Obesity 1 degree: treatment with medication, diet, exercise

Obesity, including the most "light" version of it - obesity of 1 degree - is a condition in which too much adipose tissue accumulates in the body, which not only spoils the figure, but also has a negative effect on health.

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

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

Epidemiology

Since 1980, the number of obese people in some regions of North America, Britain, Eastern Europe, the Middle East has tripled. The indicators of obesity in the US over the same period increased by 100%. The African continent (south of the Sahara) 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 are obese (representing 13% of the population). Most often it is noted in women.

But the special concern of the experts of the International Association for the Study of Obesity (IASO) causes an increase in the number of obese children. Almost 42 million children under the age of five have either excessive body weight or diagnosed obesity 1, 2 and 3 degrees. The highest risk factors for childhood obesity in Malta and the United States (25%), and the lowest in Sweden, Latvia and Lithuania.

Even in Africa, the number of children in this age group who are overweight or obese 1 degree 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 has obesity. Associate this with an increased intake of carbohydrates, not fat.

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

Causes of the obesity of 1 degree

Obesity is a complex heterogeneous disease, and more often physicians call it a metabolic syndrome. Exogenous and endogenous risk factors for its development consist of excessive food consumption (unutilized energy is stored in the body as fat), hypodynamia (lack of calorie-burning physical exertion), endocrine disorders, genetic mutations and family (hereditary) predisposition.

With overeating and hypodynamia, everything is clear. And the expenditure of energy, which gives the person food, is crucial, because, as it turned out, muscle loads contribute to the release of tissue from the skeletal muscle membrane protein FNDC5 (irisin). It has been proven by experience that irisin can regulate the involvement of visceral adipose tissue and subcutaneous fat in thermogenesis, that is, behave like an adiponectin hormone produced by cells of white adipose tissue and involved in the regulation of glucose and the cleavage of fatty acids.

The key causes of type 1 obesity are found in disorders of the metabolism of white adipose tissue, the excess of which is characterized by this pathology. Fat tissue is formed by adipocytes, which are increased in obesity due to the increased level of triacylglycerin (TAG) accumulated in them.

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

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

The cleavage of triacylglycerin requires specific lipolytic (hydrolase) enzymes present in adipose tissue (ATGL, HSL, MGL) and encoded by specific genes. The organism can not suffice these enzymes. To obesity leads and deficiency of the already mentioned hormone adiponectin, for a sufficient synthesis of which corresponds the gene ADIPQTL1. In the accumulation of excess fat mass, faults in the FTO gene that encodes the dioxygenase enzymes of the hydrolase family catalyzing the cleavage of TAG can be to blame. Any mutation and polymorphism of these genes can cause a deficiency of substances that provide fat cell metabolism. For example, people with two copies of the FTO gene allele weigh 3.5 kg more on average, and they have a higher risk of developing obesity and type 2 diabetes.

After the discovery of the fat hormone hormone leptin, endocrinologists began to better understand the mechanisms of energy homeostasis. Obesity can be the result of both defects in the transduction of the signal of this hormone in the brain, and the missense mutations of the leptin-encoding leptin. In more detail in the material - What is leptin and how does it affect weight?

The same role was played by the detection of the amino acid peptide ghrelin (secreted in the stomach and proximal part of the small intestine), which increases appetite, glucose oxidation and lipogenesis. Ghrelin is the only substance that is released in response to a decrease in the content of the gastrointestinal tract and is suppressed when it replenishes in the process of eating. Already with obesity of 1 degree, as in patients with insulin resistance, ghrelin levels are chronically low. In this case, visceral adipose tissue is more sensitive to the lack of ghrelin than subcutaneous, and this means that lipid deposition will occur predominantly in the visceral fat depots. The relationship between ghrelin deficiency and G274A and GHS-R gene mutations has been identified.

