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August 18, 2011
Obesity (Latin obesitas — completeness, an otkormlennost) — a chronic disease of which accumulation of excessive fatty tissue in a human body is characteristic that leads to increase in body weight. The disease is progressing and is followed by endocrine disturbances. Gradual increase in body weight leads to irreversible processes in cardiovascular and respiratory system.
Today in health care of our country and the whole world in general, such disease as obesity wins nearly first place the prevalence. According to statisticians of WHO since 1980 the quantity of diseases of this illness doubled, for 2008 1,5 billion people at the age of 20 years and are more senior suffered from excess weight, and and it is terrible to speak about statistical figures of children's age – 40 million children. Every year nearly 3 million people die of the excess weight or obesity.
Moreover, about 44% of diseases of a diabetes mellitus, 27% — coronary heart disease and from 7 to 40% of oncological illnesses happen because of excess weight. Speaking generally, this illness quickly enough creeps away from year to year on the globe. Various techniques it both various diets, and trainings, and surgical treatment of obesity are developed for fight against excess weight.
Delay of a metabolism owing to what the number of the calories coming to an organism with food is not burned, at the same time forming excessive accumulation of fat is the general reason of obesity. However leads a set of factors therefore the obesity reasons, eventually, can be various to delay of a metabolism.
It first of all is connected with small physical activity and irrational food, the frequent use of spicy and greasy food, especially fat grades of meat, various sweets, pasta. The wrong way of life, a long dream, a chronic sleep debt, an alcohol abuse, smoking, are also the reasons of excess weight. The use in food of a large number of caloric food, and also sweet carbonated drinks also promotes accumulation of fat in an organism.
The disease can be connected also with reception of hormonal drugs, and also with frequent stresses. In certain cases excessive body weight is caused by a hereditary factor – a superactivity of enzymes of a lipogenesis or decrease in their activity.
Some diseases can also lead to obesity, for example, endocrine diseases (an insulinoma, girotireoz), then such obesity is called endocrine. The diseases of a nervous system connected with defeat of a hypothalamus lead to hypothalamic obesity.
Besides, can lead to obesity also reception of some drugs, for example, of corticosteroids and various antidepressants. One more factor promoting increase in weight is the age. Usually after 30 flyings there is a reorganization of the special centers of a brain among which and the center which is responsible for appetite. It means that for suppression of feeling of hunger the person needs bigger quantity of food. Besides with age the metabolism of the person is slowed down that leads to gradual increase in weight.
The food saturated with digestible carbohydrates is not capable to be acquired correctly if not to balance the diet products in which there are enough proteins. The wrong diet of the pregnant woman leads to the fact that at a fruit on the third trimester of pregnancy predisposition to excess weight already forms. From there is also obesity at children.
Constantly increasing body weight is the main symptom of obesity. Against excess weight such symptoms as an asthma, fatigue, flowing off of the lower extremities, appetite increase appear, at the same time patients prefer greasy and heavy food. Also can disturb patients attacks of night hunger and thirst. At the woman of change affect the sexual sphere, the menstrual cycle is broken, hirsutism signs can appear, at men the potentiality decreases. Also hyperpegmentation of skin, especially on hands and elbows, and also emergence of small extensions (striya) on a neck, on hips and a stomach can be shown.
These symptoms of obesity appear long before excess weight begins to disturb a usual rhythm of life therefore many patients do not consider the weight excessive. At the first stages of a disease the weight of the person increases to 20% and gradually increases. Not less important symptom of a disease is hypertensia. Cholesterol has property to settle on walls of vessels, thereby complicating a blood flow.
Fatty deposits can evenly be distributed, and the person long time does not pay attention to emergence of excess weight. In a case when accumulation happens in certain places, symptoms of obesity are more noticeable. At children such localized obesity leads to a growth inhibition.
Obesity at children most often develops because of the acquired disbolism, and also heredity. Usually obesity can be observed in 1 year, and in 10-15 years. Children of 10-15 years usually have the obesity reason a hypothalamic syndrome to which emergence of extensions on hips, buttocks, mammary glands is inherent. Increase of arterial pressure is observed, also increase of intracranial pressure is possible.
