Classification of obesity by BMI, WHO, 2007
Obesity (primarily visceral) is the main component of the so-called metabolic syndrome (MS). The latter is a complex of diseases, complications and metabolic disorders that are often combined with obesity. The term MS has several synonyms: syndrome X, insulin resistance syndrome, "death quartet".
The set of MS components according to various classifications is different, however, its main components are visceral obesity, impaired glucose tolerance or type 2 diabetes mellitus, atherogenic dyslipidemia, arterial hypertension, and hyperandrogenism in women. In recent years, obstructive sleep apnea syndrome, hyperuricemia and gout, fatty liver hepatosis (liver steatosis), epicardial obesity have been included as MS components.
The main pathogenic mechanism Insulin resistance and compensatory hyperinsulinemia, which unites all the components of MS, is insulin resistance and compensatory hyperinsulinemia, because adipose tissue is insensitive to insulin and an increased amount of insulin is required for glucose uptake by cells. Prolonged hyperinsulinemia leads to depletion of the pancreatic islet apparatus, which leads to the development of carbohydrate metabolism disorders (impaired glucose tolerance and type 2 diabetes).
The clinical significance of the identified disorders lies in the fact that their combination is associated with a high risk of developing CVD and type 2 diabetes.
On the other hand, MS is a reversible condition and with appropriate treatment and strengthening of preventive measures, it is possible to achieve the disappearance or, at least, a decrease in the severity of its manifestations.
The prevalence of MS in the general population ranges from 15% to 25%. In the United States, among people aged 20-29 years old, it is registered in 7%, in 60-69 years old - in 43.5%, in 70 years and older - in 42%. The prevalence of MS in Russia in older age groups is up to 40%.
The main method for diagnosing visceral obesity is the measurement of waist circumference. When measuring the circumference of the waist is carried out in a standing position, patients should wear only underwear. The measuring point is the middle of the distance between the top of the iliac crest and the lower lateral edge of the ribs. It does not have to be at the level of the navel. The measuring tape should be kept horizontal.
With an increase in this indicator above 80 cm for women and 94 cm for men, abdominal obesity is diagnosed.
A more accurate determination of the mass of visceral fat is possible when performing CT and/or MRI in special modes. In recent years, it is very promising to determine epicardial fat using ECHO_KG, NMRI and/or high-resolution CT.
The International Diabetes Federation in 2005 proposed criteria for diagnosing MS that include central obesity as defined by ethnicity-adjusted waist circumference (Europeans 94 cm or more for men and 80 cm or more for women) in combination with any two of the following: signs:
Elevated serum triglycerides (≥ 1.7 mmol/l) or treatment for this disorder;
lowering the level of high-density lipoprotein cholesterol (HDL cholesterol) (< 1,0 ммоль/л у мужчин и < 1,3 ммоль/л у женщин);
high blood pressure (BP) (≥ 130/85 mm Hg) or treatment for hypertension;
Elevated serum glucose concentration (≥ 5.6 mmol / l) or previously diagnosed type 2 diabetes, impaired glucose tolerance.
The new criteria of the International Diabetes Federation are convenient for use in clinical practice, as they are primarily focused on healthcare practitioners and avoid the need for complex and expensive examination methods.
Questions for consolidation
1. Name the acute complications of diabetes.
2. Name the main reasons for the development of ketoacidosis.
3. Name the main reasons for the development of hypoglycemic coma.
4. Name the main manifestations of micro- and macroangiopathies.
5. List the main methods for diagnosing obesity.
6. Name the main manifestations of the metabolic syndrome.
1.Correction of eating habits and expansion of physical activity.
2. A hypocaloric diet with an energy value of about 1200 kcal per day, minimizing fat intake. In addition, the inclusion of a large amount of dietary fiber is recommended. The goal is to reduce body weight by 5-10% during the first year.
3. Drug treatment is indicated for the ineffectiveness of lifestyle changes, diet therapy, as well as the development of complications of obesity and a high risk of developing cardiovascular pathology. Indications for their use is the presence of BMI≥30 kg/m2 or BMI≥27kg/m2 in the presence of MS.
3.1 Treatment of obesity:
orlistat (xenical) inhibits intestinal and pancreatic lipases, resulting in impaired breakdown of fats and their absorption from the intestine;
Sibutramine (Meridia) is a serotonin reuptake inhibitor. Until recently, it was used as an effective means of combating obesity. However, with long-term use of the drug, there was an increase in the incidence of adverse cardiovascular outcomes, which in recent years has significantly limited the use of this drug.
3.2. Correction of the lipid spectrum. For this purpose, the normalization of impaired lipid metabolism is used lipid-lowering drugs - statins and fibrates.
3.3. Antihypertensive therapy.
3.4. Insulin resistance and hyperglycemia. Treatment of type 2 diabetes mellitus is carried out according to general principles. Metformin in some cases can be prescribed already at the stage of prediabetes and is an effective treatment for type 2 diabetes, both in monotherapy and in combination with other hypoglycemic drugs.
4. Surgical treatment: formation of a small stomach (gastric
roplasty), bypass gastric bypass, resection of part of the tonsil
which intestines and so on.
Mortality among patients with severe (morbid) obesity aged 25-30 years is 12 times higher than in people with normal body weight. With a weight loss of 10% or more, the risk of developing cardiovascular diseases is reduced by 9%, diabetes - by 44%, mortality from cancer associated with obesity - by 40%, overall mortality - by 20%.
The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician. All drugs have contraindications. You need to consult a specialist, as well as a detailed study of the instructions!
What role does adipose tissue take in the exchange of sex hormones?
Of particular note is the exchange of steroid (sex) hormones, in which adipose tissue takes part. For example, in a normal healthy woman with normal body weight, from 10 to 60% of various fractions of sex hormones (testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate), as well as a large amount of female sex steroids - estradiol and estrone, are produced in body fat. Speaking about the formation and metabolism of hormones in adipose tissue, it should be noted that not only their production takes place in it, but also their storage (deposition). In addition, fat accumulates many other biologically active, mainly fat-soluble compounds. Changes in the pubertal period (adolescence), as well as the onset of the first menstruation (menarche) in a girl, directly depend on body weight and the volume of adipose tissue.
After the cessation of menstrual function (menopause), adipose tissue becomes the main source of sex steroid hormones, that is, the severity and nature of menopausal disorders will largely depend on its hormone-forming activity.
Obviously, with a change in body weight (both with an emerging deficiency and with obesity), there is a change in the production and hormonal ratio of biologically active substances in adipose tissue.
What determines the process of accumulation and expenditure of adipose tissue?
This process depends on the following factors: - balance of energy metabolism (ratio of energy intake and expenditure)
- the ratio of food nutrients in the diet (diet)
- balance of metabolic processes of synthesis (formation) and decay of adipose tissue
- hereditary - constitutional features of all types of metabolism, including fat metabolism
What are the types of obesity? The main reasons for the development of primary and secondary obesity.
To better understand the problem, consider the main causes of obesity. Obesity happens primary and secondary. Primary obesity - alimentary-constitutional obesity, that is, caused by malnutrition and individual characteristics of metabolism. Secondary obesity develops against the background of the underlying disease and is a consequence. So, secondary obesity develops in the presence of the following pathologies:- hypofunction of the thyroid gland (decrease in the functional activity of the organ)
- insulinoma (tumor of the pancreas)
- corticoestroma
- cerebral obesity due to damage to areas and areas of the brain involved in the regulation of eating behavior
- diencephalic syndrome (postpartum neuroendocrine-metabolic syndromes, hypothalamic syndrome of puberty)
- growth hormone deficiency (idiopathic growth hormone deficiency, brain tumors, surgery and radiation exposure to the brain, congenital malformations)
- mental disorders - neurotic disorders, eating disorders
- genetic syndromes and diseases (Lawrence-Biedl syndrome, Albright osteodystrophy and others)
- certain medications (eg, glucocorticoids)
How human eating behavior is regulated, the role of serotonin and dopamine in the regulation of appetite.
It is worth dwelling on violations of the regulation of eating behavior in more detail. The regulation of food reflexes and eating behavior, food intake, nutritional (taste) preferences is a rather complex mechanics. The leading role in this process belongs to the hypothalamic structures (the nuclei of the hypothalamus). These hypothalamic nuclei respond to blood levels of regulatory substances, glucose and insulin levels. In the nuclei of the hypothalamus, information about the content of glycogen in the liver and muscles and the state of the body's fat depots is also evaluated.Also an important role in these regulatory processes is played by the metabolism of special substances - biogenic amines and mediators (intermediaries in the transmission of nerve and chemical signals) in the central nervous system, mainly in the brain. Changes in concentration, as well as changes in the mutual ratio in the brain tissue of catecholamines (adrenaline, norepinephrine), serotonin, dopamine, significantly affect food intake.
An increase in the content of serotonin in brain tissues leads to a decrease in eating behavior. It is also reduced by such biologically active substances as: cholecystokinin, vasopressin, melanostimulating hormone, glucagon, leptin, bombesin. On the contrary, they enhance eating behavior, that is, stimulate food intake, - neuropeptide gamma, beta-endorphins, fragments of the adrenocorticotropic hormone molecule.
Often the causes of increased fat formation and storage are a decrease in physical activity in parallel with an increase in the calorie content of the diet. At the same time, the main contribution is made by fats coming from food, and not by proteins and carbohydrates.
Inhibition of the normal rate of fat breakdown is at the basis of the development of obesity in insulinoma and underfunctioning of the thyroid gland.
When does the body's ability to break down fat decrease?
The body's ability to break down fat has been proven to decrease with age. It is this mechanism that underlies the increase in the number of cases of obesity in the age group of 40-60 years. The habit to a certain food, the mode of eating remains (I basically eat as usual, but for some reason I gain weight - this is what these people often say), but the ability to break down fats progressively decreases. And as a result - an increase in body weight.It should be noted separately that some drugs - for example, rauwolfia preparations and some drugs for lowering blood pressure (beta-blockers) also reduce the rate and amount of fat breakdown.
How is eating behavior regulated in the brain? How is eating behavior related to emotions?
An imbalance of mediators of the central nervous system (catecholamines, serotonin, dopamine) creates the basis for neurotransmitter dysfunction and, as a result, neuroendocrine disorders. Various motivational disorders appear. Changes in the motivational sphere are diverse, and not only higher needs are violated, for example, in self-realization and cognition, but also basic biological needs, namely, a change in eating behavior, sexual function, and the need for sleep. As a rule, changes in appetite, sleep and sexual desires often accompany each other, the degree of these changes in each case varies. Thus, endocrine and motivational disorders should be considered interrelated and considered together.An increase in appetite may be accompanied by a lack of satiety, which leads to progressive weight gain, and eventually to obesity. Quite often, the basis for increasing the amount of food consumed is not a feeling of hunger or an increase in appetite, but a feeling of a state of emotional discomfort.
Many people are familiar with this state - as they say, "eat stress", make a "trip to the refrigerator." Such people, as a rule, begin to eat not for the purpose of satiety or satisfying hunger, but in order to dispel a bad mood, take boredom, relieve feelings of melancholy, anxiety, loneliness, apathy, depressive depression. It is also possible, in this way, an attempt is made to escape from reality, to cope with a stressful or traumatic situation. Often this happens when there is a change in value orientations, changes in worldview and social attitudes.
What is food drinking? How common is this phenomenon? Who is at risk for developing food binge?
