Obesity. Obesity and overweight Result to excess body weight

Overweight syndrome – current problem modern world. A sedentary lifestyle, stress, bad habits, street fast food are risk factors that lead the population of all ages to varying degrees of obesity.

The United States holds the record for the number of overweight people - two-thirds of Americans are overweight. Europe is in second place with about 28% of obese people. Japan ranks third with 20% of overweight people.

Chronic obesity is gradually becoming a global epidemic. Overweight and obesity have become common diagnoses even among people in developing countries. Previously, the acute problem here was the lack of food, now every tenth person suffers from diseases associated with excess weight.

The presence of excess weight can be determined using Quetelet’s formula: BMI = Weight/Height2 [kg/m2]. A BMI greater than 25 indicates overweight.

Quetelet's formula is the main guideline in diagnosing excess weight. Please note that a BMI that is slightly higher than normal does not warrant a diagnosis of obesity. But if accompanying symptoms occur (extra pounds make it difficult to tolerate physical activity, the functions of internal organs, skin, stomach upsets, constipation, thirst, shortness of breath, joint pain), then it’s time to seek help from specialists in the field of nutrition.

Overweight and obesity are different concepts. With obesity, a thick layer of fat accumulates under the skin. Fat forms in the chest, abdomen, thighs and buttocks, covers the heart, blood vessels and liver, causing organ dysfunction and chronic diseases.

• Cardiovascular diseases develop. deposited on the walls of blood vessels, blood clots form. Blood circulation worsens, blood pressure increases, and the risk of developing atherosclerosis, hypertension, and strokes increases. The heart increases in size and becomes covered with fat. Performance decreases, shortness of breath torments.
• Metabolism is disrupted and diabetes mellitus develops. The retinas of the eyes and kidneys suffer, the body does not fight infections well - due to high level Sugar in the blood becomes an ideal breeding ground for pathogenic bacteria.
Poor digestibility of proteins, fats, carbohydrates and salts provokes dysfunction of the musculoskeletal system. Salts are deposited, joints hurt, and the risk of developing arthritis, arthrosis, neuritis, and gout increases. Excess weight puts stress on the spine and leg joints. The center of gravity shifts, cartilage tissue wears away, and curvature of the spine occurs.
• Overeating is bad for the liver. Combined with a sedentary lifestyle, excessive carbohydrate consumption fills the liver with glycogen and fat deposits. Excess weight causes fatty liver, diseases of the gallbladder and ducts, and the formation of stones.
• Gastrointestinal diseases occur. Chronic overeating overloads the digestive system. The stomach and small intestine increase in size by up to 40%, which leads to digestive disorders, chronic gastritis and other diseases.
• Sexual functions are impaired. Half of obese women have disrupted menstrual cycles, problems with conception, and infertility. Excess weight, even in young men, leads to impotence and decreased sperm activity.

Causes of excess weight

Doctors are confident that the main causes of obesity are associated with genetic and endocrine disorders and heredity. Nutritionists respond by stating that an innate predisposition to excess weight will not manifest itself if a person is taught to eat properly from childhood. Psychologists say that overweight is a consequence of stress and dislike for one’s own body.

If a participant decides to ignore traditions, he will certainly encounter condemnation and resistance from others. By changing eating behavior, the participant unwittingly forces others to adjust their diet, which they clearly did not plan.

Lack of understanding and support from family and friends makes it difficult to achieve the goal, and sometimes stops a person halfway to losing excess weight.

Eating habits

The harm of eating habits imposed by the Western lifestyle is known to people, but changing habitual behavior is not so easy. It seems that the crazy rhythm of life, busy work schedule, bustle and stressful situations should promote weight loss. As a result, another risk factor for the development of obesity arises. Pay attention to the list of habits that do not bring anything good to people, but harm the body and figure.

• People have forgotten how to have breakfast. Breakfast is the main source of energy. In the morning, a person should consume at least 400 kilocalories to feel normal. If you didn’t have breakfast in the morning, you eat on the go, quickly and a lot, or you eat up for the whole day with a hearty dinner.
• They eat poor quality food. Delicacies, sweets, smoked meats, fast food - food rich in flavors, carbohydrates, calories. Nutrients – zero, one harm to the body. A lack of fruits and vegetables interferes with the synthesis of good cholesterol and the elimination of bad cholesterol.
• Eat in large portions. Nutritionists recommend placing a portion on a plate that fits in two palms. People are able to eat 2-3-4 times more food, but the body will absorb and process only the first portion into energy, and subcutaneous fat is formed from excess food.
• They eat and watch TV. While eating, you need to look at the food, and listen to your own stomach in order to receive a signal from the body in time: “I’m full”! TV occupies the brain with unnecessary information, so there is no control over the saturation process. And it is also being produced conditioned reflex: The TV turned on - my mouth began to water, I urgently need to make a sandwich.
• They chew gum. Chewing gum contains carbohydrates; in addition, chewing gum on an empty stomach provokes gastritis and other gastrointestinal diseases. As a result, digestion and metabolism are disrupted.
• They forget. Water is an essential solvent for digestion. You need to drink two liters of clean water at room temperature per day. Not tea, not soda, not juices - just plain water.

Lack of physical activity

The era of a sedentary lifestyle has arrived for humans. We work while sitting, we drive while sitting, we eat while sitting, while sitting we watch TV or sit at the computer, we sit with friends in a cafe... Lack of physical activity is a major risk factor for overweight and obesity. Being active and athletic is also good for appearance, and for the health of the whole body.

A person needs healthy physical activity, at least 60 minutes of daily exercise: running, jumping jacks, swimming, regular morning exercises.

Sleep problems

Chronic sleep problems lead to exhaustion of the body. A person who has not had enough sleep feels lethargic and is not ready for vigorous activity. Instinctively, the body looks for a source of additional energy and finds it in food. In addition, fatigue reduces the level of protein, which is responsible for regulating appetite, and metabolism slows down. No matter how much a person eats, the energy reserves in the body will not be replenished. Calories burn slowly, and the feeling of hunger continues to torment you.

Psychological

People who are in a state of chronic emotional stress strive to drown out internal discomfort by any means. Having not found support among loved ones, many find solace in food.

Stress

Stressful situations increase the level of hormones in the human body. In order to protect against an aggressive external environment, hormones are produced: cortisol (responsible for preserving energy resources) and cortisone (causes the accumulation of fat reserves). The fight against stress begins.

