Excess body weight mcb. E66 Obesity

Most often, obesity is treated with a weight-reducing diet and increased exercise. Typically, daily calorie intake is reduced by 500-1000 of the number recommended for people of the same height, sex and age as the patient. An individual diet is designed in such a way as to ensure a slow, gentle weight loss. The diet can be adjusted by a doctor or nutritionist, although in addition the patient can join a self-help group. Regular moderate-intensity exercise is essential for weight loss.

Pharmacotherapy.

Medications that suppress appetite may be effective. Sibutramine regulates appetite by acting on neurotransmitters in the brain. In addition, medications, such as orlistat, which reduce the ability of the digestive tract to absorb nutrients, may be helpful. In rare cases, obesity is treated with surgery. For example, the stomach may be braced to reduce its size.

The article discusses obesity of the 2nd degree. We talk about the causes of its appearance, symptoms, diagnosis and treatment methods,. You will find out what drugs treat this disease, whether they take the army with such a diagnosis, the possible consequences and nutritional characteristics for women, men and adolescents.

Obesity 2 (medium) degree (ICD code 10 - E66) is a serious disease resulting from overweight and after the first stage of obesity. It occurs as a result of maintaining an incorrect and sedentary lifestyle, due to various diseases, taking certain medications and ignoring treatment.

This pathology is an increase in the thickness and volume of internal and subcutaneous fat. A large amount of fat that forms around the internal organs and compresses them causes a violation of their structure and work (visceral obesity), which entails a dangerous condition for human life and health, as it subsequently leads to the development of various complications.

Adults and the elderly, as well as adolescents and children, are equally susceptible to this condition. You can learn more about childhood obesity from this.

The main indicator characterizing this condition is BMI in the range of 35-39.9 kg/m2. The calculation of body mass index is carried out according to the formula:

I = m / h2

Where weight in kg is divided by height squared (height is measured in meters).

How to Calculate Body Mass Index

In young women, stage 2 obesity results from overeating and a sedentary lifestyle. After 35 years, a slow metabolism can provoke such a condition. But, as a rule, the main reason is a hormonal failure. The disease develops according to the gynoid type, the figure is in the form of a pear.

In men, this pathology is less often diagnosed due to the fact that the body of a man does not have such a tendency to hoarding as a woman's. The main factors in gaining excess body weight are the use of fatty foods, physical inactivity, as well as excessive passion for alcoholic products, especially beer. The disease develops according to the abdominal type, in which the figure is an apple.

In children under 1.5 years of age, obesity develops due to hereditary factors or through the fault of the parents. The main reasons are over-indulgence in milk formulas and improper introduction of complementary foods. One of the most dangerous stages is puberty, during which the body reacts inadequately to the changing hormonal background. Pathology develops in a mixed type.

Types of obesity

Experts distinguish between primary and secondary forms of obesity. Primary obesity (alimentary, exogenous-constitutional) occurs as a result of a sedentary lifestyle and overeating. Secondary obesity (endocrine, hypothalamic) is caused by disturbances in the functioning of various parts of the brain, adrenal glands and endocrine organs.

Primary obesity is the most common form of pathology. According to statistics, the appearance of excess and overweight is associated with:

• malnutrition - consumption of large amounts of alcohol, carbonated drinks, sweet, spicy and salty foods, as well as dishes with a lot of fats and carbohydrates;
• low physical activity - ignoring sports, sedentary work, spending the weekend at the TV and computer.

Secondary obesity is associated with malfunctioning of the endocrine system and hypothalamus. But the quality of nutrition also plays an important role in the appearance of excess weight, so it will not be superfluous to adhere to the principles.

Causes

The main reason for the development of stage 2 obesity is the neglect of the first stage of the disease.

Provoking external and internal factors include:

• hormonal disorders;
• diseases of the endocrine system;
• various viruses and infections;
• iodine deficiency;
• consequences of poisoning;
• complications after TBI;
• little physical activity;
• chronic lack of sleep;
• the use of psychotropic drugs;
• frequent stress and nervous tension;
• unbalanced diet;
• lack of thyroid hormones;
• genetic predisposition to be overweight.

