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Obesity – a chronic disease of system of a metabolism of which the excess progressing development of fatty tissue which leads to complications and recurrence after a course of treatment is characteristic.
The disease is strongly widespread. So, for example, only among Europeans of 50% have obesity symptoms – excess weight, and 30% a long time suffer from obesity. Every decade patients become 10% more. Distribution of an illness is promoted by some factors. Demographic factors: increase in life expectancy, race, nationality, female. Welfare factors: decrease in educational level, low income, marital status. The number of childbirth is considered the biological factor influencing developing of obesity. But the main factors on which have influence and previous it is behavioural – improper feeding, alcohol intake and smoking, decrease in physical activity.
The mass of our body is constantly neyrogumoralno controlled. The hypothalamus is responsible for expressiveness of food motivation, that is feeling of hunger and saturation, in its supraoptic kernels there are main centers of these feelings and the center of regulation of a metabolism in an organism. This center is answered by the main glands – thyroid, a pancreas and adrenal glands. Also the vegetative system is subordinated to this center.
Today there is no uniform system of classification of obesity. Conditionally distinguish four degrees of obesity. Most often primary form of a disease meets, these are 75% of cases. Ratio distortion of the received and burned energy is an origin of primary obesity. Disturbance of power balance leads to increase of synthesis of triglycerides of fatty tissue that promotes its accumulation. In big percent of cases genetic predisposition is the reason of primary obesity.
Not less often symptomatic obesity meets, such irregular shapes of a disease as cerebral obesity and various syndromes belong to it. The cerebral form of obesity is connected with disturbances of functions of the central nervous system. The disease arises because of damage of a brain owing to injuries, infectious diseases. Zhelino's syndrome is characterized by obesity and comas. Also obesity is a characteristic symptom of such syndromes: Pradera-Willie, Tsondek's syndrome, Babinsky-Frelikh's illness. Endocrine obesity meets as a symptom of pathology of endocrine system. There is this degree of a disease at a hypothyroidism, diabetes, the cosecreting insulioma and other disturbances.
Distinguish also local obesity, the lipophilic nutritional dystrophy, lipomatoz and Derkum's syndrome belongs to it. At lipophilic dystrophy obesity is shown by hypostases of hypodermic fatty tissue, elephantiasis of extremities. Lipomatoz is a benign hyperplasia of fatty tissue. Meets more often at men, it is characterized by emergence of painless lipomas on extremities. Painful lipomas are a sign of a syndrome of Derkum. At such local obesity of a lipoma are localized symmetrically on a trunk and extremities, are characterized by a generalizirovanny itch.
At obesity patients often complain of a febricula, short wind, headaches. Excessive thirst, appetite increase, drowsiness is noted. Sudden attacks of hunger are followed by weakness and dizziness. Symptoms of obesity are in most cases connected with associated diseases. At disturbance of work of the alimentary system abdominal pains, nausea, heartburn, intestinal frustration are observed. Defeats of cardiovascular system are characterized by hypostases of the lower extremities, pains in a myocardium, an asthma.
Obesity at the age of 30-60 occurs at women twice more often than at men. In the anamnesis of life professional factors, feeding habits, the postponed stresses and diseases are noted. At inspection of patients with obesity hypodispersion of fatty tissues at an exchange and alimentary form is observed and adiposities in a breast, a stomach, on a face, at a gipotalamo-pituitary form of obesity. The hypoovarian form of a disease is characterized by fatty deposits in the field of a basin and hips, often in a nape the fatty pillow – withers is formed.
At obesity integuments normal. But in case of development of a disease during puberty in areas of a breast, stomach, hips and shoulders reddish neatrofichny striya are formed. Symptoms of obesity of a hypothalamic form also of a striya but already tsianichny, besides on skin pigmentation, a black acanthosis is observed. At patients function grease is usually increased and sweat glands, skin wet is often subject to acne rash, a pyoderma and other skin diseases.
Diagnosis of obesity
At diagnosis of obesity an important point is value of normal body weight which is determined by tables taking into account growth, like a constitution, gender and age. Data of tables are an average normal value. Exceeding of these indicators is also obesity degree. For determination of disease severity it is not enough to determine excess weight, it is important to know surplus of mass of fatty tissue. Such indicator can differ at people with identical indicators of weight and growth. For this purpose there is a system of methods of definition of body composition, in this case percent of fatty weight.
