Grade 1 obesity: treatment with medication, diet, exercise

Obesity, including its “mildest” version – obesity of the 1st degree – is a condition in which too much fatty tissue accumulates in the body, which not only spoils the figure, but can also negatively affect health.

In ICD-10, obesity is classified as a disease of the endocrine system, eating disorders and metabolic disorders and has the code E66. And for two decades now – since 1997 – obesity has been officially recognized as a global epidemic by the World Health Organization.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]

Epidemiology

Since 1980, the number of obese people in some regions of North America, Great Britain, Eastern Europe, and the Middle East has tripled. Obesity rates in the United States have increased by 100% over the same period. Sub-Saharan Africa is the only region in the world whose inhabitants do not suffer from obesity.

According to WHO, as of 2014, more than 600 million adults worldwide (13% of the population) suffer from obesity. It is more common in women.

But the experts of the International Association for the Study of Obesity (IASO) are particularly concerned about the increase in the number of children with obesity. Almost 42 million children under five years of age are either overweight or have been diagnosed with obesity of 1, 2 and 3 degrees. The highest risk of developing obesity in childhood is in Malta and the USA (25%), and the lowest in Sweden, Latvia and Lithuania.

Even in Africa, the number of children in this age group who are overweight or class 1 obese has almost doubled, from 5.4 million in 1990 to 10.6 million in 2014.

About half of these children live in Asian countries. For example, in China, every tenth city child is obese. This is associated with increased consumption of carbohydrates, not fats.

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ]

Causes grade 1 obesity

Obesity is a complex heterogeneous disease, and doctors increasingly call it metabolic syndrome. Exogenous and endogenous risk factors for its development include excess food consumption (unspent energy is stored in the body as fat), physical inactivity (lack of calorie-burning physical activity), endocrine disorders, genetic mutations, and family (hereditary) predisposition.

Everything is clear with overeating and physical inactivity. Moreover, the expenditure of energy that food gives a person is of decisive importance, because, as it turned out, muscle loads contribute to the release of membrane protein FNDC5 (irisin) from skeletal muscle tissue. It has been experimentally proven that irisin can regulate the participation of visceral adipose tissue and subcutaneous fat in thermogenesis, that is, it behaves like the hormone adiponectin, produced by white adipose tissue cells and participating in the regulation of glucose levels and the breakdown of fatty acids.

The key causes of stage 1 obesity are rooted in metabolic disorders of white adipose tissue, the excess of which characterizes this pathology. Adipose tissue is formed by adipocytes, which are enlarged in obesity due to the increased level of triacylglycerol (TAG) accumulated in them.

There are two main processes in adipose tissue: adipogenesis (lipogenesis) – cell differentiation, as a result of which preadipocytes become full-fledged fat cells, and lipolysis – the breakdown of TAG contained in adipocytes. The products of this breakdown in the form of fatty acids are released into the vascular system for use as energy substrates.

Since white adipose tissue can normally perform its functions (TAG accumulation and its remobilization) with a balance of both biochemical processes, the pathogenesis of obesity is associated with dysregulation of this balance. As a rule, this is a decrease in the intensity of lipolysis, which is regulated by numerous hormones, enzymes and polypeptide mediators.

The breakdown of triacylglycerol requires specific lipolytic (hydrolase) enzymes present in adipose tissue (ATGL, HSL, MGL) and encoded by certain genes. The body may lack these enzymes. Obesity is also caused by a deficiency of the aforementioned hormone adiponectin, for the sufficient synthesis of which the ADIPQTL1 gene is responsible. The accumulation of excess fat mass may be due to malfunctions in the FTO gene, which encodes dioxygenase enzymes of the hydrolase family that catalyze the breakdown of TAG. Any mutations and polymorphism of these genes can cause a deficiency of substances that ensure the metabolism of fat cells. For example, people with two copies of the FTO gene allele weigh on average 3.5 kg more, and they have a higher risk of developing obesity and type 2 diabetes.

After the discovery of the adipose tissue hormone leptin, endocrinologists began to better understand the mechanisms of energy homeostasis. Obesity can result from both defects in the signal transduction pathway of this hormone in the brain and missense mutations in the leptin-encoding gene LEP. More details in the material - What is leptin and how does it affect weight?