This type of increase in appetite and increase in the amount of food consumed is called emotional eating behavior, the so-called food drinking. It must be said that such a situation in the population is observed not so rarely - in about 30% of cases. Studies show that this type of eating behavior is more common among women who are prone to depressive-anxiety reactions and to overweight. It is important, however, that such emotiogenic eating behavior as a stereotypical reaction to stress is attributed to some rather peculiar, socially safe and acceptable pathological form of protection against stressful influences. This reaction, as mentioned above, is more characteristic of mentally immature individuals with high socially oriented attitudes.Why is there an increase in mood after eating? The role of serotonin in the feeling of happiness or pleasure
Biochemical studies allow us to recognize the mechanism for improving mood after eating, as well as to find out why certain foods act as a kind of remedy for depression. The fact is that preference in a stressful situation is given to easily digestible food, which contains a significant amount of carbohydrates. A significant intake of carbohydrates in the body leads to a chain of biochemical transformations and subsequent physiological results. Initially, an excess of carbohydrates leads to an increase in blood glucose levels (hyperglycemia), then to an increased release of insulin. This reaction enhances cellular metabolism, increases the flow of glucose into the cell. At the same time, there is an increase in the permeability of the brain vessels, and an increased selective entry into the brain cells of certain amino acids (mainly tryptophan). Tryptophan, in turn, is a precursor of biogenic amines of the central nervous system, such as serotonin and dopamine. The amino acid tryptophan is the starting material for the synthesis of serotonin. As a result, in the central nervous system, there is an increase in the synthesis of serotonin, which is called the “pleasure hormone” or “happiness substance”. Serotonin received this name because of its ability to create a feeling of pleasure and happiness when it is present in brain structures in certain concentrations.Thus, the act of eating can act as a modulator of the level of serotonin in the structures of the brain, both in general and in the departments responsible for the formation of emotions, behavioral, food and other reactions. And already an increase in the synthesis of serotonin is subjectively accompanied by a feeling of satiety and emotional comfort.
In short, from the point of view of biochemistry and physiology, it is the deficiency of serotonin in the brain that leads to changes in eating behavior and depressive states. For example, it is precisely the deficiency of serotonin in brain structures that underlies emotional eating behavior. Pronounced emotional eating behavior leads to a significant increase in body weight and is associated with an increase in the level of anxiety and depression. The whole point is how long such an adaptive reaction to stress will persist in each individual.
What forms can emotional eating behavior (eating drunkenness) acquire? Manifestations of night eating syndrome and compulsive eating behavior
The first form or so-called night eating syndrome, is characterized by a combination of lack of appetite in the morning, but increased appetite in the evening and at night, combined with insomnia.The second form of emotional eating behavior is compulsive eating behavior. This scientific term refers to the following: recurring episodes of significant overeating, during which food is consumed in quantities greater than usual, and eating occurs much faster than usual. During such periods, self-control over the amount and speed of food intake is completely lost. Characteristically, these episodes last an average of several hours (often no more than two) and are observed two or more times a week. This form of eating disorder in obesity occurs in 25% of patients.
As a consequence, these forms of changes in eating behavior lead to a significant increase in body weight. According to some authors, emotional eating behavior is observed in 60% of obese patients.
Morgagni-Morel-Stewart hereditary syndrome
It is necessary to dwell on one hereditary disease associated with obesity. This obesity is associated with depression, the so-called Morgagni-Morel-Stewart syndrome. The genetic disease is based on excessive production of growth hormone and adrenocorticotropic hormone, which leads to disruption of the hypothalamic-pituitary system. And the main signs of this genetic pathology from a clinical point of view are: obesity, arterial hypertension, decreased function of the gonads, headaches, depression, thickening of the frontal bones of the skull.General principles for the treatment of obesity
Consider the principles of treatment of this type of obesity. At present, a regularity has been established, indicating that in case of obesity, in violation of eating behavior, the leading role belongs to the insufficient functioning of brain structures. In these brain structures responsible for the formation of eating behavior, serotonin serves as a mediator. The discovery of this relationship between serotonin and eating behavior has led to the creation of a new class of appetite suppressants. These drugs include drugs of the fenfluramine group, the action of which is similar to the effects of serotonin in the central nervous system. Drugs of this class help reduce the amount of food absorbed, increase satiety while eating, improve hormonal balance, and reduce depressive manifestations. However, unfortunately, fenfluramine derivatives are not used due to a number of complications. These drugs still need to conduct multiple additional clinical trials.To date, there is evidence of the successful use of a number of drugs from the group of antidepressants for the treatment of obesity associated with eating disorders. The drugs of this group of antidepressants block the reuptake of serotonin in the structures of the brain.
Symptom complex of bulimia nervosa - how it manifests itself, a characteristic of the behavior of a person who has this syndrome
Now let's look at the little-known, but common types of changes in eating behavior.First of all, let's consider symptoms of bulimia nervosa(increased appetite). As a rule, this symptom complex occurs in young women. Manifested by episodes of compulsive (episodic) meals, lasting no more than two hours. During such episodes of continuous food intake, preference is given to cakes, pastries, jam, ice cream, buns, and all kinds of dough products. However, unlike the forms discussed above, such attacks - episodes are accompanied by maintaining a critical attitude to what is happening, understanding the situation that such eating behavior is not normal. The person is disturbed by guilt and fear of not being able to stop the episode of overeating. Preservation of self-criticism makes it necessary to carefully hide such bouts of excessive gluttony from others. Usually such attacks - episodes are interrupted by spontaneous vomiting or severe pain in the abdomen.
Also, a factor leading to stopping overeating is the appearance of one of the strangers. When the increase in body weight becomes quite significant, such people learn to induce vomiting on their own after bouts of overeating. Again, remaining critical of the status quo leads to the adoption of rigid, strict low-calorie diets that are designed to prevent weight gain after bouts of overeating. In such individuals, obesity does not reach a pronounced character. Often, however, bulimia nervosa leads to menstrual irregularities. It may sound disappointing, but it is believed that the main cause of bulimia nervosa is atypical underlying depression.
What are the principles of treatment of the symptom complex of bulimia nervosa?
The main type of treatment for bulimia nervosa is the appointment of drugs from the group of antidepressants, the mechanism of action of which is the selective suppression of serotonin reuptake in brain structures.Seasonal appetite disorders
Another type of eating disorder is seasonal affective (emotional) disorders. The basis of the disease is depression. This type of eating disorders is singled out as a special form due to its wide prevalence among the population. In mild and erased forms, this type of eating disorder occurs in 40% of people, and in its expanded form - only in 6%. That is, the structure of this violation is similar to an iceberg - only a small part is visible on the surface. The prevalence in the population of mild forms of seasonal affective eating disorders is quite high. The peculiarity of seasonal emotional disorders is associated with the seasons. These seasonal affective disorders develop during the dark, cold season, namely, depending on the geographical latitude, from mid-autumn to mid-March. Most often seen in women. They are always combined with a violation of eating behavior by the type of increased appetite, leading to the appearance of excess body weight. For such women, the presence of premenstrual syndrome is typical, as well as menstrual irregularities by the type of rare and short menstruation.
During the manifestation of the disease, such women show an increase in complaints of a wide variety of chronic pain. Depression associated with seasonal affective disorder is usually mild or moderate in severity. Basically, it is manifested by a lowered background of mood, apathy, decreased performance, constant fatigue, depression, and an increase in the duration of sleep. However, in this case, for the most part, sleep is restless and intermittent. Moreover, despite a long stay in a dream, such a dream does not bring a feeling of rest. And as a result, such people are lethargic, tired, feeling overwhelmed in the morning.
Symptoms of seasonal affective disorder, what are the causes?
So, a typical patient with seasonal affective disorder looks something like this: more often this is a woman, usually young or middle-aged, with prolonged sleep and lack of satisfaction from sleep, suffering from premenstrual syndrome, possibly with menstrual irregularities, eating disorders type of increased appetite, increasing body weight and depression of mild or moderate severity. Interestingly, during the daylight hours, when the amount of sunlight is sufficient for these individuals, the symptoms of the disease disappear on their own, without treatment. Since the manifestation of symptoms is largely dependent on illumination, the mechanism of neurohormonal changes can be tried to be explained as follows.In the dark season, there is a change in the cyclic daily production of melatonin (the pituitary hormone) with a consistent decrease in the production of special hormones of the hypothalamus, serotonin and dopamine. It is with the altered metabolism of dopamine and serotonin that the increase in body weight, eating disorders, and manifestations of depression are associated. In the daytime, the symptoms reverse their development and disappear altogether.
What are the principles of treatment for seasonal affective disorder?
Seasonal affective disorders can be treated with light. For phototherapy (phototherapy) use special lamps with a light intensity of 2500-10000 lux. It is preferable to carry out procedures in the morning. The duration of a single therapy procedure, depending on the intensity of the lamp light, varies from 30 minutes to one hour.Another method of therapy is the use of antidepressants with a mechanism of action based on the inhibition of serotonin reuptake. The duration of the course of drug therapy is usually 3-4 months. Such courses are held in the dark season. The combination of phototherapy with courses of drug therapy can reduce the duration of drug treatment.
Patients suffering from seasonal affective (emotional) disorders should be exposed to sunlight more often, walk on sunny days even in winter, it is better to spend holidays in ski resorts, avoid wearing dark or tinted glasses in everyday life.
It must be remembered that the use of antidepressants, like many other drugs, is permissible only on the recommendation and under the supervision of an appropriate specialist doctor.
Summarizing all of the above, we can say that the problem of overweight is multi-causal, often combined with various endocrine-metabolic disorders and disorders of the emotional sphere.
What are the types and degrees of obesity?
It is very important to determine not only the cause of excess weight, but also the degree of obesity, the intensity of treatment also depends on this. Degrees of obesity determined using the body mass index, which can be determined using the body mass index calculator or by the formula: BMI = weight in kg / (height in m) 2 .
- 1 degree- body mass index is from 20 to 30. With this degree of obesity, it is quite easy to lose weight, you need to adjust your diet and add moderate physical activity.
- 2 degree- body mass index is from 30 to 40. At this stage, the risk of developing diseases associated with obesity (atherosclerosis, diabetes mellitus, and many others) increases. Losing weight will be much harder. It is necessary to strictly observe dietary nutrition, increase physical activity. A feature of this obesity is the rapid return of extra pounds after the transition to the old lifestyle. Therefore, proper nutrition and physical activity should become commonplace, and not just a short-term event.
- 3 degree- Overweight index from 40 to 60. Losing weight on your own is very difficult. It is difficult for a person to move, bend over, bouts of food intoxication are often observed, shortness of breath appears after minor physical exertion. The risk of developing concomitant serious diseases is high. As with the 2nd degree, you need to completely reconsider and change your lifestyle. At this stage, it is often necessary to resort to additional methods of losing weight (psychotherapeutic, surgical). If left untreated, over the years, the 4th degree of obesity develops - a deadly disease.
- 4 degree- body mass index above 60. These are very sick people with a whole bunch of diseases. In addition to impaired motor functions of the body, symptoms of heart and respiratory failure (shortness of breath even at rest) are increasing, which can lead to complete cardiac arrest. This degree of obesity is very difficult to cure. Many believe that this is not possible, although nothing is impossible.
In addition to degrees of obesity, there is such a thing as type of obesity, which differ depending on the distribution of fat in the body.
Types of alimentary-constitutional obesity (primary obesity):
1. female type- mainly characteristic of women, with this type of fat is more distributed in the buttocks and thighs, often such people have massive legs. Fat is usually located directly under the skin, the skin becomes loose, often has the appearance of an orange peel, cellulite develops. This type of figure is also called the pear type. Interestingly, with this type of obesity, a person has a bad mood, depression, sleep disturbance, and apathy appears. In physical activity, exercises with a power load on the legs should prevail. It is also important to reconsider not only nutrition, but also the water regime. It is plentiful drinking (non-carbonated purified water) that will contribute to the faster removal of fat metabolism products from the subcutaneous fat layer.
2. male type- is the same for both women and men. Such people have a large rounded tummy, massive shoulders and enlarged mammary glands. This type of obesity in severe cases contributes to obesity and internal organs, which is life-threatening. Such a figure is compared with an apple. Unlike the female type, people with male obesity are very cheerful, active, despite their weight, and eating food brings them great pleasure. With this type of obesity, it is important that the food is fractional, that is, you need to eat often, but in small portions, avoid eating in the evening and eating "fast food". It is also necessary to exclude smoked, spicy, salty, sweet foods from the diet. And among physical activities, it is better to give advantages to cardio loads: running, jumping, swimming, dancing, and so on.
