Overview of obesity classifications: its types, types and degrees depending on the different characteristics of the disease. How is eating behavior regulated in the brain? How is eating behavior related to emotions? Forms of obesity: changes in the human body

Today, overweight problems are of great concern to doctors. The number of people suffering from obesity is growing inexorably day by day.

Unbalanced and excessive nutrition, low physical activity, violation of the diet leads to the fact that an increasing number of the population begins to suffer from overweight.

Due to the choice of the wrong tactics of losing weight, most people find it difficult to get rid of this problem. After all, there are 6 types of obesity, and each of them requires specific ways to fight.

What is obesity?

Obesity is a disease accompanied by excessive body fat, and developing as a result of metabolic disorders. Excess weight is one of the most serious medical and social problems, since it reduces the patient's life expectancy and significantly worsens its quality.

The World Health Organization (WHO) considers excessive deposition of adipose tissue as an epidemic that has captured millions of people.

Diagnosis of excess weight refers to body mass index. It is defined as the ratio of body weight to the square of height in meters (kg/m2). This value reflects the fat reserves in the body, and promptly signals the occurrence of excess fat, the development of obesity and the problems associated with it.

Currently, the classification of obesity by BMI developed by WHO is used. With its help, you can set the type of body weight:

  • indicator less than 18.5 - underweight;
  • ranging from 18.5–24.99 - normal weight;
  • indicators in the range from 25 to 29.99 - preobesity;
  • the weight index is 30–35 – ;
  • BMI indicators are in the range of 35–39.99 -;
  • body mass index exceeds 40 - the third degree of obesity.

Unfortunately, to combat extra pounds, it is not enough to determine only the weight index. Additionally, you need to set the type of obesity. Depending on the location of the deposits of adipose tissue, 6 varieties are distinguished. Below is more detailed information on each type of disease.

Overeating obesity

According to WHO, this type of obesity is the most common in the world. The localization of adipose tissue in the upper body (from the chin to the buttocks) is a consequence of overeating. Excessive food intake affects the activity of the appetite center in the brain, and disrupts its normal operation.

Therefore, the amount of food necessary to satisfy hunger will not be enough, and the body will require a new portion.

When people try to cope with this type of obesity, they try to eat less food, however, there are no visible results. The fact is that obesity caused by overeating is associated not so much with the amount of food consumed, but with an imbalance between the calories received and spent.

To cope with overeating obesity, you must follow some basic rules:

  • You need to minimize your carbohydrate intake. Eliminate sugar from your daily diet.
  • The working volume of the stomach should be reduced. To prevent a person from eating too much during a meal, before eating (30 minutes) you need to drink 1-2 glasses of clean water.
  • People who constantly overeat should burn most of the calories that enter the body. It is worth paying attention to physical exercises at least 30 minutes a day.

Stress obesity

Obesity of nervous origin is characterized by the accumulation of superficial fat in the abdomen, the so-called lifeline. This is explained by the production of an excess amount of adrenaline during stress.

It stimulates receptors on the surface of cells, and causes them to accumulate fatty tissue. Most of these receptors are located in the abdomen and intestines, so excess weight is formed around the waist.

To solve the problem of the disease in question, first of all, it is necessary to cope with stress and anxiety. Directly normalization of the psycho-emotional background can lead to a decrease in extra pounds. The patient should learn to perceive any troubles more calmly.

Additionally, it is worth abandoning simple sugars, for example, various sweets, rich products. If a person learns to control himself in stressful situations and stops using confectionery, then soon his body weight will return to normal.

obesity caused by gluten

Gluten obesity manifests itself in the form of deposition of fat masses in the thighs. This type of disease occurs against the background of hormonal imbalance or menopause. This type of obesity is quite difficult to fight.

Statistical research data indicate that there are twice as many obese women as men. This is due to the advent of menopause. During menopause in women, the concentration of testosterone, estrogen and progesterone decreases.