The same role was played by the discovery of the amino acid peptide ghrelin (secreted in the stomach and proximal small intestine), which increases appetite, glucose oxidation and lipogenesis. Ghrelin is the only substance that is released in response to a decrease in the contents of the gastrointestinal tract and is suppressed when it is replenished during a meal. Already in stage 1 obesity, as in patients with insulin resistance, ghrelin levels are chronically low. At the same time, visceral adipose tissue is more sensitive to ghrelin deficiency than subcutaneous tissue, and this means that lipid deposition will occur mainly in visceral fat depots. A connection between ghrelin deficiency and mutations in the G274A and GHS-R genes has been identified.

In addition, common causes of grade 1 obesity are endocrine disorders such as increased production of the lipase enzyme and insulin hormone by the pancreas, and insufficient levels of thyroid hormones (triiodothyronine). For example, when blood glucose levels rise, endogenous insulin not only lowers them, but also inhibits the secretion of the pancreatic counter-regulatory hormone glucagon, one of whose functions is to stimulate lipolysis. So insulin actually prevents glucagon from fighting fat.

Certain pathological changes in the functioning of certain structures of the brain, in particular the anterior pituitary gland (adenohypophysis), play an equally important role in the pathogenesis of obesity. Thus, the breakdown of TAG is impeded by a low level of the lipolysis-stimulating hormone somatotropin and increased production of adrenocorticotropic hormone (ACTH). Due to excess ACTH, the adrenal cortex begins to produce more cortisol, which leads to an increase in blood sugar levels and inhibition of the breakdown of triacylglycerol.

Sex steroids (estrogen, testosterone), somatomedin (IGF-1, insulin-like growth factor-1), catecholamines (adrenaline, the receptors of which are present in adipose tissue) are directly related to the process of accumulation and breakdown of adipose tissue cells. They are triggers of G-protein receptors, and their signals (passing through the adenylate cyclase signal transduction system) affect the activation of lipolytic enzymes of adipose tissue.

Grade 1 obesity is quite often observed in schizophrenia and schizoaffective disorders, prolonged depression, as well as bipolar and panic disorders and agoraphobia (fear of open spaces and crowded places).

Drug-induced obesity can be provoked by atypical neuroleptics, tricyclic antidepressants, hypoglycemic agents of the thiazolidinedione group, sulfonylurea drugs, steroids, some anticonvulsants and hormonal contraceptives.

[ 17 ], [ 18 ]

Symptoms grade 1 obesity

The first signs of obesity are extra pounds. A person's weight is considered normal with a body mass index (BMI) of 18.5-25. BMI is usually expressed in kilograms per square meter (kg/m2) and is calculated by dividing a person's weight by their height squared.

What is the easiest way to calculate it? Divide your weight in kilograms by your height in meters, and then divide the result by your height again. For example: if you weigh 70 g and are 1.75 m tall, you need to divide 70 by 1.75. The answer is 40. Then divide 40 by 1.75 and get a body mass index of 22.9 (22.85). This is an excellent, i.e. healthy BMI!

Weight is considered simply excessive when the BMI is 25-30, and a BMI of 30-35 indicates stage 1 obesity.

According to endocrinologists, if there are no complications, symptoms of stage 1 obesity do not appear until the initial stage becomes progressive. That is when heaviness in the stomach, belching, flatulence, headaches, shortness of breath with tachycardia, attacks of weakness and hyperhidrosis may occur.

In general, the specifics of symptoms are determined by the types of obesity, which endocrinologists distinguish depending on the cause as exogenous and endogenous. And all of the above applies to primary obesity, that is, developing due to overeating and physical inactivity. This type of excess accumulation of adipose tissue has such name options as - alimentary obesity of the 1st degree, or alimentary-constitutional obesity of the 1st degree, or exogenous-constitutional obesity of the 1st degree.

All other causes of obesity are endogenous (see the previous section), and the pathology can be diagnosed as endocrine obesity (hormonal, pituitary, hypothyroid, diabetic, etc.), cerebral (hypothalamic) or hereditary. In short, the division of obesity into types is not strictly unified.

