OBESITY

OBESITY - a pathological condition characterized by an increase in body weight due to excess fat deposition in the body. Depending on the excess weight of the body in relation to the so-called ideal mass, 4 degrees of obesity are distinguished: at grade I it is 10-29%; At grade II - 30-49%; At the III degree - 50-99%; At the 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, the degree of development of the muscles, age, sex). Excess body weight creates an additional burden on the musculoskeletal system (for example, promotes the development of arthrosis), cardiovascular and respiratory systems, combined with muscle hypotrophy and intestinal hypotension with obesity. With obesity, energy is consumed more than is consumed. In the etiology of obesity, the role of heredity, social factors (obesity is more prevalent in the lower strata of society, especially in women), endocrine factors, features of the psyche (see Bulimia), decreased physical activity, hypothalamus damage.

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

The most common is alimentary obesity, usually in individuals with hereditary predisposition to fullness. It develops in those cases when the calorie content of food exceeds the energy costs of the body, and is noted, as a rule, by several members of the same family. This type of obesity is more likely to affect middle-aged and elderly women, leading a sedentary lifestyle. When collecting an anamnesis with a detailed explanation of the daily ration, it is usually established that the patients systematically overeat. For alimentary obesity is characterized by a gradual increase in body weight. Subcutaneous adipose tissue is distributed evenly, sometimes more accumulates in the abdomen and thighs. Symptoms of lesion of the endocrine glands are absent.

Hypothalamic obesity is observed in diseases of the central nervous system with the defeat of the hypothalamus (in tumors, in the outcome of injuries, infections). This type of obesity is characterized by rapid development of obesity. Fat deposition is noted mainly on the abdomen (in the form of an apron), buttocks, hips. Often there are trophic skin changes: dryness, white or pink stretch marks (striae). On clinical symptoms (for example, headache , sleep disorders) and the neurological examination of the patient, it is usually possible to establish a pathology of the brain. As a manifestation of hypothalamic disorders, along with obesity, there are various signs of autonomic dysfunction - increased blood pressure, sweating, etc.

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

A kind of obesity is the so-called painful lipomatosis (Dercum's disease), which is characterized by the presence of fatty nodes, painful on palpation.

In patients with obesity II-IV degrees, there are changes in the cardiovascular system, lungs, digestive organs. Often observed tachycardia , muffled heart tones, increased blood pressure. Sometimes respiratory failure and chronic pulmonary heart develop due to high diaphragm standing. Most obese patients have a tendency to constipation, the liver due to fat infiltration of its parenchyma is increased, often symptoms of chronic cholecystitis and pancreatitis are revealed. There are pains in the lower back, arthrosis of the knee and ankle joints. Obesity is also accompanied by irregularities in the menstrual cycle, 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 a background of hereditary characteristics or due to acquired metabolic and energy disorders. More often obesity is noted at the 1st year of life and in 10-15 years. As in adults, children are more likely to have exogenous-constitutional obesity, which is based on a hereditary (constitutional) predisposition to excessive fat deposition, often combined with family tendencies to overeating and overfeeding of children. Excess fat deposition usually begins already at the 1st year of life and is unequally distributed in boys and girls. Girls are born with a more developed subcutaneous fat tissue than boys; With age, this difference increases, reaching a maximum in adults, and causes a high incidence of obesity in girls and women.

In children 10-15 years, the most common cause of obesity is the hypothalamic syndrome of the pubertal period, 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. It is noted, as a rule, 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 are the consequences of head injury, neuroinfection.

The diagnosis is usually established already during the examination of the patient, refining it after measuring the growth and determination of body weight. Differential diagnosis of various types of obesity is based on data of anamnesis, features of the distribution of fat deposits in the body, the presence of clinical and laboratory signs of lesion of the endocrine glands. Diagnosis of painful lipomatosis is established in the presence of painful palpation of isolated lipomas, outside of which excessive fat deposition, as a rule, is not noted.

Treatment of all types of obesity at any age includes the use of therapeutic nutrition in order to reduce the amount of energy consumed. Adults are prescribed a subcaloric (1200-1600 kcal) protein rich (up to 120 g) diet, high in vitamins and trace elements, but with a low content of fat in the diets (40-50 g) and rapidly absorbed carbohydrates (100-150 g). Meals are consumed up to 5 - 6 times a day to reduce appetite, 1-2 times a week spend unloading days (consumption of 600-700 kcal). Completely eliminate the use of alcoholic beverages, including beer. Because of possible side effects, the use of drugs that reduce appetite (fepranone, desopimonone, etc.) is limited.

With endocrine and hypothalamic obesity, it is necessary to treat the underlying disease, carry out according to the indications of hormone replacement therapy (hypothyroidism - thyroid hormones, hypogonadism - sex hormones, etc.). Patients with mild diabetes, obese, sometimes appointed biguanides (adebit, glucophagus) in order to normalize carbohydrate and lipid metabolism. In hypothalamic obesity, which has developed as a result of the transferred neuroinfection, along with therapeutic nutrition, anti-inflammatory therapy is sometimes necessary. When obese children with hypothalamic syndrome of the pubertal period are treated with dehydration therapy (for example, prescribe diacarb), drugs that normalize the activity of the brain (nootropil, cerebrolysin, aminalon, etc.) are used. 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; Effective general massage, hydromassage, contrast baths. Therapeutic physical training is the most important component of complex therapy. It is indicated for all types and degrees of obesity, if the general health status allows you to increase physical activity. The therapeutic effect of physical exercises is based on increasing energy costs, normalizing all types of metabolism, and increasing the 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, sex and physical preparedness of the patient. For young and middle-aged people, in the absence of diseases of the cardiovascular system, exercise is recommended for endurance (walking, running, swimming, rowing, etc.), sports games, and therapeutic gymnastics - exercises that promote the development of spine flexibility and strengthen the abdominal muscles The transition from the supine position to the sitting position and reaching the feet with the hands with unbent legs, the movement of the legs as when riding a bicycle). The duration of the gymnastics session should be 45-60 minutes per day. For patients with obesity with concomitant pathology of the cardiovascular system, lungs or other organs, exercise therapy is performed 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 in the case of patients performing therapeutic and preventive recommendations. With hypothalamic and endocrine obesity, the prognosis depends on the underlying disease.

Prevention consists in the elimination of hypodynamia and rational nutrition. Children need to comply with the rules of feeding and regular monitoring of the child's physical development by systematically measuring growth and body weight (especially with a constitutional predisposition to obesity). It is important early detection and treatment of diseases accompanied by hypothalamic and endocrine obesity.