The last two hormones affect the localization of adipose tissue in the gluteal-femoral region. The hormone estrogen controls the metabolism of fats and carbohydrates. A decrease in the level of this substance causes the addition of extra pounds.

To solve this problem, you need . Medications are selected that are aimed at correcting metabolism. The patient should give up addictions and increase physical activity.

Atherogenic metabolic imbalance

This type of disease is characterized by the deposition of fatty masses around the abdominal cavity. The accumulated fat puts pressure on the diaphragm, causing the obese patient provoked by an atherogenic metabolic imbalance to experience shortness of breath.

There is a deterioration in the quality of sleep, dizziness appears due to a lack of oxygen. This disease is more common in males.

Of the six types of obesity, it is this type that leads to the development of diabetes mellitus, heart attack, stroke and arterial hypertension. Therefore, a patient with such a problem must undergo a medical examination to identify the above diseases.

The disease under consideration requires an integrated approach. The patient needs to get rid of addictions, increase physical activity and eat rationally. The amount of food consumed should be moderate. Gradually, the amount of food should be reduced. From the daily diet you need to exclude:

  • alcohol;
  • sugar;
  • products made from white flour;
  • fatty foods, especially of animal origin.

The defeat of the venous channels

Obesity of the venous channels has a genetic cause. This type of disease affects mainly women, especially with hormonal changes (or climatic period). The disease is characterized by the deposition of fat masses on the legs.

To get rid of the disease, it is necessary to organize the correct physical activity. Various weight lifting machines pose a threat to a person suffering from this type of obesity. Therefore, the best options for solving the problem are walking, swimming, cycling.

That is, a variety of loads that do not allow fluid to stagnate in the lower body, keeping the muscles in good shape. Any classes must be agreed with the attending physician, and take place under the supervision of an instructor.

Obesity inactivity

Obesity due to sedentary activity is observed in people who have sharply reduced their usual physical activity. This category includes former professional athletes. Fat deposits are localized in the back, waist and middle abdomen.

You can cope with the pathology by changing the diet. With a weight index of more than 30, overeating and starvation are contraindicated, as they exacerbate the problem. You should eat at certain hours, portions should be small.

It is worth giving preference to products of plant origin, and reduce the amount of refined carbohydrates. Refuse sweets.

Gradually begin to be active. First, learn to do daily exercises in the morning. Then introduce regular workouts with an emphasis on cardio, designed to effectively burn adipose tissue.

Obesity has become one of the most common diseases in recent years. The WHO has recognized it as an epidemic of the 21st century. Of course, in such a situation, effective tactics of treatment and prevention are simply necessary. By following simple rules, the formation of visible fat deposits and the disease in general can be prevented.

Obesity is a chronic disease that is characterized by excessive deposition of adipose tissue in the body. It is often accompanied by an imbalance in metabolism, the development of concomitant pathologies.

Depending on the number of extra pounds, several degrees of obesity are distinguished. Each of them is characterized by a certain ratio of weight and height of a person. This indicator is called the body mass index (BMI). It must be taken into account when choosing therapeutic measures aimed at eliminating the disease.

Degrees of obesity

The main cause of obesity is excessive consumption of high-calorie foods against the background of low physical activity. In this case, hereditary predisposition plays a certain role. Excess weight due to endocrine, psychological, genetic diseases is less common.

Body mass index is used to assess the severity of obesity. To calculate it by the height and weight of a person, use the formula: weight (kg) / height squared (m2).

Previously, there were 4 degrees of pathology. Currently, according to the WHO (World Health Organization) classification, only 3 are distinguished. Each of them is characterized by a certain range of BMI values. Also introduced is the concept of excess body weight.

Tablecompliance with BMI degree of obesity:

The largest degree is the third. Such patients need a comprehensive examination to identify the cause of fullness and the presence of concomitant complications.

Using BMI, it is impossible to determine the type of obesity. This parameter is also uninformative when assessing the physique in children, pregnant women and people with well-developed muscles.

