Obesity is a disease characterized by excessive development of adipose tissue. More often obesity occurs after 40 years, mainly in women.
The main factor leading to the development of obesity is a violation of the energy balance, which consists in a discrepancy between energy intakes in the body and their costs. Obesity is most commonly caused by overeating, but may be due to impaired control of energy expenditure. Undoubtedly, the role of hereditary-constitutional predisposition, decreased physical activity, age, gender, occupational factors, some physiological conditions (pregnancy, lactation, menopause).
Obesity is a hypothalamic-pituitary disease, in the pathogenesis of which the leading role is played by hypothalamic disorders expressed to varying degrees, causing a change in behavioral reactions, especially eating behavior, and hormonal disorders. The activity of the hypothalamic-pituitary-adrenal system increases: ACTH secretion increases, the rate of cortisol production increases, its metabolism accelerates. The secretion of somatotropic hormone, which has a lipolytic effect, decreases, the secretion of gonadotropins and sex steroids is disturbed. Characterized by hyperinsulinemia, a decrease in the effectiveness of its action. The metabolism of thyroid hormones and the susceptibility of peripheral tissues to them are disturbed.
Allocate alimentary-constitutional, hypothalamic and endocrine obesity.
Alimentary-constitutional obesity is of a family nature, it 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 occurs as a result of impaired hypothalamic functions and therefore has a number of clinical features.
Endocrine obesity is one of the symptoms of the primary pathology of the endocrine glands: hypercortisolism, hypothyroidism, hypogonadism. However, in all forms of obesity, there are, to varying degrees, hypothalamic disorders that occur either initially or during the development of obesity.
A common feature of all forms of obesity is overweight. There are four degrees of obesity and two stages of the disease – progressive and stable.
At degree I, the actual body weight exceeds the ideal by no more than 29%, at degree II – the excess is 30-40%, at degree III – 50-99%, at IV – the actual body weight exceeds the ideal by 100% or more.
Sometimes the degree of obesity is estimated by body mass index, calculated by the formula: Body weight (kg) / height (m) (squared); the mass index is taken as the norm, which is 20-24.9, with I degree – an index of 25-29.9, with II – 30-40, with III – more than 40.
Patients with I-II degrees of obesity traditionally do not complain, with more massive obesity they are concerned about 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.
With hypothalamic obesity, increased appetite is often disturbed, especially in the afternoon, hunger at night, and thirst. In women – all kinds of menstrual irregularities, infertility, hirsutism, in men – a decrease in potency. Impurity and trophic skin disorders, small pink striae on the thighs, abdomen, shoulders, armpits, hyperpigmentation of the neck, elbows, friction points, increased blood pressure. An electroencephalographic study of patients with hypothalamic obesity reveals signs of damage to the diencephalic structures of the brain. Determination of excretion of 17-OKS and 17-KS often reveals their moderate increase.
For differential diagnosis of hypothalamic obesity and hypercortisolism, a small dexamethasone test, an X-ray examination of the skull and spine are performed.
In the presence of thirst, dry mouth, the content of sugar in the blood on an empty stomach is determined and throughout the day, according to indications, a glucose tolerance test is performed.
In case of menstrual irregularities – gynecological examination, ultrasound examination of the pelvic organs, measurement of rectal temperature, other tests of functional diagnostics.
Treatment is complex, aimed at reducing body weight, including diet therapy and physical therapies. A balanced low-calorie diet is recommended by reducing the content of carbohydrates and partly fats, predominantly of animals, with a sufficient content of proteins, vitamins, and minerals (taking into account energy costs). They use foods with a high content of fiber, which contributes to rapid saturation, accelerating the passage of food through the intestines. Feed fractional, 5-6 times a day. Apply fasting days. Active motor mode, systematic therapeutic exercises, shower, massage are necessary. In grade IV obesity, surgical methods of treatment are the treatment of choice. With endocrine forms of obesity, the underlying disease is treated.