Classification of obesity. Causes, symptoms, diagnosis and treatment of obesity

One of the problems of society in the twenty-first century was obesity. The disease "recruits" new adherents around the world. This is due to malnutrition, sedentary lifestyle, a significant number of chronic endocrine pathologies and many other factors. Literally, obesity means that the body weight increases not due to muscular densification, but due to fat deposits on different parts of the body. What is dangerous obesity? Looking at people with overweight, any doctor will name a dozen reasons, and in the first place will be diseases of the heart, blood vessels, joints and bones, violation of water-salt metabolism. In addition, this disease makes social life more difficult, as in today's society, tendencies towards sport and a healthy lifestyle prevail.

Etiology

The disease "obesity" can develop for a variety of reasons. The most obvious is hypodynamia, that is, the discrepancy between the calories received and the energy wasted. The second common cause of the appearance of excess weight is a disruption of the gastrointestinal tract. This may be a deficiency of pancreatic enzymes, a decrease in liver function, problems with digestion of food. In addition, the risk of obesity can be determined at the genetic level.

There are factors that contribute to weight gain, they include:
- the use of sweet drinks or a diet that contains a lot of sugar;
- endocrine diseases such as hypogonadism, hypothyroidism, pancreatic tumor;
- psychological disorders (eating disorders);
- permanent stressful situations and lack of sleep;
- taking hormonal or psychotropic drugs.

The evolution of a long 2 million years has provided a mechanism for accumulating nutrients in case there is a shortage of food. And if for ancient people this was actual, then modern man does not need such "storages". However, our body is designed in such a way that it reacts stereotypically to both positive and negative influences from the outside. Therefore, the problem of obesity has become so acute right now.

Pathogenesis

Regulation of the deposition and mobilization of fat stores is a result of a complex interaction between the nervous system and the glands of internal secretion. The main reason for the accumulation of a large number of lipids is the mismatch between the cerebral cortex and the hypothalamus. It is there that the centers are located, the regulation of appetite. The body requires more food than it spends energy, so all the excess is left "in reserve", which leads to an increase in body weight and the appearance of excess fat tissue.

Such a violation of coordination by the center can be both an innate condition and acquired as a result of upbringing. In addition, these problems are sometimes a consequence of trauma, inflammation, chronic endocrine pathology.

When the pituitary gland, the cortical layer of the adrenal glands and - the cells of the pancreas begin to show pathological activity, and the amount of growth hormone drops sharply, practically all the fat and glucose that enter the body are deposited in tissues and organs. This leads to morphological disorders of the liver, kidneys, thyroid gland.

Classification by BMI

Classification of obesity is better to begin with the one that is known to the general population. As a rule, the primary diagnosis of this disease is based on such an index as the body mass index (BMI). This is a particular value obtained after dividing the body weight in kilograms by the height in meters, squared. There is the following degree of obesity in this indicator:

1. Deficiency of weight - if BMI is less than or equal to 18.5.
2. Normal body weight - the mass index should be in the range from 18.5 to 25.
3. Pre-fattening - BMI ranges from 25 to 30 points. At this time, the risk of comorbid conditions, such as hypertension, decubitus and intertrigo, increases.
4. Obesity of 1 degree is set in the event that BMI is from 30 to 35.
5. Obesity 2 degrees - the index is close to 40 points.
6. Obesity of grade 3 is diagnosed when the mass index exceeds 40 points, while the person has concomitant pathologies.

Etiopathogenetic classification

The following classification of obesity is one of the most detailed in this area, as it takes into account the causes and mechanism of the development of pathology. According to her, primary and secondary obesity is isolated. Each of them has its own subclasses.

So, the primary obesity is divided into:
- gluteal-femoral;
- abdominal;
- caused by eating disorders;
- stressful;
- provoked by a metabolic syndrome.

In secondary, symptomatic obesity, four subtypes can be derived:

1. Hereditary, with a gene defect.
2. Cerebral, provoked by neoplasms, infections or autoimmune brain damage.
3. Endocrine, caused by a violation of the thyroid gland, hypothalamic-pituitary, adrenal and gonadal glands.
4. Medication, associated with taking steroid drugs, hormonal contraceptives and cytotoxic drugs.