Poor diet causes obesity

If the cause of the disease is rare physical activity, stress and improper diet, then it will be quite simple to deal with this problem. It is much more difficult to deal with pathology if it is caused by various diseases. To begin with, you will have to undergo a course of treatment, but therapy is not always effective.

signs

Signs of obesity of the second degree are:

• the occurrence of shortness of breath at rest;
• deterioration of well-being;
• visible ugly fullness;
• body mass index over 35;
• decrease in working capacity, physical activity;
• weakness for no reason;
• the formation of puffiness on the arms and legs in the summer;
• increase in heart rate during physical activity;
• increased sweating.

Each of these signs cannot indicate the presence of obesity of the second stage. But together they make up the clinical picture of pathology. The final diagnosis can only be established by a specialist based on an examination.

According to the location of body fat, pathology is divided into 5 types:

• gynoid - buttocks and thighs;
• abdominal - stomach;
• mixed - the whole body;
• cushingoid - the whole body, except for the limbs;
• visceral - internal organs.

Photo obesity 2 degrees

Photo obesity 2 degrees in women
Photo obesity stage 2 in men
Photo of obesity of the second type in children

Treatment

Therapy of the second stage of obesity involves taking certain medications and surgery. The statement that taking pills will allow you to lose up to 20 kg per month is just an opinion, since doctors themselves doubt the effectiveness of such drugs. However, without these drugs, the process of losing weight will be longer.

What pills help to lose weight correctly with obesity of the second stage? These are anorectics and blockers of fats and carbohydrates, let's look at each of them in more detail.

Anorectics

This group of drugs has a direct effect on the human brain, namely, on the saturation center in the hypothalamus. Contribute to dulling hunger and make it easier to endure food restrictions.

In the Russian Federation, it is allowed to take sibutramine tablets, which are prohibited in some countries:

• Reduxin;
• Lindax;
• Meridia;
• Goldline;
• Slimia.

Drugs containing amfepramone (Fepranone) or phenylpropanolamine (Dietrin) may also be prescribed.

Fat and carbohydrate blockers

Such drugs prevent the absorption of fats and carbohydrates in the intestines, provoking weight gain. In combination with diet and sports activities for obesity of the second stage, such drugs show a decent result.

Most often prescribed drugs containing orlistat as the main active ingredient:

• Listat;
• Orsoten;
• Glucobay.

At the same time, various dietary supplements, for example, Chitosan, show the worst result.

If obesity is in an advanced stage, therapy is not limited to taking pills, but surgery is also necessary. In the event that other methods of weight loss have not yielded any results, and obesity threatens with serious complications, including death, specialists prescribe bariatrics (gastric bypass, or bandaging). Liposuction is not advisable, as the procedure gives only a temporary effect.

It is acceptable to use traditional medicine (diuretic and fat-burning herbs). But only after the permission of the attending physician.

Contraindications

Drug therapy for type 2 obesity is prohibited in the following situations:

• age up to 16 and over 65 years;
• breast-feeding;
• pregnancy.

In addition, each drug has its own list of contraindications, which must first be studied.

Nutrition (diet) for type 2 obesity

Diet

Since a common cause of obesity is an unbalanced diet, therapy without dietary correction will be ineffective. Many experts are inclined to believe that diet therapy is the main method of dealing with type 2 obesity, therefore it is referred to as therapeutic measures.

There is no universal diet that would help all overweight people cope with their problem. In some cases, you have to sit on several diets to find one that would be effective in a particular case. It can be noted that it is definitely not suitable for obesity, as it belongs to the category of hard and involves the use of alcohol.

When choosing a suitable diet, you should adhere to certain requirements:

