The concept of obesity, classification and degree of obesity. What is obesity Obesity concept

Obesity is a state of the body in which fat deposits begin to accumulate in excess in its fiber, tissues and organs. Obesity, the symptoms of which are weight gain of 20% or more when compared with the average values, is not only a cause of general discomfort. It also leads to the appearance of psycho-physical problems against this background, problems with the joints and spine, problems associated with sexual life, as well as problems associated with the development of other conditions that accompany such changes in the body.

general description

So, obesity, in addition to the above problems, increases the risk of developing a number of quite serious diseases in patients. These include, for example, atherosclerosis and hypertension, coronary heart disease (CHD), stroke, myocardial infarction. In addition, obesity is often a companion of diabetes mellitus, which is inextricably linked with it - it is obesity that acts as one of the main causes predisposing to its development. To the diseases that can develop against the background of obesity, you can also add diseases of the liver and kidneys. Moreover, the diseases considered as concomitant problems of obesity in obesity can cause disability, determining, in addition, a fairly high percentage of mortality for each of the options. As an addition to this part, it can also be noted that hypertension in patients with obesity occurs on average three times more often than in persons with normal weight, while coronary heart disease and angina pectoris, again, in patients with obese, is detected up to 3-4 times more often than in persons with weight within the normal range.

Transmission by obese patients of any type of disease, including “common” ARVI and influenza, occurs in a more severe and prolonged form compared to the course of these diseases in patients with normal weight, in addition, obesity significantly increases the risk of complications during the transfer such diseases. We also note that obesity can not only manifest itself as an independent disease, but can also act as one of the symptoms, respectively, of a different type of disease.

Women are most susceptible to obesity, and this predisposition for them is twice as high as the predisposition to obesity for men. The age of 30-60 years can be defined as a critical age interval for the development of obesity. On the basis of ongoing studies on obesity, WHO experts have revealed that obesity is practically a worldwide epidemic, and this epidemic is relevant for millions of inhabitants of the population of our planet, regardless of their belonging to a particular social, national, professional, age, gender or other group. In Russia alone, obesity is diagnosed on average in 30% of the working-age population, while for another 25% of the population the problem of overweight is relevant.

Obesity: causes

The following causes can be considered as concomitant to the development of obesity:

imbalance between energy expended and food consumed (that is, more food is consumed than energy is expended);
genetic disorders;
obesity develops not on the basis of endocrine disorders (it is the connection with endocrine disorders that is considered in obesity as its main cause), but as a result of disruptions in the functioning of the intestines, liver, and pancreas.

In addition, there are a number of predisposing factors for the development of obesity:

genetic factors (reduced enzymatic activity of lipolysis or increased enzymatic activity of lipogenesis);
sedentary lifestyle;
excessive consumption of easily digestible carbohydrates by patients (sugar-rich foods; sugary drinks, etc.);
eating disorders (in this case, we mean eating disorders that cause eating disorders (anorexia, bulimia, etc.));
the relevance of a certain type of disease, in particular, diseases of the field of endocrinology (hypothyroidism, hypogonadism, etc.) are considered as such;
the use of psychotropic drugs;
frequent stress;
sleep disturbances, lack of sleep.

It is extremely rare that the development of obesity is associated with certain types of injuries or with previous surgery. As a possible variant of the first connection, for example, one can single out the defeat of the pituitary gland by a gunshot wound, as a second, surgical intervention, respectively, one can designate the removal of the ovaries.

Individual cases of obesity are associated with conditions provoked by infectious encephalitis, tumor formations of the endocrine glands, for example, a tumor of the adrenal cortex or a tumor of the pituitary gland. Also, the cause of obesity, again, in some cases, may be the development of an atrophic process, for example, its development in the thyroid gland, which determines such a type of obesity as endocrine obesity. The pituitary gland in particular contains two main hormones, due to which the regulation of fat metabolism is ensured. In addition, it is closely associated with a different type of endocrine glands in our body, which, in turn, also play an important role in the processes of fat metabolism (here, in particular, the processes of such an exchange with the adrenal cortex and with the gonads should be highlighted).

In the enumeration of the reasons, we have already indicated that metabolic diseases are considered among the factors provoking the development of obesity, as the main variant that causes it, and this is not always caused by damage to any visceral or endocrine organ. Quite often, obesity is directly related to irregularities in the menstrual cycle of women, which, in turn, are especially often manifested when obesity debuts at an early age. Remarkably, obese women quite early face a problem in the form of a metabolic disorder associated with sex steroids, due to which the release of gonadotropins occurs at an accelerated pace, and this, in turn, leads to anovulation, that is, to the absence of ovulation.

Obesity: features of pathogenesis

Pathogenesis, that is, the features of the processes that eventually cause the development of obesity in a patient, cannot be unambiguously determined. In particular, the cause of the development of morbid obesity cannot be identified only as a mismatch (imbalance) of the energy expended by the body with the food consumed (and its calorie content in particular). The main question in this case is reduced to the discrepancy between the effect of autoregulatory mechanisms that ensure the constancy of normal weight indicators in healthy people for many years. After all, if we consider situations, for example, with forced rest (trauma) or with compulsion to eat (overfeeding), then the excessive appearance of fat often becomes a temporary result, that is, it is relevant until recovery occurs or until the diet stabilizes. (will not change for individually adjustable needs). For this reason, it can be indicated that persistent obesity develops precisely as a result of the functions of the cerebral cortex due to the formation of conditioned reflex connections and a complex of other processes.

Thus, as the main option for the development of obesity, one can consider disorders that occur in the functions of the main central mechanisms, namely, the hypothalamus and the cerebral cortex, it is in them that the centers that regulate appetite are concentrated. Returning to the relationship between food intake and energy consumption, we can assume that the features of this relationship are determined precisely by the functional features of these centers. They, in turn, can be both congenital and acquired (meaning options due to the nature of nutrition, upbringing, family lifestyle, etc.). With injuries that directly affect the area of such centers, with or without inflammation accompanying them, obesity may develop due to a violation of the functions of the centers that provide regulation of appetite.

Obesity: classification

WHO in 1997, based on a comparison of studies and the study of relevant criteria, a classification was developed in which, accordingly, the degrees of obesity were indicated. Such a classification is based on the allocation of a specific indicator, as such, BMI is considered - a body mass index calculated for persons aged 18-65 years in accordance with the formula for dividing weight (kg) by height (m) squared. For example: 65 / 2.89, where 66 is the weight, 2.89 is the number squared for a height of 1.70 m; the finished value is 22.49, (the correspondence of the finished number to specific indicators is below).