Types of pathology and its complications

The main symptom of the disease is the presence of excess body fat. Depending on the nature of their distribution, two types of obesity are distinguished:


To clarify the nature of obesity, the following indicators are used:

  • Waist circumference (OT). It is measured with a centimeter tape in a standing position. For men, the criterion for abdominal obesity is a value of more than 94 cm, and for women - more than 80 cm.
  • The ratio of the value of FROM to the circumference of the hips (OB) - FROM / ABOUT. It more accurately reflects the predominance of body fat in a particular area. But in practice, the first parameter is more often used.

Obesity type depending on the coefficient OT / OB:

Morbid obesity is the most severe form of the disease. It is diagnosed with a BMI of more than 40 kg / m2 and in patients with the second degree of the disease in the presence of serious complications - diabetes mellitus, hypertension, osteoarthritis. Young men with this pathology are usually shown a deferment from military service for a period of 6 months. If the state of health of the conscript does not improve during this time, he is recognized as partially fit and sent to the reserve.

Treatment

Since obesity is a chronic disease, all weight loss measures must be long-term, permanent.

The basis for the treatment of pathology in people of different sex and age is lifestyle correction. It includes the following items:

  • Changing the type of food.
  • Compliance with the drinking regime.
  • Regular physical activity.
  • Full sleep at night.

With the ineffectiveness of the above measures, as well as in the presence of complications associated with obesity, drug therapy is necessary. It is prescribed by a doctor after a complete examination of the patient. According to strict indications, methods of surgical treatment are used.

In alternative medicine, honey water is used to combat obesity, which is drunk in the morning and evening, as well as various diuretic compounds. It should be remembered that the use of folk remedies for weight loss at home threatens the development of serious adverse reactions. This is because their safety and effectiveness have not been studied.

Healthy lifestyle

A diet aimed at normalizing body weight is calculated in accordance with a person's energy consumption in a given period. In this case, the calorie content of food should be slightly lower than necessary.

The diet includes a sufficient amount of food containing dietary fiber - vegetables and fruits, whole grain bread, greens. The use of low-fat dairy products, side dishes and fatty meats is limited. It is worth completely abandoning dishes that include fast carbohydrates - pastries, fast food, sweet soda and juices, honey, confectionery. You should not eat semi-finished meat products - canned food, sausages, sausages, sausages.

A prerequisite for weight loss is to ensure sufficient drinking regimen. For the proper functioning of the body during the day, you need at least 40 ml of pure water per 1 kg of body weight.

In order to normalize the hormonal background and facilitate the process of losing weight, a full night's sleep is shown. Its duration must be at least 8 hours. It is worth giving up bad habits - smoking and drinking alcohol. They slow down the metabolic processes in the body, lead to irreversible health consequences.

Physical activity is selected taking into account age, gender, the presence or absence of chronic diseases. Exercise should be varied: both strength and cardio training are needed. Individual lessons with an instructor are optimal. The minimum amount of physical activity per day is walking at a brisk pace for 30-40 minutes. Dancing, cycling, running and other active sports are encouraged.

It is correct to lose weight gradually - no more than 10% of the initial weight per month. It is important to keep the achieved result for a long time. This often requires psychological help, which allows you to overcome bad addictions, give up bad habits and form eating behavior. A well-trained specialist will help stabilize the emotional background, increase resistance to stress. When treating children, parents must be consulted.

Medical therapy

In addition to non-pharmacological measures, drug therapy is often used to treat the disease. It is prescribed for a BMI of more than 30 kg / m2, in the presence of concomitant pathology, the inability to maintain weight against the background of lifestyle changes.