• Meals should be simple, while having sufficient nutritional value. In the body of losing weight, vitamins, trace elements and important amino acids must be supplied without fail.
• Eating a lot of fiber helps cleanse the intestines, so that excess weight will quickly go away.
• An important condition for all dishes is their low calorie content. In this case, we recommend that you try .
• For the duration of the diet, carbonated drinks should be completely excluded from the diet, replacing them with mineral water, natural berry-fruit compotes. Also banned are honey, smoked meats, sausages, sweets, pickles, flour products, alcohol, hot spices and sauces, ice cream. It is necessary to minimize the consumption of granulated sugar and salt, oils and fats. Bread can only be eaten black and gray, mostly bran.
• Allowed the use of dairy products, but with a minimum fat content, best of all - fat-free. Fruits can also be eaten, but they must contain a minimum amount of sugar, no grapes and bananas!
• During weight loss, you should reduce the volume of servings, eat fractionally (6 times a day).
• It is useful to include unsweetened fruits, fresh vegetables and herbs in the diet. You can eat apples, but only green ones.
• Be sure to arrange at least once a week a fasting day. It helps cleanse the body of harmful substances that prevent excess weight from going away. At this time, you can only eat certain foods, such as apples or cottage cheese (preferably low fat). It is permissible to eat only vegetables on a fasting day, except for potatoes.
• The importance of drinking regimen has long been proven in weight loss. You need to drink at least 2 liters of pure water per day if there are no problems with swelling. The principle is based on the drinking regime. Also useful to know.

The calorie content of the daily diet should be lower than before weight loss. But at the same time, the figure should not be less than 1200 kcal.

Below is a sample menu for obesity of the second stage. Remember, portions should be reduced, and the multiplicity of their intake increased.

Menu:

• first breakfast - unsweetened coffee with milk, boiled meat, sauerkraut;
• second breakfast - unsweetened green tea, fat-free cottage cheese;
• lunch - unsweetened fruit and berry compote, borscht cooked in vegetable broth without meat, boiled chicken meat, baked vegetables;
• afternoon snack - green apple;
• first dinner - baked potatoes, boiled low-fat fish;
• the second dinner (before going to bed) - a glass of fat-free yogurt.

Nutrition for type 2 obesity should be varied and low-calorie. If desired, borsch can be replaced with vegetable stew or soup, baked potatoes - with boiled beet salad and low-fat sour cream or baked carrots.

The most important thing in stage 2 obesity is the desire to lose weight and become healthier. So, you will need to be patient in order to achieve your goal.

Exercise for type 2 obesity

Physical activity

Excess weight will not go away on its own if you only follow a diet, and the rest of the time you sit on the couch or at the computer. Movement is life, so behavioral therapy plays a huge role in losing weight.

If you want to get rid of excess weight, you will have to change your lifestyle. For this:

1. Try to move more. If you're at home, put on some upbeat music and start cleaning. Walk up the stairs, forget what an elevator is, take walks in the fresh air.
2. Practice all the methods of complex therapy for obesity.
3. Be less nervous and worry. Rejoice in life!
4. Find the motivation to lose weight and do everything to achieve what you want.
5. Give up bad habits, forget about alcohol and high-calorie foods.
6. If you have mental health problems, take a course of antidepressants.
7. Exercise regularly. Exercise in the morning, go to the pool in the afternoon, go for a bike ride in the evenings. All these activities underlie exercise therapy (physiotherapy exercises), which can be prescribed by a specialist.
8. Get enough sleep. Sleep at least 8 hours a day.
9. Strictly follow all the recommendations of your doctor.

Stick to these rules, as well as follow the recommended diet therapy, and in a short time you will be able to achieve amazing results.

Obesity and the army

Many parents and guys are interested in the question of whether they take into the army with a second degree of obesity. We have already described above how to calculate the body mass index, now we will consider by what criteria a specialist identifies whether an overweight guy is fit for service.

• Category "A" - full suitability for military service.
• Category "B" - suitability for military service with some restrictions. When passing a medical examination, the presence of minor pathologies, for example, slightly impaired vision, is confirmed.
• Category "B" - assignment of the status of limited fit. This category exempts from military service in peacetime, but in martial law, the conscript is enlisted in the 2nd turn.
• Category "G" - assignment of the status of "temporarily unusable". It means that the conscript has some pathologies that can be treated, for example, fractures or obesity. In such a case, a delay of six months is granted, which can be extended in the future if necessary.
• Category "D" - complete exemption from military service due to unsuitability.

Based on this, it should be noted that a conscript with stage 2 obesity can be drafted into the army only after weight correction and the necessary therapy.

Complications

Due to the fact that visceral fat puts pressure on most internal organs, their functioning is disrupted and slowed down.