Diagnosis of obesity
The World Health Organization classifies obesity on IMT, that is a body weight index. IMT based on the ratio of weight to square centimeter of the area of a body is calculated. If IMT is equal or more than 25, then it is just excess body weight if 30 and more – obesity. As the option of classification, IMT wins first place on ways of identification of excess weight as it identical to both floors and all age categories.
Exact calculations of IMT are made on such formulas:
- less than 0,0185 gr. / quarter see – the insufficient weight (dystrophy);
- 0,0185-0,0249 gr. / quarter see — normal body weight;
- 0,025-0,0299 gr. / quarter see – excess weight;
- 0,030-0,0349 gr. / quarter see – the first degree of obesity;
- 0,035-0,039 gr. / quarter see – the second degree of obesity;
- more than 0,040 gr. / quarter see – the third degree of obesity.
At obesity of the fourth degree the actual body weight exceeds ideal weight more than for 100%.
For measurement of body weight at people 65 years are more senior, athletes, pregnant women and children to these formulas amendments are made.
Diagnosis of obesity is carried out also on a formula of calculation of IMT by method of an index of Brock. The ratio of growth and body weight is the cornerstone of this method. The ratio at which body weight equals to growth minus 100 in centimeters is considered normal. But calculation will be correct only within 155-170 cm of growth.
If the person has obesity of I and II degrees, then it has complaints to weakness, drowsiness, sharp decrease in mood, the increased perspiration, irritability. The meteorism and chronic locks, and also nausea can disturb. At physical exercises tachycardia and an otdyshka develops. At the I degree of obesity of the patient the otdyshka when performing physical exercises of average intensity disturbs, however working capacity remains at the former level. Already at obesity of the II degree working capacity considerably decreases, the patient complains of flowing off of legs, and also backbone pains.
At obesity of the III degree at the person disproportionality of a constitution develops, the otdyshka disturbs almost constantly, blood circulation is broken. Against the general slackness and apathy, appetite of the patient is increased. The fact that the person becomes a disabled person is characteristic of the IV degree of obesity, his mental state is broken, concerns nothing him, except food.
For diagnosis of obesity it is necessary to consider several factors. First, the age of the patient when there were first symptoms of an illness, recent changes of body weight, way of life, food preferences, existence of addictions, intensity of exercise stresses, use of various medicines is considered (hormones, various food additives, laxative).
Thus, the doctor for statement of the diagnosis the excess weight or obesity, defines IMT for the purpose of classification of a disease by severity, defines the waist circle relation to a circle of hips for clarification of nature of distribution of fatty tissues in an organism, after – measures arterial pressure. After that the patient goes to analyses. Laboratory blood analyses, for determination of level of cholesterol and lipoproteins of high and low density for the purpose of identification of disturbance of a lipometabolism, and also an echocardiography for definition of pathologies of heart and all blood circulatory system are conducted. At disturbances of a menstrual cycle conduct gynecologic researches and ultrasonic research of bodies of a small pelvis.
Complications of obesity
Obesity is characterized as an illness at which at the patient excessive fatty deposits which create additional load of a musculoskeletal system, cardiovascular and respiratory systems are defined. Therefore complications first of all are shown by diseases of these systems and bodies. Obesity is hazardous to health, for his longevity, and can lead to premature death.
Obesity very often leads to development of atherosclerosis, disturbance of blood circulation, arterial hypertension, heart disease, joints, a liver and zhelchevyvodyashchy ways, and also a diabetes mellitus. At obesity the probability of thrombosis in veins of legs is 2,5 times higher, than at people with a normal weight. Stout women till 40 flyings are subject to the greatest risk of thrombosis.
Fat tends to collect at men in an abdominal cavity (belly obesity), and at women – on buttocks and hips (pelvic obesity). At belly obesity, the probability of emergence and development of coronary heart disease repeatedly increases that leads to increase of arterial pressure, increase in content of fats in blood and developments of a non-insulin-dependent diabetes mellitus. Weight loss leads to lowering of arterial pressure at the patients suffering from an idiopathic hypertensia, and sick non-insulin-dependent diabetes it allows to stop medicinal therapy.
From digestive organs such complications of obesity as cholecystitis, pancreatitis, cholelithiasis develop.
The patients having obesity are often subject to formation of malignant tumors. At men they I affect a prostate gland and a rectum, and at women is a uterus, ovaries and mammary glands. Besides, menstrual disturbances, diseases of a gall bladder occur at such women much more often than at women with a normal weight. All this leads to disturbance of reproductive function.