Means for weight loss differ in the mechanism of action. Currently using:

  • Sibutramine (Reduxin, Lindax, Meridia). Its use is associated with a decrease in appetite, increased energy processes in the body. As a result, when eating, a feeling of fullness occurs faster, which leads to a decrease in the caloric content of the diet. Increasing the basal metabolic rate promotes more efficient fat burning. The drug is contraindicated in the presence of diseases of the heart and blood vessels, with secondary obesity, thyroid pathology. Under medical supervision, its use is allowed in persons with the first stage of hypertension against a background of pressure not higher than 145/90 mm Hg. Art.
  • Orlistat (Orsoten, Xenical). The drug prevents the absorption of fat in the intestines. Its active substance does not enter the bloodstream and does not adversely affect human organs and systems. But the use of the drug is often associated with side effects such as diarrhea, fecal incontinence, bloating and abdominal discomfort. Its long-term use disrupts the intake of fat-soluble vitamins in the body.
  • Liraglutide (Saxenda). The drug increases the residence time of food in the stomach, reduces appetite. It is administered subcutaneously using a special syringe pen with a very thin needle. A special advantage of Saxenda is a beneficial effect on metabolism, safety for patients with cardiac pathology.

The use of drug therapy in children is limited. The only approved drug is Orlistat, which can be prescribed from the age of 12 years.

bariatric surgery

Surgical therapy is indicated for persons with the third degree of obesity, as well as in the presence of severe complications. Most often, operations are performed to reduce the volume of the stomach with its suturing or the installation of intragastric balloons. Less often, interventions are performed to create gastrointestinal anastomoses, which reduce the absorption of food.

Bariatric surgery is most effective for rapid weight loss, normalization of metabolic processes and maintaining the achieved result. But, as with any surgical treatment, there are risks of adverse outcomes and consequences for the human body, which should be considered when choosing this method. In children, surgical interventions are not performed.

Currently, there is no single classification of obesity. As a worker, you can use the following:

General obesity (according to I. I. Dedov et al., 2000)

    primary, or exogenous-constitutional, or alimentary-metabolic, or "simple" (simple) obesity

    Gynoid (lower type, gluteofemoral)

    Android (upper type, abdominal, visceral)

    With separate components of the metabolic syndrome

    With advanced symptoms of metabolic syndrome

    With severe eating disorder

    night eating syndrome

    Seasonal affective fluctuations

    With hyperphagic stress response

    with pickwickian syndrome

    With secondary polycystic ovaries

    With sleep apnea

    With pubertal-youthful dispituitarism

    mixed

    Secondary, symptomatic

    With established genetic defect

    As part of known genetic syndromes with multiple organ damage

    Genetic defects of structures involved in the regulation of fat metabolism

    Cerebral (adiposogenital dystrophy, Babinski-Pehkranz-Froelich syndrome)

    Tumors of the brain, other cerebral structures

    Dissemination of systemic lesions, infectious diseases

    Hormonally inactive pituitary tumors, "empty" sella syndrome, "pseudotumor" syndrome

    Against the backdrop of mental illness

    Endocrine

    Hypothyroid

    Hypofunction of the gonads

    Hypercortisolism

    Hyperinsulinism (insulinoma)

    Obesity local

    Segmental, lipodystrophy

    Lipomatosis.

    Stages of obesity:

    progressive

    stable

    Residual (residual effects after persistent weight loss).

  1. Forms of obesity: changes in the human body

primary obesity. The most common primary form of obesity, which accounts for more than 75% of all cases of the disease. In its development, the alimentary, or exogenous, factor is recognized as the main one, which is associated with the excess energy value of nutrition with low energy return, which contributes to the accumulation of adipose tissue and the formation of obesity. Metabolic-alimentary, or exogenous-constitutional, obesity is associated with an energy imbalance, when energy intake from food exceeds its expenditure, resulting in increased synthesis of triglycerides in adipose tissue. The main ones are two etiological moments: nutritional imbalance and decreased physical activity. Alimentary imbalance is caused by the predominance of mainly animal fats and carbohydrates in the diet or a violation of the composition and diet (rare and plentiful food, consumption of the main share of the daily energy value of food in the evening). Excessive food intake is facilitated by the period of pregnancy and childbirth in women, family eating habits, etc.