Except concept of normal body weight, there is also an ideal body weight, as a rule, the last 10% less. Ideal body weight is estimated on Brock's formula, exceeding of an ideal indicator for 15-20% is considered the first degree of obesity, 30-49% — the second degree, 50-99% of exceeding are the third, and more than 100% the fourth degree of obesity. To these indicators there is a number of amendments depending on age and a floor.
Diagnosis of obesity also includes such concept as IMT – value of an index of body weight. For calculation Quetelet's formula where body weight is divided into growth is used, with a normal weight the indicator of IMT has to be 18,5-24,9 kg/sq.m. Body weight insufficient is lower than this indicator, the indicator from 30 to 40 kg/sq.m is considered obesity also above.
Not only degree of obesity is important for successful treatment, but also that where deposits of fatty tissue are located. Complications of obesity first of all depend not on amount of fat, and from that where it is located. Apply a number of measurements to high-quality diagnosis. Measurement of a circle of hips and a waist gives the chance to define localization of fatty deposits and to count risks of complications.
Complications of obesity
Obesity increases risk of developing of various diseases. Metabolic disturbances and the related diseases, such as a diabetes mellitus of the second type, a giperinsulemiya, fatty dystrophy of a liver, a hyperuricemia, cholelithiasis are observed. Also diseases of cardiovascular system an arterial hypertension, a hypertrophy of ventricles, coronary heart disease, heart failure develop. Excessive weight at obesity leads to musculoskeletal system pathologies. More often all complications of obesity are shown by arthrosis and degenerative diseases of joints.
Obesity provokes emergence of new growths, it is connected with failure of release of hormones in an organism. Also sexual frustration – an amenorrhea, decrease in a libido, fertility are for the same reason observed.
Increase in IMT is higher than 30 kg/sq.m is risk of development of swift-flowing heart diseases with a lethal outcome. Heavy degree of obesity leads to development of a pikvinsky syndrome – an apnoea in a dream, pulmonary hypertensia.
Treatment of obesity
The main principle of treatment of obesity — decrease in body weight and prevention of its repeated increase. The dietotherapy and physical exercises is for this purpose appointed. Hypocaloric diets at which the daily amount of fats and carbohydrates umenshatsya are applied, and the proteinaceous food with the content of fibers raises. Alcohol is excluded fried, acute. It is important to adhere to the correct diet, short-term low-calorie diets give unstable temporary effect, and the correct mode gives the chance to support weight at one level. Medical starvation has to be carried out only in a hospital, under supervision of the attending physician.
Along with a dietotherapy and physical exercises drug treatment of obesity is applied. Begin such therapy at IMT over 30 kg/sq.m or at inefficiency of a diet more than 12 weeks. Distinguish two directions in treatment of obesity medicines. The first group of medicines is intended for blocking of the centers of hunger and regulation of the centers of saturation. The second group is appointed for blocking of absorption of fats from food, strengthening of a lipolysis.
Within medicamentous therapy amphetamines — Phepranonum, Desopimonum, regidron are appointed. These drugs affect the central nervous system and brake feeling of hunger. Purpose of Mazindolum has anoretichesky effect, influencing serotoenergichesky system of a brain, at the same time food requirement decreases.
For combustion of excess fat in an organism Adiposinum is appointed. But this drug differs in a number of side effects. Therefore it is reasonable to appoint it in a complex with diuretics and antidepressants.
Treatment of obesity demands as well psychotherapy as cardinal change of way of life, disposal of stereotypes and habits in a diet is required. Often hypnosis is for this purpose applied, such reception helps not only to change habits, but also umenshat feeling of hunger.
At a gross obesity over 40 kg/sq.m drug treatment and a dietotherapy can be ineffective. Operational treatment of obesity is in that case applied. The technique of a liposuction recommended by cosmetologists gives short-term effect and has nothing in common with surgical treatment of obesity.
Prevention of obesity
For prevention of obesity it is necessary to adhere to a day regimen. Physical activity has to be maintained constantly. Correctly organized diet it not only prevention of obesity, but also prevention of diseases of the alimentary system and cardiovascular disturbances.