3. mixed type- the most common type of figure, associated with eating disorders and eating behavior. At the same time, fat is evenly distributed throughout the body, both on the tummy and on the hips, arms, shoulders and face. Such people move little, suffer from mood swings, constantly want to sleep, eat, seizing nervous stress. In the treatment of this type of obesity, it is very important to completely revise the diet and exercise regimen.
Also, by the type of obesity, one can judge the disease, which resulted in excess weight. So, for example, with Itsenko-Cushing's disease, fat accumulates only in the abdomen and face, with male castration, fat is distributed over the hips, buttocks, in the abdomen and mammary glands.
But no matter what type of obesity, in any case, you need to lose weight and treat their cause. Any type eventually leads to serious consequences.
How does obesity affect health?
Obesity- this is not only an ugly appearance, excess weight affects all human organs, his health.Health is a very broad concept, it is not only the proper functioning of organs, but also the normal state of the psyche, complete social adaptation, and continuous spiritual development. And only this complex makes a person healthy and happy. Many fat women cannot improve their personal lives, create or save a family, they have a lot of complexes. An unhappy person cannot be healthy.
Let's try to understand the diseases that obesity leads to. Unfortunately, a whole bunch of diseases will not keep you waiting for people with an extra couple of tens of kilograms, many of which can be life-threatening.
Diabetes mellitus in obese people
Obesity increases the risk of developing diabetes, and the greater the degree of obesity, the greater the chance of developing diabetes. So, people with 3 degrees of obesity are 10 times more likely to have diabetes. Obesity is more likely to cause type 2 diabetes mellitus, that is, acquired or non-insulin dependent.
Causes of type 2 diabetes mellitus in obesity.
The lifestyle that overweight people lead is a trigger for high blood sugar levels. So, if a person has sufficient physical activity, most of the glucose is absorbed by the muscles during their work in the form of glycogen, while much less insulin is required. With a lazy lifestyle and an increased intake of carbohydrates, the absorption of glucose requires a large amount of insulin, and excess sugar contributes to the formation of fat both under the skin and in the internal organs. At the same time, the pancreas is depleted, and insulin is not enough for a large amount of glucose - diabetes mellitus occurs.
Treatment of type 2 diabetes mellitus in obesity.
The main principle of treatment of this type of diabetes is a diet with a small amount of carbohydrates and increased physical activity. This is the cure for obesity. Diet can achieve full restoration of sugar levels without insulin replacement therapy.
Type 1 diabetes mellitus (insulin dependent diabetes) is a genetic disease that is manifested by the lack of production of its own insulin. This type of diabetes does not depend on obesity. Conversely, type 1 diabetes can cause weight gain. This happens when a person consumes a large number of bread units with food, and in order to lower blood sugar, he injects more insulin. At the same time, an increased amount of glucose is absorbed, which is deposited in the form of fat. Treatment of this type of diabetes is possible only with the use of insulin therapy.
Fatty liver or fatty liver
Fatty hepatosis is a severe complication of obesity that leads to impaired liver function. It occurs quite often in people who take a large amount of fatty foods, especially in combination with alcohol. Causes of fatty liver: if a large amount of fat is supplied with food, lipid metabolism is disrupted over time, which also occurs in the liver. Under the influence of alcohol and other harmful substances or drugs, liver cells are replaced by fat cells, and liver failure occurs.
Symptoms of fatty liver:
- violation of the heart rhythm;
- shortness of breath with little exertion or even at rest;
- high blood pressure, above 140/60 and even 200/120 mm Hg. Art.;
- headaches and so on.
Obesity and atherosclerosis
Also, excess fat is deposited on the walls of blood vessels in the form of cholesterol, which forms atherosclerotic plaques. Vascular plaques disrupt blood circulation, narrowing the lumen of both large and small vessels. Atherosclerosis is dangerous for the development of strokes, coronary heart disease, heart attack and other types of circulatory disorders. The risk of developing this disease increases already at the 1st degree of obesity.Obesity and blood vessels
In addition to atherosclerosis, other vascular problems develop with obesity - varicose veins, phlebitis and thrombophlebitis. This is due to a large load of weight on the legs, little physical activity, high blood pressure, metabolic and fluid disorders. In this case, there is a pronounced swelling and pain in the legs, fatigue even with small physical exertion. These conditions often require vascular surgery. It is often possible to improve the condition of the vessels with a decrease in body weight and proper nutrition. A therapy aimed at strengthening the vascular wall is also prescribed. Obesity and joints
Excess weight also puts a lot of stress on the musculoskeletal system. First of all, the joints of the lower extremities and spine suffer, such diseases often develop:But the worst thing is obesity. belongs to the cancer risk group. Overweight patients often have cancer of the gastrointestinal tract, breast, and genitourinary system.
Obesity and pregnancy, how to get pregnant and carry a baby?
Many women with the addition of extra pounds reduce the chances of motherhood. This is due to the fact that metabolic disorders have a bad effect on the genitals. In addition, adipose tissue secretes more estrogens, leading to an imbalance of sex hormones, as a result - a decrease in the chance of conception. With 3 and 4 degrees of obesity, the chances of getting pregnant are very small. But even if, against the background of obesity, the conception of a baby has occurred, a woman often faces various pathologies of pregnancy:
- hormonal disorders , as a result - an increased risk (1 in 10) of premature termination of pregnancy (miscarriages);
- due to circulatory disorders and chronic hypoxia, it is possible intrauterine growth retardation or, even worse, fetal fading and stillbirth;
- toxicosis of the second half of pregnancy (preeclampsia), which is manifested by high blood pressure, loss of protein in the urine, pronounced edema, harms not only the mother, but also the development of the baby; every fourth obese woman has preeclampsia;
- most afraid eclampsia in mother , which threatens her life, is manifested by convulsive syndrome, coma; the only method of treatment is caesarean section, even if the period of 38 weeks has not yet come, this is a complicated outcome of preeclampsia;
- increased risk of developing pathologies heart, liver, kidneys in a woman;
- large body weight of the baby , which makes it very difficult to manage childbirth, the risk of having a child with birth injuries;
- weak labor activity , late discharge of amniotic fluid occurs in every fourth woman in labor;
- prematurity or postmaturity pregnancy occurs in every tenth overweight woman in labor;
- high risk (1:10) development postpartum complications - uterine bleeding.
Despite the possible risks and complications, obese women still get pregnant and give birth to healthy babies, you should not despair. It's just that such women need special supervision by obstetrician-gynecologists, especially in the last weeks of pregnancy.
And further, Pregnancy is not the best time to lose weight, but still, a diet for pregnant women and moderate physical activity are necessary for easier bearing of the long-awaited child. The task of the future mother is not to gain new extra pounds, but not to lose weight.
How much weight should a woman gain during pregnancy?
- 10-12 kg in 9 months to childbirth is considered normal, 4 kg of this increase falls on its own weight, and the rest - on the fetus, uterus, placenta and amniotic fluid;
- if a woman is obese 3-4 degrees , then the weight gain should not be more than 5-6 kg;
- according to statistics , obese women during pregnancy most often gain 20 kg or more, but we must remember that extra pounds will be deposited in the form of fat on the abdomen, hips, throughout the body, it will be difficult to lose them after childbirth and feeding.
- daily calorie content - no more than 2,500 kcal, but no less, a woman must provide the baby with nutrients for normal development;
- food should be frequent, fractional, small portions;
- need a lot of protein (meat, fish, legumes, dairy products);
- limit the amount of easily digestible carbohydrates as much as possible (sweets, potatoes, baked goods, sweet fruits, sugar, honey, and so on);
- fats should be more in the form unsaturated fatty acids (fish and seafood, a small amount of butter and vegetable oil, nuts);
- high calcium content (cheese, cottage cheese, vegetables, fruits) and vitamins;
- drastic salt restriction - up to an incomplete teaspoon per day;
- reduced fluid intake (water and liquid food) up to 1.5 liters.
The question of the type and intensity of any physical activity decided individually by the doctor. Up to 12 weeks, physical activity is carried out with caution, and after a pregnant woman you need to walk a lot in the fresh air, if there are no contraindications, you can do aqua aerobics, yoga, breathing exercises, exercise therapy. Treatment of infertility against the background of obesity. In most cases (in 9 out of 10) it is possible to get pregnant after losing weight. With degrees 1 and 2 of obesity, for the successful conception of a child, it is enough to lose only 10 - 20 kg, with obesity of degrees 3-4, of course, it is harder, but everything is possible, you will have to try very hard in the fight against excess fat.
In case of hormonal disorders, a gynecologist is connected with the correction of these changes, but still one cannot do without the right lifestyle.
Obesity problems in children and adolescents, obesity in children under 1 year old, what is the treatment?
Unfortunately, in recent years, more and more children and adolescents are suffering from obesity. This is because modern life leaves its imprints on them. Many children sit for hours and days in front of the computer and TV, eating pizza and chips, drinking sugary soda. Parents have to work hard, leaving less and less time for their children. And so that the children do not walk along the dangerous streets themselves and do not contact different companies, but sit at home, close their eyes to the lifestyle of their child, depriving them of active street games. And recently, the number of children's diagnoses has increased, which exempt schoolchildren from physical education and sports in general. Inactivity and malnutrition is the fastest way to alimentary obesity, it is this type of obesity that affects children and adolescents to a greater extent. With the growth of childhood obesity, age-related diseases are getting younger, so strokes in children are no longer nonsense, and atherosclerosis is no longer only found in people over 40. Therefore, it is very important to monitor the health of your children, especially those who enter the period of sexual development, it is this age that maximizes the risk of gaining extra pounds.
In addition to eating disorders and inactivity, there are also Other causes of childhood obesity:
- genetic predisposition. If one of the parents is obese, then the child's risk of developing pathology is about 40-50%, and if both parents are overweight, then the risk increases to 80%. But we must remember that genetics only predisposes, and lifestyle, environment, psychological state, upbringing, and so on are already superimposed on it.
- Hormonal disorders - that is why obesity can occur during puberty, namely in early childhood (up to 3 years), in the period of 6-7 years, during the formation of menstruation in girls and at the age of 12-16 years in boys. In addition, obesity can develop against the background of other endocrine disorders, most often with a lack or absence of thyroid hormones (hypothyroidism).
- Diseases of the central nervous system: traumatic brain injury, hydrocephalus, meningitis, meningoencephalitis, congenital syndromes, and so on.
- Psychological trauma - obesity can develop after the loss of loved ones, an accident, mental or physical violence in the family or on the street, and other emotional experiences.
- Syndrome of inactivity - occurs in adolescents who were involved in some kind of sport in childhood, and then abruptly stopped attending training.
Determining the degree of obesity in children using the body mass index is considered uninformative, since the body is still growing rapidly.
For the gradation of degrees, either graphs of norms of weight and height for each age are often used, or centile tables, with a deviation from which it is possible to say whether there is obesity or not.
Centile table No. 1:
Growth and weight norms for boys from 0 to 17 years old *. 
Centile table number 2:
Growth and weight norms for girls from 0 to 12 years old *. 
*The norm is indicators from 10 to 90%. Values above 90% indicate overweight, and below 10% indicate underweight, both of which require consultation with a pediatrician.
Depending on the percentage of deviations from the norm of weight, four degrees of obesity are also distinguished:
- 1 degree - when exceeding the weight within 15-25%;
- 2 degree - with excess weight from 25 to 50% of the norm;
- 3 degree - if the weight exceeds 50% of the norm;
- 4 degree - excess weight is more than 100%.
The principle of treating children with alimentary obesity is the same - the transition to proper nutrition and increased physical activity.
Diet principles for obesity in school-age children and adolescents:
- Strict diets for children and adolescents are contraindicated, since a growing body requires a balance of vitamins, minerals, calcium, protein, fats (including cholesterol) and carbohydrates, proper nutrition should be preferred;
- Reduce calories gradually, by 300-400 kcal, up to 1500 kcal per day;
- The menu should contain a large amount of plant and protein foods, complex carbohydrates - these are whole grain cereals, dairy and sour-milk products, meat and fish, raw vegetables, fruits, rye bread and so on;
- Food should be fractional, frequent - 5-6 times a day;
- Exclude easily digestible carbohydrates (sweets, pastries, fresh white bread);
- Exclude smoked meats, fried, spicy, salty foods, sweet drinks;
- Observe the drinking regimen of at least 2 liters per day.