Treatment of obesity
For weight loss by sick obesity it is necessary to consume the smaller number of calories, than they spend. There are three methods for achievement of this purpose:
- psychological methods;
- clinical programs.
In case of a self-care, patients independently, or in special groups, leaning on the developed weight loss techniques, try to normalize the food, to go in for physical culture. Treat motivation of on weight loss psychological methods of weight loss, for example, desire to surprise all surrounding with the beauty and symmetry, or to put on a new dress of the small size. The similar motivation has to be actual, and connected with living position of the person. Similar motivation has to be combined with the correct diet, and daily exercise stresses.
It is very important to carry out treatment of obesity in a complex, i.e. to aim at decrease in body weight in various ways, by means of a dietotherapy, physical therapy, physical exercises and it is medicamentous.
The program of complex treatment of obesity consists usually of two stages – a stage of decrease in body weight (about 3-6 months) and a stage of stabilization of weight (6 months).
Besides, nutritionists teach patients with obesity to eat, control properly the health and quality of food. It is very important at the same time that the patient realized need of change of the eating habits and way of life.
Programs of treatment of obesity are learned as it is necessary to eat properly as it is necessary to change way of life and an eating habit for achievement of result. For this purpose doctors recommend the balanced low-calorie diet based on decrease in consumption of carbohydrates and fats of animal origin at maintenance in a diet of necessary amount of proteins, vitamins, minerals. Doctors will help to pick up individually products, taking into account age, degree of obesity, taste and way of life of the patient. It is impossible to starve and use diets with sharp restrictions in fats and carbohydrates. Enter into a food allowance products with the high content of cellulose which promote fast saturation and acceleration of passing of products through intestines (bran, green beans, oats, whole wheat). Food has to be rather frequent (5-6 times a day). Useful are also fasting days (once a week). For those who have obesity of the I-II degrees doctors recommend to limit consumption of fats moderately.
The individual system of exercise stresses, taking into account his way of life and changes in a diet is developed for the patient. Daily morning exercises, and also aerobic loading, i.e. fast walking, jogging, driving by bicycle, aerobics, soccer are most effective. These occupations have to be systematic and frequent (3-5 weekly). It is necessary to choose those exercise stresses which bring you pleasure. The professional fitness trainer will not only control her execution, but also to adjust depending on a condition of the patient. In the presence at the patient with obesity of heart diseases, vessels, loadings have to be lungs, being guided by pulse.
Medicamentous therapy promotes increase of efficiency of other methods of treatment, and at patients with obesity of the II degree drug treatment begins along with change of way of life and food. However medicinal therapy is not recommended to pregnant women, children, and to patients 65 years are more senior.
Among the medicines used at treatment of obesity, doctors appoint the drugs suppressing appetite, promoting release of the detained liquids in an organism, and also increase in power consumption and reducing digestion of nutrients in an organism. For example, Ksenikal interferes with absorption of fats in intestines, however its side effect is existence of a liquid chair. The Meridia promotes loss of appetite and increase of power consumptions, but influences cardiovascular system. Also drugs for normalization of a hormonal background can be used. For weight loss only the attending physician has to appoint drugs. However many patients supplement the treatment with special teas and collecting for weight loss, and also dietary supplements.
At diseases of obesity against other diseases, for example, of a diabetes mellitus, diseases of a musculoskeletal system, digestive organs, treatment of a basic disease is surely carried out.
Also with the patient psychocorrection sessions on which the psychotherapist will help to understand the obesity reasons can be held.
Apply surgical treatment of obesity to treatment of patients with obesity of the IV degree. Similar operations have to be performed only in institutions which specialize in this type of surgical interventions and the surgeons only qualified. In this case patients undergo an operation better, and complications arise less than at 10% of patients with a high risk. There are several surgical methods of treatment of obesity: a liposuction – removal of excess fatty tissues from under skin; an abdominoplastika – removal of a pot-belly, establishment of the gastric rings promoting reduction of volume of a stomach that promotes saturation acceleration; bypass enteroanastomoses at which of system of digestion parts of a small bowel are removed. Similar operations can lead to sharp loss of weight, approximately on a half of excess weight of the patient, and is gradually slowed down. Weight reduction promotes improvement of the general condition of the patient, to increase of its activity and working capacity, the mood also improves. Besides, operation reduces the complications caused by obesity.
