Contents
Obesity is defined as the pathological condition of an increase in body fat. Under physiological conditions, fat constitutes an average of 15% of body weight, this percentage is higher in women by 5-7%. Obesity is diagnosed when the adipose tissue content exceeds 25%. body weight in men and 30% percent. in women.
The causes of overweight and obesity
With age, the percentage of body fat in the human body increases while lean body mass decreases. This process is done by increasing the volume of fat cells (hypertrophy) or an increase in the number of fat cells (hyperplasia). Both processes can occur simultaneously, with the fat content in the cell being variable and the increase in the number of fat cells is irreversible and can increase indefinitely. In adults, the increase in the size of fat cells in relation to their number predominates.
The basis of obesity is the imbalance between energy supply and its expenditure. Excess energy is stored in adipocytes in the form of triglycerides.
The distribution of adipose tissue also plays a significant role in obesity.
- Central or viscero-abdominal obesity (androidal, “apple shape”) is characterized by the accumulation of fatty tissue inside the abdominal cavity and on the nape of the neck with relatively slim limbs. This type of obesity is associated with a high risk of developing cardiovascular disease and type II diabetes. Their development is predisposed to disorders of fat metabolism (hyperlipoproteinemia) and carbohydrate metabolism.
- Abdominal obesity increases the tissue resistance to insulin and the sensitivity to the action of catecholamines. These processes lead to an increased release of free fatty acids into the portal circulation, impaired insulin clearance in the liver, stimulation of gluconeogenesis and an increase in the synthesis of very low density lipoproteins (VLDL).
It should be remembered that central obesity, unlike gluteus – femoral (gynoid, “pear-shaped”), is particularly prone to weight loss and thus becomes a modifiable risk factor for the development of these diseases. Such relationships are not observed in the case of gluteal-femoral obesity, typical for women, where the accumulation of adipose tissue occurs around the buttocks and thighs with a slim build of the upper body.
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Overweight and obesity – ways of classifying body weight and adipose tissue
Classification of body weight and fat content
1. The due body weight can be calculated:
a.by the body mass index – BMI (body mass index, Quetelet’s index)
BMI does not differentiate between abdominal and gluteal-femoral obesity, and its clinical usefulness is limited in people with high bone and muscle mass.
b. using the formula:
Women = (height cm -100) – 10%
Men = (height cm -100) – 5%
2. The clinical indicator of the accumulation of adipose tissue in the central type is the waist-hip ratio (WHR). WHR is the waist circumference divided by the hip circumference. WHR values> 1,0 in men and WHR> 0,85 7 in women are interpreted as accumulation of viscero-abdominal fat. There is also a correlation between the waist circumference and the respective BMI range. Table 10.2 shows the classification of body weight based on BMI and waist circumference.
There are various methods of assessing body fat content:
a. biological electrical impedance method (measurement of electrical conductivity – total body electrical conductivity – TOBEC), consisting in the difference in conductivity of individual tissues (fat is a bad conductor); currently used most often – accurate, does not differentiate the distribution of adipose tissue;
b. methods using X-rays: Dual energy X-ray absorptiometry (DXA) and computed tomography mainly used for research;
c. densytometria – the essence is to determine the density of the body after immersing and weighing the body in a bath of water. A method that requires expensive equipment, cumbersome;
d. Near infrared measurement method (near infra -red) – irradiates the body with infrared rays of a specific frequency; fat content is calculated by special algorithms based on the amount of absorbed radiation – not very accurate;
e. assessment of body composition using the magnetic resonance method – very accurate, safe (it can, for example, also be used during pregnancy), but expensive and time-consuming;
f. anthropometric method for measuring skin folds – inaccurate, currently rarely used;
g. methods to determine total body water and potassium using markers – are not of practical use.
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Division of obesity for etiopathogenetic reasons
1. Simple obesity (primary, spontaneous), the cause of which is a positive energy balance and excess energy is stored in adipose tissue; it concerns people with a genetic predisposition in favorable environmental conditions.
2. Secondary obesitywhich occurs in rare genetic syndromes, organic diseases of the hypothalamus, endocrinopathies and as a result of the use of certain medications
Genetic obesity:
a. Laurence, Moon and Biedl syndrome – a complex of symptoms: obesity, hypothalamic dysfunction (diabetes insipidus, hypoplasia of the genital organs), retinitis pigmentosa, mental retardation, hearing impairment, congenital heart disease, skeletal defects such as multifangs, short stature.
b. Gelneau syndrome – paroxysmal coma, sudden loss of muscle tone resulting in falls without loss of consciousness, disturbances in the rhythm of sleep and wake, obesity as a result of bulimia and the accumulation of water in the body.
c. Prader-Labhart-Willie syndrome – obesity with a markedly increased appetite (hyperphagia), reduction of skeletal muscle tone, short stature, acromycry, hypogonadism, mental retardation and a tendency to early development of impaired glucose tolerance and type 2 diabetes.
d. Morgagni-Morell-Stewart syndrome (hyperostosis frontalis) – obesity, headaches, hirsutism. Radiographic examination of the skull revealed thickening of the inner lamina of the frontal bone. It is most common in perimenopausal women.
e. Other genetic syndromes in which obesity may be present, but is not the leading symptom: Klinefelter’s syndrome, adrenal gland syndrome (metastatic adrenal hyperplasia), Turner syndrome.
Obesity or overweight associated with various endocrinopathies:
a.hypothyroidism,
b. Cushing’s disease and syndrome,
c. growth hormone deficiency (in adults there is typically an increase in fat tissue in the visceral region, but not necessarily with overt obesity),
d. hypogonadism,
e. alleged hypoparathyroidism,
f. pancreatic islets – insulinoma,
g. polycystic ovary syndrome
Obesity associated with diseases of the hypothalamus and central nervous system:
a.inflammation, tumors in the hypothalamus (Fröhlich syndrome), infiltrative changes, degenerative changes, radiation damage, perinatal injuries, central nervous system underdevelopment, internal hydrocephalus,
b. functional changes referred to as hypothalamus (a term currently not recommended).
Obesity resulting from the use of certain groups of drugs:
a.phenothiazine derivatives: chlorpromazine, thioridazine,
b. butyrophenone derivatives: droperidol, haloperidol,
c. anticonvulsants: carbamazepine,
d. antidepressants: doxepin, lithium salts, desipramine, amitriptyline, imipramine,
e. glikokortykosteroidy, progestageny,
f. antihistamines,
g. insulin.
The mechanism of obesity accompanying the use of the above-mentioned preparations is not fully known. It is suspected that they act on the hypothalamus, increase food consumption or reduce the energy expenditure of the body.
Obesity diagnosis
A thorough history, physical examination and results of additional tests play an important role in the diagnosis of obesity.
In the interview, you should pay attention to:
a. diet (number, frequency, times of taking meals, composition of meals),
onset of obesity (age and circumstances in which weight began to increase), current treatment,
c. energy expenditure related to the lifestyle (physical activity, alcohol, cigarettes),
d. diseases (coexisting and past, currently taken medications),
e. family predisposition.
The physical examination should focus on:
a.determining the amount of excess weight,
b. determining the type of obesity (abdominal, gluteal-femoral),
c. determining the consequences of obesity (arterial hypertension, atherosclerosis, degenerative changes in joints and other organs and systems). Additional research should be focused on the differentiation of simple and secondary obesity due to different treatment methods.
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House