- active games;
- physical education at school;
- employment on horizontal bars;
- walking, running, swimming, cycling;
- any sport, dancing and so on.
Obesity in children under 1 year of age. Babies can also be obese, although many mothers, and especially grandmothers, are so happy with ruddy cheeks and folds in their little ones. But excess weight often has a negative impact on the physical and emotional development of the child, his future health and, less often, may be a sign of more severe congenital pathologies.
Diagnosis of obesity in infants is also made according to calculations using centile tables of normal height and body weight.
Obesity in infants is called paratrophy. There are three degrees of paratrophy:
- 1 degree - overweight 10-15%;
- 2 degree – from 15 to 30%;
- 3 degree – over 30%.
Risk groups for obesity in children under 1 year old:
- children whose parents are obese;
- large birth weight, more than 4 kg;
- children who are bottle-fed;
- born to mothers with diabetes;
- children with congenital hypothyroidism;
- congenital genetic syndromes, anomalies in the development of the brain, and so on.
What are the methods of surgical treatment of obesity?
Many, without willpower and patience, try to solve the issue of excess weight through surgical interventions, this method is suitable for those who are not afraid to go under the knife and are ready to adhere to a special diet and lifestyle in the future.Surgical methods used to treat obesity:
| Type of operation | Indications | The principle of surgical treatment | Peculiarities |
| Liposuction | Improving the appearance of obesity | Surgical removal of fat from the abdomen, thighs or shoulders.  | The operation eliminates a large number of kilograms at once. Liposuction is a rather bloody and difficult operation, requiring a long recovery in the postoperative period. It does not completely solve the problem of obesity and its complications. If after such an operation a person returns to the old way of life, then the return of excess weight will not be long in coming. Therefore, before deciding on liposuction, you need to switch to the right lifestyle and nutrition before the operation. |
| Operations aimed at reducing the amount of food consumed |
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| Intragastric balloon | Alimentary-constitutional type of obesity, especially complicated by diabetes mellitus, atherosclerosis and other diseases. Not suitable for those people who have problems with eating, that is, with a psycho-emotional form of obesity. In such cases, a decrease in the volume of the stomach leads to prolonged and prolonged depression, psychosis. | With the help of an endoscope, a balloon is inserted into the stomach, which is already filled with liquid in the required volume from 400 to 700 ml, thereby reducing the lumen of the stomach.  | This is the safest, organ-preserving and effective method of treating obesity, it is performed without a single incision. It allows you to significantly reduce the number of servings, promotes rapid satiety, and reduces appetite. Another important advantage of this method is the ability to remove the balloon at any time. |
| Gastric bypass | The stomach, in fact, is reshaped, a small part is isolated and connected to the duodenal bulb. | The operation is traumatic. But, in addition to reducing the volume of food, the effect of reducing appetite for sweet and fatty foods is achieved. | |
| Banding of the stomach | The stomach is divided into two parts by applying a special ring to it.  | After separation of the stomach, the volume of its upper part is only up to 50 ml. This allows you to feel full with food in very small doses, your appetite sharply decreases. This operation is transferred quite easily, the ring can be removed at any time, its high efficiency has been proven. This is the most commonly used method for obesity. | |
| Operations to reduce food absorption |
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| Small bowel bypass | Any kind of obesity, especially when eating food against the background of stress. Especially indicated in the development of complications of obesity. | The small intestine is cut at a distance of 50 cm or more from the stomach, and sutured to the large intestine, and the end of the second part of the small intestine is sutured. | This type of operation is quite complicated, can have a large number of life-threatening complications, so this operation is performed infrequently. The resulting effect is that the food taken is not digested and is excreted in transit through the rectum. |
| Biliopancreatic shunting | Part of the stomach is removed, and the excretory ducts of the liver and pancreas are sutured from the duodenal bulb into the small intestine, 1 meter from the caecum.  | The operation is very complex, combined, but nonetheless showed high efficiency in people with 3-4 degrees of obesity. There is a violation of the absorption of food in the small intestine. And this is the method, as a result of which you can eat plenty and lose weight. | |
All surgical interventions, despite their results, have a high risk of complications. Therefore, you need to think carefully before deciding to take such a step. If obesity is really severe, complicated, threatens with irreversible consequences and other methods do not help, then such methods will save not only health, but also the life of the patient.
Coding and folk remedies for obesity, pills and other non-traditional remedies effective in the treatment of obesity?
More and more various scientists, physicians, psychologists, pharmacists, traditional medicine specialists are trying to develop effective methods of dealing with excess weight. The Internet is full of various non-traditional therapies, introducing super pills, teas, baths and even slimming movies. Of course, it is impossible to speak categorically about the harm or effectiveness of all these means, but relying on them and sitting and waiting for the hated kilograms to go away is impossible and useless.Let's try to understand this mass of remedies for obesity and refute myths about easy and fast weight loss.
Myth No. 1: "Coding helps you quickly, once and for all get rid of excess weight."
With the help of various hypnotic and psychological techniques, a person is suggested that food is evil that harms and kills a person, and the feeling of joy from eating is replaced by a feeling of fear. However, any honest, experienced psychotherapist who practices this method will not give a complete guarantee of recovery. Why can't coding be called a radical method for obesity?
- For many, coding really causes an aversion to junk food and a decrease in appetite. But this method gives only short term results(from several months to 2 years), and if during this time a person does not accustom himself to proper nutrition and lifestyle, then the weight will return very quickly, also in pluses.
- Coding requires compliance with many rules, the main of which is the observance of proper nutrition and increased physical activity, and this, as you know, helps even without psychiatrists.
- Can't be coded multiple times two, maximum three times.
- In highly susceptible individuals coding can lead to bulimia and anorexia, that is, to states of eating disorders, which leads to irreversible consequences of the body and psyche.
- Well, and most importantly, not all people are susceptible to different kinds of encodings and hypnosis, then this method will be absolutely meaningless.
Myth #2: "It's completely safe to take diet pills."
Many diet pills are classified as so-called dietary supplements (biologically active additives), and contain components that affect the human nervous system and psyche, that is, psychotropic substances of plant or synthetic origin. Indeed, they suppress the hunger center of the brain, which leads to dramatic weight loss. The principle of this method is similar to taking drugs. These drugs deplete the nervous system, bringing a person to psychosis and depression. For example, Thai pills, so popular in the 90s among show business people, brought more than one “star” to the intensive care hospital bed.Myth #3: “Herbs and other herbal remedies for obesity are completely safe.”
Herbal preparations obesity can be conditionally divided into three groups: 1. Plants that have a diuretic effect:
- lingonberry leaves, currants;
- chicory;
- fennel;
- corn silk and so on.
Diuretics remove fluid, reducing overall weight, not fat, leading to dehydration and inhibition of metabolic processes. Such drugs are indicated for edema.
2. Plants that have a laxative effect:
- senna;
- aloe;
- rhubarb;
- anise;
- hibiscus and many others.
3. Plants that reduce appetite:
- spirulina;
- flax seeds;
- bran and wheat germ;
- a pineapple.
4. Herbs that are poisonous. Most commonly used hellebore . Poisonous herbs lead to chronic intoxication, negatively affecting the intestines, liver, kidneys and even the heart. Appetite, of course, is significantly reduced, kilograms go away, but at what cost.
Despite these negative aspects, many plants are very useful and will complement the diet well during weight loss, but only as a source of vitamins, trace elements, antioxidants, which are metabolic catalysts.
Myth #4: “Biomagnet for weight loss, eat and lose weight while sitting on the couch.”
There are many methods based on the action of a magnetic field in the region of various points responsible for appetite, liver function, metabolic processes, and so on. Such points are located on the ears, fingers and toes, on the nose, wrist and other parts of the body. Indeed, the effect of magnets and other healing stones has long been proven, but you need to know exactly where and when to act. And this action is not so pronounced, one magnet is not enough, you still have to adhere to a healthy diet and physical activity. Unfortunately, in most cases, biomagnets sold on the Internet and TV stores affect psychosomatics, that is, a person inspires himself that this remedy works, it helps. Pressure on the points also helps, they remind a person that he has set himself the goal of losing weight. Myth number 5. "Slimming devices at home, lose weight lying on the couch."
Basically, the market presents us with devices that act on the fat layer through the skin.The most popular weight loss devices:
- mini saunas for the abdomen;
- various massagers for problem areas;
- butterflies with heating and vibrating effect;
- cavitation preparations based on ultrasonic action and many others.
The fight against obesity and overweight, what should it be?
The most effective way to combat alimentary obesity is proper nutrition and exercise. Obesity caused by other pathologies requires treatment of the underlying disease. It is more difficult when weight gain has come due to depression, nervous stress. Psychological preparation and setting for weight loss.
Before you start treating obesity, you need to decide for yourself questions and prioritize:
- Do I need to lose weight?
- Why do I need it?
- Do I want it?
- Am I ready for this?
- How can I do this efficiently?
- Will it harm me?
- And what will experts and close people whom I trust say?
If a person seizes problems and depression, then the treatment should be accompanied by positive emotions. You can go on a trip, go to nature, do your favorite thing or even extreme sports, shopping, realize long-desired ideas. This is necessary in order to provide your body with endorphins and other hormones of happiness, which are usually released during meals, and then the need for overeating will disappear.
Some people need incentives and goals to set for themselves. For some, it is to be healthy, for some it is beautiful, many women set themselves the goal of giving birth, and someone just wants to fit into their tight dress.
People with weak willpower and character can visit a psychologist who will help to cope with various emotional problems.
Obesity nutrition tips:
1. Strict diets for obesity are not suitable, they quickly lead to weight loss, but no one will survive on such a diet for a long time, and the lost kilograms will quickly return.
2. The transition to proper nutrition, and not a diet will help solve the problem of obesity, but only this should become a rule and a way of life, and not a temporary campaign for your body.
3. Meals should be frequent, up to 5-6 times a day, but portions should be small, overeating should not be allowed, and you should eat before hunger sets in.
4. Drinking mode. Half an hour before meals, you should drink a glass of water, this will reduce your appetite. But you can’t drink food, you need to drink no earlier than 30-60 minutes after eating. You need to drink non-carbonated table or mineral water, its daily volume should be calculated as follows: 30 ml or more of water per 1 kg of body weight. In addition, for each cup of tea or coffee, add 1 glass of pure water. Carbonated and sugary drinks contribute to the deposition of fat under the skin, they should be completely excluded. Pure water is necessary for the inclusion of metabolism and its acceleration.
5. Menu for obesity should contain proteins, fats, carbohydrates, vitamins and trace elements. In the first half of the day, complex carbohydrates, fats and proteins are needed, and in the second - plant foods. The daily energy value of the diet is 1200-1600 kcal:
- Minimize the amount of easily digestible carbohydrates(sweets, including sweet fruits, pastries, chips, fresh white bread, etc.). Bread should be eaten, but rye varieties should be chosen. It is important to drink tea and coffee without sugar or honey, they quickly get used to this, you can add milk to coffee, and lemon to tea.
- Exclude: fried, spicy, smoked dishes, alcohol, fast food, quick snacks with rolls and so on.
- Amount of fat should be reduced, but not excluded, since fats, especially unsaturated fats, are necessary for the normal functioning of the body. Fats should come from fish, vegetable oil, dairy products, lean meats.
- Proteins need to be taken daily, sometimes you can do unloading protein-free days.
- Diet should be dominated plant food.
- Need to reduce the amount of salt you eat up to 0.5 teaspoon per day.
Physical activity.
A sedentary and recumbent lifestyle must be changed to an active one. Many need to start just getting out of bed, and then gradually increase their load. It's hard, but necessary. You need to start with walking, the number of steps taken per day should be at least 10-12 thousand. A set of exercises should be selected individually by a fitness trainer or exercise therapy doctor after assessing the state of health, indications and contraindications. Any effective complex includes cardio loads (running, jumping, cycling, swimming, etc.) and power loads aimed at certain muscle groups. Active physical activity should last at least 30 minutes a day 3-6 times a week, not counting daily walking, cleaning around the apartment and other necessary movements.