Numerous studies in recent years have shown that calories derived from fat are more conducive to weight gain than those derived from proteins and carbohydrates. Body weight remains stable if the proportion of energy consumed in the form of fat is equivalent to the proportion of energy received by the body from the oxidation of fats. If the amount of fat in food exceeds the possibility of its oxidation, then excess fat will accumulate in adipose tissue, regardless of how much energy is consumed that day. It is believed that individuals with a hereditary predisposition to obesity have a reduced ability to oxidize fat. The ability of muscles to oxidize fat is significantly reduced in conditions of hypodynamia, when quitting smoking and drinking coffee (nicotine and caffeine increase the sensitivity of adipose tissue to catecholamines), some endocrine diseases in which secondary or symptomatic obesity develops.

symptomatic obesity. Syndromes associated with damage to the central nervous system. cerebral forms obesity are important from the point of view of etiology, pathogenesis and clinic. In these cases, violations of the central apparatus of obesity regulation are most clearly represented. Cerebral obesity occurs most often on the basis of various brain lesions. The appearance of obesity is preceded by infectious diseases (influenza, typhus, malaria, etc.), trauma (contusion, bruise, skull fracture), organic lesions of the central nervous system (tumors, residual effects of encephalitis, Parkinson's disease, syphilitic lesions of the meninges, tuberculosis, etc. .). Diagnosis requires a thorough neurological examination (detection of motor, sensory disorders, tendon, skin, plantar reflexes, examination of the state of cranial and peripheral nerves, etc.). Examination of the fundus, radiography of the Turkish saddle, electroencephalography are necessary.

Laurence-Myna-Barde-Biedl syndrome. A rare disease that is inherited as an autosomal recessive trait. It manifests itself in childhood with dementia, slowing down of sexual development, impaired development of the limbs, skull (acrocephaly), spine (kyphoscoliosis), chest deformity, congenital heart disease, growth failure, night blindness, retinal degeneration and arteriole sclerosis, hearing loss.

Gelino's syndrome. Along with obesity, short-term coma, catalepsy (a second loss of muscle tone), a fall without loss of consciousness, double vision, a change in the rhythm of sleep and wakefulness, and hallucinations are noted. The disease is very rare and often begins in menopause. Hyperphagia and edema may be observed.

Babinsky-Frelich disease. Most often occurs in boys, in whom obesity is combined with underdevelopment of sexual characteristics, growth failure, diabetes insipidus, and the expansion of the Turkish saddle.

Morgagni-Stuart-Morel syndrome. It occurs in women of mature age and is manifested by obesity, thickening of the inner plate of the frontal bone and virilization.

Tsondek's syndrome. Type Z obesity occurs in adolescence and includes hypogonadism, feminization in boys, and virilization in girls. It is currently believed that these are private forms of Cushing's disease.

Prader-Willi syndrome. It occurs rarely and only in children and is manifested by dwarf growth, muscular atony syndrome, underdevelopment of secondary sexual characteristics, diabetes mellitus, dementia, syndactyly.

endocrine obesity. Endocrine obesity is one of the symptoms of the primary pathology of the endocrine glands: hypercortisolism, hypothyroidism, hypogonadism, hyperinsulinism.

Hypothyroidism (myxedema)- a disease caused by insufficient production of thyroid hormones. Primary hypothyroidism may be due to a congenital anomaly, inflammation, lack of iodine in the environment, damage to the thyroid gland after the introduction of radioactive iodine, an overdose of mercazolil. Secondary occurs when the hypothalamic-pituitary system is damaged. It is more common in women and is manifested by chilliness, drowsiness, lethargy, memory loss, slow speech, arthralgia, swelling of the face and extremities, dryness and pallor of the skin, thickening of the tongue, hoarseness of voice, fragility and hair loss, decrease in body temperature, constipation, bradycardia, hypotension.