It is important to remember that it is easier to reach decrease in body weight if to combine a diet and physical culture, physical therapy and drug treatment. Thermal procedures – mud procedures, hot sukhovozdushny bathtubs, salty and pine needle baths, steamings, bathing in the pool, actinothermal bathtubs, wet wrappings have salutary effect on patients with obesity. It is useful as well a sauna – a dry hot bath of the Finnish sample. Use of work therapy and the general massage is reasonable.
It is important to note that obesity at children of chest age consists only in observance of a diet, children of advanced age are treated as well as adults.
Food at obesity
As the overeating is a basic reason of obesity, doctors advise to regulate food, the same recommendations are included also by prevention of obesity. It is important that the food with a small amount of calories, caused feeling of saturation. At preparation of dishes for the patient with obesity the food is tried not to be salted. Limit consumption of products with high content of carbohydrates – bread, torments, sugar, grain, potatoes, various sweets. It is possible to eat black bread and bread with bran in number of 300 g a day. Fats in a diet limit, but do not exclude completely, in day them 50-75 g are possible. Products rich with cholesterol – a liver, an egg yolk – delete from a diet. Vegetable oil is better to use not refined, about 25-30 ml. in day. Alcohol is forbidden. Doctors allow to arrange cottage cheese day when the use of 60 g of sour cream, 600 g of cottage cheese, 2 glasses of coffee (with milk and without sugar) and 2 glasses of broth of a dogrose is authorized. And also fruit and vegetable days when consumption of 1,5 kg is authorized. crude vegetables or fruit on 5-6 receptions, apple day (2 kg. crude apples), or meat day when on 5-6 meals 250-350 g of boiled meat, and a boiled garnish without salt, 2 glasses of broth of a dogrose are authorized.
At obesity of the III-IV degrees, patients completely clean from a diet of grain and pasta, sugar, honey, sweets, at at the same time increase in amount of the consumed vegetables and fruit, the vegetable salads filled with vegetable oil are especially useful. Medical starvation which is carried out in a hospital under supervision of the doctor also can be applied to such patients.
The main diet at obesity is the diet number eight. This diet is based on reduction of caloric content of a diet at the expense of digestible carbohydrates at the increased protein content. It contains the increased amount of proteins (120 g), the lowered amount of fats (70 g), 200-250 g carbohydrate, 1 l of liquid. The diet number eight allows only food, prepared in the boiled, baked and stewed look. Consumption of fried dishes and products, orexigenic, seasonings, spices is limited. Xylitol or sorbite is applied to drinks and sweet dishes. At observance of a diet No. 8 are resolved:
- bread rye and wheat;
- vegetable soups, beetroot soup, okroshka, borsch, the fat-free beef-infusion broths;
- low-fat grades of fish and meat;
- to 1,5 eggs a day;
- kefir, milk, skim cheese, cheese, curdled milk, butter – it is limited;
- buckwheat, yachnevy and pearl-barley friable cereals;
- cabbage, cucumbers, vegetable marrows;
- unsweetened berries, fruit, compotes;
- mineral water, tea, coffee with milk (without sugar), vegetable, berry and fruit juice.
Are completely excluded from a diet at obesity white loaf, fancy pastry, fat meat and fish, sausages, smoked products, fat cottage cheese, fat cheeses, cream, semolina, rice, marinated vegetables, grapes, sugar, sweets, ice cream, mayonnaise, mustard, horse-radish, chocolate.
Though the diet number eight allows "to dump" several kilogram in the first month, it follow to adhere a long time. At the correct approach monthly loss in weight will make 1-2 kg, and it negatively will not be reflected on health in general as often happens to other diets.
In the presence of the diseases accompanying obesity, use of a diet No. 8 has to be coordinated with the attending physician.
It is possible to begin to keep the diary of food where you will be able to write down that you ate, in what quantity when and why. It will help at the first time of treatment when the way of life and style of food change very seriously.
Prevention of obesity
Prevention of obesity is reduced to elimination of a hypodynamia and observance of a balanced diet. Not to allow development of obesity in the baby, it is necessary to weigh systematically it, especially at genetic predisposition to obesity. The organization of healthy nutrition at teenagers, and also timely detection of diseases which are followed by endocrine or hypothalamic obesity is very important.