The path to the fight against obesity is very long and difficult, you need a lot of willpower, character and, most importantly, a great desire. Often, patients themselves can not cope, they need the support of relatives or specialists. But it is especially difficult in the first month of changing your habits. Then it will be easier, the body gets used to eating less and moving more, and the kilograms shed during this time will also be stimulated.
It is a healthy lifestyle that leads to effective treatment of obesity, and most importantly, a long-term effect is observed, and if such a lifestyle becomes a habit and the norm, then extra pounds can be forgotten forever. And with weight, other health problems that arose against the background of obesity also go away.
Also, people who have overcome tens of kilograms become stronger, happier, get rid of complexes and become self-confident individuals.
How does smoking and alcohol affect obesity?
Smoking and obesity.Many people think that smoking cigarettes helps to fight extra pounds and suppresses appetite. However, it's not like that at all Smokers are quite often faced with problems of excess weight, and here's why:
- Smoking a cigarette only temporarily suppresses the feeling of hunger. , it does not saturate, so very soon hunger returns, this leads to uncontrolled intake of large amounts of food and overeating - the cause of obesity.
- Tobacco addicts usually have weak willpower , so many have other types of addictions in parallel, including food. Smoking suppresses the production of its own endorphins. Food, on the other hand, contributes to their production, so smokers replace cigarettes with food, compensating for the lack of happiness hormones. That is why people who quit smoking quickly gain weight.
- Smoking causes vasoconstriction, as a result - a violation of blood circulation and a slowdown in metabolic processes in the body, energy substances are not consumed, but are deposited in the form of fat.
- Also, smokers with experience have habitual chronic weakness, as a result - sedentary lifestyle.
Alcohol and obesity.
Alcohol is almost always present in the life of adults. For many, this is the norm. Alcohol is drunk not only on holidays, but also to keep company, relieve stress and fatigue, for romance or just for a good dinner and for a good mood. And no one thinks about the consequences that strong drinks lead to, and there can be many of them, including obesity.
How does alcohol affect obesity?
- Alcohol, entering the body, produces energy in the amount of 700 kcal per 100 ml of alcohol, but this empty energy, ethyl alcohol contains neither proteins, nor fats, nor carbohydrates . This energy is consumed first, but snacks from the feast are stored as reserve fat.
- If alcohol has sugar (sweet wines, champagne, vermouth, liqueurs, liqueurs, etc.), then in addition to empty energy comes large amount of easily digestible carbohydrates , which are very quickly deposited in the form of fat.
- Alcohol leads to dehydration body, thereby further slowing down the metabolism.
- Strong drinks are irritating on the stomach and increase appetite, so almost everyone likes to bite each glass tightly. Many more people like to drink strong drinks with sweet sparkling water, increasing the risk of fat deposition at times.
- Alcohol intoxication promotes uncontrolled eating , a person simply does not feel full.
- Alcohol can make you weak , reducing physical activity both during the time of abuse and the next day of the hangover.
- Drinks with degrees increase the risk of complications of obesity (diabetes, fatty liver, etc.).
- Alcohol affects the balance of sex hormones
Diabetes. Types of diabetes mellitus, causes of development, signs and complications of the disease. The structure and function of insulin. Compensation for diabetes.
Moral: if we pretend and convince ourselves that eating is nothing more than an opportunity to fill the stomach in a social and emotional vacuum, we are very much at risk of completely losing the culture of food and the invaluable help and support that we can give ourselves. and to their children in gaining good health and a slender body.
Age also plays an important role in the development of obesity. There is a special type of obesity - age. It has been established that the maximum need for calories is observed in a person under the age of 30, after which there is a decrease in the level of metabolism every year by 0.5%, and there are several reasons for this. If you do not change your diet with age, this can lead to a gradual and imperceptible, at first, increase in body weight.
After 30 years, in the absence of active physical activity, muscle mass begins to decrease at a rate of about 250 g per year. Since muscle tissue has a higher metabolism and, therefore, consumes more energy, a decrease in its volume (as a result of detraining) while maintaining the usual dietary pattern leads to a decrease in energy metabolism and further fat deposition.
In addition, age-related obesity is associated with a change in the activity of a number of brain centers, including the centers of hunger and satiety. To satisfy hunger, more food is required with age. Very often, imperceptibly for themselves, many people over the years begin to eat more than necessary, that is, to overeat. This is partly due to the fact that over time, the sensitivity of the taste buds of the oral cavity decreases and a person is forced to add more salt and spices to dishes in order to improve their taste experience. Excess salt and spices inevitably leads to fluid retention in the body and weight gain. In addition, with age, the activity of the thyroid gland, which produces hormones involved in metabolism, deteriorates. Hormonal changes in the premenopausal and menopausal period also inevitably lead to a set of extra three to four kilograms. Therefore, with age, we must be more attentive to what we eat, when we eat and how much we eat at one time, significantly reduce the amount of food we eat so as not to get fat and maintain health.
We must not forget about such an important thing as physical activity. It is well known that a sedentary lifestyle has a great influence on weight gain. The less we move, the less energy we spend. However, most people in our technological age lead a sedentary lifestyle. As a result, due to the lack of physical activity, the calories that enter the body with food are not burned, but turn into fat. A particularly harmful occupation is long-term television viewing. For many, this complete inaction is aggravated by the absorption of a fair amount of junk food - chips, crackers, popcorn ...
All these causes lead to the so-called primary obesity. But there is also a secondary one that occurs in a number of diseases and is a concomitant factor. Often, the metabolism is influenced by diseases that are latent at a certain stage, especially the thyroid gland. Endocrine diseases such as Cushing's disease, hypothyroidism, hypogonadism, insuloma, as well as damage and some diseases of the brain, as a rule, are accompanied by obesity. The presence of such diseases can nullify all efforts to reduce weight, if you do not first make the correct diagnosis and do not select an adequate therapy for the underlying disease. Here, diets alone will not help the cause - a complex of therapeutic measures is needed, since overweight is only one of the symptoms of the underlying disease. That is why a preliminary examination of every person who decides to reduce body weight is so necessary.
But we will leave aside obesity caused by endocrine diseases. In these cases, diets are practically powerless without serious medical intervention. We are primarily interested in primary, or alimentary, obesity, which occurs in the vast majority of cases. That is a problem that we can solve.
Remember that individual metabolic activity is inherited from our parents. If both parents are overweight, then in 80% of cases their child is predisposed to obesity. If the parents have normal body weight, only 14% of children are overweight. In general, it has been established that heredity has an impact on human body weight by only 33%. Otherwise, this is a family stereotype of nutrition, the influence of the external environment, lifestyle features and eating habits (mainly excessive caloric content of food with a predominance of fats in the diet with a disturbed daily rhythm of nutrition), as well as insufficient physical activity. The perverted nature of nutrition, the departure from the traditional cuisine of their people, "fast food" led to the threatening spread of obesity.
Given the most common causes of overweight, we can develop basic rules that must be followed strictly if you want to get rid of excess weight.
1. In order not to overeat, permanently give up the following habits dear to your heart:
There is nothing to do to kill time;
Eat to calm down and cheer yourself up;
Eat while watching TV shows and movies;
There is everything that is on your plate; t eat up leftovers from home plates;
Prepare a lot of dishes for a meal and try each;
Eat every meal with dessert or bread.
2. Give up sweets as a self-reward. Choose something else for this purpose, perhaps not related to food.
3. If you can't do without sweets, then don't torture yourself and buy what you want. But do not rush to eat everything at once: eat a small piece, holding it in your mouth longer. Perhaps this will be enough to satisfy the desire.
4. Eat slowly. To slow down your meal, put your utensils on the table before taking another bite. Try eating with chopsticks. Remember, the slower you eat, the faster you feel full.
5. Get up from the table as soon as you finish eating. Do not sit too long over the last crumbs of food.
6. Ask someone close to set the table for you so that the portions are small.
7. If snacks are in the wrong place in your apartment, try to remove them as soon as possible. Shake candies out of your desk drawers, take the cup of nuts off the coffee table, and the like.
8. Eat only in the designated place and time.
9. Instead of eating forbidden sweets, go and brush your teeth. The sweet taste of toothpaste will discourage the desire to sweeten.
10. When the feeling of hunger seems irresistible, and you have eaten not so long ago, wait a few minutes before eating. Perhaps this time will be enough for you to get sick of eating.
11. Whatever you eat, try to eat with utensils - even those foods that are usually eaten with your hands, such as fruit.
12. Wear a special belt or belt that would let you know when it's time to stop while eating.
14. During the preparation of dinner, invite someone into the kitchen with you to supervise the process of tasting the food you are preparing.
15. Remember that there is nothing wrong with firmly saying to the person offering you a snack: "Thank you, I'm full."
Of course, following these rules alone is not enough to quickly and sustainably get rid of excess fat. But if you train yourself to follow them, you will take the first big step towards a slim figure.
The next such step is to correctly calculate the number of calories that you can consume without the risk of getting fat. We will talk about this further.
Counting calories
Now we will digress from physiology and we will be engaged in mathematics. Before proceeding with the preparation of the correct diet, we must determine - how much energy does a particular person need to maintain the normal state of the body during the day?
As I said, energy in the body is produced by processing nutrients. There are no other ways of its intake and formation in the body. But it is spent on various life processes and depending on lifestyle, eating habits and physical activity, and its consumption can vary greatly from person to person. Therefore, with the same diet, one can lose weight, and the other can gain weight.
The traditional unit of energy metabolism is the calorie. This is a very small value, it is equal to the amount of energy required to heat one milliliter of water by one degree Celsius. For convenience, all energy processes in the body are measured in kilocalories(one kilocalorie is equal to 1000 calories), which are denoted as follows: kcal.
To answer the question of why I am gaining excess body weight and how many kcal I need to reduce my daily diet in order to lose weight, I need to calculate how much energy the body needs and how much energy actually comes from food.
To determine the normal calorie content of the daily diet, the following formula is used:
For women:
18-30 years old (0.0621 x body weight (kg) + 2.0357) x 240 (kcal)
31-60 years old (0.0342 x body weight (kg) + 3.5377) x 240 (kcal)
over 60 years (0.0377 x body weight (kg) + 2.7545) x 240 (kcal)
For men:
18-30 years old (0.0630 x body weight (kg) + 2.8957) x 240 (kcal)
31-60 years old (0.0484 x body weight (kg) + 3.6534) x 240 (kcal)
over 60 years (0.0491 x body weight (kg) + 2.4587) x 240 (kcal)
When calculating total energy expenditure adjusted for physical activity, the basal metabolic rate should be multiplied by the physical activity coefficient:
1.1 - low activity
1.3 - moderate activity
1.5 - high activity
Although these formulas are quite cumbersome and it is clearly impossible to do without a calculator, it is better to use them, because they most accurately reflect the daily energy consumption required by the body.
For example, for a 40-year-old man who weighs 80 kg and has moderate physical activity, we will carry out the following calculation: (0.0484 x 80) + 3.6534) x 240 = 1807 kcal x 1.3 = 2345 kcal. It turns out that in order to ensure the normal functioning of the body, this man needs to receive 2345 kcal from food, and at the same time, body weight will remain stable.
Now let's make a similar calculation for a woman of the same age and body weight, who has the same intensity of physical activity. Let's apply the following formula: (0.0342 x 80) + 3.5377) x x 240 = 1506 kcal x 1.3 = 1957 kcal. Thus, a woman needs significantly less energy and, therefore, needs to eat less.
Daily energy metabolism can be represented as follows:
SECP \u003d (00 + ER + ED + SDDP + W + T) x K + EJ
In this formula:
SEPC- daily energy value of food;
00 - basic exchange;
ER- energy costs associated with professional activities;
ED- energy consumption during leisure;
SDDP- specific dynamic action of food;
W- energy in undigested food products (slags);
T-energy costs for providing thermoregulation (in comfortable conditions, they are practically absent);
TO- coefficient of energy exchange;
EJ Excess energy stored in the body as fat.
