Obesity of the 2nd degree: in women, men and children

Probably, it is very difficult to find a person who does not know that lack of physical activity, backed up by inaccuracies in nutrition, quickly enough corrects the figure in the direction of increasing body weight. If this situation persists for a long time, then in a few months you can already talk about obesity, when excess pounds appear in the form of a noticeable completeness. And if, with light obesity, fullness is perceived as a kind of cute constitutional feature, then obesity of the 2nd degree is evident already in obvious signs of excess weight, distorting forms attractive to the eye.

But obesity is so called, because this pathology is associated with excessive accumulation in the body of adipose tissue, due to which weight increases and the appearance of a person changes. The word "pathology" is used here not in vain. The thing is that obesity, unlike small completeness, is already a medical diagnosis, since it entails not only external changes, but also disruptions in the work of internal organs.

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

Epidemiology

As for obesity, the statistics on this score are far from comforting. Not so long ago, obesity was considered a "privilege" of developed countries. The United States of America occupied the first place in the rating of fat men, England and Greece - 2 nd, Germany - 3 rd, Russia - 4 th place, etc. In recent years, the situation has changed, and the underdeveloped countries, such as Qatar, the Cook Islands, Palau, Nauru, Kuwait, the United Arab Emirates, have moved to the forefront, pushing the United States to the 8th place (34% of the country's adult population, according to statistics in 2014, are overweight and 27% are obese of various stages).

And the point here is not in the level of life, but in food preferences related to the directions of the economic development of countries (for example, the sale of quality goods abroad and the use of products with low nutritional value), national traditions, etc.

The figures that say that the number of obese patients is increasing every year is also horrifying. So over the past 35 years, this figure has almost doubled. On average, about 13% of the world's adult population is obese, and about 40% will have it in the near future. And this despite the fact that the average life expectancy of such people is shorter by approximately 10 years, and the incidence of diabetes and heart disease is significantly higher than in people with normal weight.

The World Health Organization's forecast is even less consoling. In 2025, presumably, not 13 but 17 percent of the world's population will be obese. Especially in this regard, Europe will show itself, where by the year 2030 the following indicators are expected: about 89% of the male and 85% of the female population will have extra kilograms.

"Children's" obesity statistics are not much more attractive. In the US, a fifth of children and a quarter of teenagers are overweight. Over the past 16 years, the number of full-grown children has actually doubled and continues to grow rapidly.

Ukraine in the world ranking of obesity is somewhere in the middle. According to the latest data, about 26% of female representatives and 16% of men suffer from excess weight. And obesity of the 2nd degree is considered the most common among the adult population of the country and the planet as a whole.

[7], [8], [9], [10], [11], [12], [13]

Causes of the obesity of 2 degrees

So, we found out that obesity is not just external fullness, but a disease that negatively affects the overall well-being of a person and requires certain treatment. At the same time, it is extremely important to know the reasons that led to the development of obesity for the purpose of effective treatment, especially if it is not a question of the onset of the disease, but of pathology of the 2nd degree.

I think the question of what can lead to obesity of the 2nd degree, worries not only doctors. Many people are aware of the effect of overeating and carbohydrates and fat-rich foods on the growth of fatty deposits. Recently, the media has paid special attention to this issue. We are told about the correct nutrition from the Internet pages, offering various ways to combat excess weight.

And this is not surprising. In this age of computer technology, physical labor is increasingly being replaced by the intellectual, and the work of people is performed by machines. But having freed ourselves from physical labor, which requires a lot of energy, we did not change the diet, still giving preference to sweet, flour and fatty foods, and in considerable quantities. And where to get the energy received from food?

But if the consumption of high-calorie food and overeating necessarily lead to weight gain, then a fair question arises: why can one eat well and a lot, without recovering at all, and others enough to relax on holidays, and this will immediately affect the figure?

