).
Fat is deposited on the abdomen, shoulders, chest and, in small quantities, on the legs. To a greater extent, this type is inherent in men, so it is often called android or male. If it develops in a woman, then, as a rule, this is due to an imbalance of sex hormones, namely, an increase in testosterone levels.
This type of obesity poses a serious danger to the human body. The degradation of internal processes begins already from the first stages of obesity: the mobility of the abdominal wall decreases, intra-abdominal pressure begins to increase, and breathing is disturbed.
ICD-10 (International Classification of Diseases 10th Revision) classifies abdominal obesity as a category of “Diseases of the endocrine system, eating disorders and metabolic disorders.”
Fat is deposited viscerally, that is, between the abdominal organs. It accumulates toxins, increases the level of sugar and triglycerides, destroys blood vessels and causes chronic diseases, including diabetes.
Normally, visceral fat makes up approximately 10% of the total mass of all fat in the body and is even involved in the function of reproduction. But if it builds up to excessive levels, it releases unhealthy proteins, hormones, and chemicals that increase vulnerability to many diseases. So, for example, free fatty acids affect the production of lipids in the blood, and cytokines increase the risk of developing cardiovascular diseases.
In this case, the deposition of fat occurs relatively evenly in all parts of the body.
There is also primary and symptomatic obesity.
The appearance of primary obesity is based on an unhealthy lifestyle (fatty foods, a sedentary lifestyle, poor sleep, prolonged stress), as well as genetics. Often it appears in the elderly due to a decrease in metabolism, disturbances in the functions of appetite in the brain and minimal physical activity.
Symptomatic obesity is characterized by weight gain due to some disease. For example, Cushing’s disease, hypothyroidism and others.
Degrees of obesity
To assess the degree of obesity, experts use BMI (body mass index). How to calculate it, we wrote above.
According to the classification approved by the World Health Organization, a body mass index of less than 18.5 corresponds to underweight; 18.5-24.9 – normal; 25-29.9 – excess; 30 and above – obesity.
Depending on the BMI, there are 4 stages of obesity:
- Preobesity. An intermediate stage between normal body weight and obesity. BMI is in the range of 25-29.9. The patient is prone to increased appetite, deterioration of the quality of the skin of the face (excess secretion of fat, acne) and the body (flabbiness of the skin, stretch marks).
- First degree. Registered if the BMI is in the range from 30 to 34.9. Symptoms include shortness of breath, swelling, and excessive sweating. Requires immediate weight correction, active training and nutritional correction.
- Second degree. BMI varies from 35 to 39.9 In a patient with obesity of the second degree, there is a decrease in working capacity, difficulty walking.
- Third degree. BMI – above 40. The third degree brings patients significant discomfort in everyday life: shortness of breath appears not only in motion, but also at rest, the functioning of the cardiovascular, reproductive, hormonal systems is disrupted, and frequent headaches begin.
- Fourth degree. Diagnosed in patients whose weight exceeds the allowable norm twice.
Consequences of obesity
Obesity-associated diseases and conditions in which obesity exacerbates the risk of complications include:
An increase in body weight by 1 kilogram increases the risk of developing cardiovascular diseases by 3.1%. Adhesion of cholesterol to the walls of the arteries causes the formation of fatty plaques that narrow the lumen of the vessels. When the organ is completely clogged with atherosclerotic plaques, blood stops flowing, and the organ simply dies. According to this mechanism, cerebral stroke and myocardial infarction develop. If atherosclerosis affects the coronary vessels, then coronary heart disease develops.
Diseases of the gallbladder.
Obesity is a risk factor for the development of non-alcoholic fatty gallbladder disease (choleceostosteatosis, steatocholecystitis).
Obesity hinders the functioning of the respiratory system and also leads to the symptoms of sleep apnea. Hypoventilation syndrome also develops – insufficient (incomplete) ventilation of the lung or its lobe. Occurs as a result of impaired airway patency.
Obesity is a major factor in the development of type 2 diabetes. The effectiveness of insulin in this case is extremely low, since it cannot cope with the processing of fats entering the body. According to the results of the WHO population diagnostics, diabetes mellitus in overweight people develops 7 times more often than in people with normal weight.
In women, there is a violation of the menstrual cycle, thyroid disease, polycystic ovary syndrome, problems with conception, a decrease in the hormone progesterone. Overweight men experience erectile dysfunction, low testosterone and infertility.
Obesity is accompanied by an increase in the level of “bad” cholesterol, the formation of cholesterol plaques, cirrhosis of the liver.
Diseases of the musculoskeletal system.
The joints and spine in the presence of excess weight experience a tremendous load. There are severe pains that make it difficult to move. If you start the process of obesity, it will lead to deformity and destruction of the joints, the development of gout and arthritis.
In 2014, the International Agency for Research on Cancer (IARC) showed that about half a million new cases of cancer each year can be caused by being overweight. Many studies describe the existence of a strong association between obesity and an increased risk of developing cancer. At the moment, 13 types of cancer associated with obesity have been found: meningioma, cancer of the esophagus, thyroid gland, myeloma, cancer of the liver, pancreas, stomach, intestines, kidneys, breast, uterus, ovaries, endometrium.
Also, the consequences of obesity include problems with social life and the psyche.
Treatment of obesity
Treatment of patients is prescribed according to the type of obesity.
- Pre-obesity and type 1: at this stage it is very important to increase energy expenditure, adjust the diet, remove fast carbohydrates from the diet and add physical activity.
- The second type is often complicated by metabolic syndrome, arterial hypertension. In addition to the correct lifestyle and training, it is important to control laboratory blood tests (cholesterol, glucose, thyroid hormone levels). Depending on the “weak” places, the doctor prescribes medication.
- Third type. This situation requires comprehensive and immediate assistance from nutritionists, endocrinologists, neurologists, cardiologists, psychotherapists, and sometimes surgeons.
- The fourth type. The risks associated with being overweight are deadly. Therefore, surgical intervention is a common method.
Prevention of obesity
Obesity can be prevented by following a few tips from doctors:
- Control the caloric content of the diet according to the height, gender, physical activity and age of the patient;
- Limit or completely eliminate fried, sugary foods, fast carbohydrates and fast food.
- Physical activity should be regular and varied. For this, it is not necessary to go to the gym and work out to exhaustion. As a physical exercise, jogging, Nordic walking, home workouts are perfect. The most effective way would be to combine aerobic and moderate sports;
- Keep a food diary if necessary;
Develop a “good relationship” with food to eliminate the moment of emotional overeating or, conversely, refusing food for some wrongdoing. Sometimes this requires a visit to a psychologist.
What conclusions can be drawn?
The problem of overweight of the population has long passed into a number of important social issues, as it leads to a huge number of chronic diseases that are dangerous to health.
Gained extra pounds weight is often the result of a violation of metabolic processes, and at the same time they themselves are the causes of various pathologies. Therefore, this problem of excess adipose tissue is complex, and it is better not to shelve its solution, but to entrust it to competent, qualified specialists.
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