Based on the consideration of many examples, it was revealed that such a calculation accurately reflects the real situation in terms of indicators. The maximum allowable figure for the BMI norm is 25 kg / m according to such calculations. Based on this, the following picture can be distinguished:

BMI in the range below 18.5 - the figure corresponds to a weight deficit, determining for the patient the risk of developing a different type of pathological conditions against this background;
BMI in the range of 19-24.9 - corresponds to normal weight, that is, normal weight, these figures determine the lowest rates in terms of susceptibility to diseases and mortality;
BMI in the range of 25-29.9 corresponds to increased body weight, which is also defined as preobesity with the corresponding risks for further prognosis;
BMI in the range of 30-34.9 is a high indicator, in this case we are talking about such a condition as the I degree of obesity of the patient (starting from this interval, we can talk about obesity as such, moreover, it is from this period that it determines significant risks for general state of health, causing the need for an appropriate medical examination in the subsequent development of methods aimed at normalizing the state of health);
BMI in the range of 35-39.9 is a very high indicator, II degree of obesity of the patient;
BMI with a value of 40 and above is an excessively high indicator that determines the III and, accordingly, IV degree of obesity for the patient.

The classification discussed above is the most common in use for calculating the correspondence of weight to height and a specific interval that determines a health risk or indicates a norm.

In addition, there is another calculation formula, it is also easy to calculate: Mu \u003d P - 100, the Mu value is considered as the ideal body weight, P in the formula is height in centimeters. Based on the calculation according to this formula, the degrees of obesity are also distinguished, there are four of them in total. So, I degree of obesity in this variant corresponds to values exceeding the ideal body weight by an average of 15-29%, then, II degree of obesity, corresponds to values at which the excess reaches 30-49%. III and IV degrees of obesity are calculated in a similar way, for which the excess corresponds to the values of 50-99 (III), 100 or more (IV).

There are also separate types of obesity, which are determined on the basis of the main areas of concentration of body fat:

Abdominal type of obesity (android, upper type of obesity). This type of obesity determines the main areas of concentration of adipose tissue from the side of the upper body, as well as in the abdomen, on the basis of which it is possible to determine the analogy of such a physique with an apple. Men are predominantly predisposed to such obesity, in addition, quite high risks are determined here in terms of the impact on general health, which is caused by the frequent occurrence of diabetes mellitus, arterial hypertension, heart attack and stroke against the background of obesity.
Femoral-buttock type of obesity (lower type of obesity). Already on the basis of the title of this paragraph, the reader can understand that the predominant areas of localization of body fat here are the areas of the buttocks and thighs, in general, an analogy can be drawn to the type of figure with a pear. Predominantly, this type of obesity is diagnosed in women; venous insufficiency, various diseases of the spine and joints can be identified as concomitant disorders.
Mixed type of obesity (intermediate type). This type of obesity corresponds to a uniform distribution of body fat throughout the body.

In addition, obesity can be progressive, resulting in a gradual increase in body fat with a concomitant (also gradual) increase in body weight. Obesity may also correspond to a stable stage (residual stage of obesity, considered as a residual stage, noted after weight loss).

In accordance with the characteristics of the causative factor in the development of obesity, as well as in accordance with its own characteristics, obesity can manifest itself as primary (simple obesity, exogenous constitutional obesity, alimentary-metabolic obesity), as secondary (symptomatic obesity or hypothalamic obesity), and also as endocrine obesity.

The basis of primary obesity is an alimentary or exogenous factor, caused by an excessively high energy saturation in terms of the diet that is relevant for the patient with a simultaneously low energy consumption, against which, as is clear, excess weight begins to accumulate. The development of this type of obesity, in particular, is caused by a significant amount of carbohydrates in food, as well as the presence of animal fats in excess. In addition, the cause of the considered variant of obesity may be a violation of the composition and diet (rare meals, abundant meals, as well as meals in the evening in the amount of daily consumption), often it is also caused by family predisposition. The calories in fats contribute more to weight gain than the calories in carbohydrates and proteins.

As for secondary obesity, it acts as a concomitant factor for a number of syndromes, for example, Gelino syndrome, Babinski-Frelich disease, etc. In addition, symptomatic obesity, which this variant is considered as, can accompany a number of cerebral lesions, such as tumors brain, infectious diseases, craniocerebral injuries, mental disorders, etc.

And finally, endocrine obesity. Its development is accompanied by the presence of pathologies in the region of the endocrine glands. As pathological conditions that cause obesity against this background, diseases such as hyperinsulism, hypothyroidism, hypogonadism, etc. can be distinguished.

There are also separate forms of obesity the selection of which occurs on the basis of the participation in the pathogenetic process of certain links related to the regulatory system:

Diencephalic (brain, hypothalamic) obesity. This group includes such clinical manifestations of obesity that develop against the background of previous encephalitis (regardless of the characteristics of their etiology (nature of occurrence)). As such variants of encephalitis, one can consider the transfer of encephalitis that accompanies scarlet fever, typhus, as well as epidemic encephalitis, etc.
hypogenital obesity. This form of obesity develops in women during the onset of menopause (artificial or natural), during lactation. Men can also experience this form of obesity, which is accompanied by the underdevelopment of their gonads (the so-called eunuchoid obesity). The lack of sex hormone in boys can also cause the development of prepubertal obesity. Hypoovarian obesity belonging to this group is characterized by the concentration of fat in such a way that it resembles leggings, and also in such a way that its concentration defines an analogy with an apron (the concentration of fat deposits in the abdomen). In general, it can be noted that fat is distributed in frequent cases in a generalized way.
pituitary obesity. This form of obesity is close in type to diencephalic obesity, the pituitary gland is also affected here (predominantly). The deposition of fat occurs in the abdomen, chest, thighs, pubic area. Relevant is the underdevelopment of the genital organs, the general type of infantilism in patients.
Hypothyroid obesity. This type of obesity is accompanied by insufficient functioning of the thyroid gland. Characteristic features of this type of obesity: moon-shaped face, thick neck.

Obesity: symptoms

As the main symptom corresponding to obesity, as is clear, overweight is considered. The concentration of fat deposits can be very different, which thus determines their localization in the abdomen, hips, shoulder area, back, etc. Additionally, the formation of body fat is accompanied by such a symptom as the underdevelopment of the muscular system. There are also characteristic changes in the appearance of patients. So, they have a second chin, pseudogynecomastia (enlargement of the mammary glands) is noted, the hips become similar in shape to riding breeches, characteristic fat folds begin to hang down like an apron. Often, against the background of actual changes in obesity, hernias develop (inguinal, umbilical).

I and II degrees of obesity may not be accompanied by any characteristic complaints, while at more “serious” stages of the development of obesity within these degrees, where it manifests itself in a more pronounced form, there is increased sweating, drowsiness and weakness, shortness of breath , swelling, constipation, pain in the joints and in the spine.