Yes, the wrong diet and its relationship with the growth of body weight in different people has its own individual manifestations. Someone in the family was thin, and it is often very difficult to recover such a person. And the other all my life I have to fight with excess weight, because in the family they have all plump. Therefore, to ensure that non-nutritional food provokes weight gain, certain other factors are needed that contribute to the development of obesity under favorable conditions, which are overeating and enthusiasm for high-calorie food.

[14], [15], [16], [17], [18],

Risk factors

The risk factors for obesity are:

• lack of physical activity,
• hereditary predisposition, sometimes called addiction to fullness,
• some pathologies, hormonal disorders that can cause weight gain (endocrine diseases, complications after traumatic brain injuries, consequences of intoxication and the negative impact of the infectious factor, etc.),
• stresses (strangely enough, eating stress with sweets, often even those who are at first sight fully refreshed are not recovered)
• use of psychotropic drugs,
• lack of sleep,
• The situation when a person remains confined to bed for a long time,
• some viruses (adrenovirus-36 - one of the causative agents of respiratory diseases and inflammatory eye diseases, is able to convert stem cells of adipose tissue directly into fat cells).

The causes of obesity of the 2nd degree in children and adolescents may also be incorrect introduction of complementary feeding in infancy, improper dosage of milk formulas, congenital deficiency of thyroid hormones, iodine deficiency in the body, hereditary factor.

Obesity of the 2nd degree can not arise by itself. This pathology is the result of an irresponsible attitude to one's health, because it was preceded by a minor completeness and obesity of the 1st degree, which also required corrective measures. In connection with this mediated cause of the development of obesity of the 2 nd degree, it is possible to consider a conniving attitude and failure to take the necessary preventive measures and treatment at the initial stage of the pathological process.

[19], [20], [21], [22], [23], [24], [25], [26]

Pathogenesis

Factors predisposing to the development of the disease, including obesity, 2 degrees, can cause weight gain only if there is a provoking factor. That's why consuming a large number of calories with a lack of physical activity is considered the main cause of obesity. In itself, the energy converted to fat, from the air and water does not arise, which means that it enters the body with other foods that are different in composition and calorie content.

Energy is necessary for the human body to carry out various processes of life and work. Another question, what is the balance of the energy entering the body and the energy it consumes? If energy is consumed less than what comes with food, its excess, of course, remains in the body in the form of fat, accumulating in fat cells (adipocytes) and causing their proliferation (hyperplasia). An increase in the amount of subcutaneous and internal fat leads to an increase in body weight and corresponding changes in its forms.

It would seem that harmless snacks while working at the computer would hardly have affected the figure, but no, they persistently settle in the form of fat deposits on different parts of the body. And the reason is that snacks are most often chosen to provide fast saturation of flour and sweet products, rather than vegetables and fruits with a modest calorie content.

Buns and pies are also preferred by students, which is the main reason for the development of obesity at a young age.

Weight gain is promoted not only by sweet, fatty and flour dishes, but also spicy, abundantly seasoned with spices, causing an unreasonable appetite and leading to overeating. The same effect is observed when drinking alcohol and sweet carbonated drinks.

Our body is the most complex system, which provides for the control of all processes that are necessary for carrying out life activity. In the regulation of fat metabolism (accumulation and consumption of fat) take part:

• the brain (in particular its cortex and subcortical areas),
• the nervous system (and involved in this process as a sympathetic, working with a load, and parasympathetic, a resting nervous system),
• endocrine organs.

At the heart of the pathogenesis of the development of obesity are still failures in the work of the cerebral cortex and subcortical organ, called the hypothalamus. They are responsible for regulating appetite and maintaining the optimal ratio between supplied and consumed energy. Pathologies of appetite regulation centers can be both congenital and acquired, including those that have emerged under the influence of inflammatory processes and brain injuries.

An important role in the pathogenesis of obesity as a pathology of metabolism is assigned to the glands of internal secretion (pituitary gland, adrenal glands, thyroid gland, islet apparatus of the pancreas, sex glands). Dysfunctions of these organs can lead to excessive accumulation of fat, inhibition of its mobilization and oxidation in the liver. This happens with an increase in the activity of the "pituitary-adrenal cortex-pancreas" system, a decrease in the production of growth hormone in the anterior pituitary gland, an inadequate thyroid hormone production by the thyroid gland, a decreased production of adrenaline, etc.