In the absence of therapy and control by specialists, obesity of the second stage becomes the cause of such diseases:

• diseases of the gastrointestinal tract - pancreatitis with complications;
• gallbladder disease (more common in women);
• haemorrhoids;
• hypertension;
• type 2 diabetes;
• fatty hepatosis;
• cardiac ischemia;
• myocardial infarction;
• ailments of the musculoskeletal system;
• labored breathing;
• impotence, infertility.

If you ignore the treatment, then pregnancy may not occur. Such a diagnosis during pregnancy is dangerous, since in this case the risk of developing various complications in the early stages of pregnancy, anemia and respiratory ailments in the later stages increases.

Obesity of the 2nd degree is not a death sentence and is not as dangerous as the last stage of the disease. But at the same time, it carries more serious consequences than the initial stage of obesity. Therefore, it is important to seek help from specialists, and not wait for the problem to go away on its own.

Video: Three tests for obesity

Currently, the terms "obesity in children" and "overweight" are used equally often in pediatrics, with the term "overweight" being more preferable.

Obesity (lat. adipositas, alimentary obesity) - a chronic eating disorder characterized by excessive accumulation of adipose tissue in the body.

ICD-10 codes

• E65-E68. Obesity and other types of overnutrition.
• E66. Obesity.
• E66.0. Obesity due to excess intake of energy resources.
• E66.8. Other forms of obesity.
• E66.9. Obesity, unspecified.
• E68. Consequences of overnutrition.

Epidemiology of childhood obesity

In economically developed countries, including Russia, 16% of children are already obese and 31% are at risk for the formation of this pathology, which occurs more often in girls than in boys.

According to the WHO Regional Office for Europe (2007), over the past twenty years, the prevalence of obesity has increased 3 times, reaching epidemic proportions. According to epidemiological studies, in the presence of obesity in the father, the probability of its development in children is 50%, in the presence of this pathology in the mother - 60%, and in the presence of both parents - 80%.

The causes of the obesity epidemic are considered to be a change in the composition of the diet (increased consumption of energy-rich foods), eating habits (eating in fast foods, frequent use of ready-made breakfast cereals), insufficient consumption of fruits and vegetables, and a sharp decrease in physical activity.

What causes obesity in children?

In the vast majority of children, obesity is not associated with hereditary or endocrine diseases, although the role of hereditary predisposition to obesity is considered established. The leading role in the formation of a positive energy balance is played by genetically determined features of metabolism and the structure of adipose tissue:

• increased number of adipocytes and their accelerated differentiation from fibroblasts;
• congenital increased activity of lipogenesis enzymes and reduced - lipolysis;
• increased intensity of fat formation from glucose;
• reduced formation of leptin in adipocytes or a defect in leptin receptors.

The pathogenesis of obesity

One of the main pathogenetic mechanisms for the development of obesity in children is an energy imbalance: energy consumption exceeds energy consumption. As it is currently established, the pathogenesis of obesity is based not only on energy, but also on nutrient imbalance. Obesity in children progresses if the body is not able to ensure the oxidation of incoming fat.

Obesity in children: types

Obesity in children currently does not have a generally accepted classification. In adults, the diagnosis of obesity is based on the calculation of BMI [the ratio of body weight (in kilograms) to a person's height (in meters) squared]. BMI can overestimate the obesity of trained athletes or muscular children, however, BMI calculation is the most reliable and reliable method for determining overweight. Other methods for assessing obesity are also used, but they are either very expensive (ultrasound, CT, MRI, X-ray absorptiometry), or require special equipment (caliper), or are poorly reproduced (measurement of waist and hips), or do not have standards for children ( bioelectrical impedance analysis).

How to recognize obesity in children?

Obesity in children is not accompanied by specific changes in the results of a complete blood count and urinalysis. A biochemical blood test detects:

• increased levels of cholesterol, triglycerides, low-density lipoproteins, free fatty acids;
• decrease in the content of high density lipoproteins;
• acidosis;
• hyperinsulinemic type of glycemic curve.

Obesity screening

Systematic (once a quarter) monitoring of weight and growth indicators with the determination of BMI, as well as blood pressure.

Treatment of obesity in children

Obesity in children should be treated with the following goals - to achieve an energy balance between energy intake and energy expenditure. The criterion for the effectiveness of the treatment of obesity in children is weight loss. A necessary condition for diet therapy in all age groups is the calculation of nutrition in terms of proteins, fats, carbohydrates, as well as calories, with a comparison of actual and recommended consumption.