In order to get rid of stress state a person needs to apply an active strategy: find and eliminate the cause of the situation. But more often the struggle takes place in a passive form, the body tries to eliminate the consequences, and not the cause of the situation.

People who are prone to obesity choose passive strategies to deal with stress - instead of looking for solutions, they “eat up problems.”

Psychotherapists have noticed that symptoms of central obesity in women (when excess abdominal fat accumulates on the abdomen) indicate dissatisfaction with life. A thick fat pad forms in the solar plexus area - energy center, for protection from the outside world. The more a woman is dissatisfied with herself and her life, the more fat forms on her stomach.

Alexithymia

With alexithymia, a person cannot distinguish between emotions and does not recognize the difference between feelings of fear and anxiety, sadness and anger. Feeling nervous tension, boredom, disappointment, people experience emotional hunger, but mistake it for physical hunger. As a result, every emotional outburst is accompanied by a hearty snack.

Sexual problems

Lack of regular sex life leads to a lack of the good hormone oxytocin. Oxytocin, the “calm hormone,” is also released when consumed. Therefore, single people compensate for the lack of sex by eating fatty foods.

Excess body weight may be associated with negative sexual experiences in the past.

People who have experienced sexual violence experience anxiety and fear when thinking about intimate relationships, and unconsciously strive. Excess weight helps them get rid of attractive shapes, hide natural sexuality, avoid repeating unpleasant experiences.

Many women gain weight after marriage. Psychologists say that slender beauties who have found family happiness turn into plump women due to the loss of the need to seduce and attract men. Married woman there is no one to demonstrate the dignity of the figure except her own husband. And the husband supposedly loves his wife “in any form”...

Homework: After familiarizing yourself with the mechanisms of excess weight accumulation, make a list of risk factors that lead to the accumulation of fat in your body or prevent you from losing weight. Using the list, find solutions that will help you eliminate the causes and develop a weight loss strategy.

Fighting excess weight

The fight against excess weight is, first of all, an internal confrontation between willpower and excessive appetite and laziness. The latter factors win out more often, which is why few people manage to get closer to their cherished ideal weight.

If your decision to lose weight is harder than rock, you are ready to believe in the power healthy eating and adjust your diet, stop sitting on the couch and start doing a daily set of exercises for weight loss - you can win over excess weight!!!

Help from a nutritionist

Consulting a nutritionist is a necessary step on the path to weight loss. Each body is unique, so there is no single prevention that can help everyone. By contacting a nutritionist, you will receive comprehensive information about your body and find out which weight loss strategy will suit your body. The specialist will explain in detail the basic rules for losing weight that you will have to follow throughout your life.

• Not to starve! The diet only needs to be slightly adjusted: reduce the single serving, replace harmful foods with healthy analogues. Strict diets, instead of losing weight, have the opposite effect. Feeling prolonged hunger, the body decides that extreme times have come and it urgently needs to stock up on fat.
• Eat little and often! Nutritionists recommend eating your daily diet in 5 meals: breakfast, second breakfast, lunch, afternoon snack, dinner. Feeling the urge to grab a quick snack, choose fruits, vegetables,... You should not eat before going to bed.
• Maintain a balance of nutrients! Balance your diet so that you eat 30% protein, 20% fat and 50% carbohydrates per day.
• Burn more calories than you eat! Therefore, the more you eat at lunch, the more physical activity you need to burn off the calories. Conclusion: either eat in moderation, or sweat in the gym sparing no effort.
• Drink water! A glass of water, drunk half an hour before meals, will dull hunger and the desire to devour all the dishes that are on the table. In addition, water is a universal solvent and is necessary for digestion.

Help from a psychologist

Normal eating behavior is the best therapy for excess weight. Keep track of what you think about, do and feel while eating, write down your observations in your diary. The recordings will help you understand what behaviors need to be changed.

• Eat mindfully! Listen to your inner feelings, try to eat to satisfy your hunger, and do not “eat” stress and emotional tension.
• Turn off the TV! You need to eat at the table, looking at the plate, thinking about the benefits that the food you eat will bring. Break the association between eating and watching TV, reading, and talking.
• Distinguish between hunger and emotions! Find out what emotion makes you feel hungry? Fear, boredom, sadness, fatigue? If you are drawn to the refrigerator by emotion rather than hunger, find other ways to satisfy your emotional needs.
• Learn to think sensibly! A negative attitude towards healthy eating makes dieting a punishment for those losing weight. Learn to overcome negative attitudes and encourage healthy eating habits, otherwise therapy will not be effective.
• Choose an active rhythm! Use to track your activity level and track calories burned during the day. This way you will quickly learn self-control and make sure that you have chosen the right path.

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– excess fat deposits in subcutaneous tissue, organs and tissues. It manifests itself as an increase in body weight by 20 percent or more of the average due to adipose tissue. It causes psycho-physical discomfort, causes sexual disorders, diseases of the spine and joints. Increases the risk of developing atherosclerosis, coronary artery disease, hypertension, myocardial infarction, stroke, diabetes mellitus, kidney damage, liver damage, as well as disability and mortality from these diseases. The most effective treatment for obesity is the combined use of 3 components: diet, physical activity and appropriate psychological adjustment of the patient.

General information

According to WHO international experts, obesity is a global epidemic of our time, affecting millions of people on the planet, regardless of professional, social, national, geographical, gender and age groups. In Russia, up to 30% of the working population are obese and another 25% are overweight. Women are susceptible to developing obesity twice as often as men; the critical age for the appearance of excess weight is from 30 to 60 years.

Obese patients are 2-3 times more likely to suffer from hypertension, 3-4 times more likely to suffer from angina pectoris and coronary heart disease than people with normal weight. Almost any disease, even such as ARVI, influenza and pneumonia, in obese patients takes longer and is more severe, and has a higher percentage of complications.

Causes of obesity

The development of obesity is most often caused by an imbalance between energy intake from food and energy expenditure of the body. Excess calories that enter the body and are not consumed by it are converted into fat, which accumulates in the body’s fat depots (mainly in the subcutaneous tissue, omentum, abdominal wall, internal organs, etc.). An increase in fat reserves leads to an increase in body weight and disruption of the functioning of many body systems. Overeating leads to obesity in more than 90%; another 5% of obesity cases are caused by metabolic disorders.