And depending on where the fat accumulates, there are different types of obesity: abdominal (other terms are upper, central, android or male) with a characteristic increase in the volume of adipose tissue in the abdominal region (on the stomach) - both under the skin and due to visceral (intra-abdominal) fat; femoral-gluteal (female or gynoid); mixed (most common in endocrinopathies).

Clinical practice has shown that grade 1 obesity of the abdominal type has more serious complications.

Obesity of the 1st degree in women

When characterizing stage 1 obesity in women, it is important to note the crucial role of sex hormones in regulating energy balance. First of all, this is the ratio of androgens and estrogens.

Even with a relatively normal diet, women may have problems regulating the homeostasis of adipose tissue. Thus, with an imbalance in the direction of testosterone, hyperandrogenism develops, often associated with increased accumulation of visceral fat; this also happens in cases of polycystic ovary syndrome in women, and during menopause.

Why is normal estrogen levels so important? Because the female ovarian sex hormone can activate the synthesis of the pituitary neuropeptide alpha-melanocyte-stimulating hormone, which induces a number of catabolic effects, including the breakdown of fat deposits. In addition, the action of estrogens in the hypothalamus increases the local activity of leptin, which inhibits food intake and increases energy expenditure.

It is also necessary to note not only the presence of white adipose tissue's own hormones that affect energy metabolism, but also its ability to produce steroid hormones, in particular, the same estradiol. And the more adipose tissue, the more serious the hormonal imbalance in the female body can be, leading to problems with the regularity of the menstrual cycle, fertility, glucose tolerance, the risk of developing uterine and mammary gland cancer during menopause, as well as complications during pregnancy. Find out more about why women over 30 gain weight

Obesity of the 1st degree during pregnancy can occur as excessive gestational weight gain. Pregnant women gain 10-18 kg, and this is due to hormonal changes in the body and the biological and physiological needs of this condition. However, obesity of the expectant mother significantly increases the risk of intrauterine fetal pathologies and various obstetric complications.

Obesity of the 1st degree in men

Over the past 25 years, grade 1 obesity in men 20 years and older has become a problem for 15-18% of the male population in developed and developing countries.

This is grade 1 obesity of the abdominal type - with a thick belly and a swollen waist, and the fat layer in the armpits and shoulder girdle area also thickens significantly.

The thicker the waist of men after 30 years, the lower the level of testosterone in the body: according to foreign researchers, an increase in waist size by 10-12 cm reduces the production of male sex hormones by 75%, which leads to the development of erectile dysfunction. While the natural aging process reduces testosterone levels by an average of 36%. The reason for this is that fatty tissue produces estrogens (which was already mentioned above). At the same time, the reproductive function of a man suffers due to the low number of spermatozoa and decreased mobility.

Many experts identify obesity hypoventilation syndrome (OHS) in men, which combines stage 1 obesity, hypoxemia (decreased oxygen levels in the blood) during sleep, hypercapnia (increased carbon dioxide levels in the blood) during the daytime – as a result of breathing that is too slow or shallow (hypoventilation).

Frequent companions of obesity in men are kidney stones, benign prostatic hyperplasia, urinary incontinence, and changes in the metabolism of sex hormones, which can provoke the development of prostate cancer.

By the way, how do grade 1 obesity and the army go together? Obesity is not listed in the list of diseases attached to the order of the Ministry of Defense "On military medical examination in the Armed Forces of Ukraine", so the suitability or limited suitability of an obese guy for military service is determined on an individual basis.

Obesity of the 1st degree in children

Depending on age, gender and constitutional features, the body weight of healthy children varies. A one-year-old child can weigh 9-12 kg with a height of 70-80 cm.

Obesity of the 1st degree in children is diagnosed when their weight exceeds the average age norm by 20-25%. And chronic overeating can be observed already in a two-year-old child.

Thus, obesity can be found in a one-year-old child with a body weight of more than 12-13 kg; at the age of three - more than 18 kg; in five-year-olds - more than 24-25 kg; at seven years old - over 30-32 kg; at 10 years old - more than 45-47 kg, and at 16 - over 85 kg.