In addition, frequent causes of type 1 obesity are endocrine disorders such as increased pancreas production of lipase enzyme and insulin hormone, insufficient level of thyroid hormones (triiodothyronine). For example, when the blood glucose level rises, endogenous insulin not only reduces it, but at the same time inhibits the secretion of the counter-regulatory hormone of the pancreas of glucagon, one of whose functions is stimulation of lipolysis. So insulin actually prevents glucagon from fighting fat.

No less important role in the pathogenesis of obesity is played by certain pathological changes in the work of certain structures of the brain, in particular, the anterior lobe of the pituitary (adenohypophysis). Thus, the low level of stimulating lipolysis of the hormone of somatotropin and the increased production of adrenocorticotropic hormone (ACTH) prevent the TAG from cleavage. Due to the excess of ACTH, the adrenal cortex begins to produce more cortisol, which leads to an increase in blood sugar and inhibition of triacylglycerin cleavage.

Sex steroids (estrogen, testosterone), somatomedine (IGF-1, insulin-like growth factor-1), catecholamines (adrenaline, whose receptors are present in adipose tissue) are directly related to the process of accumulation and cleavage 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.

Obesity of 1 degree is often observed in schizophrenia and schizoaffective disorders, prolonged depression, as well as in bipolar and panic disorders of the psyche and agoraphobia (fear of open spaces and crowded places).

Medical obesity can be provoked by atypical antipsychotics, tricyclic antidepressants, hypoglycemic agents of thiazolidinedione group, sulfonylurea preparations, steroids, some anticonvulsants and hormonal contraceptives.

[17], [18]

Symptoms of the obesity of 1 degree

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 / m 2) and is calculated by dividing the weight of a person by the square of his growth.

How it is easier to calculate? Divide your weight in kilograms by your height in meters, and then divide the result again by the growth rate. For example: if you weigh 70 g with an increase of 1.75 m, you need 70 divided by 1.75. Answer 40. Then divide 40 by 1.75 and get the body mass index - 22.9 (22.85). This is an excellent, that is a healthy BMI!

Weight is considered simply superfluous when BMI is 25-30, and a BMI of 30-35 indicates obesity of 1 degree.

According to endocrinologists, in the absence of complications, the symptoms of obesity of the 1st degree do not appear until the transition from the initial stage to the progressive one. Here then there may be a heaviness in the stomach, eructations, flatulence, headaches, dyspnea with tachycardia, fits of weakness and hyperhidrosis.

In general, the specificity of the symptoms is determined by the kinds of obesity that endocrinologists distinguish depending on the cause on exogenous and endogenous. And all of the above concerns primary obesity, that is, developing due to overeating and hypodynamia. This type of excessive accumulation of adipose tissue has such variants of the name, as - alimentary adiposity of 1 degree, or alimentary-constitutional obesity of 1 degree, or exogenously-constitutional obesity of 1 degree.

All other causes of the development of obesity are endogenous (see the previous section), and pathology can be diagnosed as endocrine obesity (hormonal, pituitary, hypothyroid, diabetic, etc.), cerebral (hypothalamic) or hereditary. In a word, the division of obesity into species is not distinguished by strict unification.

And according to the one where fat accumulates, types of obesity are distinguished: abdominal (other terms - upper, central, android or masculine) with a characteristic increase in fatty tissue in the abdominal area (abdomen) - both under the skin and visceral (intra-abdominal ) fat; femoral-buttock (feminine or gynoid); mixed (the most common in endocrinopathies).

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

Obesity of 1 degree in women

Characterizing the obesity of grade 1 in women, it should be noted the crucial role of sex hormones in the regulation of energy balance. First of all, this ratio of androgens and estrogens.

Even with a relatively normal diet, women may have problems with the regulation of fat tissue homeostasis. Thus, with a preponderance of testosterone, hyperandrogenism develops , often associated with an increased accumulation of visceral fat; it also occurs in cases of the presence of polycystic ovary syndrome in women , and in the period of menopause.