International Classification of Diseases 10th Revision (ICD-10)

Version 2016

E65-E68 Obesity and other types of malnutrition

E65 Localized fat deposition

Including: fat pads

E66 Obesity

Excluded:
E66.0 Obesity due to excess intake of energy resources

E66.1 Drug-induced obesity

If necessary, to identify the medicinal product, use an additional external cause code (class XX).

E66.2 Extreme obesity with alveolar hypoventilation

pickwick syndrome

E66.8 Other forms of obesity
E66.9 Obesity, unspecified

Simple obesity NOS

E67 Other types of power redundancy

Excluded:

overeating NOS (R63.2)
consequences of overnutrition (E68)

E67.0 Hypervitaminosis A

E67.1 Hypercarotenemia

E67.2 Vitamin B6 megadose syndrome

E67.3 Hypervitaminosis D

E67.8 Other specified forms of overnutrition
E68 Consequences of oversupply

Note. Should not be used for chronic overeating. This code is for the current overeating.

Notes. 1. This version corresponds to the 2016 version of the WHO (ICD-10 Version: 2016), some positions of which may differ from the version of the ICD-10 approved by the Ministry of Health of Russia.

2. NOS - without additional specifications.

3. The translation into Russian of some terms in this article may differ from the translation in the ICD-10 approved by the Ministry of Health of Russia. All comments and clarifications on translation, design, etc. are accepted with gratitude by e-mail.

4. An asterisk marks optional additional codes related to the manifestation of the disease in a separate organ or area of ​​the body, which is an independent clinical problem.

Obesity(lat. adipositas- literally: "obesity" and lat. obesitas- literally: fullness, obesity, fattening) - the deposition of fat, an increase in body weight due to adipose tissue. Adipose tissue can be deposited both in places of physiological deposits, and in the area of ​​​​the mammary glands, hips, and abdomen.

Obesity is divided into degrees (according to the amount of adipose tissue) and types (depending on the reasons that led to its development). Obesity leads to an increased risk of diabetes, hypertension and other diseases associated with being overweight. The causes of excess weight also affect the distribution of adipose tissue, the characteristics of adipose tissue (softness, firmness, percentage of fluid content), as well as the presence or absence of skin changes (stretching, enlarged pores, the so-called "cellulite").

What Causes Obesity:

Obesity can develop as a result of:

• imbalance between food intake and energy expended, that is, increased food intake and reduced energy expenditure;
• obesity of non-endocrine pathology appears due to disorders in the systems of the pancreas, liver, small and large intestines;
• genetic disorders.

Predisposing Factors for Obesity

• Sedentary lifestyle
• Genetic factors, in particular:
  • Increased activity of lipogenesis enzymes
  • Decreased activity of lipolysis enzymes
• Increased intake of easily digestible carbohydrates:
  • drinking sweet drinks
  • a diet rich in sugars
• Certain diseases, in particular endocrine diseases (hypogonadism, hypothyroidism, insulinoma)
• Eating disorders (for example, binge eating disorder), in Russian literature called eating disorders, a psychological disorder leading to an eating disorder
• Tendency to stress
• sleep deprivation
• Psychotropic drugs

In the process of evolution, the human body has adapted to accumulate a supply of nutrients in conditions of an abundance of food in order to use this reserve in conditions of a forced absence or restriction of food - a kind of evolutionary advantage that made it possible to survive. In ancient times, fullness was considered a sign of well-being, prosperity, fertility and health. An example is the sculpture "Venus of Willendorf" (Venus of Willendorf), dated to the 22nd millennium BC. e. (perhaps the earliest known illustration of obesity).

Viruses

Human infection with adenovirus-36 (Ad-36) (long thought to be the causative agent of respiratory and eye diseases) converts mature adipose tissue stem cells into fat cells; moreover, those cells in which the virus was not detected remained unchanged.