[27], [28], [29], [30], [31]

Symptoms of the obesity of 2 degrees

A person with obesity of the 2nd degree can not be overlooked simply impossible. After all, this is not an easy completeness, which even decorates some people. In addition, extra pounds leave their imprint on physical activity and work, not to mention the state of health.

The first signs of obesity are noticeable completeness (fat deposits can be located evenly or concentrate in separate places, most often in the waist, abdomen and thighs) and shortness of breath.

The appearance of dyspnea, even with minor physical exertion, suggests that the excess fat that has settled in the subcutaneous layer and on the internal organs complicates the work of the cardiovascular and respiratory systems, which allows treating obesity as a disease.

As for body weight, then with obesity of 2 degrees, there is an excess of the norm by 30-40%, which outwardly looks far from attractive.

Among other symptoms of obesity of the 2 nd degree, one can distinguish such manifestations as:

• increased sweating,
• a strong and frequent heartbeat, especially with small or significant loads,
• general weakness, despite the fact that a person leads a habitual way of life for him, normally eats and sleeps,
• swelling of the extremities or only fingers on the hands, especially during the hot season.

All these symptoms are not specific, including dyspnoea and weight gain, and may indicate different pathologies, although in combination they represent the symptomatology of a moderate degree of obesity. But as far as this corresponds to reality, only a professional doctor can determine the methods of differential diagnosis.

By external signs determine whether a person is obese or simply plump in principle, you can, but with the definition of the degree of obesity there are certain difficulties. The thing is that each person is individual, has a unique external appearance. And so the ratio of weight and height for each his own. And it should be considered taking into account age and sex.

For example, 90 kg with an increase of 180 cm in men will look perfect, but the woman will seem large. The same 90 kg in a person with a height of 160 cm will indicate the developing obesity, while the weight of 60 kg will be ideal. Again for a teenage girl of 11-12 years, even these 60 kgs seem superfluous, not to mention boys who ideally should have no more than 49 kg with a height of 158 cm.

Well, how do you understand that your weight is almost half deviated from the ideal? We receive scales and special tables that help you determine the ideal weight that corresponds to your age, growth and constitutional type.

In principle, the average ideal weight for women can be calculated by the formula: growth (in centimeters) minus 100. This formula is best suited for middle-aged women (40-50 years). Young women from the resulting result should take 10 percent, and the elderly, on the contrary, add about 5-6%.

With men, teenagers and children, the situation is more complicated, but there are various tables that help to calculate the ideal weight for these categories of the population, taking into account age and constitutional features.

Obesity in different population groups

Childhood obesity is a problem that modern doctors face almost every day. The positive aspects of intellectual and economic progress can not be denied, but its influence on our future is sometimes negative when it comes to the incorrect use of the useful achievements of the human mind.

So obesity of 2 degrees in children 1-1,5 years is most often due to the fault of parents who feed the baby with milk formulas without taking into account their nutritional value and influence on weight. The second cause of excess weight in infants is the incorrect introduction of complementary foods.

The beginning of obesity in children up to 12 months is considered to be an excess of body weight more than 15%.

The next peak in the development of obesity is at the age of 10-15 years. Teenagers can sit for days with a bun or chips at the computer, preferring it to active games and playing sports. Hence the excess weight and other health problems.

Increased appetite often reminds of yourself and hormonal adjustment. If during this period to give vent to their irrepressible desire to eat something tasty and high-calorie, the consequences will not be long in coming and will soon appear in the form of magnificent forms.

There is, of course, a certain percentage of children and adolescents in whom obesity is associated with congenital or acquired thyroid dysfunction or hereditary predisposition. So, if both parents are prone to obesity in the family, the same problem exists in the child in 80% of cases, if one of the parents - the probability of obesity development varies between 38-50%.