A number of factors contribute to the development of obesity:

• inactive lifestyle;
• genetically determined disorders of enzymatic activity (increased activity of lipogenesis enzymes and decreased activity of enzymes that break down fats (lipolysis);
• errors in the nature and diet (excessive consumption of carbohydrates, fats, salt, sweets and alcoholic drinks, eating at night, etc.);
• some endocrine pathologies (hypothyroidism, hypogonadism, insulinoma, Itsenko-Cushing's disease);
• physiological conditions (lactation, pregnancy, menopause);
• stress, lack of sleep, taking psychotropic and hormonal drugs(steroids, insulin, birth control pills) etc.

Pathogenesis

Changes in eating behavior occur as a result of disruption of the hypothalamic-pituitary regulation, which is responsible for controlling behavioral reactions. Increased activity of the hypothalamic-pituitary-adrenal system leads to an increase in ACTH production, the rate of cortisol secretion and an acceleration of its metabolism. There is a decrease in the secretion of somatotropic hormone, which has a lipolytic effect, hyperinsulinemia develops, a violation of the metabolism of thyroid hormones and tissue sensitivity to them.

Classification

In 1997, the World Health Organization proposed a classification of degrees of obesity based on the definition of an indicator - body mass index (BMI) for persons from 18 to 65 years. BMI is calculated using the formula: weight in kg / height in meters squared. Based on BMI, the following types of body weight and the risk of developing associated complications are distinguished:

• BMI from 18.5 to 24.9 (usual) – corresponds to normal body weight. With this BMI, the lowest morbidity and mortality rates are observed;
• BMI from 25.0 to 29.9 (increased) - indicates overweight or pre-obesity.
• BMI from 30.0 to 34.9 (high) – corresponds to stage I obesity;
• BMI from 35.0 to 39.9 (very high) – corresponds to stage II obesity;
• A BMI of 40 or more (excessively high) indicates obesity of III and IV degrees.

A BMI of 30 or more indicates the presence of obesity and a direct threat to health, requiring a medical examination and the development of an individual treatment regimen. By comparing actual and ideal body weight, obesity is divided into 4 degrees:

• in grade I, excess weight is no more than 29%
• II degree is characterized by excess weight by 30-40%
• III – by 50-99%
• at grade IV, there is an increase in actual body weight compared to the ideal by 2 or more times. Ideal body weight is calculated using the formula: “height, cm - 100.”

Based on the predominant localization of fat deposits on the body, the following types of obesity are distinguished:

1. Abdominal(upper or android) – excessive deposition of adipose tissue in the upper half of the torso and abdomen (the figure resembles an apple in shape). It develops more often in men and is most dangerous to health, as it is associated with the risk of arterial hypertension, diabetes, stroke and heart attack.
2. Femorogluteal(lower) – predominant deposition of adipose tissue in the hips and buttocks (the figure resembles a pear in shape). It is more common in women and is accompanied by dysfunction of the joints, spine, and venous insufficiency.
3. Intermediate (mixed) - uniform distribution of fat deposits throughout the body.

Obesity can be progressive in nature with an increase in the volume of fat deposits and a gradual increase in body weight, or be in a stable or residual stage (residual after weight loss). According to the mechanism and causes of development, obesity can be primary (nutritional-metabolic or exogenous-constitutional, or simple), secondary (hypothalamic or symptomatic) and endocrine.

1. The development of primary obesity is based on an exogenous, or nutritional, factor associated with the increased energy value of the diet with low energy consumption, which leads to the accumulation of fat deposits. This type of obesity develops as a result of the predominance of carbohydrates and animal fats in food or a violation of the diet (rich and rare meals, consumption of the main daily calorie intake in the evening) and often has a family predisposition. Calories contained in fats contribute more to weight gain than those contained in proteins and carbohydrates. If fats supplied with food exceed the capabilities of their oxidation in the body, then excess fat accumulates in fat depots. Physical inactivity significantly reduces the ability of muscles to oxidize fat.
2. Secondary obesity accompanies such hereditary syndromes as Babinski-Froelich disease, Gelineau syndrome, Lawrence-Myn-Bardet-Biedl syndrome, etc. Also, symptomatic obesity can develop against the background of various cerebral lesions: brain tumors, dissemination of systemic lesions, infectious diseases, mental disorders, traumatic brain injuries.
3. The endocrine type of obesity develops with pathology of the endocrine glands: hypothyroidism, hypercortisolism, hyperinsulinism, hypogonadism. With all types of obesity, hypothalamic disorders are observed to one degree or another, which are either primary or occur during the course of the disease.

Obesity symptoms

A specific symptom of obesity is excess body weight. Excess fat deposits are found on the shoulders, abdomen, back, sides of the body, back of the head, hips, and pelvic area, while underdevelopment of the muscular system is noted. The patient’s appearance changes: a double chin appears, pseudogynecomastia develops, fat folds on the abdomen hang down in the form of an apron, and the hips take the shape of riding breeches. Umbilical and inguinal hernias are typical.

Patients with degrees I and II obesity may not present any special complaints; with more severe obesity, drowsiness, weakness, sweating, irritability, nervousness, shortness of breath, nausea, constipation, peripheral edema, pain in the spine and joints are noted.

Patients with grade III-IV obesity develop disturbances in the functioning of the cardiovascular, respiratory, and digestive systems. Objectively, hypertension, tachycardia, and muffled heart sounds are detected. A high position of the dome of the diaphragm leads to the development of respiratory failure and chronic pulmonary heart disease. Fatty infiltration of the liver parenchyma, chronic cholecystitis and pancreatitis occurs. Pain in the spine and symptoms of arthrosis of the ankle and knee joints appear.

Obesity is often accompanied by menstrual irregularities, including the development of amenorrhea. Increased sweating causes the development of skin diseases (eczema, pyoderma, furunculosis), the appearance of acne, stretch marks on the abdomen, hips, shoulders, hyperpigmentation of the elbows, neck, and places of increased friction.

Nutritional obesity

Obesity various types has similar general symptoms, differences are observed in the pattern of fat distribution and the presence or absence of signs of damage to the endocrine or nervous systems. With nutritional obesity, body weight increases gradually, fat deposits are uniform, sometimes predominant in the thighs and abdomen. There are no symptoms of damage to the endocrine glands.

Hypothalamic obesity

With hypothalamic obesity, obesity develops quickly, with a predominant deposition of fat on the abdomen, thighs, and buttocks. There is an increase in appetite, especially in the evening, thirst, night hunger, dizziness, and tremor. Trophic skin disorders are characteristic: pink or white stretch marks (stretch stripes), dry skin. Women may develop hirsutism, infertility, disorders menstrual cycle, in men - deterioration in potency. Neurological dysfunction occurs: headaches, sleep disturbance; autonomic disorders: sweating, arterial hypertension.