Symptoms of obesity III and IV degree are accompanied by much more serious violations of the functions of the whole organism. In particular, violations of the respiratory, cardiovascular and digestive systems manifest themselves in it. An objective examination of patients is determined by a change in heart sounds, tachycardia and hypertension. Against the background of an altered state of the dome of the diaphragm against the background of obesity, respiratory failure develops, in addition, cor pulmonale becomes a frequent companion of these degrees of obesity. “Suffers” from obesity at these stages and the liver parenchyma (its outer surface, in particular, it is subject to fatty infiltration), pancreatitis, cholecystitis (its chronic form) also develops. Again, complaints of pain in the spine appear, symptoms are often noted that indicate the development of arthrosis of the knee and ankle joints.

In frequent cases, any degree and form of obesity is accompanied by menstrual irregularities, which can reach the state of amenorrhea (that is, the complete absence of menstruation).

Due to excessive sweating due to obesity, skin diseases such as eczema, furunculosis often develop. Pimples (acne) appear, striae (i.e. stretch marks) are noted in the thighs, abdomen, and shoulders (inner surface). In areas of increased friction, areas of hyperpigmentation form, they also appear on the neck and elbows.
Depending on the specific type of obesity, meanwhile, it is characterized by symptoms common to varieties, the existing differences relate mainly to the distribution of body fat, as well as signs indicating damage to the nervous and endocrine systems (this type of symptoms may also be absent during the course of the disease).

So, alimentary obesity characterized by the predominant relevance of such a factor as a hereditary predisposition to overweight/obesity. The development of such obesity is relevant with increased calorie content of food and reduced energy consumption of the body; basically, this type of obesity is diagnosed in several people at once in the family. The main group of people who develop alimentary obesity are women who lead a sedentary lifestyle, middle/old age. During the survey, it turns out that overeating is also frequent in the lifestyle. Weight gain occurs gradually, the distribution of fat mass occurs evenly, its largest accumulation is in the thighs and abdomen. There are no signs indicating a concomitant lesion of the endocrine glands.

The next option is hypothalamic obesity. This form is relevant for concomitant pathologies of the central nervous system, accompanied by damage to the hypothalamus (against the background of infections, injuries, and tumor formations). This form of obesity is accompanied by general obesity of patients, fat is mainly deposited in the form of an apron in the abdomen, as well as on the hips and buttocks. Often, in this case, the skin is subject to trophic lesions, it becomes dry, pinkish or white stripes of striae appear on it (as we noted above, these are stretch marks). Based on the clinical manifestations associated with obesity, such as sleep disorders, headaches, etc., as well as on the basis of data obtained during a neurological examination, it becomes clear that there is a pathology of the brain. As additional manifestations associated with this type of obesity, we can designate high blood pressure, excessive sweating.

This form of obesity endocrine obesity, is diagnosed in patients with relevant endocrine diseases for them, we previously listed them (this is hypothyroidism, etc.), the actual symptoms of such diseases are predominant in the overall picture of obesity. Fat deposits are concentrated unevenly, there are signs indicating hormonal disorders (gynecomastia (enlargement of the mammary glands in men), feminization (the appearance of somatic and mental signs in men, generally inherent in the female sex), etc.). On the surface of the skin in different areas, you can also determine the presence of stretch marks.

Lipomatosis (otherwise this type of obesity is also defined as Derkum's disease), is a peculiar form of the disease in question, it is accompanied by the appearance of characteristic fatty nodes, which, when palpated, reveal soreness. Diagnosed mainly in men, concentration - torso, limbs. Additional symptoms: itching of the nodes, general weakness.

Obesity: complications

In addition to the psychological problems associated with obesity, almost all obese people face a number of diseases and syndromes common to them that develop against the background of overweight. In particular, these are the following already noted diseases: diabetes mellitus, coronary artery disease, arterial hypertension, angina pectoris, heart failure, myocardial infarction, stroke. Chronic heartburn also appears, arthritis, osteochondrosis, arthrosis, and colon cancer develop.

Relevant "female" pathology, such as polycystic ovary syndrome (polycystic), cancer of the breast, uterus, ovaries. Obese men can develop prostate cancer. Complications associated with obesity often cause sudden death of patients against their background.

Diagnosis and treatment

Diagnosis of obesity can be primarily made on the basis of the above calculations of ideal body weight and BMI. The degree of deposition of subcutaneous fat is made on the basis of a study of the skin fold. The most accurate results in terms of volume, percentage and localization of adipose tissue can be obtained by carrying out the following auxiliary diagnostic measures: ultrasound, computed tomography, nuclear magnetic resonance, x-ray densitometry, etc. Additionally, studies are individually assigned to identify concomitant changes provoked by obesity .

Treatment of obesity is carried out in a complex way, given that it takes time. To achieve the appropriate results in terms of weight, to consolidate them and prevent the option in which the weight after treatment will return in double volume, it is necessary to choose the right diet and the necessary physical activity, and these are the main methods of treating obesity that are implemented in the practice of combating excess weight. . Additionally, drug therapy can be prescribed, the selection of drugs occurs on an individual basis. In a therapeutic diet, in particular, they are guided by "table number 8" with limiting the consumption of fats, proteins and carbohydrates to certain values and achieving a total calorie content of the diet within no more than 1800 kcal.

If symptoms indicating obesity appear, it is necessary to visit an endocrinologist, in addition, consultation with a psychotherapist and nutritionist may be necessary.

obesity) - the accumulation of excess fat (especially under the skin). A person is considered obese if their weight exceeds normal by more than 20% and continues to increase further. The deposition of excess fat is usually associated with the consumption of more food than the body needs to maintain its energy balance. In recent years, obesity has become one of the most common eating disorders in Western countries (and in Russia - ed.); in some cases, for the treatment of obese patients, it is even necessary to resort to surgical intervention in order to achieve significant weight loss in them. (Recently, it has been proven that the main cause of obesity is a mutation in the structure of the gene that expresses leptin in fat cells. Leptin signals the saturation of the body; if leptin synthesis is disturbed, a person has a constant desire to eat. Another gene has been discovered - the fat gene, which determines the reaction of the body for leptin) - Fat (obese).

OBESITY

Most definitions of this term are expressed in language that characterizes an individual as having, to one degree or another, excess weight. In fact, this is not correct. Obesity is characterized by excess body fat, but not overweight. While these two things are usually related, there are exceptions. An athlete, for example, may be "overweight" in comparison to the established norms due to highly developed muscles, but it would be wrong to define him as obese. However, since the procedures for determining obesity from a nutritionist's point of view have become very complex and involve many factors, some general rule of thumb is still needed. Thus, for practical purposes, an individual is considered obese if his body weight is more than 30% above normal, with normal usually given in standard tables of optimal weight ranges depending on age, sex and body constitution. Obesity can be caused by a large number of factors ranging from purely physiological to psychological. Several of the most commonly identified types of obesity are listed in the following articles.