Basal metabolism maintains the vitality of the body at the lowest possible level, that is, without physical activity, in comfortable conditions and on an empty stomach. For men, its norm is 1 kcal per 1 kg of body weight per hour. For women, this value is 0.9 kcal per 1 kg of body weight per hour. This difference is due to the presence in men of greater muscle mass, to maintain the tone of which, of course, more energy goes.
It has been established that up to 26% of basal metabolic energy is spent on maintaining muscle tone. In addition, 26% of the basal metabolic energy is also spent on the functioning of the liver, since the liver takes the main part in metabolic processes. 18% of the energy is spent on brain activity, 9% on the work of the heart, 7% on the kidneys, while the activity of other organs accounts for only 14% of the basal metabolic energy.
With a sedentary lifestyle, energy, aimed at maintaining muscle tone, consumes approximately the same amount. With active physical education or work associated with significant physical exertion, muscle mass increases, which leads to an increase in basal metabolism and fat burning even at rest.
The amount of energy consumed for the implementation of professional activities depends on the nature of the latter. For an 8-hour workday, a 5-step scale of physical activity levels is used:
1st step characteristic of sedentary work. During the working day, about 500 kcal is consumed. It is this intensity of work that occurs in most overweight and obese people.
2nd step- for workers of mechanized labor with minimal physical effort (medical workers, salespeople, teachers, etc.). To ensure such activities during a work shift, 1000 kcal is needed.
3rd step- for workers with moderately hard physical work, but mostly mechanized (transport drivers, machine operators, etc.). For the implementation of their professional activities, about 1500 kcal per shift is required.
4th and 5th steps found in hard physical workers and professional athletes. They spend 2000 kcal or more. In the vast majority of cases, these people are not overweight and can only gain it after retirement or retirement, if they do not change their eating behavior.
Increasing calorie consumption by increasing the intensity of labor is a thankless task. How can say, an office worker burn more calories per working day? Not on the run as he draw up contracts! But to fill your leisure time with physical activity is within the power of everyone. Free time from work is great for “shaking fat”. But we will talk about this in more detail in a separate chapter.
What else is used daily for the energy produced in the body from food? Yes, to the processing of these same products! The increase in metabolism during the assimilation of food products is called the specific dynamic action of food. The magnitude of this action depends both on the amount of food eaten and on its qualitative composition. The increase in metabolic intensity after a meal can last up to 12 hours, and after a protein meal - up to 18 hours. Mixed food increases metabolism by approximately 6.5%, and protein - up to 30% and above. Carbohydrates and fats increase metabolism by only 2-3%.
When calculating the daily energy balance, we must take into account that most foods are not fully digested. This is especially true for products containing a large amount of plant fibers, which are practically not digested at all. With a mixed diet, the correction for incomplete digestion of food is approximately 6.5%. With a vegetarian diet, this value can reach 50%. This fact is widely used in various diets aimed at reducing body weight. Indeed, with a high fiber content in foods, it is possible to “deceive” an empty stomach and at the same time not pick up extra calories.
It is necessary to take into account when calculating the daily energy consumption and thermoregulation. In our greenhouse conditions of life, energy costs for maintaining thermoregulation are minimal and can be ignored in our calculations.
The coefficient of energy metabolism is derived in our formula because there are several types of energy metabolism. That is, metabolic processes can proceed at different speeds.
With the first type energy exchange (K = 1.2), there is a low ability to store energy in adipose tissue. Calories from food are almost completely burned. In people with this type of energy metabolism, as a rule, even with a high-calorie diet, there is a decrease in body weight and a low likelihood of developing obesity. These are eternal skinny.
For the second type energy exchange (K = 1.0) is characterized by high plasticity of metabolic processes in the body and high resistance to external changes in the environment and food regimen. If a person consumes as much energy with food as he spends, obesity does not threaten him. It develops only in cases of prolonged overeating and physical inactivity.
Third type(K = 0.8), unlike others, has an energy exchange with a tendency to accumulate body fat. It is this type of energy metabolism that is most often observed in obese individuals. This type of energy exchange occurs in 5-10% of all people.
Now, in order to make all these formulas and figures more clear to you, we will determine the energy balance using a specific example.
Our patient will be a 35-year-old man with a body weight of 90 kg and a height of 178 cm. Let's say that over the past year, after moving to a managerial job, he gained 8 kg in weight. Previously, body weight remained stable during normal motor mode. Our man did not follow any special diets. He always had his main meal after 20:00.
First, let's determine the normal body weight of our patient. It is calculated according to Brock's formula and is 178 - 100 \u003d 78 kg.
Basal metabolic rate (00) is calculated by multiplying normal body weight by 1 kcal and by 24 hours. We get: 78 x 1 x 24 \u003d 1872 kcal. Thus, the main exchange is 1872 kcal.
Next, we calculate the energy costs for work and leisure. Since our patient has a sedentary lifestyle, which is characterized by the 1st stage of professional labor activity, he spends about 500 kcal per day on it. After work, he is not very mobile, and for leisure, no more than 500 kcal is also required. We should also add 6.5% for the specific dynamic action of food and the same amount for incomplete digestion of products, which will total 187 kcal x 2 = 374 kcal. Our patient has the second type of energy exchange, which is characterized by a coefficient K = 1.0.
Adding up all the components of the daily energy exchange, we get: (1872 + + 500 + 500 + 374) x 1.0 = 3246 kcal, i.e. the daily energy balance of a man is about 3246 kcal. This is exactly the energy exchange in which the body weight should be 78 kg, and in our case it is 90 kg - that is, an extra 12 kg.
Now let's see what needs to be done to normalize body weight. First of all, it is necessary to determine how many extra kilocalories have accumulated in the body. It is known that the energy value of 1 kg of adipose tissue is about 7500 kcal. Given that our patient has 12 extra pounds, we calculate the surplus kcal by multiplying 7500 kcal by 12 kg and get 90,000 kcal.
A noticeable increase in weight was noted during the last year, when it increased by 8 kg, i.e. by 60,000 kcal. Our man added only 166 kcal per day. It would seem - a trifle! But just like that, gradually overeating every day, he accumulated an extra 8 kilograms! To regain your previous weight within a year, you can undereat 166 kcal of food. But this can be achieved much faster using special hypocaloric nutrition programs. Knowing their daily calorie content, you can calculate how many calories a person will lose daily. Then you need to divide the number of your extra calories by the result and, thus, calculate how many days you can return your lost forms. But that's only half the story! We should not forget that it is necessary to constantly adjust your daily diet in order to maintain the results achieved.
But counting calories is only half the battle. It is not enough to know how much food you need to eat per day. It is necessary to have a reference point in the form of the body weight that suits you. That is, imagine how much you should weigh normally, how many kilograms you have to get rid of, and whether you need to get rid of them at all.
It is to these questions that the next chapter is devoted. In it, we will learn how to determine the type and degree of obesity, and also answer the question of whether you need to lose weight.
DIAGNOSIS OF OBESITY.
TO LOSE OR NOT TO LOSE
There was nothing complicated, because in two weeks I got rid of all the problems. You can eat often and a little - no difficulty. You just need to be responsible.
Olesya Sudzilovskaya
Before losing weight, you need to understand whether it is necessary to do this at all. That is, you need to find out if you are facing the problem of excess weight. And here everything is not as simple as it might seem at first glance.
In general, I never drive anyone into any framework. I don't like to do this. I mean those frames that are determined by the parameters 90 x 60 x 90. And I'm not saying that a person's weight must necessarily be calculated according to some intricate formulas. Dry numbers do not guarantee health, that's the point.
Ideal for a person is that weight (unless, of course, this weight is pathological), at which he feels great. This is the main rule that I follow when working with my patients. It is not so important whether a person has any folds on his stomach or not. If he wakes up and feels healthy, happy, if he looks at his own reflection in the mirror, and it suits him, if he lives the day with pleasure, if he is efficient, positive, self-confident - then what is the point of changing something in yourself ? For what? To meet some standards that no one knows who invented? Will it bring joy? Indeed, for such a correspondence, one will have to change oneself, change one's Self. That is, in fact, to abandon one's own Self in favor of incomprehensible norms, rules, requirements. Yes, of course, a person can lose several kilograms of weight, but at the same time, he may also lose a sense of joy, the fullness of life.
Therefore, if everything is in perfect order with health and a person is satisfied with himself, I usually say that there is no need for my help.
But if a person has a large, really large weight and the state of health is far from satisfactory, then we can talk about some numbers. The fact is that at a certain stage, excess weight turns into a serious problem, which entails a lot of diseases. And basically the blow falls on the cardiovascular system.
With a significant degree of obesity, fat accumulates in the abdominal cavity, and all internal organs are located on a large fat pad. And this leads to the manifestation of the so-called metabolic syndrome. That is, to a whole range of different medical problems that drastically reduce performance, worsen the quality of human life and its duration.
This is what happens in the body when a large excess of fat accumulates in it. Fatty hepatosis develops, and the liver increases in size. A large number of harmful lipids are produced, which leads to their deposition on the vascular wall. The diaphragm rises, the heart turns and takes a horizontal position, the lungs are pulled up and compressed, which reduces their volume. Accordingly, the volume of oxygen entering the lungs and then into the blood also sharply decreases. Hypoxia, ischemia and insufficient blood supply to organs and cells develop. This disrupts their normal operation. The heart tries to provide oxygen to the organs and begins to work in an enhanced mode, pumping more blood. It works with about the same load as the heart of a professional athlete.
But the resources of the heart are not infinite. The walls of the heart thicken, arterial hypertension develops. Along the way, the sensitivity of the receptors of muscles and other organs to insulin decreases, and it can no longer maintain a normal level of glucose in the blood, which leads to the development of insulin resistance and type II diabetes mellitus.
All together - this is the so-called metabolic syndrome, which can be safely called the disease of our century. People who are diagnosed with such a diagnosis have a lot of problems in everyday life.
Those changes that are functional can be brought within the normal range with the help of properly selected nutrition, physical activity, and a healthy lifestyle in general. But changes that have already become organic are difficult to normalize through nutrition, they require serious treatment with drugs. That is, a person cannot help himself on his own, he needs the help of a doctor.
As you can see, being overweight is not just about wardrobe difficulties and associated inferiority complexes. This is an absolutely real disease, which, like many other diseases, is easier to prevent than to treat.
But how do you know when excess weight becomes a serious problem?
If you look at overweight people, you can see that they can look very different from each other. It depends not only on the amount of fat, but also on where the fat accumulates predominantly. For example, in men, fat deposits often appear in the abdomen, and their figure takes on the shape of an apple. This fat deposition is due to the activity of male sex hormones and is called android obesity. In women, fat is deposited mainly on the thighs and buttocks. Such fat deposition also depends on the activity of sex hormones, but in this case, female ones. The silhouette of a woman becomes like a pear, and obesity is called gynoid. This fat, which accumulates in the lower part of the body, is a kind of strategic reserve, a reserve source of energy in case of pregnancy and lactation.
There is also a mixed form of obesity, which is observed with large deposits of fat.
The deposition of fat in the abdomen poses a great threat to health, since it is much more likely to develop coronary heart disease, arterial hypertension, diabetes, and some forms of cancer.
But not only genetic factors and hormonal levels determine the form of obesity. It has been established that smoking and alcohol abuse, as well as stress, contribute to the deposition of fat in the abdomen.
Determining the type of obesity is quite simple. To do this, measure the circumference of the waist and hips and calculate their ratio.
Waist circumference should be measured between the hypochondrium and the pelvic bone along the mid-axillary line. An ordinary centimeter tape is suitable for this. Stand up straight and relax your shoulders. Make sure the measuring tape fits snugly against your body, but does not dig into your skin, and is parallel to the floor. Now exhale and hold your breath - waist circumference is always measured while holding your breath, this is very important.