Endocrine obesity

The endocrine form of obesity is characterized by a predominance of symptoms of underlying diseases caused by hormonal disorders. The distribution of fat is usually uneven, with signs of feminization or masculinization, hirsutism, gynecomastia, and cutaneous stretch marks. A unique form of obesity is lipomatosis – benign hyperplasia of adipose tissue. Manifested by numerous symmetrical painless lipomas, it is more often observed in men. There are also painful lipomas (Dercum lipomatosis), which are located on the limbs and trunk, are painful on palpation and are accompanied by general weakness and local itching.

Complications

In addition to psychological problems, almost all obese patients suffer from one or a number of syndromes or diseases caused by excess weight.

• cardiovascular system: coronary artery disease, arterial hypertension, angina pectoris, heart failure, stroke
• metabolic processes: type 2 diabetes mellitus
• digestive system: cholelithiasis, liver cirrhosis, chronic heartburn
• musculoskeletal system: arthritis, arthrosis, osteochondrosis
• reproductive organs: polycystic ovary syndrome, decreased fertility, libido, menstrual dysfunction, etc.

Obesity increases the likelihood of breast, ovarian and uterine cancer in women, prostate cancer in men, and colon cancer. There is also an increased risk sudden death against the background of existing complications. The mortality rate for men aged 15 to 69 years with an actual body weight that is 20% greater than ideal body weight is one third higher than for men of normal weight.

Diagnostics

When examining patients with obesity, attention is paid to the medical history, family predisposition, the minimum and maximum weight after 20 years, the duration of the development of obesity, the activities carried out, the patient’s eating habits and lifestyle, and existing diseases are determined. To determine the presence and degree of obesity, the method of determining body mass index (BMI) and ideal body weight (IB) is used.

The nature of the distribution of adipose tissue on the body is determined by calculating a coefficient equal to the ratio of the waist circumference (WC) to the hip circumference (HC). The presence of abdominal obesity is indicated by a coefficient exceeding 0.8 for women and 1 for men. It is believed that the risk of developing concomitant diseases is high in men with WC > 102 cm and in women with WC > 88 cm. To assess the degree of subcutaneous fat deposition, the size of the skin fold is determined.

The most accurate results of determining the location, volume and percentage of adipose tissue from the total body weight are obtained using auxiliary methods: ultrasound, nuclear magnetic resonance, computed tomography, x-ray densitometry, etc. If patients are obese, they need to consult a psychologist, nutritionist and physical therapy instructor.

To identify changes caused by obesity, determine:

• blood pressure indicators (to detect arterial hypertension);
• hypoglycemic profile and glucose tolerance test (to detect type II diabetes mellitus);
• level of triglycerides, cholesterol, low- and high-density lipoproteins (to assess lipid metabolism disorders);
• changes in ECG and echocardiography (to identify disturbances in the circulatory system and heart);
• uric acid level in biochemical analysis blood (to detect hyperuremia).

Obesity treatment

Each obese person may have their own motivation for losing weight: a cosmetic effect, reducing health risks, improving performance, the desire to wear smaller clothes, the desire to look good. However, goals for weight loss and its pace should be realistic and aimed, first of all, at reducing the risk of complications associated with obesity. Treatment of obesity begins with a diet and physical exercise.

Diet therapy

For patients with BMI

When following a hypocaloric diet, basal metabolism decreases and energy is conserved, which reduces the effectiveness of diet therapy. Therefore, a hypocaloric diet must be combined with physical exercise, which increases the processes of basal metabolism and fat metabolism. The prescription of therapeutic fasting is indicated for patients undergoing hospital treatment with severe obesity for a short period.

Drug therapy

Drug treatment of obesity is prescribed when a BMI is >30 or the diet is ineffective for 12 weeks or more. The action of drugs from the amphetamine group (dexafenfluramine, amfepramone, phentermine) is based on inhibition of hunger, acceleration of satiety, and anorectic effect. However, side effects are possible: nausea, dry mouth, insomnia, irritability, allergic reactions, addiction.

In some cases, the administration of the fat-mobilizing drug adiposine, as well as the antidepressant fluoxetine, which changes eating behavior, is effective. The most preferred drugs today in the treatment of obesity are sibutramine and orlistat, which do not cause significant adverse reactions or addiction. The action of sibutramine is based on accelerating the onset of satiety and reducing the amount of food consumed. Orlistat reduces the absorption of fats in the intestines. For obesity, symptomatic treatment of underlying and concomitant diseases is carried out. In the treatment of obesity, the role of psychotherapy (conversation, hypnosis) is high, changing the stereotypes of developed eating behavior and lifestyle.

Surgical treatment of obesity

Prognosis and prevention

Timely, systematic interventions for the treatment of obesity bring good results. Already with a decrease in body weight by 10%, the overall mortality rate decreases by >20%; mortality caused by diabetes > than 30%; caused by cancer concomitant with obesity, > than 40%. Patients with I and II degrees of obesity remain able to work; with degree III - they receive disability group III, and in the presence of cardiovascular complications - disability group II.

To prevent obesity, a person with normal weight only needs to spend as many calories and energy as he receives during the day. With a hereditary predisposition to obesity, after the age of 40, with physical inactivity, it is necessary to limit the consumption of carbohydrates, fats, and increase protein and plant foods in the diet. Reasonable physical activity is required: walking, swimming, running, visiting gyms. If you are dissatisfied with your own weight, in order to reduce it you need to contact an endocrinologist and nutritionist to assess the degree of violations and draw up an individual weight loss program.

Obesity has become one of the problems of society in the twenty-first century. The disease is “recruiting” new adherents around the world. This is due to poor nutrition, a sedentary lifestyle, a significant number of chronic endocrine pathologies and many other factors. Literally, obesity means that body weight increases not due to muscle compaction, but due to fat deposits in different parts of the body. Why is obesity dangerous? Looking at people with excess body weight, any doctor will name a dozen reasons, and in the first place will be diseases of the heart, blood vessels, joints and bones, and impaired water-salt metabolism. In addition, this disease makes social life difficult, since modern society trends towards sports and a healthy lifestyle prevail.

Etiology

The disease “obesity” can develop for a variety of reasons. The most obvious is physical inactivity, that is, the discrepancy between calories received and energy expended. The second common cause of excess weight is disruption of the gastrointestinal tract. This could be a lack of pancreatic enzymes, decreased liver function, or problems with digesting food. In addition, the risk of obesity can be determined at the genetic level.