Obesity of the second degree in women is most often the result of banal overeating, hobbies sweets and baked goods and low physical activity. The second cause of obesity in women are hormonal failures (increased appetite with menstrual, weakened control of saturation in menopause, etc.). Well, again, the genetic factor plays an important role. If there is a predisposition to the development of obesity, weight control should be permanent.

In a woman's life there is also a special period when active weight gain is considered a norm rather than a deviation. It's about the time during which a new life grows and develops within the female body, and hence the future mother has to eat for two. And here it is important what kind of products the woman chooses for saturation: vegetables and fruits or rolls, sweets and heavy hearty meals that lead directly to the development of obesity 1, and then 2 degrees in pregnant women.

In pregnancy, normal weight gain is considered to be within 8-12 kg (at the end of pregnancy). Exceeding the initial body weight by more than 12 kg often leads to certain problems with the health and bearing of the baby.

Obesity of the 2nd degree in men is observed a little less often than in women, because the male body is not so inclined to accumulation, as female. Nevertheless, the use of high-calorie food and a sedentary lifestyle make itself felt by the appearance of excess weight and in this case. A hobby for alcoholic beverages, and especially beer, only aggravates the situation, because for hot drinks you need a good snack.

Risk factors for the development of obesity in grade 2 in men are all the same bad heredity, susceptibility to stress, traumatism and endocrine diseases.

Forms

Since obesity can be caused by various, unrelated causes and requires a different approach to treatment, it is usually divided into the following types:

• primary obesity, which is associated with an incorrect lifestyle and irrational nutrition,
• secondary obesity, the cause of which are pathologies, in which the regulation of appetite and metabolism is disturbed.

Based on this division, we can distinguish such types of obesity:

• exogenously-constitutional (it is alimentary or primary) obesity, which depending on the stage and neglect of the process can be 1, 2, 3 and 4 degrees. The reason for the development of this type of pathology is the abuse of high-calorie food against a background of low physical activity. It is formed more often on the background of a hereditary predisposition to excess weight.

For alimentary obesity, frequent overeating, a gradual increase in weight, a more or less even distribution of subcutaneous fat (in women sometimes it is slightly larger in the abdomen and thighs), the absence of endocrine disorders is characteristic.

• Hypothalamic obesity is associated with the pathology of the central nervous system, which affects primarily the hypothalamus (tumors, injuries, the effect of the infectious factor). It is characterized by:

• rapid weight gain,
• localization of fatty deposits in the abdomen (such deposits are sometimes called the apron), thighs and buttocks,
• dry skin,
• the appearance of stretch marks,
• headaches and sleep disorders, indicating the disease of the brain,
• Vegetative disorders, such as hypertension, hyperhidrosis, etc.

• Endocrine (morbid) obesity. It can be diagnosed against the background of certain pathologies of the endocrine system (hypothyroidism, diabetes, etc.). The symptomatology of such obesity includes general symptoms and signs of a pathology that caused a rapid weight gain, in the form of deterioration in well-being and hormonal disorders. Often there are signs of the opposite sex in the patient, for example, excessive growth of hair on the body in women or female roundness in the male figure.

Hypothalamic and endocrine obesity of 1,2, 3 and 4 degrees are related to the secondary type of weight pathology.

Classification by the location of fatty tissues implies the division of obesity into such types:

• Gynoid obesity (female type) with localization of fatty deposits in the buttocks and thighs.
• Abdominal obesity (according to the male type) is the accumulation of adipose tissue on the abdomen.
• Mixed obesity with more or less even distribution of adipose tissue.
• Cushingoid obesity associated with impaired function of the pituitary and adrenal glands. In this case, the fat deposits are localized throughout the body except for the hands and feet.
• Visceral obesity. The most dangerous type of obesity, in which adipose tissue entangles the internal organs (heart, liver, etc.), and outwardly signs of obesity may not be.

[32], [33], [34], [35],

Complications and consequences

No violations in our body can not do without consequences, including the accumulation of excess weight. If the whole matter was only in the psychological discomfort associated with teasing in childhood and condemnation from the side in adulthood. In fact, the problem is much more difficult, especially if we take into account the fact that obesity of the 2nd degree represents a significant excess of weight, which is a big burden on the body.