Obesity

Metabolic disorders in the direction of the predominance of fat metabolism. At the same time, excess fat mass accumulates in the body. Distinguish between primary (exogenous) O., associated with excess (relative to the cost of energy and matter) nutrition, and secondary (endogenous), caused by diseases of the endocrine and / or nervous system. There are degrees of obesity: overweight (exceeding the norm up to 9%), 1 tbsp. - within 10–29%, 2 tbsp. - 30–49%, 3 tbsp. - 50-99% and 4 tbsp. – 100% or more. O. is a significant risk factor for diseases such as hypertension, angina pectoris, atherosclerosis, diabetes mellitus, gout, cerebrovascular accidents, etc.

OBESITY

a pathological condition characterized by an increase in body weight due to excessive deposition of fat in the body. Depending on the excess body weight in relation to the so-called ideal weight, 4 degrees of obesity are distinguished: at degree I, it is 10 - 29%; with II degree - 30 - 49%; at III degree - 50 - 99%; at IV degree - 100% or more. To determine the ideal body weight, you can use the Broca index: body weight in kilograms should be equal to a person’s height in centimeters minus 100 with possible fluctuations of ± 10% (depending on the constitution, degree of muscle development, age, gender). Excess body weight during obesity creates an additional load on the musculoskeletal system (for example, contributes to the development of arthrosis), the cardiovascular and respiratory systems, is combined with muscle hypotrophy and intestinal hypotension. Obesity consumes more energy than it expends. In the etiology of obesity, heredity, social factors play a role (obesity is more common in the lower strata of society, especially in women), endocrine factors, mental characteristics (see Bulimia), decreased physical activity, damage to the hypothalamus.

Clinical manifestations of different types of obesity are basically similar. There are differences in the distribution of excess body fat and in the presence or absence of symptoms of damage to the nervous or endocrine system.

The most common alimentary obesity, usually in individuals with a hereditary predisposition to be overweight. It develops in cases where the caloric content of food exceeds the energy expenditure of the body, and is observed, as a rule, in several members of the same family. This type of obesity is more common among middle-aged and elderly women who lead a sedentary lifestyle. When collecting an anamnesis with a detailed clarification of the daily diet, it is usually established that patients systematically overeat. For alimentary obesity is characterized by a gradual increase in body weight. Subcutaneous adipose tissue is distributed evenly, sometimes accumulates to a greater extent in the abdomen and thighs. There are no signs of damage to the endocrine glands.

Hypothalamic obesity is observed in diseases of the central nervous system with damage to the hypothalamus (with tumors, as a result of injuries, infections). This type of obesity is characterized by the rapid development of obesity. The deposition of fat is noted mainly on the abdomen (in the form of an apron), buttocks, thighs. Often there are trophic changes in the skin: dryness, white or pink stretch marks (stretch marks). Based on clinical symptoms (eg, headache, sleep disturbances) and neurologic findings, the patient can usually be diagnosed with brain pathology. As a manifestation of hypothalamic disorders, along with obesity, various signs of autonomic dysfunction are observed - increased blood pressure, sweating disorders, etc.

Endocrine obesity develops in patients with certain endocrine diseases (for example, hypothyroidism, Itsenko-Cushing's disease), the symptoms of which predominate in the clinical picture. On examination, along with obesity, which is usually characterized by uneven deposition of fat on the body, other signs of hormonal disorders (for example, masculinization or feminization, gynecomastia, hirsutism) are revealed, and striae are found on the skin.

A peculiar type of obesity is the so-called painful lipomatosis (Derkum's disease), which is characterized by the presence of fatty nodes that are painful on palpation.

Patients with II-IV degrees of obesity show changes in the cardiovascular system, lungs, and digestive organs. Often observed tachycardia, muffled heart tones, increased blood pressure. Sometimes respiratory failure and chronic cor pulmonale develop due to the high standing of the diaphragm. Most obese patients have a tendency to constipation, the liver is enlarged due to fatty infiltration of its parenchyma, symptoms of chronic cholecystitis and pancreatitis are often detected. Pain in the lower back, arthrosis of the knee and ankle joints are noted. Obesity is also accompanied by menstrual irregularities, amenorrhea is possible. Obesity is a risk factor for the development of diabetes mellitus, atherosclerosis, hypertension, coronary heart disease, with which it is often combined.

Obesity in children, as in adults, develops against the background of hereditary characteristics or as a result of acquired metabolic and energy disorders. Obesity is most often observed in the 1st year of life and in 10-15 years. As in adults, exogenous-constitutional obesity is more common in children, which is based on a hereditary (constitutional) predisposition to excessive fat deposition, often combined with family tendencies to overeat and overfeed children. Excess fat deposition usually begins as early as the 1st year of life and is not equally common in boys and girls. Girls are born with already more developed subcutaneous adipose tissue than boys; with age, this difference increases, reaching a maximum in adults, and causes a greater incidence of obesity in girls and women.

In children 10-15 years old, the most common cause of obesity is the hypothalamic syndrome of puberty, which is characterized by the appearance of thin striae on the skin of the thighs, mammary glands, buttocks, and the inner surface of the shoulders. There is usually a transient increase in blood pressure; in some cases, signs of increased intracranial pressure are found. Less often, the cause of hypothalamic obesity in children is the consequences of a traumatic brain injury, neuroinfection.

The diagnosis is usually established already during the examination of the patient, specifying it after measuring the height and determining the body weight. The differential diagnosis of various types of obesity is based on the history, the distribution of fat deposits in the body, the presence of clinical and laboratory signs of damage to the endocrine glands. The diagnosis of painful lipomatosis is established in the presence of isolated lipomas that are painful on palpation, outside of which there is usually no excess fat deposition.

Treatment of all types of obesity at any age includes the use of therapeutic nutrition to reduce the amount of energy consumed. Adults are prescribed a sub-calorie (1200 - 1600 kcal) protein-rich (up to 120 g) diet, full of vitamins and trace elements, but with a reduced content of fats (40 - 50 g) and rapidly absorbed carbohydrates (100 - 150 g) in the daily diet. Meals are increased up to 5-6 times a day to reduce appetite, fasting days are spent 1-2 times a week (consumption 600-700 kcal). Completely exclude the use of alcoholic beverages, including beer. Due to possible side effects, the use of drugs that reduce appetite (fepranone, deopimone, etc.) is limited.

With endocrine and hypothalamic obesity, it is necessary to treat the underlying disease, perform hormone replacement therapy according to indications (for hypothyroidism - thyroid hormones, for hypogonadism - sex hormones, etc.). Patients with a mild form of diabetes mellitus who are obese are sometimes prescribed biguanides (adebit, glucophage) in order to normalize carbohydrate and lipid metabolism. With hypothalamic obesity, which has developed as a result of a neuroinfection, along with therapeutic nutrition, anti-inflammatory therapy is sometimes necessary. In case of obesity in children with hypothalamic syndrome of puberty, dehydration therapy is carried out (for example, diacarb is prescribed), drugs are used that normalize brain activity (nootropil, cerebrolysin, aminalon, etc.). Treatment of painful lipomatosis is ineffective; sometimes lipomatous nodes are removed surgically.