There are factors that contribute to weight gain, these include:
- drinking sugary drinks or eating 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.

Evolution of 2 million years has provided a mechanism for accumulating nutrients in case there is a sudden shortage of food. And if this was relevant for ancient people, then modern man does not need such “reserves”. However, our body is designed in such a way that it reacts stereotypically to both positive and negative influences from outside. Therefore, the problem of obesity is this moment stood up so sharply.

Pathogenesis

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 large amounts of lipids is a mismatch between the cerebral cortex and the hypothalamus. This is where the appetite regulation centers are located. The body requires more food than it expends energy, so everything excess is left “in reserve”, which leads to the appearance of excess adipose tissue.

Such a violation of coordination by the center can be either a congenital condition or acquired as a result of upbringing. In addition, such problems are sometimes the result of injury, inflammation, or chronic endocrine pathology.

When the pituitary gland, adrenal cortex and pancreatic cells begin to show pathological activity, and the amount of growth 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, and thyroid gland.

Classification by BMI

It is better to start classifying obesity with one that is known to the general population. As a rule, the primary diagnosis of this disease is carried out based on an indicator such as This is a particular value obtained after dividing body weight in kilograms by height in meters squared. There is the following gradation of obesity according to this indicator:

1. Weight deficiency - if BMI is less than or equal to 18.5.
2. Normal body weight - mass index should be between 18.5 and 25.
3. Pre-obesity - BMI ranges from 25 to 30 points. At this point, the risk of concomitant diseases such as hypertension, bedsores and diaper rash increases.
4. Class 1 obesity is diagnosed if the BMI is between 30 and 35.
5. Obesity 2 degrees - the index is approaching 40 points.
6. Obesity of the 3rd degree is diagnosed when the mass index exceeds 40 points, and 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 development of the pathology. According to it, primary and secondary obesity are distinguished. Each of them has its own subclasses.

Thus, 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 derived:

1. Hereditary, with a gene defect.
2. Cerebral, caused by neoplasms, infections or autoimmune damage to the brain.
3. Endocrine, caused by dysregulation of the thyroid gland, hypothalamic-pituitary system, adrenal glands and gonads.
4. Medication associated with the use of steroid drugs, hormonal contraceptives and cytostatics.

Clinical and pathogenetic classification

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

Alimentary-constitutional. Weight gain is associated with excess fat in the diet and lack of exercise. It usually manifests itself in childhood and can be associated with a hereditary predisposition.
- Hypothalamic. An increase in adipose tissue occurs due to damage to the hypothalamus and, as a result, a violation of its neuroendocrine function.
- Endocrine. Fatness is based on the pathology of the endocrine glands - the pituitary gland, the thyroid gland, and the adrenal glands.
- Iatrogenic. Obesity is caused by medical intervention. This could be taking medications, removing an organ or part of it, damaging 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 the same distribution of weight. Therefore, over time, a classification of obesity was developed based on the characteristic location of the fat layer.

The first type, also known as the upper type, also known as the android type, is distinguished by the fact that the upper half of the body, face, neck and arms are enlarged. It occurs more often in men, but can also be seen in women who have entered menopause. A number of authors argue that there is a connection between this type of obesity and the risk of developing diabetes mellitus, as well as pathology of the cardiovascular system.

The second type, lower or gynoid, is an accumulation of adipose tissue on the hips and buttocks, and is more common in the fair half of humanity. The figure of such women takes on the shape of a “pear”. It can also develop from childhood if it is aggravated by a violation of the 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 throughout the body, smoothing out the waist, neck, and buttocks.

In order to determine what type of obesity the patient has addressed, it is necessary to determine the ratio of waist and hip circumference. If in women this figure is more than 0.85, and in men more than one, then it can be argued that the person has the first variant of the distribution of adipose tissue.

Morphological classification

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

1. Hypertrophic obesity. It is characterized by a pathological increase in the size of fat cells, while their number remains the same.
2. Hyperplastic obesity, in which adipocytes actively divide. This form occurs in children and is very difficult to treat, since the number of cells can be reduced only by aggressive methods.
3. Mixed obesity, as it is logical to assume, is a mixture of the previous two. 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 excess body weight. Of these, 8.5% are urban residents, and 3.5% are rural residents. Obesity in adolescents and children has become such a common pathology that pediatricians decided to introduce a special section in their educational work with young parents regarding diet. Obesity is considered a condition when a child's body weight exceeds 15% of what it should be for his age. If correlated with BMI, its value will be close to 30 points.

There are two forms of obesity among children: primary and secondary. Primary is caused, as a rule, by poor nutrition, early complementary feeding or refusal breast milk in favor of the cow. But it can also be hereditary if the family is dominated by overweight people. But even in this case, the child is not born fat, he just has a slow metabolism, and with the proper diet and exercise, he will maintain his weight within normal limits. The first three years of life and puberty are critical for primary obesity.

Secondary obesity is associated with the presence of acquired endocrine pathologies. The criteria by which the degree of excess weight gain is determined still remain controversial. The following scale was proposed:
- 1st degree - weight is 15-25% more than expected;
- 2nd degree - from 25 to 49% excess weight;
- 3rd degree - the mass is 50-99% more;
- 4th degree - excess weight is two or more times the age norm.

Symptoms

The signs of obesity are basically similar to each other, the only difference is the uniformity of distribution of excess fiber, as well as the presence of concomitant pathologies or their absence.

Most often in patients it occurs that is associated with a violation of the normal diet. Typically, such people have a hereditary predisposition to weight gain, and eating too much food leads to weight gain. Symptoms occur in all family members, as they all eat together. In addition, older women who, due to their poor health, lead a sedentary lifestyle, are susceptible to this type of obesity.

Obesity of the 1st 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 bed.

Characterized not only by weight gain, but also by the presence of symptoms of the disorder nervous system and endocrine regulation. Obesity develops very quickly and is usually not associated with changes in diet. Fat appears mainly on the front of the abdomen, thighs and buttocks. Trophic changes may occur: dry skin, stretch marks, hair loss. Such patients complain of insomnia, headaches and dizziness. A neurologist is usually able to identify pathology in his area.

Diagnostics

People with obesity have extremely reduced criticism of their condition, so persuading or forcing them to go to the doctor even for a simple consultation is not an easy task. It’s a completely different matter for patients of an endocrinologist or neurologist. These themselves want to be examined and lose weight for a speedy recovery.

