Obesity

Obesity is a disease characterized by excessive development of adipose tissue. Often obesity occurs after 40 years, mainly in women.

Etiology, pathogenesis. The main factor leading to the development of obesity is a violation of the energy balance, which is the inconsistency between energy inputs to the body and their costs. Most often obesity arises from overeating, but can occur due to a violation of energy consumption monitoring. The role of hereditary-constitutional predisposition, decrease in physical activity, age, sex, occupational factors, certain physiological conditions (pregnancy, lactation, menopause) is undoubtedly important.

Obesity is a hypothalamic-pituitary disease, in the pathogenesis of which the hypothalamic disorders, which lead to a change in behavioral reactions, especially of food behavior, and hormonal disorders play a leading role. The activity of the hypothalamic-pituitary-adrenal system increases: the secretion of ACTH increases, the production rate of cortisol increases, its metabolism is accelerated. The secretion of a growth hormone with a lipolytic effect decreases, and the secretion of gonadotropins and sex steroids is disrupted. Characterized by hyperinsulinemia, a decrease in the effectiveness of its action. The metabolism of thyroid hormones and the sensitivity of peripheral tissues to them are disturbed.

Allocate alimentary-constitutional, hypothalamic and endocrine obesity. Alimentary-constitutional obesity is of a family nature, develops, as a rule, with systematic overeating, eating disorders, lack of adequate physical activity, often among members of the same family or close relatives. Hypothalamic obesity arises from the violation of hypothalamic functions and, in connection with this, has a number of clinical features. Endocrine obesity is one of the symptoms of the primary pathology of the endocrine glands: hypercorticism, hypothyroidism, hypogonadism. However, with all forms of obesity, there are some degree of hypothalamic disorders that arise either primarily or in the process of developing obesity. Symptoms, course. A common sign of all forms of obesity is the excess weight of the tep. There are four degrees of obesity and two stages of the disease - progressive and stable. At 1 degree, the actual body weight exceeds the ideal body weight by no more than 29%, with II - excess 30-40%, at grade III-50-99%, with IV-the actual body weight exceeds the ideal one by 100% or more.

Sometimes the degree of obesity is estimated by the body mass index, calculated by the formula: Body mass (kg) / height (m) (squared); For the norm is taken the mass index is 20-24.9, with the I degree - the index of 25-29.9, with II - 30-40, with III - more than 40. Patients I-II degree of obesity usually do not complain, while more Massive obesity is disturbed by weakness, drowsiness, decreased mood, sometimes nervousness, irritability; Nausea, bitterness in the mouth, shortness of breath, swelling of the lower extremities, pain in the joints, spine.

When hypothalamic obesity is often worried about increased appetite, especially in the afternoon, hunger at night, thirst. In women - various violations of the menstrual cycle, infertility, hirsutism, in men - a decrease in potency. Unclean and trophic skin disorders, small pink striae on the hips, abdomen, shoulders, axillary cavities, hyperpigmentation of the neck, elbows, places of friction, increased blood pressure. In the electroencephalographic study of patients with hypothalamic obesity, signs of damage to the diencephalic structures of the brain are revealed. The determination of excretion of 17-ACS and 17-CS often reveals their moderate increase.

For differential diagnosis of hypothalamic obesity and hypercorticism, a small dexamethasone test is performed, an x-ray study of the skull and spine. In the presence of thirst, dry mouth determines the sugar content in the blood on an empty stomach and within 24 hours, according to the indications, a glucose tolerance test is performed. With violations of the menstrual cycle - gynecological examination, ultrasound examination of pelvic organs, measurement of rectal temperature, other tests of functional diagnostics. Treatment is complex, aimed at reducing body weight, including diet and physical methods of treatment. A balanced low-calorie diet is recommended due to a decrease in the carbohydrate content (100-120 g) and partly fats (80-90 g) predominantly in animals with a sufficient protein content (120 g), vitamins, minerals (taking into account energy costs). Use foods high in fiber, which helps fast saturation, accelerate the passage of food through the intestines. Nutrition is fractional, 5-6 times a day. Apply unloading days: protein (350 grams of boiled meat or 500 g of cottage cheese), fruit, etc. An active motor system is necessary, systematic therapeutic exercises, shower, massage.

Against the background of loss of body weight, the main metabolism decreases, which contributes to the preservation of energy from the diet and a decrease in the effectiveness of dietary treatment. This requires in the process of treatment the recalculation of the daily calorie content of food and increase in motor activity. Patients with increased appetite appoint anorexigenic drugs: fepranone, teronak. The course of treatment is not more than 1 -1.5 months because of the possible appearance of addiction to them. In connection with the exciting effect of drugs it is recommended to apply them in the morning. As a fat-mobilizing agent, adiposine is prescribed at 50 units 1 to 2 times a day for 20-30 days in combination with diuretics. Use thyroid preparations (thyroid up to 0.3 g per day, triiodothyronine from 20 to 100 mgk) under the control of the pulse and ECG studies. If tolerance to carbohydrates is violated - biguanides (adebit, diformin, gliobin), which also have lipolytic and partly anorexigenic properties.

In women, in the absence of restoration of the function of the ovaries, medication correction with synthetic estrogen-gestagenic preparations (bisekurin, non-vellon, ovidone, ригевидон) is performed against the background of decrease and normalization of body weight. In cases of increased body weight against the background of progestogen-estrogenic drugs, they are canceled and pro-gesterone and synthetic gestagens are prescribed. In some cases, effective therapy with clomiphene citrate (clostilbugite, clomid), menopausal human gonadotropin in combination with chorionic gonadotropin. With hirsutism - antiandrogens (androkur) in combination with microfollin, veroshpiron.

With obesity IV degree, therapies for choice are surgical methods of treatment. With endocrine forms of obesity, the main disease is treated.