It would seem that a simple surplus of fat, but causes many unpleasant and even dangerous consequences and complications. Their list can be called more than impressive. So, obesity of the 2nd degree can lead to development:

• Diseases of the digestive tract, in particular pancreatitis. At the same time the disease is more severe, often with complications.
• Diseases of the gallbladder, in particular cholelithiasis. This is more true of women, because the process of formation of stones in them is in great dependence on body weight. In men, this dependence can be traced much more rarely.
• Hemorrhoids, which is especially dangerous in the presence of constipation.
• Fatty hepatosis (in the case of visceral obesity) with a violation of the functionality of the liver.
• Hypertension. Increased pressure in obese patients occurs almost 3 times more often than in people with normal weight. In patients with obesity of grade 2, the pressure will be 20-25 mm Hg. Art. Above the norm.
• Diabetes mellitus, developing in type 2. As in the case of hypertension, there is an almost threefold increase in the number of patients. The most susceptible to diabetes patients with abdominal obesity.
• Ischemia of the heart (IHD) and myocardial infarction. The risk of developing pathology is again higher for abdominal or visceral obesity. With an increase in body weight, the number of deaths increases.
• Varicose veins and the formation of blood clots in the vessels.
• Pathologies of the respiratory system: shortness of breath, development of hypoventilation syndrome, stopping breathing in sleep.
• Diseases of the musculoskeletal system, such as gout, osteoarthritis, platypodia, scoliosis (in children), etc. The development of such diseases is associated with too much strain on the joints and muscles of the legs and back.
• Problems in the sexual and reproductive sphere, including impotence and infertility.

Especially dangerous is obesity of the 2nd degree in pregnancy. In this case, there is a high risk of complications (about 75-80%) in the early stages, as well as anemia and respiratory diseases in late pregnancy.

In addition, shortness of breath with obesity is fraught with the fact that the fetus while in the womb will lack oxygen. Danger of obesity and the threat of miscarriages, weak labor, the development of postpartum complications. No wonder these women are under special control of doctors.

Obesity of the 2nd degree not only brings a certain psychological and physical discomfort, but also limits physical activity, which leads to a further increase in body weight, development of subsequent stages of the disease and deterioration of health. That is why it is so important to stop the pathological process as early as possible, while we have not yet had to contend with its consequences.

[36], [37], [38]

Diagnostics of the obesity of 2 degrees

Despite the fact that overweight in the overwhelming majority of cases has pronounced external manifestations, it is only on the basis of a simple examination of the patient that the doctor can not formulate an exact diagnosis. Diagnosis of obesity is a complex and multifaceted process with several objectives:

• to establish the very fact of obesity, differentiating it from the excess body weight,
• determine the degree of obesity (the diagnosis should sound specifically, for example, "obesity of the 2nd degree"),
• determine the type and type of obesity,
• To establish the reasons which have led to pathological growth of parameters of weight,
• to reveal other pathological changes in the body: congenital anomalies, the consequences of injuries, diseases of internal organs, which can be both the cause and consequence of the complication,
• the definition of an effective approach to the treatment of obesity.

The beginning of diagnostic studies is the collection of anamnesis, measurements and external examination of the patient. Obesity of the 2nd degree is very difficult to confuse with the usual easy fullness, unless of course it is not visceral type, when the fat deposits are localized on the internal organs, almost without changing the external forms of the person. And yet the line between obesity of grade 2 and pathology of 1 or 3 degree is rather thin, therefore, it is simply impossible to do without anthropometric studies.

[39], [40], [41], [42], [43], [44]

Anthropometric studies

The leading study to determine the degree of obesity is the calculation of the body mass index (BMI). The formula for the calculation of BMI was developed by the Belgian statistician A. Quetelet in the late 60s of the 18th century. Nevertheless, doctors are successfully using it to this day.