The most commonly used criterion for diagnosing overweight is the body adiposity index. That is, how much greater the actual mass is than the expected one. To determine the severity, it is important not only to prove the presence of excess weight, but also that it is realized due to adipose tissue, and is not muscle mass. Therefore, they are actively trying to introduce into medical practice methods for determining 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, height and body type, there are tables with already calculated pathology and norm values. Scientists have found that centenarians have body weight that is 10% less than normal. Morbid obesity is diagnosed in the opposite case, when weight is 10% above the upper limit of the permissible limit.

There are several formulas for calculating ideal body weight. All fashionistas know one of them - you need to subtract one hundred from your 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. Measuring the waist-to-hip ratio also has great importance in the characteristics of obesity, since the location of fatty tissue depends on the cause of weight gain.

Treatment

The fight against obesity is being carried out aggressively and everywhere. Nowadays the media is actively promoting healthy image life and the cult of a beautiful, athletic body. Of course, there is no point in taking the situation to the point of absurdity, but the general direction of the youth movement is preferable to decadent hedonia.

The basic principles of obesity treatment include:
- a diet rich in complex carbohydrates and fiber, vitamins, nuts and greens. Be sure to limit baking, sweets and carbonated drinks.
- physical exercises that should strengthen the body and speed up metabolism.
- medications to reduce weight and appetite;
- psychotherapy;
- surgery.

To achieve long-term results with any type of treatment, you need to change your diet and 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 caloric content of food that the patient normally consumes and gradually reducing the amount of calories. It is necessary to reach the level 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 addiction to fast food restaurants and sweet soda. Medications in the process of weight loss help achieve only a short-term effect. After stopping taking the pills, the patient returns to the previous lifestyle and does not comply with the recommendations received upon discharge. Despite the fact that now the pharmacological industry can offer a large selection of drugs for excess weight, almost all of them are prohibited due to the side effects they cause.

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 speed of food passage becomes higher. The second option is gastric banding. A ring is installed in the cardiac part, which narrows the lumen of the esophagus and food, touching this artificial obstacle, irritates the saturation center, allowing the patient to eat less.

What type of obesity is the most dangerous? Perhaps that's all. 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 is the pathological increase in weight due to excess fat accumulation.

According to the World Health Organization (WHO), more than 1.9 billion people over 18 years of age (representing 39% of all adults in the world) are overweight. Of these, over 600 million people (13% of the population) are obese.

Obesity is a common problem in Russia: about 60% of adults in our country are overweight. 20–30% of our fellow citizens are obese. At the same time, according to sociological surveys, only 51% of women and 38% of men see themselves as fat.

A simple and reliable way to determine whether you are overweight or obese is to calculate your body mass index (BMI). It shows the ratio of a person's body mass to his weight. For most adults, a BMI of 18.5 to 24.9 is considered normal. A BMI between 25 and 29.9 indicates overweight, while a BMI over 30 is considered obese. However, there are exceptions when BMI is not a reliable indicator.

Firstly, BMI cannot be used to calculate a child’s normal body weight, since the child’s body is still developing. To determine if your child is overweight, see your doctor. Secondly, standard BMI indicators are calculated for representatives of the Caucasian race. For representatives of different nationalities, the threshold for overweight and obesity may differ. Finally, standard BMI indicators are not suitable for people with well-developed muscles (for example, weightlifters). Their body weight increases due to muscles, and not due to fat deposits. Therefore, BMI values ​​are rejected as elevated.

The presence of excess fat is determined more accurately by waist circumference. Normally, men's waist circumference should not exceed 94 cm, and women's - 80 cm. Extra centimeters around the waist increases the risk of diseases associated with obesity. Another indicator that is easy to determine yourself is hip circumference. This value should be measured at the very top of the leg. After taking your measurements, calculate the ratio of your waist circumference to your hip circumference. An obesity indicator is considered to be 0.85 or more for women and 1.0 or more for men.

Based on how much body weight exceeds the norm, it is customary to distinguish several degrees of obesity:

• obesity 1st degree- body weight exceeds standard indicators by no more than 29%, body mass index 30-34.9;
• obesity 2 degrees- in the body there is from 30 to 49% excess fat, the body mass index corresponds to a value of 35-39.9;
• obesity 3rd degree- overweight is 50-99%, body mass index is more than 40.

Sometimes there is a 4th degree of obesity, when a person’s weight is more than twice the norm.

In grades 1 and 2 obesity, excess weight, as a rule, causes only a cosmetic defect and does not interfere with ability to work or well-being. Therefore, people from this group try to cope with the problem of obesity on their own, without resorting to the help of a doctor, they lose weight irregularly, inconsistently and often waste time. Obesity that has reached degree 3 and especially 4 is called morbid (from the Latin “morbus” - disease). That is, it causes serious disruptions in the functioning of the body, which are always manifested by deterioration of health and the appearance of a whole “bouquet” of diseases.

Obese people are often worried about high blood pressure (hypertension), pain and interruptions in the heart (angina), and the risk of rapid development of atherosclerosis and heart failure increases. Excess fat provokes the development of type 2 diabetes, which often goes hand in hand with obesity. Other accompanying complaints with excessive obesity include: sweating, fatigue, shortness of breath, pain and heaviness in the legs, prolonged constipation, menstrual irregularities and infertility, poor sleep and frequent colds.

At this stage, it is much more difficult to cope with obesity and related diseases. Therefore, you need to seriously engage in treatment already from the 1st and 2nd degrees of obesity, and not perceive excess weight only as an aesthetic drawback.

There is another classification where obesity is divided into types:

• Primary, nutritional-constitutional type of obesity- develops due to poor nutrition and hereditary predisposition. The key to treating this type of obesity is diet and a healthy lifestyle.
• Secondary type of obesity, usually associated with imbalance of hormones (dyshormonal obesity), brain diseases (cerebral obesity) or mental disorders. It is very difficult to get rid of excess weight in this type of obesity without treating the underlying disease.

It is customary to distinguish three types of fat deposition:

• gynoid (“female” type of obesity, “pear” type) fat deposition mainly in the thighs and buttocks is the most benign;
• android (“male” type of obesity, “apple” type) fat deposition mainly in the abdomen and internal organs, the most dangerous obesity, is often accompanied by various diseases;
• mixed type of obesity.

Causes of obesity (excess weight) in children and adults

As a rule, obesity is caused by overeating and lack of physical activity. If you eat a lot of sweets and fatty foods, but do not spend the resulting energy on sports and exercise, the body will store most of this excess energy as fat.