For all types of obesity, patients are recommended daily long walks, in the absence of contraindications - swimming; general massage, hydromassage, contrast baths are effective. Therapeutic exercise is the most important part of complex therapy. It is indicated for all types and degrees of obesity, if the general state of health allows you to increase physical activity. The therapeutic effect of physical exercises is based on an increase in energy consumption, the normalization of all types of metabolism, and increased utilization of fat. The nature of the exercises and the intensity of the recommended load depend on the degree of obesity, the presence of concomitant diseases, as well as on the age, gender and physical fitness of the patient. Persons of young and middle age in the absence of diseases of the cardiovascular system are recommended to perform physical activity for endurance (walking, running, swimming, rowing, etc.), sports games, as well as therapeutic exercises - exercises that promote the development of flexibility of the spine and strengthen the abdominal muscles ( transition from a supine position to a sitting position and reaching the feet with hands with unbent legs, leg movements, as when riding a bicycle). The duration of therapeutic exercises should be 45 - 60 minutes per day. For obese patients with concomitant pathology of the cardiovascular system, lungs or other organs, physiotherapy exercises are carried out according to the method used for diseases of these systems and organs, taking into account the presence of obesity.

The prognosis for alimentary obesity is favorable if the patient complies with therapeutic and preventive recommendations. With hypothalamic and endocrine obesity, the prognosis depends on the underlying disease.

Prevention is to eliminate hypodynamia and rational nutrition. Children need to follow the rules of feeding and regularly monitor the physical development of the child by systematically measuring height and body weight (especially with a constitutional predisposition to obesity). Early detection and treatment of diseases accompanied by hypothalamic and endocrine obesity is important.

Good day, dear readers!

In today's article we will consider with you the issue of excess weight - obesity, its causes, symptoms, stages, treatment, prevention and ways to lose weight.

Losing weight today is one of the main problems of modern mankind. From year to year, more and more people begin to suffer from various diseases associated with excess weight. Violation of the psyche, the heart, digestive organs, problem skin, chronic fatigue, heart attacks, strokes, diabetes, joint problems ... This list goes on and on. In fact, obesity is a time bomb that gradually and imperceptibly destroys its owner's body. We will try to expand this post, and over time, add new and relevant information to it. We will also welcome your feedback, dear readers, with effective and effective methods of losing weight, combating obesity and extra pounds. So…

What is obesity?

Obesity- a disease that is characterized by excessive accumulation of fat in the body, leading to an increase in body weight. In most cases, obesity develops due to excessive food intake (90% of cases), reduced energy expenditure (a sedentary lifestyle) and metabolic disorders.

Obesity is an increase in body weight by 20% or more of the norm, due to the growth of adipose tissue. This disease delivers not only psycho-physical discomfort, but also causes diseases of the spine, joints, sexual and other disorders. Obesity increases the risk of developing life-threatening diseases such as kidney and liver disease. In addition, obesity can lead a person to disability. Diseases such as, and many other diseases, in obese patients are more severe and prolonged, often with a number of complications.

Causes of obesity

The development of obesity is promoted by:

frequent overeating;
malnutrition (eating at night, excessive consumption of carbohydrates, fats, salt, soda, alcohol and others);
inactive lifestyle (for example, sedentary work);
hereditary predisposition;
diseases of the nervous system (damage to the area of the brain that is responsible for eating behavior);
diseases of the endocrine glands (tumors, hypogonadism);
taking certain medications (hormones, antidepressants, etc.);
physiological conditions (pregnancy, lactation,).

The main signs of obesity are:

weight gain due to fat deposition;
drowsiness, decreased performance;
shortness of breath, ;
increased sweating;
swelling;
stretch marks on the skin in places of accumulation of extra pounds;
pain in the spine and;
disorders of the cardiovascular, respiratory and digestive systems;
nervousness, irritability;
decreased self-esteem, dissatisfaction with appearance, complexes, difficulties in communicating with people;
decreased sex drive.

In women, obesity may be accompanied by disorders, infertility, in men, a deterioration in potency.

Complications of obesity

hernias;

Types of obesity

Obesity is classified by severity, appearance, and development.

Degrees of obesity

The degree of obesity is determined by the body mass index.

Body mass index (BMI) is calculated by the formula: body weight / height (m) squared.

Consider all degrees of obesity in detail.

Preobesity. This degree is characterized by the presence of 25-29.9% of excess weight compared to the norm. It is considered the initial form, the main symptoms of obesity are absent. It lends itself well to correction through proper nutrition and exercise.

Obesity 1 degree. It is characterized by the presence of 30-34.9% of the devoid of weight. Outwardly, this degree is already more pronounced. It is often regarded not as a disease, but as a cosmetic defect. The first signs of obesity begin to appear - swelling, excessive sweating, shortness of breath, etc. This is the stage at which it is necessary to start taking measures to combat excess weight.

Obesity 2 degrees. The presence of 35-39.9% of excess weight. This degree is already expressed even more clearly - significant fat deposits are visible. There are symptoms of obesity, reduced performance and physical activity. With this degree, urgently begin to fight excess weight, because. it can quickly develop into grade 3 obesity.

Obesity 3 degrees. It is characterized by the presence of 40% or more excess weight. This degree is very easy to determine in appearance. At this stage, almost all the symptoms of obesity appear: shortness of breath, even at rest, disturbances in the work of the cardiovascular system, etc. It becomes difficult for a person to serve himself. It is urgent to contact a specialist and start treatment!

For easier orientation in the degrees of obesity, I suggest looking at the following table of correspondence between height and body weight:

This classification takes into account the appearance of a person according to the nature of the distribution of adipose tissue.

Obesity type "apple". This type of obesity is characterized by the accumulation of fat mainly in the abdomen, while the hips and legs practically do not change.

Obesity type "pear". In this case, the upper body remains practically unchanged, and the hips and buttocks increase significantly in volume.

Mixed type of obesity. With this variant of obesity, adipose tissue is evenly deposited both on the abdomen and on the hips.

Development of obesity over time

Progressive. Weight is constantly and rapidly growing.

Stable. Excess weight is present for a long time and does not increase.

Diagnosis of obesity

To diagnose obesity, you need:

- calculate the body mass index, measure the circumference of the waist and hips;
- undergo an examination and consultation with a specialist;
- measure the amount of adipose and muscle tissue, as well as water in the body;
-, thyroid gland, adrenal pituitary gland.
- pass (to determine the level of cholesterol, lipids, sugar levels, hormones).

Treatment of obesity, i.e. weight loss is carried out in a complex and includes:

- diet;
- physical activity;
- medicines (as prescribed by a doctor);
- treatment of complications (if any).

For the treatment of 1 and 2 degrees of obesity, proper nutrition and physical activity are sufficient.

Diet for weight loss

It is used for the treatment of obesity and weight loss.

The calorie content of the diet for obesity is 1500-1800 kcal per day.

It is necessary to limit the consumption of fatty, sweet and starchy foods.