Domestic pediatricians are confident that the main causes of childhood obesity are associated with excessive and improper nutrition (especially the habit of sweets, sweetened drinks and snacks), which disrupts metabolism, and a sedentary lifestyle, while endocrine or cerebral problems cause a fairly low percentage of grade 1 obesity in children.

Indeed, according to medical statistics, in 93% of cases obesity in children is recognized as idiopathic, that is, arising for an unknown reason. Only 7% of cases are associated with hormonal or genetic factors. And more often than other hormone deficiency conditions, hypothyroidism and growth hormone deficiency are noted. And the so-called syndromic obesity, diagnosed in congenital Cushing, Prader-Willi, Bardet-Biedl or Pekhkrantz-Babinski syndromes, is very rare.

Genetics plays a significant role in the development of childhood obesity: according to some data, 80% of children whose parents are obese are also significantly overweight.

But it is impossible to completely exclude the influence of hypothalamic and pituitary disorders on the mechanism of obesity development in children. In adolescence, mostly in girls, the initial stage of endogenous obesity can be a sign of hypothalamic syndrome of puberty (pubertal dyspituitarism) - one of the types of disorders of the hormonal balance of the hypothalamic-pituitary-adrenal axis and general metabolism. Fat reserves are localized in a mixed type - on the buttocks, thighs, chest, shoulders, and stripe atrophoderma (striae) also appears there.

Complications and consequences

To have a general idea of the consequences and complications that excess fat in the body entails, even with stage 1 obesity, it is enough to note the increase in the blood level of low-density cholesterol (LDL) and the development of atherosclerosis, hypertension, heart failure, coronary heart disease, etc. on this basis.

Obesity impairs the body's response to insulin and contributes to high blood glucose levels: excess fat is the cause of 64% of diabetes cases in men and 77% of cases in women.

In addition, obesity can result in: obstructive sleep apnea, cholelithiasis and urolithiasis, gastroesophageal reflux disease, fatty liver disease and fatty pancreatic necrosis, chronic renal failure, degenerative-dystrophic pathologies of the joints, lymphangiectatic edema of the lower extremities, menstrual disorders and infertility in women, erectile dysfunction in men.

And this is far from a complete list of health problems that grade 1 obesity leads to. British Heart Foundation experts associate at least ten types of oncological diseases that develop with excess weight.

And obesity in childhood and adolescence is associated with an increased risk of developing obesity in adulthood (up to 41-63%), with associated long-term health risks.

[ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]

Diagnostics grade 1 obesity

Diagnosis of stage 1 obesity begins with weighing, measuring height (to calculate BMI), and determining the ratio of waist and hip circumference (which allows for more precise localization of fat deposits).

What tests are needed to make a diagnosis? Endocrinologists perform various laboratory tests on blood samples, including blood sugar, cholesterol, serum adiponectin and leptin levels; gastric juice analysis for lipase content. See also - Hormonal tests for weight loss

To determine the volume of adipose tissue and its distribution, instrumental diagnostics are performed using X-ray absorptiometry (DEXA), ultrasound densitometry, and MRI to identify the amount of visceral fat.

[ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ]

Differential diagnosis

Differential diagnostics are necessary to identify possible pathologies: hypothyroidism, polycystic ovary syndrome (or Stein-Leventhal syndrome in women), tumor of the insulin-producing cells of the pancreas (insulinoma), congenital tumor of the pituitary tract in children (craniopharyngioma), etc.

Treatment grade 1 obesity

Today, dietary changes – a calorie-reduced diet for stage 1 obesity – and exercise are the generally accepted methods of treating stage 1 obesity.

The quality of nutrition can be improved by increasing the consumption of dietary fiber and reducing the consumption of high-calorie foods such as fats and carbohydrates. But at the same time, the diet should include foods containing all the necessary vitamins, micro- and macroelements. The ultimate goal is to lose up to 5-10% of weight.

How to lose weight with obesity of the 1st degree, for more details see – Diet 8 for obesity. In this publication there is a list of products that should be avoided, and an approximate menu of the diet for obesity of the 1st degree.

