Obesity
Description:
Obesity (Latin adipositas — literally: "obesity" and lat. obesitas — literally: completeness, obesity, an otkormlennost) — an adiposity, increase in body weight at the expense of fatty tissue. Fatty tissue can be deposited both in places of physiological deposits, and in mammary glands, hips, a stomach. Now obesity is considered as the chronic exchange disease arising at any age, which is shown excess increase in body weight preferential due to excessive accumulation of fatty tissue, followed by increase in cases of the general incidence and mortality of the population. Incidence of obesity sharply grows in civilized society, despite the lack of changes in a genetic pool, that is irrespective of hereditary factors.
Development of obesity results from an imbalance between absorption and expenses of energy in an organism. Regulation of body weight in an organism is carried out by difficult interaction of a complex of the interconnected systems exercising control of a power system of an organism: an absorbed energy (calories) = the spent energy. To development of obesity the positive power balance (hypodynamia) and a source of easily available carbohydrates which excess accumulates skosobstvut (stocks up) in an organism in the form of triglycerides in fatty tissue. The negative power balance between the absorbed and spent energy (even throughout a short period) is threat for organism life. Therefore for maintenance of power balance the organism has to adjust the level of hormones, reduce energy expenses, increase efficiency of digestion of nutrients, correct a feeding behavior (to increase appetite), to mobilize missing energy from fat power depos. Regulation of each of the listed links regulate certain genes.
Obesity symptoms:
The central obesity is called surplus of fatty deposits around a stomach. The central obesity is considered the most dangerous type of obesity and, statistically, is connected with the increased risk of heart diseases, supertension and diabetes mellitus. The popular belief that the central obesity ("a beer stomach") can be connected with the use of beer, does not find confirmation: neither the body weight index, nor a ratio of a circle of a waist and a circle of hips (en:Waist-hip ratio) are associated with the use of beer.
The patient is considered sick central obesity if the waist volume relation to the volume of hips exceeds 0,9 for women or 1 for men.
Pathological types of obesity are, as a rule, connected with the disturbances in endocrine system of the person leading to disturbances of a lipometabolism.
Obesity is divided into degrees (by amount of fatty tissue) and into types (depending on the reasons which led to its development). Obesity leads to the increased risk of emergence of a diabetes mellitus, idiopathic hypertensia and other diseases connected with existence of excess weight. The reasons of surplus of weight also exert impact on distribution of fatty tissue, the characteristic of fatty tissue (softness, elasticity, percent of content of liquid), and also on presence or lack of changes of skin (stretching, enlarged pores, so-called "cellulitis").
Clinical displays of obesity are characterized by an adiposity in various parts of a body as a result of excess consumption of calories with food and decrease in energy costs.
Obesity reasons:
Genetic predisposition to obesity is obvious in families of the persons having obesity. The genes responsible for regulation of body weight evolved throughout all history of an origin and development of human society, but at the same time also factors внешенй the Wednesdays which are defining consumption of nutrients and reduced usual physical activity significantly changed.
Obesity can develop as a result:
* disturbances of balance between the eaten food and the spent energy, that is the increased receipt of food and the cut power consumption;
* obesity not of endocrine pathology develops because of disturbances in systems of a pancreas, liver, thin and thick intestines;
* genetic disorders.
The contributing obesity factors:
* Slow-moving way of life
* Genetic factors, in particular:
o Superactivity of enzymes of a lipogenesis
o Decrease of the activity of enzymes of a lipolysis
* The increased consumption of the easily acquired carbohydrates:
o drink of sweet drinks
o diet rich with sugars
* Some diseases, in particular endocrine diseases (hypogonadism, hypothyroidism, insulinoma)
* Disturbances of food (for example, binge eating disorder), in the Russian literature called disturbances of a feeding behavior — the psychological disturbance leading to frustration of meal.
* Tendency to stresses
* Sleep debt
* Psychotropic drugs
In the course of evolution the human body adapted to accumulate a reserve of nutrients in the conditions of abundance of food to spend this stock in the conditions of forced lack or restriction of food — some kind of evolutionary advantage allowing to survive. In ancient times completeness was considered as a sign of wellbeing, prosperity, fertility and health. The sculpture Venus of Willendorf dated in the 22nd millennium BC is an example (perhaps, the earliest known illustration of obesity).
Treatment of Obesity:
The main ways of treatment at the excess weight and obesity:
* Refer observance of a diet with the increased content of cellulose, vitamins and other biologically active components to them (cereals and wholegrain products, vegetables, fruit, nuts, greens, etc.) and restriction of the use of the carbohydrates which are easily acquired by an organism (sugar, sweets, pastries, bakery and pasta from high-grade flour), and also physical exercises.
* The general approach at medicinal treatment of obesity consists in testing of all known drugs for treatment of obesity. For this purpose use Drugs for treatment of obesity.
* If the result of drug treatment is insignificant or it is absent, then it is necessary to stop such treatment. Consideration of a question of expediency of performing surgical treatment is possible.
Obesity dietotherapy.