For calculations according to Adolf Ketle's formula, only weight in kilograms and a person's height in meters are needed. BMI according to the formula can be calculated by dividing the patient's weight by its height, taken in a square:

BMI = m / h ², where m - weight (in kg), h - growth (in m).

The normal body mass index is in the range of 18.5-24.9. If the weight and height of the patient, or rather their ratio is such that BMI will be within 35-39.9, which happens with obesity of the middle stage, the diagnosis will be unambiguous - obesity of the 2nd degree, in which the likelihood of developing concomitant pathologies is high. And this means that further complex examination of the patient will be needed to detect or prevent these pathologies.

So, we found out that with obesity of grade 2 BMI exceeds the norm by about 25-50%. And this is a considerable indicator, there is something to think about. But only this data is not enough to understand the cause of weight gain and its consequences. To determine the type of obesity by the location of fat deposits, the physician will need to measure the circumference of the chest, waist and hips (OG, OT, OB), and also measure the thickness of the fat fold on the abdomen with a special caliper device.

[45], [46], [47], [48], [49], [50],

Anamnesis and external examination

Collecting anamnesis in the diagnosis of obesity of the 2nd degree is not a waste of time, because in this way it is possible to establish the cause of the disease development by chance, even without additional studies. Since obesity of the 2nd degree is visible to the naked eye, it makes no sense to start the diagnosis from measurements to determine if a person has obesity or not.

It is more reasonable to begin reception with studying of a way of life and a state of health of the patient. Patients with obesity often do not want to recognize their problem, so communication with them must be conducted very delicately. Trust is the first step towards successful treatment, which, note, can last even more than one year.

First you need to find out when the patient has a problem with the weight, whether it was a child's age, or it all started already in adulthood, whether it is possible to associate weight gain with hormonal splashes in the body. Refine the patient's eating habits, the regime of the day, the level of physical activity, exposure to stress.

To clarify the cause of the development of obesity, the study of the patient's health will help: whether there were nerve and infectious diseases, whether the strengthened diet was prescribed, what were the injuries, including those after which a prolonged immobilization was carried out, and what medications were treated. Pay attention to the type of puberty (premature or delayed puberty can also provoke obesity).

Patients with excess weight do not like to talk about food, but still the doctor needs to find out:

• what kind of food and how much the patient uses,
• how often does he eat,
• evening menu and dinner time,
• whether there are night meals,
• how often the patient takes part in events with feasts.

In talking with the patient, you need to find out the patient's relationship with the parents and family traditions concerning eating and physical activity, whether there is a propensity for obesity in relatives, whether there were conflict situations at work and at home, whether the patient tried to lose weight in the past, how many times and with what result.

An important role in obesity of the 2nd degree is given to the external examination of the patient. Some information about the health status and hormonal status of the patient can give an examination of the skin of the patient: skin purity, color, type and intensity of the hair, the presence of stretch marks, edema, manifestations of hemorrhagic diathesis. Then the boundaries of the heart, liver and lungs are determined, which allows to identify such accompanying pathologies as cardiopulmonary insufficiency or obstructive bronchitis.

During the examination, the doctor determines the mobility of the joints of the lower limbs and spine, reveals whether there is varicose veins and whether there are signs of venous insufficiency.

[51], [52], [53], [54]

Laboratory research

In the course of diagnostic measures, multiple analyzes are conducted to determine the type and cause of obesity of grade 2, which allow us to see the problem from the inside out. It is clear that the general analysis of blood can not do it, because it is more important to identify the effects of obesity, such as anemia or leukocytosis.

More information is provided by a biochemical blood test, especially the level of sugar (elevated indices indicate the development of diabetes mellitus) and cholesterol (determining the likelihood of developing atherosclerosis). Sometimes more detailed study of such indicators as bilirubin, enzymes, transmases, etc. Is required.

It will help with the definition of the cause of obesity and the features of the course of the disease and an analysis of the hormones produced by the thyroid gland, the adrenal glands, the pituitary gland, the sex glands.