Dietary changes are also effective in limiting excessive weight gain during pregnancy.

If you are interested in what exercises for stage 1 obesity you need to do daily, read here - Exercises for losing belly fat

Along with diet and exercise, medications can be used to treat obesity, in particular, the drug Xenical (other trade names: Orlistat, Orlimax, Orsoten), which suppresses lipase and reduces intestinal absorption of fats. This pharmacological agent is taken three times a day - one capsule before each meal. But it is contraindicated for use in the presence of kidney stones and increased oxalate levels in the urine, pancreatitis, cystic fibrosis and celiac disease. Possible side effects include nausea, diarrhea, flatulence, headaches, and sleep disorders.

Surgical treatment

If diets, exercises, behavioral psychotherapy and pharmacology do not work, resort to extreme measures and conduct surgical treatment by bariatric surgery. This treatment has strict indications and is not intended for those who believe that they are simply overweight. As a rule, indications for surgical treatment of obesity arise with a BMI above 40. However, if the patient has problems such as type 2 diabetes, hypertension, varicose veins and problems with leg joints, indications arise already with a BMI of 35.

Surgical intervention can be in the form of:

1. insertion of an intragastric balloon to reduce the volume of the stomach;
2. gastric bypass, in which the stomach is divided into two separate "compartments" of different sizes, leaving only the smaller part functioning;
3. applying a bandage to the stomach, which slows down the movement of food;
4. sleeve gastroplasty (vertical excisional gastrectomy).

In case of obesity of the 1st degree, gastroplasty is mainly used, during which part of the stomach is removed, and a long and rather thin "sleeve" is formed from the remaining part. The capacity of the stomach is reduced by approximately 10 times (to 150-200 ml).

Folk remedies

Among the folk remedies for obesity, green tea and celery root are considered the most effective. Tea can increase the level of metabolism and accelerate the oxidation of fats, and by stimulating the nervous system, it can make you move more and, accordingly, burn more calories. And digesting dishes from celery root requires a lot of energy

Doctors strongly discourage treatment with herbs that have diuretic and laxative effects. But to suppress your appetite a little, herbalists recommend eating plantain leaves. Plantain contains fibers that completely fill the stomach, which promotes a feeling of satiety and also normalizes blood glucose levels. In addition to plantain leaves, you can eat kelp, which enhances the thyroid gland, dulling the feeling of hunger.

Spices like turmeric, ginger, cumin, cayenne pepper, black pepper, cardamom, cumin (jeera) can help maintain a healthy body weight by activating your metabolism. In addition to their weight-loss benefits, spices are actually some of the most powerful antioxidants, which is also good for your health.

And now a little exotic. The Namib Desert plant Hoodia gordonii, a member of the Gentian family, contains glycoside P57, which is believed to suppress appetite, according to the Journal of Medicinal Plants Research. And the succulent Caralluma adscendens is an edible cactus native to hot countries, where local rural populations have long quenched their thirst and hunger. The main phytochemical components of the plant are glycosides, saponins, and aglycones. Tests on laboratory rats have shown that Caralluma extract significantly reduces blood glucose levels.

[ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ]

Prevention

According to the WHO Global Strategy on Diet, Physical Activity and Health, adopted by the World Health Assembly in 2004, obesity prevention involves maintaining a healthy diet and regular physical activity.

Healthy eating involves limiting energy intake from fats and sugar; increasing the proportion of fruits, vegetables, legumes, whole grains and nuts in the diet. And the optimal amount of physical activity is considered to be 60 minutes per day for children and 150 minutes for adults.

We also recommend reading the article - Modern approaches to obesity prevention

And advice on preventing stage 1 obesity during pregnancy can be found in the article – How not to gain weight during pregnancy

[ 38 ], [ 39 ], [ 40 ], [ 41 ]

Forecast

Obesity is a leading preventable cause of death, and its prognosis depends on its severity and the complications that arise.

Obesity of the 1st degree reduces life expectancy by an average of three years. Researchers from the medical faculty of Oxford University, based on data from British clinics, came to the conclusion that only one person in five with such obesity lives to 70 years.

[ 42 ], [ 43 ], [ 44 ], [ 45 ]