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

It should also be noted not only the presence of fatty white tissue of its own hormones that affect energy metabolism, but also its ability to produce steroid hormones, in particular, the same estradiol. And the more fatty tissue, the more serious the hormonal imbalance in the female body, leading to problems with the regularity of the menstrual cycle, fertility, tolerance in glucose, the risk of development of oncology of the uterus and breasts during the menopause, as well as with complications during pregnancy. Learn more about why women recover over 30 years of age

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

Obesity of 1 degree in men

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

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

The thicker the waist in men after 30 years, the lower the level of testosterone in the body: according to foreign researchers, an increase in waist circumference by 10-12 cm reduces the production of male sex hormone 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 explained by the fact that fatty tissue produces estrogens (as discussed above). At the same time, the reproductive function of a man suffers because of the low number of spermatozoa and a decrease in their mobility.

Many specialists allocate in men the syndrome of hypoventilation obesity (OHS), combining obesity of 1 degree, hypoxemia (lowering of oxygen level in the blood) during sleep, hypercapnia (high content of carbon dioxide in the blood) during the day - as a result of too slow or shallow breathing ( hypoventilation).

Frequent companion obesity in men - kidney stones, benign prostatic hyperplasia, urinary incontinence, as well as changes in the metabolism of sex hormones, which can provoke the development of prostate cancer.

By the way, how do obesity of the 1st degree and the army combine? In the list of diseases attached to the order of the Ministry of Defense "On Military Medical Examination in the Armed Forces", obesity is not available, so the suitability or limited fitness of a fat guy for military service is determined on an individual basis.

Obesity of 1 degree in children

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

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

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

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

Indeed, according to medical statistics, in 93% of cases obesity in a child is recognized as idiopathic, that is, arising for an unknown reason. With hormonal or genetic factors, only 7% of cases are associated. And more often than other hormone-deficient conditions, hypothyroidism and a lack of growth hormone are noted. And the so-called syndromic obesity, diagnosed with congenital syndromes Cushing, Prader-Willy, Barde-Biddle or Pehkrantz-Babinsky, is very rare.

A significant role in the development of childhood obesity is played by genetics: according to some data, 80% of children whose parents are obese, also have a significant excess of body weight.

But it is impossible to completely exclude the influence of hypothalamic and pituitary dysfunctions on the mechanism of the development of obesity in children. In adolescence, mostly in girls, the initial degree of endogenous obesity can be a sign of the hypothalamic syndrome of puberty (puberty dyspituiti- ism), one of the types of disturbances in the hormonal balance of the hypothalamic-pituitary-adrenal axis and total metabolism. Fat reserves are localized in a mixed type - on the buttocks, hips, chest, shoulders, and there appears a striped atrophodermia (striae).

Complications and consequences

In order to have a general idea of what consequences and complications entail an excess of body fat in the body, even with obesity of 1 degree, it is enough to note an increase in blood levels of low-density cholesterol (LDL) and the development of atherosclerosis, hypertension, heart failure, coronary heart disease and etc.

Obesity worsens the body's response to insulin and increases blood glucose levels: excess fat is the basis of 64% of cases of diabetes in men and 77% of cases in women.

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

And this is not a complete list of health problems, leading to obesity of 1 degree. Experts at the British Heart Foundation associate at least ten types of cancer, developing with overweight.

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

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

Diagnostics of the obesity of 1 degree

Diagnosis of type 1 obesity begins with weighing, measuring growth (to calculate BMI), as well as determining the ratio of waist circumference to hips (which allows us to clarify the location of fat deposits).

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

To determine the volume of adipose tissue and its distribution, instrumental diagnostics using fluoroscopic absorptiometry (DEXA), ultrasonic densitometry, and MRI - to detect the amount of visceral fat.

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

Differential diagnosis

Differential diagnosis is necessary to identify possible pathologies: hypothyroidism, ovarian polycystosis (or Stein-Leventhal syndrome in women), a tumor of insulin-producing pancreatic cells (insulin), a congenital pituitary gland tumor in children (craniopharyngioma), etc.