Pathogenesis (what happens?) during Obesity:

The regulation of the deposition and mobilization of fat from fat depots is carried out by a complex neurohormonal mechanism (cerebral cortex, subcortical formations, sympathetic and parasympathetic nervous system, as well as endocrine glands). The main role in the pathogenesis of obesity is played by dysfunctions of the central nervous mechanisms - the cerebral cortex and hypothalamus (hypothalamus), where the centers that regulate appetite are located. Disruption of coordination between energy consumption and appetite, which determines the arrival of energy material and the intensity of metabolic processes, causes the accumulation of fat. Apparently, the functional state of the centers that regulate eating behavior may have congenital characteristics or acquired (brought up) from childhood in connection with the lifestyle of the family, the nature of nutrition, etc. Disturbances in the functional state of the hypothalamic centers that regulate appetite may also be a consequence of inflammatory process or injuries, accompanied by damage to the hypothalamus.

In the pathogenesis of obesity, one cannot but attach importance to the endocrine organs and, above all, to the pituitary gland, adrenal glands, pancreatic islet apparatus, thyroid and gonads.

An increase in the functional activity of the pituitary - adrenal cortex and insular apparatus of the pancreas contributes to the accumulation of fat in fat depots. A decrease in the somatotropic activity of the adenohypophysis, accompanied by a weakening of the processes of fat mobilization from the depot and its subsequent oxidation in the liver, also acts as a pathogenetic factor, especially in the alimentary-constitutional form of obesity. A certain pathogenetic role in hypothalamic-pituitary obesity is played by the thyroid gland (due to a lack of thyroid hormones, the release of fat from fat depots and its oxidation in the liver is inhibited).

Reduced production of adrenaline - an active lipolytic factor - is essential in reducing fat mobilization and is one of the pathogenetic factors of obesity. The role of the gonads in the pathogenesis of primary obesity has not been studied enough.

Obesity Symptoms:

Clinical manifestations of different types of obesity are basically similar. There are differences in the distribution of excess body fat and in the presence or absence of symptoms of damage to the nervous or endocrine system.

Most common alimentary obesity, usually in individuals with a hereditary predisposition to be overweight. It develops in cases where the caloric content of food exceeds the energy expenditure of the body, and is observed, as a rule, in several members of the same family. This type of obesity is more common among middle-aged and elderly women who lead a sedentary lifestyle. When collecting an anamnesis with a detailed clarification of the daily diet, it is usually established that patients systematically overeat. For alimentary obesity is characterized by a gradual increase in body weight. Subcutaneous adipose tissue is distributed evenly, sometimes accumulates to a greater extent in the abdomen and thighs. There are no signs of damage to the endocrine glands.

hypothalamic obesity observed in diseases of the central nervous system with damage to the hypothalamus (with tumors, as a result of injuries, infections). This type of obesity is characterized by the rapid development of obesity. The deposition of fat is noted mainly on the abdomen (in the form of an apron), buttocks, thighs. Often there are trophic changes in the skin: dryness, white or pink stretch marks (stretch marks). Based on clinical symptoms (eg, headache, sleep disturbances) and neurologic findings, the patient can usually be diagnosed with brain pathology. As a manifestation of hypothalamic disorders, along with obesity, various signs of autonomic dysfunction are observed - increased blood pressure, impaired sweating, etc.

endocrine obesity develops in patients with certain endocrine diseases (for example, hypothyroidism, Itsenko-Cushing's disease), the symptoms of which predominate in the clinical picture. On examination, along with obesity, which is usually characterized by uneven deposition of fat on the body, other signs of hormonal disorders (for example, masculinization or feminization, gynecomastia, hirsutism) are revealed, and striae are found on the skin.

A peculiar type of obesity is the so-called painful lipomatosis(Derkum's disease), which is characterized by the presence of fatty nodes, painful on palpation.

In patients obesity II-IV degrees there are changes in the cardiovascular system, lungs, digestive organs. Often observed tachycardia, muffled heart tones, increased blood pressure. Sometimes respiratory failure and chronic cor pulmonale develop due to the high standing of the diaphragm. Most obese patients have a tendency to constipation, the liver is enlarged due to fatty infiltration of its parenchyma, symptoms of chronic cholecystitis and pancreatitis are often detected. Pain in the lower back, arthrosis of the knee and ankle joints are noted. Obesity is also accompanied by menstrual irregularities, amenorrhea is possible. Obesity is a risk factor for the development of diabetes mellitus, atherosclerosis, hypertension, coronary heart disease, with which it is often combined.