Diets often strengthen obesity. The reason is that the rigid diet (sharp reduction of consumption of calories) can quickly help to lose weight, but after the termination of a diet appetite amplifies, digestibility of food improves and the weight surpassing the fact that was to a diet is gained. If the patient with obesity tries to lose weight by means of a rigid diet again, each time dropping weight happens more and more difficultly, and a set of weight — is easier and easier, and the gained weight increases each time. Therefore the diets oriented to bystry result (to dump as it is possible bigger weight for a short time), are harmful and dangerous practice. Besides, many means for weight loss contain diuretic and laxative components that leads to water loss, but not fat. Loss of water is useless for fight against obesity, is unhealthy, and weight after the termination of a diet is recovered.
Moreover, according to a research of the American psychologist Tracey Mann and her colleagues, a diet in general are useless as means of fight against obesity.
However it should be noted that without adequate control of caloric content of food and the accounting of adequacy of number of the arriving calories successful treatment of obesity is impossible for an exercise stress. WHO for successful weight reduction recommends to calculate the usual caloric content of food, and then to monthly lower caloric content by 500 kcal before achievement of figure on 300 — 500 kcal below adequate power requirement. For the persons who are not doing active manual work, this value makes 1 500 — 2 000 kcal.
Drug treatment of obesity.
All drugs have effect only during reception and have no the prolonged effect. If after the termination the patient did not change a course of treatment a way of life and does not observe dietary recommendations, then body weight increases again. Each drug is selected the doctor individually:
* Phentermine (adipeks-P, Fastinum, ionamine — group of amphetamine) — works as a neurotransmitter noradrenaline, reducing appetite. Can cause nervousness, a headache and sleeplessness;
* Orlistat (Xenical) — inhibitor of a pancreatic lipase, approximately reduces absorption of fats by 30%, does not quash feeling of hunger, however can cause a chair incontience;
* Sibutramin (meridia) — inhibitor of the return serotonin reuptake and noradrenaline. Drug influences the centers of saturation and thermogenesis located in a hypothalamus. Drug is contraindicated to patients with uncontrollable arterial hypertension!
* Fluoxetine (Prozac) — antidepressant, is applied by some specialists for the purpose of appetite suppression, however there is no information on long-term effects.
Drugs of a plant origin:
Along with a diet and medicamentous therapy drugs of a plant origin in a look чаёв can be used or other medicines, however it is necessary to know their structure well.
Surgical treatment of morbidny obesity.
As it was found out on the basis of long researches, at treatment of obesity surgery (bariatrichesky surgery) has the maximum effect. Only surgical treatment gives the chance to solve this problem finally. Now in the world two types of operation at obesity are used preferential. One of methods — imposing of a bypass gastric anastomosis across Ru; another — bandaging — placement of a silicone bandage in the field of an upper third of a stomach that leads to change of a shape of a stomach (it takes a form of hourglasses). The USA and Canada apply gastric shunting in the form of Roux-en-Y gastric bypass (90% of all operations). It gives the chance to get rid of 70 — 80% of excess weight. In Europe and in Australia adjustable bandaging of a stomach (90% of all operations) which gives the chance to get rid of 50 — 60% of excess weight dominates. Restrictive surgical ways of treatment of obesity realize a way of restriction of receipt of food to a gastric cavity. The second group of operations is combined that as a result of their use nutritive absorption decreases that also leads to gradual weight reduction.
Now all bariatrichesky operations become in the laparoscopic way (that is without section, through punctures) under control of tiny optical system.
In case of inefficiency of a dietotherapy and medikamentozhny treatment of obesity the question of surgical treatment is considered. Liposuction — as operation during which lipoblasts are sucked away is used not for fight against obesity now, and only for cosmetic correction of local small fatty deposits. Though the amount of fat and body weight after liposuction can decrease, but, according to a recent research of the British doctors, for health such operation is useless. Apparently, harm to health applies not the hypodermic, but visceral fat which is in an epiploon and also around the internals located in an abdominal cavity. Earlier single attempts to do liposuction for weight reduction (so-called megaliposuction with removal to 10 kg of fat) became, however now it is left as extremely harmful and dangerous procedure which is inevitably giving a set of heavy complications and leading to rough cosmetic problems in the form of roughness of a body surface.
Operational treatment of obesity has strict indications, it is not intended for those who consider that they just have an excess weight. It is considered that indications to surgical treatment of obesity arise at IMT higher than 40. However, if the patient has such problems as a diabetes mellitus of the 2nd type, a hypertension, a varicosity and problems with joints of legs, indications arise already at IMT 35. Recently in the international literature there are works studying efficiency of bandaging of a stomach at patients with IMT 30 above.
Obesity complications:
* Metabolic syndrome.
* Gastroesophageal reflux disease
* Diabetes mellitus of the 2nd type.
* Coronary heart disease.
* Myocardial infarction.
* Stroke.
* Arterial hypertension.
* Chronic venous insufficiency.
* Cholecystitis.
* Zhelchekamenny disease.
* Arthritises.
* The deforming osteoarthrosis.
* Hernias of intervertebral disks.
* Syndrome of polycystic ovaries.
* Oncological diseases.
* Pancreatitis.
* Fatty dystrophy of a liver.
* Extreme degree of obesity with alveolar hypoventilation.
* Sudden death from not clear reasons.