Normally, the waist circumference (OT) in women should not exceed 80 centimeters, and in men - 94 centimeters. If these figures are higher, it means that there are excess fat deposits in the abdomen. To be diagnosed with abdominal* obesity, a waist circumference must be greater than 102 centimeters for men and greater than 88 centimeters for women.
* Abdominal type of obesity - excess fat mass mainly in the abdominal cavity or intraviscerally.
Then you need to measure the circumference of the hips (OH). The circumference of the hips should be measured at the most protruding part of the buttocks, also keeping the centimeter tape parallel to the floor.
Now it remains only to divide the waist by the hips. If the ratio exceeds 0.8 in women and 0.9 in men, android obesity.
But volume is not everything. Knowing the form of obesity is, of course, important. But it is equally important to determine the severity of obesity. That is how far things have gone. Now the most informative indicator of the degree of obesity is the body mass index (BMI). Calculating it is simple - you need to divide body weight by height squared. But keep in mind that this indicator may not be entirely accurate in people who have well-developed muscles, as well as in those who, for some reason, have lost a large amount of muscle tissue.
So, to calculate the body mass index, the first thing you need to know is your height and weight.
It would seem, what could be easier than measuring your weight? It is enough to stand on the scales, and in a second you are already upset or, on the contrary, satisfied with yourself. In fact, everything is not so simple. Even with such a seemingly elementary procedure, many mistakes can be made. To avoid them, the following rules must be observed.
Weigh you need in the morning, after emptying the intestines and bladder, on an empty stomach, in the same light home clothes. In addition, you need to use the same scales. And don't weigh yourself more than once a day. The fact is that during the day there can be a significant change in body weight. You eat throughout the day, right? And the eaten portion, lying comfortably in the stomach, can very easily “add” extra grams to you. In general, it is better to weigh yourself once or twice a week. This is quite enough not to miss the moment when the weight begins to change in one direction or another.
At the same time, it is important to set yourself not overestimated, but quite realistic goals, so that with frequent monitoring of the dynamics of weight, there is no dissatisfaction with the slow pace of its reduction. Otherwise, refusal of further therapy, disappointment and a quick return of lost kilograms are possible. The reason is ignorance of the laws of the physiology of one's own body and the mechanism of its self-regulation with a periodic transition to a more economical mode of calorie expenditure and the formation of a "weight plateau" *. Knowledge of such physiological characteristics makes it easy, without emotional breakdowns, to overcome the "weight plateau" and get good results in the process of reducing body weight.
measure height also need at the same time, best of all - in the morning. During the day, a person's height can decrease by 0.5-2 cm, and in some people even more.
* “Weight plateau”, or weight standing point, is the period when the body switches to a more economical mode of energy expenditure, adapting to new metabolic conditions. It can last from one to three months.
Now that you have all the necessary data about yourself, you need to do the math. This is how the formula for determining the body mass index looks like:
For example, you weigh 70 kilograms, and your height is 180 centimeters, that is, 1.8 meters. We consider: we divide 70 by 1.8 x 1.8 (3.24), we get approximately 21.6.
Is it a lot or a little? To answer this question, let's look at the table below:
Classification of obesity by BMI (WHO, 1997)
In our example, the indicator of 21.6 fits into the norm. So, everything is in order, there is nothing to worry about.
If your indicator is higher and fits into the line "overweight", you should not panic, but this is an occasion to think about the future. Overweight is not yet obesity as a clinical condition, and there is no serious threat to health yet. But still, some weight loss will be beneficial. Maybe you should change something in your diet or increase physical activity.
As you can see, the method is very simple. All you need to have on hand are scales, a centimeter tape and a calculator. But, like all simple available methods, it has its drawbacks. I have already said that over or under development of muscles can affect the accuracy of determining the body mass index. That is, it may happen that in a person with well-developed muscles, the BMI indicator will report overweight. But after all, we do not have excess fat, but pumped up muscles. And this is a completely different matter, muscle mass does not pose any threat to health, on the contrary. So, you don't have to worry about losing weight.
Excess water in the body can also affect the accuracy of BMI. Excess water appears, for example, during intense strength exercises, as well as in certain diseases.
Are there more accurate ways to determine excess fat? Of course have. Normally, muscles account for approximately 42% of the weight of the total body weight, the bones of the skeleton - about 16%, the skin - 18%, the internal organs - about 8%, and the body fat - 16% of the weight. So with obesity, the amount of fat in the body increases to 50% or more! So, we just need to determine the percentage of adipose tissue to total body weight. It sounds complicated, but it's actually quite simple.
To do this, you will need a special tool - a caliper or a simple caliper. It is easier to measure the thickness of the fat fold with a caliper, and the result is more accurate. The difficulty is that you can not buy this tool in every store. Will have to search.
To begin with, expose the abdomen, the fat fold cannot be measured through clothing. Stand up straight, don't slouch. Take the caliper in your right hand. With the thumb and forefinger of the left hand, gently grab the skin fold along with subcutaneous fat and slightly pull it forward, separating it from the muscles. The place where the skin fold should be taken is to the right or to the left of the navel, preferably on the right (always on one side to track the dynamics).
Now lay the ends of the caliper in the middle between the base and the top of the pleat. While still holding the pleat with your left hand, slowly press your right thumb against the caliper platform until you hear a click. Everything, you can take readings and check the table, which I will give below.
Before naming specific figures, I will name a few rules that must be observed when measuring the fat fold with a caliper. First of all, measure the crease on the right half of the body. So you will be much more comfortable. Do not use the caliper on broken or diseased skin. No extra problems for you. To make it easier to capture the crease correctly, do not use creams and lotions before measuring. The skin must be dry and clean. Do not measure the fat fold immediately after exercise or visiting the sauna - fluid may accumulate under the skin and the results will be inaccurate. It is better to measure the fold at the same time with the same tool.
So, the measurement was successful, what now? And now you need to look at the received numbers. Normally, the thickness of the fat fold at the age of 30 should not be more than 2-3 cm. After 30 years, it can increase to 3-4 cm.
But there is one problem - adipose tissue can be distributed in the body in different ways. To achieve more accurate results, it is better to measure the thickness of the fat fold in four places, and not in one. Namely: near the navel, under the shoulder blade, in the biceps and triceps. Well, then you need to add up all the numbers.
The resulting amount fairly accurately reflects the percentage of fat in the body. Now, with the numbers in hand, you can look at the table.
Obesity has become one of the problems of society in the twenty-first century. The disease "recruits" new adherents around the world. This is due to malnutrition, a sedentary lifestyle, a significant number of chronic endocrine pathologies and many other factors. Literally, obesity means that body weight does not increase due to muscle compaction, but due to fat deposits in different parts of the body. Why is obesity dangerous? Looking at overweight people, any doctor will name a dozen reasons, and in the first place there will be diseases of the heart, blood vessels, joints and bones, a violation of water-salt metabolism. In addition, this disease makes social life difficult, as modern society is dominated by trends towards sports and a healthy lifestyle.
Etiology
The disease "obesity" can develop for a variety of reasons. The most obvious is physical inactivity, that is, a discrepancy between the calories received and the energy expended. The second common cause of excess weight is a violation of the gastrointestinal tract. This may be a lack of pancreatic enzymes, decreased 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, these include:
- consumption of sugary drinks or a diet high in 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 2 million years has provided a mechanism for the accumulation of nutrients in case there is a sudden shortage of food. And if for ancient people this was relevant, then modern man does not need such "stores". However, our body is designed in such a way that it stereotypically reacts to both positive and negative external influences. Therefore, the problem of obesity at the moment has risen so acutely.
Pathogenesis
The regulation of the deposition and mobilization of fat depots is carried out as a result of a complex interaction between the nervous system and the endocrine glands. The main reason for the accumulation of a large amount of lipids is the mismatch of 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 consumes energy, so all the excess is left "in reserve", which leads to the appearance of excess adipose tissue.
Such a violation of the coordination of the center can be both an innate condition and acquired as a result of education. In addition, such problems are sometimes the result 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 somatotropic hormone drops sharply, then almost 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.
BMI classification
The classification of obesity is better to start with the one that is known to the general population. As a rule, the primary diagnosis of this disease is carried out based on such an indicator as This is a private value obtained after dividing body weight in kilograms by height in meters squared. There is the following gradation of obesity according to this indicator:
- Underweight - if BMI is less than or equal to 18.5.
- Normal body weight - mass index should be in the range from 18.5 to 25.
- Preobesity - BMI ranges from 25 to 30 points. At this point, the risk of comorbidities, such as hypertension, bedsores and diaper rash, increases.
- Obesity 1 degree is set if the BMI is from 30 to 35.
- Obesity 2 degrees - the index is approaching 40 points.
- Obesity of the 3rd degree 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 it, primary and secondary obesity are distinguished. Each of them has its own subclasses.
So, primary obesity is divided into:
- gluteal-femoral;
- abdominal;
- caused by eating disorders;
- stressful;
- provoked by metabolic syndrome.
In secondary, symptomatic obesity, four subtypes can be deduced:
- Hereditary, with a gene defect.
- Cerebral, provoked by neoplasms, infections or autoimmune brain damage.
- Endocrine, caused by dysregulation of the thyroid, hypothalamic-pituitary system, adrenal glands and gonads.
- Medication associated with taking steroid drugs, hormonal contraceptives and cytostatics.
Clinical and pathogenetic classification
If we take as a basis the mechanisms that lead to the appearance of overweight, then we can make the following classification of obesity:
Alimentary-constitutional. Weight gain is associated with excess fat in the diet and inactivity. It manifests itself, as a rule, in childhood and can be associated with a hereditary predisposition.
- Hypothalamic. The increase in adipose tissue occurs due to damage to the hypothalamus and, as a result, a violation of its neuroendocrine function.
- Endocrine. At the heart of fatness is the pathology of the endocrine glands - the pituitary gland, thyroid gland, adrenal glands.
- Iatrogenic. Obesity is caused by medical intervention. This can be medication, removal of an organ or part of it, damage to the endocrine system during treatment, and much more.
Classification by localization of adipose tissue
After examining overweight patients, it was noticed that not everyone has it distributed equally. Therefore, over time, a classification of obesity was derived, based on the characteristic location of the fat layer.
The first type, also known as the upper, or android type, differs in that the upper half of the torso, face, neck, and arms increase predominantly. It occurs more often in men, but it can also be seen in women who have entered the menopause period. A number of authors claim that there is a link between this type of obesity and the risk of developing diabetes mellitus, as well as the pathology of the cardiovascular system.
The second type, the lower or gynoid, is an accumulation of adipose tissue on the thighs 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. in this case, there will be pathologies of the spine, joints and vascular network of the lower extremities.
The third type is mixed or intermediate obesity. In this case, excess weight is more or less evenly distributed over the body, smoothing the line of the waist, neck, buttocks.
In order to determine which type of obesity the patient applied for, it is necessary to determine the ratio of waist and hip circumference. If in women this indicator is more than 0.85, and in men it is more than one, then it can be argued that a person has the first variant of the distribution of adipose tissue.
Morphological classification
In the process of obesity, changes affect all levels of life organization, not only the whole body, but also individual organs, tissues, and even just cells. Adipocytes (fat cells) may undergo qualitative or quantitative changes. Depending on this, there are:
- hypertrophic obesity. It is characterized by a pathological increase in the size of fat cells, while their number remains the same.
- Hyperplastic obesity, in which adipocytes are actively dividing. This form occurs in children and is treated very poorly, since the number of cells can be reduced only by aggressive methods.
- Mixed obesity, as it is logical to assume, is a mixture of the two previous ones. That is, the cells not only increase, but there are more of them.
Classification of obesity in children
According to statistics, in Russia now about 12% of children suffer from overweight. Of these, 8.5% are urban residents, and 3.5% are rural. Obesity in adolescents and children has become such a common pathology that pediatricians have decided to introduce a special section in their educational work with young parents about diet. Obesity is considered a condition when the body weight of a child exceeds 15% of the due at his age. If correlated 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 feeding, or the rejection of breast milk in favor of cow's. But it can also be hereditary if overweight people predominate in the family. But even so, the child is not born fat, he just has a slow metabolism, and with proper diet and exercise, he will keep his weight within normal limits. Critical for primary obesity are the first three years of life and puberty.