Energy value products are measured in kilocalories (kcal). On average, a man leading an active lifestyle needs about 2500 kcal per day to maintain normal body weight, and a woman needs 2000 kcal. And, unfortunately, exceeding this norm is easier than it seems. For example, a large hamburger, a side of fries, and a milkshake from a fast food restaurant can add up to 1,500 calories—and that's just one meal.

Poor nutrition is the main cause of obesity

Obesity does not develop overnight; it develops gradually, under the influence of poor nutrition. The main causes of obesity are:

• frequent consumption of fast food and processed foods rich in fats and sugar;
• alcohol abuse - alcoholic drinks are very high in calories, and those who abuse them are often overweight;
• eating out - in a restaurant the atmosphere is conducive to ordering an additional appetizer or dessert, and the dishes themselves may contain more fat or sugar;
• incorrect eating habits - if your family or friends eat large portions, you may become accustomed to overeating from childhood;
• abuse of sugary drinks - including sparkling water and fruit juices;
• “Problem eating” is an attempt to cope with depression or low self-esteem through food.

Bad eating habits are usually supported by all family members, so children get used to eating poorly from an early age, and then suffer from overeating throughout their lives.

A sedentary lifestyle (physical inactivity) as a cause of excess weight

Another important factor leading to obesity is a sedentary lifestyle. Many of us spend most of our time at work sitting at a desk in front of a computer. We prefer to move around the city by private car or public transport rather than by bike or on foot. Thus, during the working day from early morning until evening, we practically do not move, using every opportunity to sit down, and instead of stairs we use elevators.

In our free time, most of us watch TV, surf the Internet or play games. computer games. As a result - when sedentary In life, the energy that enters the body with food is not completely spent (since mental work burns much fewer calories than physical activity) and is stored as fat.

Meanwhile, adults with normal weight body, it is recommended to spend at least 150 minutes each week of moderate-intensity aerobic exercise, such as walking or cycling. It is not necessary to do one workout lasting 150 minutes; this time can be divided into several workouts throughout the week. For example, 30 minutes a day for five days.

Heredity and obesity

There is an opinion that excess weight is inherited, but this is not entirely true. Indeed, there are genetic diseases associated with obesity, such as Prader-Willi syndrome. But they are extremely rare. Much more often the tendency to obesity is inherited, but not the disease itself. In families with a predisposition to obesity, there may be some genetic characteristics - such as an increased appetite or a tendency to quickly accumulate fat - that contribute to weight gain. It is more difficult for people with such hereditary burden to lose weight and maintain normal body weight, but it is quite possible.

More often, familial obesity is more associated, for example, with bad eating habits learned in childhood: the tradition of watching TV, addiction to fatty and floury foods or sweets. If you abandon the established rules and start monitoring your own diet and diet, then you can completely avoid the excess weight that other members of your family have.

Medical causes of obesity

In some cases, weight gain is due to a chronic disease, namely:

• an underactive thyroid gland (hypothyroidism) - when the thyroid gland does not produce enough hormones;
• Itsenko-Cushing syndrome is a rare disease that causes excessive production of steroid hormones.

Timely and effective treatment these diseases helps maintain normal body weight.

The accumulation of extra pounds may be associated with certain medications, including hormones, medications for epilepsy and diabetes, and some medications prescribed for mental health conditions, such as antidepressants and medications for schizophrenia. Weight gain can also be side effect when quitting smoking.

Diets for obesity

There is no universal menu for obesity that would suit most people who want to lose weight. But if you are overweight, it is recommended to consume 600 kcal per day less than usual. To do this, it is best to replace unhealthy foods - for example, fast food, processed foods and sugar-containing drinks (including alcoholic drinks) - with healthier ones.

Check the energy content of every food and drink you consume to ensure you do not exceed daily norm. The menus of some restaurants and cafes sometimes indicate the calorie content of dishes. Keep an eye on this when eating out, as you can easily exceed your daily caloric intake by eating certain foods, such as hamburger, fried chicken, meat lasagna, or some Chinese dishes.

To meet the requirements of a healthy diet, the diet must be:

• Balanced, that is, contain the necessary amounts of proteins, fats, carbohydrates, as well as vitamins and minerals for health. The diet rules should indicate when and how many times to take food, and how to prepare it.
• Without strict restrictions, with a sufficient variety of permitted products.
• Long-term, aimed at gradual weight loss, and not at quick results that are unlikely to be maintained.

Avoid diets that recommend unhealthy practices, such as fasting (fasting from food for long periods of time) or eliminating entire food groups. Such weight loss methods can lead to poor health and do not provide long-term results, since they do not instill healthy eating habits. But this does not mean that any popular weight loss program is harmful. Many of them are developed based on proven medical and scientific principles and help some people.

Diet No. 8 for obesity

Diet No. 8 for obesity is a low-calorie menu in which the proportion of simple carbohydrates(glucose, fructose, sucrose), fats, especially of animal origin, and the amount of protein remains normal. Dishes are steamed, baked or boiled. Instead of sugar, substitutes are used; during cooking, food is not salted or spices are used. It is recommended to take food in small portions, 5-6 times a day.

• Wheat bread is made from wholemeal flour, and rye bread is limited. Butter pastries, puff pastry, cookies are excluded from the diet.
• Lean meat and fish, as well as jellied meat. Avoid eating sausages, smoked meats, fish roe, salted meats and fish.
• Eggs in any form.
• Low-fat dairy products.
• Of the oils and fats, butter and butter can be used to a limited extent. vegetable oil. Animal fats are excluded: lard, cooking oil, etc.
• Buckwheat and pearl barley are recommended. Other grains, as well as pasta and legumes, should be limited or eliminated.
• Vegetables in any form, except pickled and salted. You can eat some sauerkraut.
• From soups you should exclude potato, pasta, cereal, dairy and legume soups: pea, lentil, etc.
• As for fruits and sweets, diet No. 8 limits the consumption of: watermelons, grapes, raisins, figs, dates, honey, jam, ice cream, sweets, sugar and jelly.
• All appetite-increasing sauces, spices and dressings, including mayonnaise, are excluded.
• Prohibited drinks for obesity are sweet juices, cocoa, sweet kvass, carbonated waters with natural sugar.

The basic diet for diet No. 8 consists of 100-110 g of protein, 80-90 g of fat and 120-150 g of carbohydrates per day. The energy value of such a diet is 1600-1850 kcal/day. For a healthy adult, this is enough to lose weight without much physical activity.