In the diet, you need to focus on the use of fruits, vegetables, and.

The diet, with such a diet, is fractional, in small portions with light snacks between main meals. The last meal should be no later than 3-4 hours before bedtime.

If weight loss, at some stage of a proper diet, stops, then you can arrange it once a week, but only after consulting a doctor.

Important! See a nutritionist for the right diet! Do not use fasting and improper diets, as this can not only aggravate the process of treating obesity in the future, but also damage your health!

Exercise stress

Physical activity does not imply a mandatory trip to the gym, although if your health allows, then it is better to do so. Start small - do daily morning exercises, go for walks in the fresh air, swim, ride a bike, play volleyball, football or badminton. Loads should not be excessive, duration and intensity should be increased gradually.

Below is a set of some exercises for weight loss:

Medications

Important! Medications can be prescribed only by a doctor, if necessary! Medicines for weight loss have many side effects, so their use should be carried out under the strict supervision of the attending physician.

Medicines for weight loss are divided into:

- Violating the absorption of fats in the intestine - Orlistat ("Xenical", "Orsoten");
- contributing to an increase in satiety, a decrease in appetite - Sibutramine (Lindaksa, Meridia, Reduxin), Pramlintide (Simlin);
- contributing to an increase in heat production - Mexidol, Mildronate, Trimetazidine.

Important! It is very important not to confuse "miracle pills" for weight loss with drugs. From the so-called miracle cures for weight loss, there are serious health problems, displayed in the form of mental, cardiovascular, digestive and other serious diseases.

Treatment of complications

If complications and concomitant diseases arise due to obesity, the attending physician prescribes the appropriate treatment:

- in case of hypertension, antihypertensive therapy is prescribed, aimed at lowering blood pressure;
- in diabetes mellitus, hypoglycemic drugs are prescribed;
- to improve the lipid composition, statins are prescribed.

Obesity develops as a result of an imbalance between energy intake and expenditure in the body. Weight regulation is carried out due to a simple formula: absorbed energy (calories) = energy expended.

Important! You can use folk remedies for obesity only after consulting a nutritionist or your doctor!

To lose weight, try to follow these recommendations:

drink 1 glass of warm water every morning on an empty stomach;
replace black tea with green;
drink freshly squeezed fruit and vegetable juices;
eat fresh fruits, vegetables and herbs;
do not eat fresh bread - replace it with yesterday's bread, and preferably with crackers;
dishes, when cooking, boil, stew or bake (try to exclude fried);
arrange a fasting day once a week;
play sports.

Folk remedies for weight loss

Herb tea. Take 25 g of birch buds, flowers, perforated grass and sandy immortelle grass. Stir and 1 tbsp. pour a spoonful of the collection into the teapot, pour 0.5 liters of boiling water. Let stand 15 minutes. Drink as tea, in the morning and in the evening, 1 glass each, adding 1 teaspoon of honey instead of sugar.

Sherbet from oatmeal. To prepare the product, we need 2 tbsp. spoons of oatmeal ("Hercules"), 1 cup of sugar, 1 teaspoon of nuts, 1 teaspoon of raisins and 100 g of butter. Melt the butter, add sugar, nuts and raisins. Stir and boil for 15 minutes over low heat. Pour in the flakes and, stirring, cook until the mass becomes golden in color (this takes about 30 minutes). Grease a mold with butter or line with parchment paper. Put the finished sherbet in a mold and leave to cool. When cool, send to the freezer. Serve cooked sherbet pre-cut into pieces.

Honey and celery. Mix honey and celery juice in a 1:1 ratio. The prepared mixture, take 2 tbsp. spoons 3 times a day.

Water and apple cider vinegar. Add 2 teaspoons of natural apple cider vinegar to a glass of water. Take 1 glass 3 times a day, 30 minutes before meals.

Barley groats. Just include barley porridge in your diet or boil barley soup. It contains a large amount of fiber, it is poorly absorbed in the body, but at the same time gives a feeling of satiety. Also, fiber contributes to the passage of food through the gastrointestinal tract, and taking with it harmful products comes out with feces. Cell is a typical "cleaner" of the body.

It is also good, in combination, to take baths for weight loss and do things that contribute not only to weight loss, but also to the treatment of cellulite, if present ...

Prevention of obesity

In order to always stay in good shape, have a normal weight, you must adhere to some rules for the prevention of obesity:

- eat right;
- arrange fasting days;
- lead an active lifestyle;
- give up bad habits.

Who to contact for weight loss?

Nutritionist

Video about weight loss

Obesity is a disease and pathological condition characterized by excessive deposition of fat in the subcutaneous tissue, other tissues and organs, caused by metabolic disorders, and accompanied by changes in the functional state of various organs and systems. The most commonly used diagnostic criterion for obesity is an excess of total body weight in relation to the norm, established statistically. However, we emphasize that the value that largely determines the severity of the course of the disease is not so much the body weight itself, but the excess fat mass. This excess can vary significantly even among patients of the same age, height and weight. M (body) = M (bones) + M (muscles) + M (adipose tissue).

In the initial stages of obesity, the functional and adaptive properties of the organism are preserved. These stages are often referred to as compensated obesity. Adolescents with grade I obesity often do not complain, but they are concerned about excessive fat deposition for cosmetic reasons.

The appearance of stretch marks on the body of patients deserves special attention. At first, they have a flesh-pink color, later they acquire a gray-yellow color (the exception is purple-bluish striae that appear on the body with hypercortisolism). The arrangement of the bands is usually symmetrical, in places of maximum accumulation of adipose tissue (abdomen, thighs, buttocks, mammary glands). In the appearance of stretch bands, the mechanical factor (overstretching of the skin) and the trophic factor, which causes disturbances in protein metabolism (collagen formation is reduced), are important.

Currently, the most common classification according to D. Ya Shurygin, taking into account the polyetiology of obesity:

1. Forms of primary obesity:

a) alimentary-constitutional (accumulation of fat due to excess food intake in conditions of a sedentary lifestyle).

b) neuroendocrine: hypothalamic-pituitary; adipose-genital dystrophy (obesity associated with the presence of tumors of the hypothalamus and brain stem, trauma to the skull or stroke, with hypercortisolism and hypothyroidism). According to statistics, primary obesity in 80% of children belongs to the I-II degree.

2. Forms of secondary obesity:

a) cerebral, b) endocrine, c) diencephalic

With cerebral obesity, there is a gross (organic) lesion of the brain regions responsible for the regulation of fat metabolism. At the same time, all signs of the disease progress. Diencephalic obesity occurs as a complication after inflammatory diseases of the diencephalon and is accompanied by signs of impaired function. Endocrine obesity occurs as a result of a violation of the activity of certain endocrine glands. In this case, obesity is secondary, and other, more severe signs of the disease come to the fore.