Secondary obesity is associated with the presence of acquired endocrine pathologies. The criteria by which the degree of overweight gain is determined are still debatable. The following scale has been 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 or more times higher than the age norm.
Symptoms
The signs of obesity are basically similar to each other, the difference is only in the uniform distribution of excess fiber, as well as the presence of concomitant pathologies or their absence.
Most often in patients occurs that is associated with a violation of the normal diet. As a rule, such people have a hereditary predisposition to weight gain, and excessive food intake leads to weight gain. Symptoms occur in all members of the family, as they all eat together. In addition, this type of obesity affects older women who, due to their poor health, lead a sedentary lifestyle.
Obesity 1 degree is observed in most people who systematically transmit, especially in the evening. This happens because there is no time and desire for breakfast and lunch. Hungry people consume their daily calorie intake at dinner and go to sleep.
It is characterized not only by weight gain, but also by the presence of symptoms of disorders of the nervous system and endocrine regulation. Obesity develops very quickly and is usually 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 pathology in his area.
Diagnostics
Obese people have extremely reduced criticism of their condition, so to persuade or force them to go to the doctor even for a simple consultation is not an easy task. Quite another matter - patients of the endocrinologist or the neuropathologist. These themselves want to be examined and reduce weight for a speedy recovery.
The most commonly used criterion for diagnosing overweight is the body obesity index. That is, how much the actual mass is more than the due. To determine the severity, it is important not only to prove the fact of the presence of excess weight, but also the fact that it is realized at the expense of adipose tissue, and is not a muscle mass. Therefore, in medical practice, they are actively trying to introduce methods for determining exactly the fat mass, and not the entire body weight.
The norm is determined taking into account statistical data collected by doctors of various specialties over the years of practice. For each gender, age, dew and physique, there are tables with already calculated pathology and norm values. Scientists have found that centenarians have a body weight of 10% less than normal. Pathological obesity is diagnosed in the opposite case, when the weight exceeded the upper limit of the permissible by 10%.
There are several formulas for calculating ideal body weight. All fashionistas know one of them - one hundred must be taken away from height in centimeters. The resulting number will be the desired value. But this is a very conditional and unreliable study. More accurate is the BMI or 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 of the weight gain.
Treatment
The fight against obesity is carried out viciously and everywhere. Now the media is actively promoting a healthy lifestyle and the cult of a beautiful, athletic body. Of course, it is not worth bringing the situation to the point of absurdity, but the general direction of the youth movement is more preferable than decadent hedonism.
The main principles of obesity treatment include:
- 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 speed up the metabolism.
- drugs for weight loss and appetite;
- psychotherapy;
- surgery.
To achieve long-term results of any of the types of treatment, it is necessary to change your diet and the frequency of meals. 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 the food that the patient consumes as usual and gradually reducing the number of calories. It is necessary to reach the mark of 1500 - 1200 kilocalories, provided that the person does not overload himself physically.
Psychotherapy is aimed at strengthening willpower and self-control in relation to food intake and dependence on fast food restaurants and sweet soda. Medicines in the process of weight loss help to achieve only a short-term effect. After stopping the pills, the patient returns to the previous lifestyle and does not follow the recommendations received at discharge. Despite the fact that now the pharmacological industry can offer a large selection of overweight drugs, almost all of them are prohibited due to the side effects caused.
Surgical methods include suturing the stomach, 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 small intestine is sutured to the smaller one. Thus, the volume of the stomach decreases, and the rate of passage of food becomes higher. The second option is gastric banding. A ring is installed in the cardial part, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritates the satiety center, allowing the patient to eat less.
What type of obesity is the most dangerous? Perhaps everything. No one can say that typing is good for a person. The level of danger depends on how much the actual weight exceeds the norm, and what concomitant diseases he has.
Obesity has somehow imperceptibly turned from a problem of an individual into a scourge of modern society. In the developed countries of the world, such as the United States, the number of people suffering from obesity reaches a staggering 68%, and every year this statistic is only getting worse. But what is even worse, obesity has firmly taken the second place among the diseases leading to death. What can we say about others, if in Russia 50% of men and 62% of women over 30 are obese. And this is a direct path to the development of heart disease, atherosclerosis, diabetes, and hence a heart attack or stroke.
It seems that the reasons for the development of obesity are well known to everyone - a sedentary lifestyle, passion for fast food, overeating and constant stress, but only the normalization of nutrition and an active lifestyle do not always guarantee the return of a slim figure and health promotion. “Perhaps you are putting in the wrong effort!” say nutritionists. To get rid of excess weight and prevent health problems, first of all, you need to find out if you have obesity and what type it is, and only then, based on the available data, build an effective weight loss strategy. This is worth looking into in detail.
Definition of obesity by body mass index
First, let's figure out how to determine if you have obesity. To do this, it is not necessary to go to the doctors, because it is enough to calculate your body mass index to find out if you have excess weight, and if so, at what stage is obesity.
The Body Mass Index (BMI) is very easy to calculate. To do this, you need body weight (in kilograms), divided by height (in meters), squared. For example, with a height of 182 cm and a weight of 77 kg, the body mass index will be calculated as follows: BMI \u003d 77: (1.82 x 1.82) \u003d 23.3.
- For a woman, a BMI below 19 is considered underweight, 19-24 is normal weight, 25-30 is overweight, 30-41 is obese, and above 41 is severely obese.
- For men, a BMI below 20 is considered underweight, 20-25 is normal weight, 26-30 is overweight, 30-41 is obese, and above 41 is severely obese.
If you look at the appearance of a person, you can see that fat deposits are localized in different parts of the body. Based on this, doctors distinguish 3 types of obesity:
- gynoid type (female-type obesity);
- android type (male-type obesity).
- mixed type.
Gynoid type of obesity
Gynoid obesity, often referred to as female-type obesity, is an accumulation of fatty deposits on the buttocks, thighs, and lower legs. Most often, this problem occurs in women whose body is pear-shaped. In this case, even having lost extra pounds, excess fat mass treacherously remains in the lower body, which seriously spoils the appearance and negatively affects self-esteem.
According to doctors, this type of obesity develops against the background of increased production of female sex hormones. That is why this problem most often haunts women, although occasionally it also occurs in men who have partially or completely impaired testosterone production. Pear-shaped individuals who are prone to obesity suffer from varicose veins, hemorrhoids, diseases of the musculoskeletal system (osteochondrosis, arthritis, spondylosis and coxarthrosis), as well as venous insufficiency and cellulite.
Fighting this type of obesity is the most difficult, since fat from the hips and buttocks will go last. It is important to be patient, change your diet, and at the same time train the lower limbs, doing running, cycling and other active exercises, where most of the legs and buttocks are involved. Regular massage of local areas will also be useful.
If we talk about nutrition for female obesity, then it is important to remember that the number of meals should be at least 5 times a day, and the main emphasis should be on dinner, which should contain 40% of the daily diet. The fact is that in people with gynoid obesity, metabolic processes accelerate in the evening, which means that most of the food should be eaten at dinner, the main thing is that it should be no later than 19:00 and no later than 3 hours before bedtime. Breakfast should be left at 20%, lunch at 30% of the daily ration, and the remaining 10% should be equally divided between two snacks.
It is also important to exclude the consumption of trans fats (cooking oil, margarine), to minimize the consumption of chocolate, soft caramel, muffins and confectionery. White flour, sugar, coffee and alcoholic beverages should also be avoided. The basis of the daily diet should be raw and boiled vegetables and fruits, bran, cereals and wholemeal bread.
Let's also say that fat accumulating in the thigh area provokes the development of cellulite. To counter this scourge, you need to "lean" on foods with a large amount of antioxidants, namely fruits (lemons and apples) and berries (currants, blueberries, raspberries). The total amount of fruits or berries consumed per day should be at least 300 grams.
Android type of obesity
Android obesity is often called male-type obesity, and all because this form is more common in men (beer belly). With it, fat deposits accumulate in the upper body, mainly on the abdomen, in the chest and in the armpits. Doctors call this obesity the most dangerous for a person, since most of the fat accumulates in the internal organs, leading to high blood pressure, diabetes, infertility (in women) and impotence (in men). Moreover, from excess fat, the functioning of the liver and kidneys is disrupted, which, without treatment, can threaten the patient with kidney or liver failure.
It is not difficult to determine this type of obesity. Outwardly, in a person with such a problem, you can notice a bulging belly and the absence of a waist, which is larger in girth than the circumference of the hips. For medical reasons, a waist circumference of more than 80 cm in women and more than 94 cm in men indicates the risk of android obesity. In addition, the presence of this type of obesity can be calculated by dividing the waist circumference by the hip circumference. If the resulting index is more than 1 for a man and more than 0.85 for a woman, there is every reason to talk about male-type obesity.
However, there is also good news. The fact is that this type of obesity is the easiest to treat. To do this, first of all, it is necessary to normalize nutrition, where breakfast should be given 40% of the diet, 30% for lunch and 20% for dinner, and the remaining 10% for two snacks. Moreover, you need to start your day with food rich in heavy carbohydrates (all kinds of cereal cereals). During the day, you should eat lean meat, fish with polyunsaturated fatty acids (tuna, salmon, halibut, trout), as well as boiled or fresh vegetables and fruits, in soups and in the form of salads. You need to end your day with a light dinner with a vegetable salad and a piece of lean meat, or with kefir and bread.
Mixed type of obesity
This is the most common type of obesity, in which fat is deposited evenly throughout the body - on the arms, legs, stomach, hips and back. The danger of such obesity lies in its invisibility, because after gaining an extra 10-15 kilograms, a person practically does not notice visual changes in the figure. The hormonal background in people with such a problem is normal, and therefore the metabolism throughout the day is the same.
In this case, it is necessary to fight the problem of obesity according to the "classic" scenario, that is, eat five times a day (3 main meals and 2 snacks), where the main meals should account for 25% of the daily diet, and snacks - 12 ,5%.
Tellingly, this type of obesity is associated with fluid retention in the body. You should not be afraid of this, just as you should not limit yourself to fluid intake (this will only reduce your chances of losing weight). Try to consume 1.5-2 liters of fluid per day (including liquid foods), limit salt intake, and make sure that protein foods are always present in the diet. On average, one should start from the norm of 1 g of protein per 1 kg of body weight, however, the norm of protein can be increased to 2 g of protein if a person regularly exercises. At the same time, it is desirable to obtain protein from lean meat and fish (rabbit, chicken breast, cod, pollock, hake), as well as from milk, eggs and plant foods (cereals, peas, beans and nuts).
So, any obese person, regardless of type, should permanently stop smoking and stop drinking alcohol. It is important to minimize the use of salt and sugar, to refuse canned foods, various purchased sauces (mayonnaise, ketchup), to reduce the consumption of confectionery and sweet muffins. White bread should also be banned, and dietary wholemeal bread should be used instead.
Physical activity in obesity
Let's not forget about physical activity, which should stimulate blood circulation, improve metabolism, and therefore accelerate fat burning and strengthen the body. A doctor should select physical activity, since some sports can be traumatic for overweight people.
For people with severe obesity, it is enough just to start moving regularly. To do this, they need a regimen of 200 minutes of cardio activity per week. You can just take daily walks and light jogs, but it is best to spend this time in the pool, swimming. Water helps to relieve stress on the spine, and besides, all the major muscles of the body are involved during swimming, which perfectly increases the effectiveness of any diet.
Obese people can ride a bike, dance or go to the gym while working on cardio equipment. But team sports, which involve jumping and any impact loads, are contraindicated for such people, as they can damage the ankles and knees. Gymnastics, namely callanetics, will also be an excellent solution. This type of gymnastics is specially designed for weight loss and healing of the body. It perfectly speeds up the metabolism and reduces the volume of the body due to the rapid burning of body fat. Being engaged in callanetics 3 times a week for an hour, in a month you can notice amazing weight loss results. Health to you and a beautiful figure! Photo: Photobank Lori