Clinical and pathogenetic classification

If we take as a basis the mechanisms that lead to the appearance of excess weight, then we can make such a classification of obesity:

- Alimanno-constitutional. Weight gain is associated with an excess of fat in the diet and lack of mobility. It manifests itself, as a rule, in childhood and can be associated with hereditary predisposition.
- Hypothalamic. The increase in fat tissue occurs due to damage to the hypothalamus and, as a consequence, disturbances in its neuroendocrinal function.
- Endocrine. At the core of the fatness is the pathology of the glands of internal secretion - the pituitary gland, the thyroid gland, the adrenal glands.
- Iatrogenic. Obesity is caused by medical intervention. This can be taking medications, removing the body or part of it, damaging the endocrine system during treatment, and much more.

Classification of adipose tissue

After examination of patients with obesity, it was observed that not all of them are distributed equally. Therefore, over time, the classification of obesity, based on the characteristic location of the fat layer, was derived.

The first type, it's the upper one, it's the same android, differs in that it increases mainly the upper half of the trunk, face, neck and arms. It occurs more often in men, but it can be seen in women who entered the menopause period. A number of authors argue that there is a link between this type of obesity and the risk of developing diabetes, as well as the pathology of the cardiovascular system.

The second type, the lower or the gynoid, is an accumulation of adipose tissue on the hips and buttocks, and is more common in the beautiful half of humanity. The figure of such women takes the form of a "pear". It can also develop from childhood, if aggravated by a violation of a normal diet. Associated diseases in this case will be pathologies of the spine, joints and vascular network of the lower limbs.

The third type is mixed or intermediate obesity. In this case, excess weight more or less evenly distributed throughout the body, smoothing the waistline, neck and buttocks.

In order to determine with what type of obesity the patient turned, it is necessary to determine the relationship between the circumference of the waist and hips. If in women this indicator is more than 0.85, and for men more than one, then it can be asserted that the person has the first variant of fat tissue distribution.

Morphological classification

In the process of obesity, changes affect all levels of the organization of life, not only the whole body, but also individual organs, tissues and even just cells. Adipocytes (fat cells) can undergo qualitative or quantitative changes. Depending on this, there are:

1. Hypertrophic obesity. It is characterized by a pathological increase in the size of fat cells, while their number remains the same.
2. Hyperplastic obesity, in which adipocytes actively divide. This form is found in children and is very poorly treated, since it is possible to reduce the number of cells in extremely aggressive ways.
3. Mixed obesity, as logically assumed, is a mixture of the two previous ones. That is, the cells not only increase, but they also become larger.

Classification of obesity in children

According to statistics, in Russia now about 12% of children suffer from excessive body weight. Of these, 8.5% are urban residents, and 3.5% are rural. Obesity in adolescents and children has become so frequent a pathology that pediatricians have decided to introduce a special section in their educational work with young parents regarding the diet. Obesity is considered to be a condition when the child's body weight exceeds 15% of that due at his age. If you compare with BMI, then its value will approach 30 points.

There are two forms of obesity among children: primary and secondary. Primary is caused, as a rule, by malnutrition, early lactation or refusal of breast milk in favor of the cow. But it can be hereditary, if people with overweight predominate in the family. But even in this case, the child is not born fat, he just has a slow metabolism, and with the proper diet and physical exertion, he will keep his weight within the norm. Critical for primary obesity are the first three years of life and pubertal age.

Secondary obesity is associated with the presence of acquired endocrine pathologies. The criteria by which the degree of overweight is determined is still debatable. The following scale was proposed:
- 1 degree - the weight is more by 15-25% of the due;
- 2 degree - from 25 to 49% of excess weight;
- 3 degree - the mass is more by 50-99%;
- 4 degree - overweight is two and more times higher than the age norm.

Symptoms

Signs of obesity are basically similar to each other, the difference is only in the uniformity of the distribution of excess fiber, and also in the presence of accompanying pathologies or their absence.

Most often, patients have alimentary obesity, that is, associated with a violation of a normal diet. Typically, such people have a hereditary predisposition to weight gain, and excessive eating results in weight gain. Symptoms occur in all family members, as they all eat together. In addition, this type of obesity is affected by elderly women, who due to their shaky health lead a sedentary lifestyle.