Syndrome and Itsenko-Cushing's disease. May be a clinical manifestation of dysfunction of the hypothalamus, pituitary gland and adrenal cortex. The anatomical substrate may be hypertrophy, pituitary adenoma. Women get sick 3-4 times more often than men. Characterized by a moon-shaped face, obesity of the upper half of the body, arterial hypertension, hirsutism, pink striae, hemorrhagic diathesis and subcutaneous hemorrhages, acne, increased thirst, hyperglycemia, osteoporosis, amenorrhea, hypokalemia, plethora, hyponatremia.

Diabetes of "bearded women". It is associated with trunk-type obesity, hirsutism, mild diabetes, and sometimes arterial hypertension. The differential diagnosis is carried out with Cushing's syndrome and adrenal-sexual syndrome.

secreting insulinoma. It is most often diagnosed at the age of 30-50 years, and in 75% of cases it occurs in women. Manifested by obesity, hypoglycemia, mental disorders, hunger intolerance, increased secretion of insulin. Diagnosed by angiography and scintigraphy of the pancreas, sometimes laparoscopy is necessary.

Adiposogenital Syndrome. It is not always combined with obesity, which is more common in the acquired form of the disease. This syndrome should be differentiated from hermaphroditism and Cushing's syndrome.

Hypogonadism. It is caused by insufficient secretion of androgens due to congenital underdevelopment of the gonads, their toxic, radiation damage, dysfunction of the hypothalamic-pituitary system. Manifested ganoid type of obesity. With damage to the testicles before puberty (prepubertal), typical eunuchoidism, high disproportionate growth, elongated limbs, underdevelopment of the chest and shoulder girdle, gynecomastia, lack of hair on the face and body, high voice, underdevelopment of the genitals develop. With secondary hypogonadism, obesity, lack of potency and sexual desire are also observed. In the post-pubertal form of hypogonadism, the symptoms are less pronounced.

Hyperprolactinemia occurs with an increase in the secretion of prolactin by the pituitary gland due to the tumor process, the use of drugs (neuroleptics, cerucal, contraceptives, etc.), primary hypothyroidism. Elevated prolactin levels lead to decreased gonadotropin function and infertility. In women, in addition to obesity, amenorrhea, decreased libido, hypoplasia of the uterus, vagina are observed, in men - oligo- or azospermia, impotence, decreased libido, gynecomastia.

Klinefeld syndrome. Most often manifested clinically in menopause. It can be combined with obesity and impaired glucose tolerance, hypertrophy of the mammary glands, testicular underdevelopment, female-type hair growth, sexual dysfunction, azo- and oligospermia, and increased excretion of gonadotropins in the urine.

Stein-Leventhal syndrome. Excessive obesity is combined with dysmenorrhea, infertility, underdevelopment of the uterus, virilization, sexual dysfunction, persistent headache and abdominal pain, and constipation. A gynecological examination makes it possible to detect ovarian cysts and make a diagnosis.

local obesity. Lipophilic alimentary dystrophy. Apparent obesity depends on edema of the subcutaneous adipose tissue, elephantiasis of the limbs, muscular adynamia, gynecomastia and testicular atrophy in men, polyneuritis, swelling of the parotid glands, osteoporosis, bradycardia, cracking of the mucous membrane of the corners of the lips, glossitis and pharyngitis appear. It is necessary to differentiate with myxedema.

Lipomatosis. Refers to benign hyperplasia of adipose tissue, sometimes with a connective tissue capsule or passing into the area of ​​normal adipose tissue without distinct boundaries. The most common form of the disorder is numerous lipomas, which are localized symmetrically on the limbs. Seen predominantly in men. Lipomas are painless on palpation and are similar in histological structure to normal adipose tissue. Lipoma adipocytes are resistant to lipolytic factors.