In recent years, there has also been a tendency to subdivide obesity based on the distribution of fat into abdominal, when the bulk of fat is located in the abdominal cavity, on the anterior abdominal wall, trunk, neck and face (male type of obesity) and gluteofemoral with predominant fat deposition on the buttocks and thighs ( female type of obesity). This is due to the fact that with abdominal obesity, complications are observed much more often than with gluteofemoral obesity. It has been established that complications in abdominal obesity are observed at a younger age and with a relatively smaller excess of body weight.

According to the type of distribution of adipose tissue in the body, there are:

Android, deposition of adipose tissue in the upper body.

Gynoid, accumulation of adipose tissue in the lower part of the body

Mixed, even distribution of adipose tissue

According to morphological changes in adipose tissue, there are:

a) hypertrophic (increase in the mass of each adipocyte) obesity;

b) hyperplastic (increase in the number of adipocytes) obesity.

The hyperplastic form of obesity develops mainly in children and adolescents, while an increase in the number of fat cells (adipocytes) is observed. However, after reaching maturity, the number of fat cells in the body remains unchanged. The hypertrophic form of obesity develops at a later age. The number of fat cells is normal, but they increase in volume, which causes the growth of fatty subcutaneous tissue.

Depending on the nature of the distribution of fat, obesity is distinguished:

a) subcutaneous (the volume of subcutaneous fatty tissue increases);

b) visceral, when fat accumulates in the tissues of internal organs.

According to the nature of the course, obesity is divided into: progressive; slowly progressive; resistant; regressive.

To diagnose obesity and determine the degree, the body mass index is used: BMI = weight (kg) / height (m) 2 (see table 1).

It has been proven that BMI correlates with the amount of adipose tissue in the body in both adults and children.

Table 1

Classification of overweight and obesity by body mass index (WHO)

Criteria for overweight and obesity in children and adolescents are determined by percentile tables or BMI standard deviations (see Annex 1). They take into account not only the height, weight, but also the sex and age of the child. This is due to the fact that the value of BMI in children changes with the development of the child, gradually increasing during puberty, which generally reflects the dynamics of adipose tissue.

These standards are united by a common principle: percentiles should be symmetrical about the median (50th percentile). WHO uses standard deviations of -1, -2, -3 SDS, median, and +1, +2, +3 SDS. Based on WHO recommendations, obesity in children and adolescents should be defined as +2.0 SDS BMI, and overweight from +1.0 to +2.0 SDS BMI.

In children and adolescents, normal BMI parameters differ depending on age (BMI centile distribution curves). BMI values greater than the 85th line (percentile line) indicate excess body weight, and more than 95th (percentile line) indicate obesity.

Gaivoronskaya A.A. identifies 4 degrees of obesity in children:

Obesity I degree - body weight exceeds the norm by 15-24%;

Obesity II degree - body weight exceeds the norm by 25-49%;

Obesity III degree - body weight exceeds the norm by 50–99%;

Obesity IV degree - body weight exceeds the allowable age norm by more than 100%.

The classification of overweight and obesity according to body fat content is presented in table 2.

table 2

Classification of overweight and obesity by body fat content

Indicators of average body weight and height for boys and girls are presented in table 3.

Table 3

Indicators of average norms of body weight and height for boys and girls according to I. M. Vorontsov, A. V. Mazurin

Age	Girls	boys
Weight, kg	Height, cm	Weight, kg	Height, cm
Average	Norm range	Average	Norm range	Average	Norm range	Average	Norm range
12 years	44,0	36,5-51,5	152,8	146-160	41,20	33,8-48,6	150,0	143-158
13 years	48,5	40,4-56,6	156,8	151-163	45,8	40,6-57,1	156,6	149-165
14 years	51,3	44,6-58,5	160,8	154-167	51,2	43,8-58,5	162,6	155-170
15 years	54,8	47,0-62,3	161,9	156-167	56,3	47,9-64,8	170,1	159-175
16 years	55,6	48,8-62,6	162,6	157-167	62,0	54,5-69,9	173,6	168-179
17 years	56,4	49,2-63,5	162,9	158-168	66,8	58,0-75,5	175,3	170-180

Etiology and pathogenesis

In adolescence, the leading factor in the occurrence of obesity should be considered low physical activity.

The study of children's activity uses physical measurements (for example, accelerometry), which can show the ratio of active and passive time of the child. With some measuring systems it is also possible to register different activity intensities. Along with the questionnaire, these measurements allow for a comparative analysis. The dependence of children's activity on gender and age is confirmed by accelerometry data. They show a marked decrease in physical activity in modern children in the prepubertal period, as well as in adolescence. Based on the data of diaries of daily activity of schoolchildren, the following results were obtained: "lying" - 9 hours, "sitting" - 9 hours, "standing" - 5 hours, movement - only 1 hour.

The study of the motor mode of schoolchildren showed that about 80% of overweight students were limited to physical exercises in the classroom at school, and only 20% were additionally engaged in various sports sections. However, these classes were not permanent and were often interrupted due to illness. In the families of students, morning exercises were either not done by any of the family members, or only by the father, without involving the child in this. As a rule, sports and recreational physical education were not practiced in such families. In most cases, students spent their free time reading fiction, and spent a lot of time watching TV. Thus, students in grades 1-4 in 44-58% of cases spent watching television programs up to 2 hours daily, and students in grades 5-9 - more than 3 hours. Thus, of all forms of physical education for overweight schoolchildren, only a physical education lesson is used, that is, the daily range of movements is clearly low.

There is no doubt that the cultural and technological revolution contributes greatly to the spread of obesity. Improvement of vehicles, use of technical equipment for games (computer, laptop, consoles); access to "virtual reality" - the Internet, are the factors that lead adolescents to a sedentary lifestyle (physical inactivity), which leads to energy imbalance and contributes to obesity.

Modern food industry, subjecting all products (sugar, flour, etc.) to refining, modern methods of cooking, in which all biologically active substances are destroyed; lead to the fact that people begin to suffer from a lack of minerals, vitamins and other substances useful for digestion. Since these substances are essential for the body, it acutely feels their hidden lack. This manifests itself in overeating. The consequence of malnutrition is a violation of the acid-base balance in the body, which leads to the formation of excess uric acid in the blood. The feeling of false hunger in people with excess uric acid is one of the reasons for overeating, thereby increasing body weight. At present, the role of excess fat intake in the development of obesity has been absolutely proven.

In the etiology of obesity, they also attach importance to acute psychogenic factors (fear, fear, anger) or prolonged mental experiences, negative emotions. During adolescence, the psyche and behavior of a person change dramatically. Adolescents often cannot respond correctly to stress. Tension is suppressed, and stress continues to torment. Therefore, people try to relieve stress by resorting to food.