Treatment of the obesity of 1 degree

To date, changes in diet - a diet for obesity of 1 degree with a decrease in caloric intake - and exercise are universally recognized methods of treatment of obesity 1 degree.

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

How to lose weight for obesity of 1 degree, for more details see - Diet 8 for obesity. In the same publication there is a list of products to be avoided, and an approximate diet menu 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 obesity 1 degree you need to do daily, read here - Exercises for weight loss belly

Along with diet and exercise in the treatment of obesity, medications, in particular, suppressing lipase and reducing intestinal fat absorption, Xenical (other trade names Orlistat, Orlimax, Orsoten) can be used in the treatment of obesity. This pharmacological agent is taken three times a day - before each meal, one capsule. But it is contraindicated to use in the presence of kidney stones and increased content of oxalate in the urine, with pancreatitis, cystic fibrosis and celiac disease. Among the possible side effects noted nausea, diarrhea, flatulence, headaches, sleep disturbances.

Operative treatment

If diets, exercises, behavioral psychotherapy and pharmacology do not have an effect, resort to extreme measures and conduct surgical treatment by bariatric surgery. This treatment has strict testimony and is not intended for those who believe that they simply have extra weight. 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, the indications appear even with BMI 35.

Surgical intervention is in the form of:

1. introduction of an intragastric balloon to reduce the volume of the stomach;
2. shunting of the stomach, in which it is divided into two separate "compartments" of different sizes, leaving only a smaller part in the functioning state;
3. the imposition of a bandage on the stomach, which slows the progress of food;
4. sleeve gastroplasty (vertical excision gastrectomy).

With obesity of 1 degree, gastroplasty is mainly used, during which part of the stomach is removed, and the remainder forms a long and rather thin "sleeve". The capacity of the stomach at the same time decreases approximately 10 times (up to 150-200 ml).

Alternative treatment

Among the alternative treatments for obesity, green tea and celery root are the most effective. Tea can increase the level of metabolism and accelerate the oxidation of fats, and due to stimulation of the nervous system - to make you move more and, accordingly, spend more calories. A digestion of dishes from the root of celery requires a lot of energy

Treatment with herbs that have a diuretic and laxative effects, doctors categorically not recommended. But in order to muffle the appetite, phytotherapists advise eating plantain leaves. Plantain contains fibers that completely fill the volume of the stomach, which contributes to feeling full, and also normalizes the level of glucose in the blood. In addition to the leaves of plantain, you can consume seaweed laminaria, which strengthens the thyroid gland, dulling the feeling of hunger.

Spices such as turmeric, ginger, cumin, cayenne and black pepper, cardamom, cumin (zira), can help maintain a healthy body weight by activating the metabolism. In addition to their use for weight, spices are actually one of the most powerful antioxidants, which is also good for health.

And now a little exotic. Growing in the Namib desert plant hoodia (Hoodia gordonii) family gentian, according to the Journal of Medicinal Plants Research, contains glycoside P57, which is believed to depress the appetite. And caralluma adscendens succulent is an edible cactus that comes from hot countries, whose local rural population has long quenched thirst and hunger. The main phytochemical components of the plant are glycosides, saponins and aglycons. Tests on laboratory rats have shown that the carilloma extract significantly reduces the level of glucose in the blood.

[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, the prevention of obesity is the maintenance of healthy nutrition and regular physical activity.

Healthy eating involves limiting energy consumption through fat and sugar; increase the proportion of fruits, vegetables, legumes, whole grains and nuts in the diet. And the optimum is 60 minutes of daily physical activity for children and 150 minutes for adults.

Also we recommend reading the article - Modern approaches to the prevention of obesity

And advice on the prevention of obesity of 1 degree in pregnancy can be found in the material - How not to recover during pregnancy

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

Forecast

Obesity is the leading preventable cause of death, and the prognosis of its development depends on the degree and complications arising.

Obesity of 1 degree reduces life expectancy by an average of three years. Researchers at the Oxford University Medical School, based on data from British clinics, concluded that only one in five people with this obesity survives to 70 years of age.

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