Painful lipomas (Derkum's syndrome)- Numerous painful lipomas located symmetrically on the trunk and extremities, sometimes accompanied by generalized itching and general weakness.

clinical picture. Usually obese patients present numerous complaints. They are concerned about general malaise, headache, shortness of breath even with mild physical exertion, and increased fatigue. With hypothalamic-pituitary obesity, thirst, increased appetite, drowsiness, a sudden feeling of hunger, accompanied by weakness, sweating, tremors, dizziness, which occur in the evening and at night, are often noted. In the hypothyroid form, patients complain of lethargy, apathy, chilliness, constipation, etc.

Often complaints are due to concomitant diseases. With damage to the digestive organs, heartburn, abdominal pain, nausea, and upset stools are often observed. With changes in the cardiovascular system, patients are concerned about shortness of breath, palpitations, pain in the heart, swelling of the lower extremities. In case of violations in the osteoarticular apparatus, pain in the joints, lumbar region, etc. is noted.

In the anamnesis of life, often burdened heredity, professional factors, features of diet and lifestyle, past diseases. It is known that obesity occurs twice as often in women than in men, and between the ages of 30 and 60 years.

An objective examination of persons with metabolic-alimentary obesity shows a uniform distribution of adipose tissue throughout the body, with hypothalamic-pituitary - fat deposition in the face, upper shoulder girdle, mammary glands and abdomen. In hypoovarian obesity, fat deposits are located mainly in the pelvis and thighs, often in the back of the head a “fat pad” is determined. Hypothyroid obesity is characterized by a uniform distribution of fat with a pale tint and dryness of the skin.

The skin is usually of normal color, rarely pale or hyperemic. If obesity develops during puberty, narrow, non-atrophic striae are often found on the skin of the abdomen, mammary glands, the inner surface of the shoulders and thighs. In patients with android type of obesity and advanced gynoid, the function of sweat and sebaceous glands is often increased, so the skin is moist, greasy, with pustules, eczematization, pyoderma, furunculosis. Inguinal and umbilical hernias are typical.

With hypothalamic obesity, cyanotic striae, pigmentation in places of friction, black acanthosis are observed. Frequent hyperinsulinemia in obesity is one of the factors in the pathogenesis of arterial hypertension and polycystic ovary syndrome. Hypertrichosis is quite typical for obesity and is explained by the formation of secondary polycystic ovaries with anovulation. In contrast to severe hirsutism in secondary obesity, excessive hair growth is moderately developed.

Obesity is a chronic pathological process that tends to recur and is characterized by metabolic disorders leading to excessive accumulation of adipose tissue in the human body. Obesity is one of the most serious medical and socio-economic problems, as it affects the reduction in life expectancy and deterioration in the quality of life of patients.

The prevalence of obesity is growing rapidly from year to year. In our country, about a third of the working-age population suffers from obesity. Statistical research data indicate that there are twice as many obese women as men.

Obesity can develop against the background of a number of diseases, and can be combined with such severe pathological processes as diabetes mellitus, cancer, dysfunction of the genital organs. In addition, obesity is one of the main risk factors for the development of diseases of the cardiovascular system.

Classification of obesity by body mass index

Diagnosis of obesity, along with determining its degree, as well as the presence of a risk of its development, is based on indicators of the body mass index, which is determined by the ratio of the body weight of the subject to his height in meters, squared. According to the classification of obesity by body mass index, the following types of body mass are distinguished:

1. underweight- while the body mass index is less than 18.5, and the risk of comorbidities is minimal.

2. normal body weight when the body mass index is in the range of 18.5 - 25.0

3. Preobesity- body mass index varies between 25.0 - 30.0. In this case, the risk of concomitant diseases increases in the examined patients.

4. Obesity 1 degree- body mass index is 30.0 - 35.0

5. Obesity 2 degrees- body mass index indicators are in the range of 35.0 - 40.0

6. Obesity 3 degrees diagnosed in cases where the body mass index is equal to or greater than 40.0. The risk of developing comorbidities is extremely high.