Obesity in children, as in adults, develops against the background of hereditary characteristics or as a result of acquired metabolic and energy disorders. Obesity is most often observed in the 1st year of life and at 10-15 years. As in adults, exogenous-constitutional obesity is more common in children, which is based on a hereditary (constitutional) predisposition to excessive fat deposition, often combined with family tendencies to overeat and overfeed children. Excess fat deposition usually begins as early as the 1st year of life and is not equally common in boys and girls. Girls are born with already more developed subcutaneous adipose tissue than boys; with age, this difference increases, reaching a maximum in adults, and causes a greater incidence of obesity in girls and women.

In children aged 10-15 years, the most common cause of obesity is the hypothalamic syndrome of puberty, which is characterized by the appearance of thin striae on the skin of the thighs, mammary glands, buttocks, and the inner surface of the shoulders. There is usually a transient increase in blood pressure; in some cases, signs of increased intracranial pressure are found. Less often, the cause of hypothalamic obesity in children is the consequences of a traumatic brain injury, neuroinfection.

Obesity Diagnosis:

The most commonly used diagnostic criterion for obesity is the determination of excess total body weight in relation to the norm, established statistically. However, to determine the severity of the disease, it is not so much the excess of the total body weight that is important, but the excess of the mass of adipose tissue, which can differ significantly even in individuals of the same age, height and body weight. In this regard, the development and implementation in the clinic of diagnostic methods for determining body composition and specifically fat mass is quite relevant.

The starting point in determining the degree of obesity is the concept of normal body weight. Normal body weight is determined according to special tables, taking into account gender, height, body type and age, and is the average value corresponding to each group.

Along with the concept of normal body weight, the concept of ideal body weight is of great importance in the clinic. This indicator was developed by order of health insurance companies and was supposed to determine at what body weight insured events (illness or death) are the least likely. It turned out that the body weight at which life expectancy is maximum is about 10% less than normal body weight. The ideal body weight is determined taking into account the human constitution (normosthenic, asthenic and hypersthenic). Exceeding this value is considered overweight. Obesity is said to be in cases where excess body weight is more than 10%.

A number of methods have been proposed for calculating ideal body weight. The simplest formula was proposed by the anthropologist and surgeon Brock (1868):

Mi = R- 100 ,

where Mi- ideal body weight, kg, R- height, see

Depending on the value of this indicator, 4 degrees of obesity are distinguished: the 1st degree of obesity corresponds to an excess of ideal body weight by 15-29%, the 2nd degree - by 30-49%, the 3rd - by 50-99%, 4- I am more than 100%.

Currently, the most widely used indicator of the degree of obesity is the body mass index (BMI), or Quetelet index:

BMI \u003d Body weight (kg) / height (m 2).

It is believed that for people aged 20-55 years who have a height close to the average (men - 168-188 cm, women - 154-174 cm), BMI quite accurately reflects the situation. Most studies on the relationship of body weight with morbidity and mortality confirm that the maximum allowable body weight corresponds to a BMI of 25 kg/m 2 .

Classification of excess mbody scores in adults depending on BMI (WHO report, 1998)

Measurement of the circumference of the waist and hips. Of great clinical importance is not only the severity of obesity, but also the distribution of fat. It must be determined primarily in patients with average overweight, since this does not take into account BMI. It is believed that the risk of complications in obesity to a greater extent depends not on excess body weight, but on the localization of adipose tissue deposits. The amount of visceral fat can be measured using MRI. However, a simpler and more accurate measure of fat distribution is the waist-to-hip ratio (WHT).

Measurement of WTP is important in determining body fat deposition, which is of particular importance in assessing the risk of morbidity. Depending on the distribution of fat, two types of obesity are distinguished: android and ganoid. android, or apple-shaped obesity is called the distribution of fat around the waist. The deposition of fat around the buttocks and thighs is known as hypoid, or obesity in the form of a pear. In the case of android fat distribution, the likelihood of morbidity and mortality is higher than in the ganoid type. With the deposition of the bulk of fat on the trunk and in the abdominal cavity, the likelihood of complications associated with obesity (hypertension, coronary heart disease, type 2 diabetes) increases significantly. It is believed that normally in women the OTB does not exceed 0.8, and in men - 1, the excess of these parameters is associated with metabolic disorders. If the waist circumference in men reaches 102 cm, and in women - 88 cm, in this case there is a serious risk of increasing the risk of morbidity and weight loss should be recommended (Table 40.3).