Obesity of 1 degree is observed in most people who systematically transmit, especially in the evening. This happens because there is no time and no desire for breakfast and lunch. Hungry people at dinner consume a daily calorie rate and go to sleep.

Hypothalamic obesity is characterized not only by weight gain, but also by the presence of symptoms of nervous system disorders and endocrine regulation. Obesity develops very quickly and, as a rule, is not associated with a change in diet. Fat appears mainly on the front surface of the abdomen, thighs and buttocks. Perhaps the appearance of trophic changes: dry skin, stretch marks, hair loss. Such patients complain of insomnia, headaches and dizziness. A neurologist usually manages to identify a pathology in his field.

Diagnostics

People with obesity have extremely reduced criticism to their condition, so persuading or getting them to go to the doctor even for a simple consultation is not a simple matter. Quite another matter - the patients of an endocrinologist or neurologist. They themselves want to be examined and reduce weight for a speedy recovery.

The most commonly used criterion for diagnosing excess weight is the body obesity index. That is, how much the actual mass is more than what is necessary. To determine the severity it is important not only to prove the fact of having excess weight, but also that it is realized at the expense of adipose tissue, and is not a muscle mass. Therefore, in the medical practice are actively trying to introduce ways to determine exactly fat mass, rather than the entire body weight.

The norm is determined taking into account the statistics collected by doctors of various specialties for years of practice. For each sex, age, dew and physique, there are tables with already calculated values of pathology and norm. Scientists found out that in long-livers weight of the body is 10% less than normal. Pathological obesity is diagnosed in the opposite case, when the weight by 10% exceeded the upper limit of the permissible.

There are several formulas for calculating the ideal body weight. One of them is known to all women of fashion - from growth in centimeters it is necessary to take away one hundred. The resulting number is the desired value. But this is a very conditional and unreliable study. More accurate is the BMI or the Quetelet index, which was given above. Measurement of the ratio of the circumference of the waist and hips is also of great importance in the characterization of obesity, since the location of fatty tissue depends on the cause, which is caused by weight gain.

Treatment

The fight against obesity is conducted maliciously and ubiquitously. Now the media actively promotes a healthy lifestyle and the cult of a beautiful, athletic body. Of course, to bring the situation to the point of absurdity is not worth it, but the general direction of the youth movement is more preferable than decadent hedonism.

The basic principles of treating obesity are:
- a diet rich in complex carbohydrates and fiber, vitamins, nuts and greens. Be sure to limit baking, sweet and carbonated drinks.
- physical exercises that should strengthen the body and accelerate the metabolism.
- drugs for weight loss and appetite;
- Psychotherapy;
- surgery.

To achieve long-term results of any kind of treatment, you need to change your diet and the frequency of food intake. There is an opinion that diets are useless in the fight against obesity, but they help to consolidate the achieved weight and prevent the disease from returning. The World Health Organization recommends calculating the calorie content of food that the patient consumes normally and gradually reduces the number of calories. It is necessary to reach a mark in 1500 - 1200 kcal, provided that a person does not overload himself physically.

Psychotherapy is aimed at strengthening the will power and self-control in relation to food intake and dependence on fast food restaurants and sweet soda water. Medications in the process of weight loss help to achieve only a short-term effect. After stopping the taking of the pills, the patient again returns to the past way of life and does not follow the recommendations received at discharge. Despite the fact that now the pharmacological industry can offer a large selection of drugs for overweight, almost all of them are prohibited due to side effects.

Surgical methods include gastric closure, popular in the sixties of the last century. The essence of the operation is that the organ is divided into two unequal parts and the smaller one is sewn into the small intestine. Thus, the volume of the stomach decreases, and the rate of passage of food becomes higher. The second option is gastric banding. In the cardiac part, a ring is fixed, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritates the saturation center, allowing the patient to eat less.

What type of obesity is the most dangerous? Perhaps, everything. No one can say that it is useful to type for a person. The level of danger depends on how much the actual weight exceeds the norm, and what co-morbidities it has.