Etiopathogenetic classification of obesity

One of the most detailed classifications based on the causes and mechanisms of obesity is the etiopathogenetic classification of overweight, which distinguishes two main forms of obesity - primary and secondary. primary obesity is further subdivided into:

Buttock-femoral;

Abdominal;

With severe eating disorders;

stress hyperphagia;

Syndrome "night food";

with signs of metabolic syndrome.

Secondary or symptomatic obesity divided into:

1. With an established gene defect

2. Cerebral obesity, which developed against the background of neoplasms of the brain, infectious and systemic lesions. The development of this form of obesity can be facilitated by the presence of mental diseases in the patient.

3. Endocrine obesity associated with disorders in the functioning of the thyroid gland, adrenal glands, pituitary and hypothalamus, gonads

4. Medical obesity.

Clinical and pathogenetic classification of obesity

Depending on the mechanisms that contribute to the development of overweight in humans, the following are distinguished: forms of obesity:

Alimentary-constitutional, associated with the peculiarities of the diet, as well as with heredity and usually developing from childhood;

Hypothalamic, developing when the hypothalamus is damaged;

Endocrine, caused by such endocrine pathologies as hypothyroidism, hypercortisolism, hypogonadism, etc.;

Iatrogenic or drug-induced form of obesity, the development of which is facilitated by the intake of a number of drugs - corticosteroids, some antidepressants, antipsychotics, contraceptives, etc.

Classification of obesity according to the type of localization of adipose tissue in the body

When examining obese patients, a specific distribution of adipose tissue is revealed, the systematization of which makes it possible to distinguish three forms of obesity:

Top type or android obesity;

By the lower type or gynoid obesity;

- mixed or intermediate obesity.

In the upper type of obesity, fat deposits are localized mainly in the upper body, mainly in the abdomen, neck and face. This type of obesity is typical for men; in women, this type of obesity can be found during menopause. It develops after puberty. Studies by a number of authors confirm the relationship of this type of obesity with an increase in the risk of developing diabetes mellitus and a number of diseases of the cardiovascular system (arterial hypertension, heart attack, coronary heart disease, etc.). To determine the risk of developing diseases associated with metabolic disorders, computed and magnetic resonance imaging are performed to reveal the predominance of one of the types of adipose tissue - subcutaneous or visceral (enveloping the internal organs of the abdominal cavity). These studies also make it possible to quantify the mass of adipose tissue and its fluctuations during therapeutic interventions.

The gynoid type of obesity is characterized by the localization of adipose tissue in the lower part of the body (in the femoral and gluteal regions) and is more often observed in female representatives, whose figure acquires a "pear-shaped" shape. It develops most often from early childhood. Concomitant pathology in this type of obesity are diseases of the spine, joints and vessels of the lower extremities.

The mixed type of obesity is characterized by a tendency towards a relatively uniform distribution of adipose tissue throughout the body.

To differentiate this or that form of obesity, a number of authors recommend determining the ratio of the circumference of the waist and hips. If this indicator exceeds 1.0 in men and 0.85 in women, we can talk about obesity according to the upper type.

Classification of obesity based on morphological changes in adipose tissue

Depending on whether fat cells - adipocytes - undergo quantitative or qualitative changes, the following forms of obesity are distinguished:

- hypertrophic obesity, in which the size of each fat cell increases against the background of a stable indicator of their number;

- hyperplastic obesity, which is characterized by an increase in the number of adipocytes; this form of obesity usually develops from childhood and is difficult to correct due to the fact that the number of fat cells remains unchanged even with a sharp weight loss.

- mixed obesity when, along with an increase in the number of fat cells, their enlargement is noted due to an increase in the fat content in them by a factor of three.

  • Obesity

    Obesity is a chronic disease characterized by an excess of adipose tissue in the body.

  • Consultation with a nutritionist-endocrinologist

    The most reasonable and reasonable is the treatment of obesity in St. Petersburg under the supervision of such a doctor as a nutritionist-endocrinologist. Reviews of patients who were treated for obesity and prescribed a diet by a nutritionist-endocrinologist testify to the high effectiveness of such treatment.

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