Definition of overweight and obesity by waist circumference (cm)

Obesity Treatment:

Basic treatments for overweight and obesity

• These include adherence to a diet with a high content of fiber, vitamins and other biologically active components (cereals and whole grains, vegetables, fruits, nuts, herbs, etc.) and limiting the use of easily digestible carbohydrates (sugar, sweets, pastries, bakery and pasta from flour of the highest grades), as well as physical exercises.
• The general approach in the drug treatment of obesity is to test all known drugs for the treatment of obesity. For this purpose, drugs are used to treat obesity.
• If the result of drug treatment is insignificant or absent, then it is necessary to stop such treatment.

Then the question of surgical treatment is considered. Liposuction - as an operation during which fat cells are sucked off, is currently used not to combat obesity, but only for cosmetic correction of local small fat deposits. Although the amount of fat and body weight after liposuction may decrease, but, according to a recent study by British doctors, such an operation is useless for health. Apparently, it is not the subcutaneous, but the visceral fat located in the omentum, as well as around the internal organs located in the abdominal cavity, that causes harm to health. Previously, isolated attempts were made to do liposuction for weight loss (the so-called megaliposuction with the removal of up to 10 kg of fat), but at present it is abandoned as an extremely harmful and dangerous procedure, inevitably giving many serious complications and leading to gross cosmetic problems in the form of uneven body surface .

Diets often increase obesity. The reason is that a rigid diet (dramatic reduction in calorie intake) can help you lose weight quickly, but after you stop the diet, your appetite increases, food digestibility improves, and you gain more weight than before the diet. If an obese person tries to lose weight again with a strict diet, each time losing weight becomes more difficult, and gaining weight becomes easier, and the weight gain increases each time. Therefore, diets focused on quick results (lose as much weight as possible in a short time) are a harmful and dangerous practice. In addition, many weight loss products contain diuretics and laxatives, resulting in water loss rather than fat loss. Loss of water is useless to fight obesity, it is harmful to health, and weight is restored after stopping the diet.

Moreover, according to a study by American psychologist Tracey Mann and her colleagues, diets are generally useless as a means of combating obesity.

However, it should be noted that without adequate control of the calorie content of food and taking into account the adequacy of the amount of incoming calories to physical activity, successful treatment of obesity is impossible. For successful weight loss, the WHO recommends calculating habitual calorie intake and then reducing calories by 500 kcal each month until reaching a figure 300-500 kcal below adequate energy intake. For persons not engaged in active physical labor, this value is 1500-2000 kcal.

Surgical treatment of morbid obesity

Long-term studies have shown that surgery (bariatric surgery) has the maximum effect in the treatment of obesity. Only surgical treatment makes it possible to solve this problem definitively. Currently, the world uses mainly two types of surgery for obesity. In the USA and Canada, gastric bypass is used in the form of Roux-en-Y gastric bypass (90% of all operations). It makes it possible to get rid of 70-80% of excess weight. In Europe and Australia, adjustable gastric banding dominates (90% of all operations), which makes it possible to get rid of 50-60% of excess weight.

Currently, all bariatric operations are performed laparoscopically (that is, without incision, through punctures) under the control of a miniature optical system.

Operative treatment of obesity has strict indications, it is not intended for those who believe that they are simply overweight. It is believed that indications for surgical treatment of obesity occur with a BMI above 40. However, if the patient has problems such as type 2 diabetes, hypertension, varicose veins and problems with the joints of the legs, the indications already arise with a BMI of 35. Recently, studies have appeared in the international literature that have studied the effectiveness of gastric banding in patients with a BMI of 30 or more.

Obesity Prevention:

Prevention of obesity is to eliminate hypodynamia and rational nutrition. In children, compliance with the rules of feeding and regular monitoring of the physical development of the child by systematically measuring height and body weight (especially with a constitutional predisposition to obesity) are necessary. Early detection and treatment of diseases accompanied by hypothalamic and endocrine obesity is important.