Numerous hormonal active compounds are involved in the regulation of body weight, and a disturbance in the synthesis or receptor transmission of the action of any of these agents can contribute to a change in the energy balance in the body, which is manifested by a change in eating behavior and the development of obesity. Recently, the ghrelin protein, identified in 1999, has attracted special attention of scientists. Ghrelin controls energy consumption, food intake, and activates the secretion of growth hormone. It can stimulate lactotropic and corticotropic functions, participate in cell proliferation, circulation, digestion, affect gastric contractions and hydrochloric acid production, pancreatic function and glucose metabolism. However, in general, the action of ghrelin in the body is still poorly understood. Probably, compulsive eating behavior may be associated with a violation of its production.

Therefore, among the main causes of obesity are considered:

1. Internal factors (hereditary predisposition, organic lesions of the central nervous system (CNS), hypothalamic-pituitary region, hormonal disorders).

2. External or environmental factors (irrational nutrition, family traditions of malnutrition and the lack of a sufficient motor regimen for children and adolescents at home and at school).

Obesity, which began in childhood (if it is not stopped in time), progresses and goes through three phases of the pathological process: uncomplicated, transient and complicated. The uncomplicated phase of obesity (I degree) in most cases occurs in boys 9 years old and in girls 9-11 years old. The analysis of progress in the program "physical culture" showed that at this age schoolchildren still cope with all the requirements of the program, and have a grade of "4" and "5". Starting from the age of 12-13, schoolchildren with initial degrees of obesity begin to lag behind sharply in the development of endurance, speed and strength. In particular, they do not cope with exercises on shells, rope climbing, and acrobatic exercises. They do not succeed in high jumps, high-speed running. This can be explained by the progression of a hidden pathological process - disorders of the cardiovascular system, metabolic disorders.

The regulation of food intake is carried out by the food center, localized in the hypothalamus. Lesions of the hypothalamus of an inflammatory and traumatic nature lead to an increase in the excitability of the food center, increased appetite and the development of obesity. In the pathogenesis of obesity, a certain role belongs to the pituitary gland. Speaking about the development of obesity, one should not underestimate the importance of hormonal factors, since the processes of fat deposition mobilization are closely related to the functional activity of most endocrine glands. Obesity develops in various diseases of the pituitary gland, thyroid gland, adrenal glands and the islet apparatus of the pancreas (diabetes mellitus), which are actively involved in the regulation of lipid metabolism. A decrease in the functions of the thyroid and sex glands leads to obesity. Strengthening the activity of the islet apparatus of the pancreas leads to increased synthesis of sugar into glycogen, its transition to fat and inhibits the mobilization of the latter from the depot. Cortisone, which is a hormone of the adrenal cortex, also enhances fat deposition. Violation in any link of this complex regulation leads to a violation of fat metabolism and the development of certain forms of obesity.

In the etiology of obesity, the hereditary-constitutional factor has a certain significance. The risk of developing obesity in a child reaches 80% if both parents have it; the risk is about 50% if only the mother is obese, about 38% if the father is obese, and about 7-9% if the parents are not obese. Naturally, obesity in itself is not a congenital disease, but the predisposition to it may be hereditary. The obvious presence of a hereditary predisposition to the occurrence of obesity is also evidenced by statistical data on the frequency of obesity in relatives of obese patients. According to some reports, approximately 50% of children develop obesity if one of the parents was obese, if both, then obesity was observed in 2/3 of children.

One of the main factors in increasing body fat is excessive consumption of carbohydrates. Glucose entering the blood (as a result of absorption from the intestines) in quantities that exceed the needs of the liver or the capacity of the glycogen storage process is primarily used for the synthesis of fatty acids. The most important site for the formation of endogenous, predominantly saturated fatty acids is the liver cells. The excess glucose coming from the liver is captured by adipose tissue cells, in which additional amounts of fatty acids are synthesized. In obese people, there is a significant increase in the content of insulin in the circulating blood. Excessive nutrition of carbohydrates not only promotes glucose uptake by adipose tissue, but also induces the synthesis of a number of enzymes (an enzyme that breaks down citrate, acetyl-CoA - carboxylase and fatty acid synthetase) in the cells of the liver and adipose tissue, which leads to stimulation of lipogenesis. In addition, an increase in insulin concentration inhibits hormone-sensitive lipase, which causes a further shift in the disturbed balance towards fat deposition.

Alimentary-constitutional obesity develops as a result of overnutrition and a sedentary lifestyle. At the same time, more energy substances enter the body than they are consumed. The source of increased fat deposition is not only overeating or a large amount of fat in the diet, but also excessive consumption of carbohydrates. Rare, irregular meals and eating mainly in the evening leads to overeating. And during rest and sleep, as you know, energy consumption is low, so excess nutrients from food are deposited in the form of fat in adipose tissue. Thus, the development of the alimentary-constitutional form of obesity is closely related to motor activity and the amount of energy supplied with food. At the age of 7-16 years, in such cases, symptoms appear: decreased exercise tolerance, shortness of breath, increased blood pressure. By the age of sixteen, ¼ of children have a metabolic syndrome, which is manifested not only by obesity, but by insulin resistance, arterial hypertension and dyslipidemia.

Excess body weight puts an excessive load on the musculoskeletal system (joints of the lower extremities, spine) and contributes to the development of various degenerative processes in it, arthrosis of the knee and hip joints, flat feet, herniated discs (osteochondrosis) occur. For the abdominal type of obesity, pronounced violations of the structure of the spine and changes in the skeleton are characteristic. The spine becomes inactive, loses flexibility, herniated discs form. Due to the large abdomen, which pulls the lumbar spine, lumbar lordosis develops, which contributes to the rise of the ribs and the formation of a barrel chest. The high position of the diaphragm in obese individuals reduces its excursion and contributes to the development of inflammatory processes (bronchitis, pneumonia, rhinitis, tracheitis) in the bronchopulmonary system. Diseases of the gastrointestinal tract (chronic cholecystitis, cholelithiasis, chronic colitis) are detected. The liver in these patients is usually enlarged due to fatty infiltration and congestion. Diabetes mellitus develops, menstrual irregularities, amenorrhea, infertility, gout occur.

Obesity can underlie functional disorders of the nervous system (memory impairment, dizziness, headaches, drowsiness during the day and insomnia at night). A depressive state may occur: complaints of poor health, mood swings, lethargy, drowsiness, shortness of breath, pain in the heart, swelling, etc.

The data of clinical studies indicate that in obese patients, changes in the cardiovascular system are observed quite early, characterized, on the one hand, by myocardial dystrophy, and on the other, by atherosclerotic lesions of the arteries. The activity of the heart in obesity is significantly hampered.

With obesity, there are shifts in the functioning of the endocrine glands. Abdominal obesity, which is characterized by insulin resistance and hyperinsulinemia, is a leading factor in the development of type 2 diabetes mellitus (DM), which in 85-90% of cases develops against the background of obesity. It should be emphasized that with a decrease in body weight in patients with type 2 diabetes and obesity, insulin sensitivity improves, insulin resistance decreases, and blood glucose and cholesterol levels normalize.