Very low calorie diets

A low-calorie diet involves consuming less than 1000 kcal per day. Such extreme nutrition allows you to quickly lose weight, but it is not safe for your health. Therefore very low calorie diet used only as a last resort when obesity causes severe complications and rapid weight loss is required. It is generally not recommended to follow this diet for longer than 12 weeks at a time and should only be followed under the supervision of a qualified professional.

To learn more about diets and weight loss, read the following articles in the “Tips” section of our website:

• Anorexia, bulimia and other eating disorders

How to Treat Obesity with Exercise

Reducing your daily calorie intake will help you lose weight, but to avoid gaining it back, you need to combine your diet with regular physical activity. A physical therapy doctor or fitness specialist can draw up individual plan training, including several hours of moderate-intensity physical activity per week. With moderate physical activity the pulse and breathing increase, sweating is stimulated, but at the same time the person can carry on a conversation without faltering. Such activities include:

• fast walk;
• jogging;
• swimming;
• tennis;
• walking on a stepper (or other similar machine) in the gym.

Choose an activity that you like so that you don’t want to quit training. Start training gradually. For example, to begin with, devote 15-20 minutes to sports 5 times a week, and then increase this time. Adults of normal weight may benefit from at least 150 minutes of moderate-intensity exercise each week. If you are obese, you may need to exercise more actively. In most cases, it is recommended to spend up to five hours a week training.

Treatment of obesity with surgery

The surgical treatment of obesity is a branch of medicine called bariatric surgery. The question of radical intervention in the body is raised only with very high body weight - morbid obesity (3rd degree obesity), when the BMI is 40 or higher. An indication for surgery is also a BMI of 35 or higher in combination with a serious illness that can be alleviated by losing weight, for example, type 2 diabetes, obstructive sleep apnea syndrome, or high blood pressure.

Unfortunately, in our country, surgical treatment of obesity is not included in the list of types of medical care free of charge under compulsory medical insurance. However, many clinics have extensive experience in bariatric surgeries and offer their clients several types of surgical interventions, which are selected depending on the individual characteristics and preferences of the patient.

The most common surgeries for treating obesity are:

• installation of an intragastric balloon (a silicone ball that allows you to feel full when taking a small portion of food);
• gastric banding (placing an adjustable ring on the upper part of the stomach, dividing the organ into two parts and allowing one to feel full when the upper part of the stomach is filled with food);
• gastric bypass (creating a small reservoir in the upper part of the stomach and a bypass into the small intestine);
• sleeve gastrectomy (giving the stomach the shape of a uniformly narrowed tube by cutting off most of it).

All these operations are performed laparoscopically, that is, without large incisions on the abdomen, through endoscopic manipulation through several holes in the anterior abdominal wall and navel.

In rare cases, bariatric surgery is indicated as the first treatment option if the BMI is 50 or higher.

Treatment of obesity in children

Very often, parents do not notice obesity in their children, so it is important to listen to the opinion of the pediatrician who regularly examines and weighs your child. Treatment of obesity in children follows the same principles as treatment of adults - limiting calorie intake and regular exercise. The number of calories a child should consume per day depends on his age and height. Consult your doctor about this.

Ideally, a child should devote at least an hour a day to moderate-intensity physical activity, such as playing football or volleyball. Passive activities, such as watching TV or playing computer games, should take no more than two hours a day (14 hours a week).

Orlistat is prescribed extremely rarely for childhood obesity - for example, in cases of high obesity or the development of diseases associated with excess weight. In world medical practice, there are cases when bariatric surgery was performed to reduce weight in children to treat obesity, but in most countries (including Russia) such interventions are prohibited until the age of 18.

6 rules to combat obesity

1. Place real goals. Losing 3% of body weight significantly reduces the risk of obesity complications.
2. Eat more slowly and watch what and when you eat. Never satisfy your hunger by sitting in front of the TV.
3. Avoid situations that may trigger overeating.
4. Enlist the help of friends and family to motivate you to lose weight.
5. Monitor your progress by, for example, weighing yourself regularly and recording your weight in a diary.
6. If necessary, seek help from a psychologist who can change your relationship with food and strengthen your self-confidence.

Why is obesity dangerous?

Obesity not only spoils appearance and creates difficulties in Everyday life, but also increases the risk of developing many serious diseases.

Obese people often suffer from:

• feeling of lack of air (shortness of breath);
• increased sweating;
• snoring;
• difficulties with normal physical activity;
• frequent fatigue;
• joint and back pain;
• self-doubt and low self-esteem;
• feelings of loneliness.

Some physical problems caused by obesity can also affect relationships with family and friends, and sometimes lead to depression.

Excess weight increases the risk of disease

Obesity increases the likelihood of developing potentially serious diseases, including the following:

• diabetes mellitus type 2;
• increased cholesterol and atherosclerosis (narrowing of the arteries due to fatty deposits), which can cause coronary heart disease and stroke;
• bronchial asthma;
• pregnancy complications such as gestational diabetes and preeclampsia (a potentially dangerous increase in blood pressure during pregnancy).

On average, excess weight reduces life expectancy by 3-10 years, depending on the degree of obesity.

Which doctor should you consult if you are obese?

If you are overweight or obese, be sure to consult your doctor about safe weight loss methods and possible complications which can be caused by excess weight. As a rule, the diagnosis of obesity is carried out by a general practitioner or family doctor. If necessary, he can refer you to specialists involved in diagnosing the causes and complications of obesity:

• see a cardiologist (since obesity is often accompanied by hypertension and atherosclerosis);
• see an endocrinologist (since obese people often have impaired glucose tolerance and type 2 diabetes, and excess weight itself can cause disruption in the production of certain hormones);
• see a gynecologist (in some cases, the development of obesity may be associated with polycystic ovary syndrome);
• see a nutritionist (this doctor specializes in proper nutrition, he will help you choose an adequate diet for weight loss).

You can find these specialists by following the links provided.

Using the Napopravku.ru service, you can find medical weight loss centers where they use a combination of psychological and nutritional methods to combat obesity, and also offer a system of physical exercises that promote weight loss. In addition, there are paid hospital departments and specialized centers where obesity is treated surgically - bariatric clinics.

Localization and translation prepared by Napopravku.ru. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not reviewed, and takes no responsibility for, the localization or translation of its original content

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All site materials have been checked by doctors. However, even the most reliable article does not allow us to take into account all the features of the disease in specific person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. The articles have been prepared for informational purposes and are advisory in nature.