To determine violations in the work of the kidneys, general urine analysis and special samples can be prescribed.

To establish an inherited predisposition to obesity, a molecular genetic study is performed on the basis of venous blood (or a piece of skin) of the patient and his relatives.

Instrumental diagnostics

Instrumental studies in diagnosing obesity of grade 2 are used as auxiliary methods to help clarify the patient's health and determine the effect of excess weight on the work of his internal organs. They are especially important if there is a visceral type of obesity, which is rightfully considered the most dangerous.

The most informative methods of instrumental diagnostics in this situation are:

• Computer and magnetic resonance imaging (CT and MRI). They help with a high accuracy to estimate the thickness of the subcutaneous and the volume of visceral (internal) fat, and also to reveal some pathologies of the internal organs.
• Ultrasound examination (ultrasound). Also helps to determine the thickness of subcutaneous fat, plus fixes changes in the structure of internal organs, which are a dangerous consequence of obesity of the 2nd degree.
• Densitometry. Absorption of X-ray energy by different tissues occurs in different ways. This is the basis of the above method, which allows you to determine the amount of fat stores. With his help, you can identify such a dangerous disease of bone tissue, like osteoporosis, which is not a rare complication of obesity.
• Impedanceometry. Another specific method for determining the amount of adipose tissue, which has the greatest bioelectrical resistance.

X-ray examination in its pure form with obesity is carried out only with suspicion of the pathology of the digestive organs.

Differential diagnosis

External examination of the patient, collection of anamnesis, counting of BMI, laboratory and instrumental studies give the endocrinologist a great opportunity for reflection. After all, he needs not only to determine the degree and classification of obesity, but also to identify the accompanying pathologies, in which obesity of the 2nd degree can act only as one of the symptoms. And if the primary (alimentary) obesity is more or less clear, then the secondary requires more complete study.

The purpose of differential diagnosis is precisely these pathologies that have become the cause of secondary obesity, without the treatment of which the fight against excess weight will not be successful.

So, obesity can be one of the symptoms of the following pathological conditions:

• Intracranial tumors.
• Tuberculous meningitis.
• The Lawrence-Moon-Biddle-Barde syndrome is a hereditary pathology with multiple symptoms.
• Gelino syndrome in women, in which there is an increased appetite and short-term comatose conditions.
• Babinsky - Frohlich disease in boys. It is accompanied by obesity or type 1 diabetes, impaired growth and development of the genital organs.
• Morgagni-Stuart-Morel Syndrome. He is characterized by a large weight, the appearance of male features and a thickening of the inner plate of the frontal bone in women after 40 years.
• Syndrome Itenko - Cushing. Obesity (often visceral) is observed against the background of increased body hair growth, hypertension, osteoporosis, etc.
• Stein - Leventhal Syndrome. Symptoms: a large amount of fat tissue, dysmenorrhea, disruptions in the development of the uterus and as a result of infertility, pain in the head and abdomen, the appearance of masculine traits (the breast is sufficiently developed at the same time).
• Syndrome Martin - Albright. Diagnosed in childhood and accompanied by a lag in mental development.
• Secreting insuloma, characterized by intolerance to hunger, mental disorders and elevated levels of insulin.
• Syndrome Shihena. Symptoms: overweight, lack of lactation and menstruation after childbirth.
• De-Tony syndrome, in which obesity is combined with physical and mental underdevelopment, kidney disease, diabetes, osteoporosis.
• Diabetes. Obesity against the background of increased blood sugar.

And every year the list of such pathologies leading to secondary obesity of the 2 nd degree becomes more and more. So, the statistics will record the increase in the incidence of obesity, not only because of overeating and low physical activity, but also because of health pathologies that affect the weight of a person.

Treatment of the obesity of 2 degrees

Obesity is a disease that does not have one, but several treatment options : multiple diets, various exercise complexes (LFK), physiotherapy procedures, massage, drug therapy, hypnosis and psychotherapy, surgical treatment. All these methods of combating obesity are applicable for obesity of the 2nd degree, but only in each specific case is assigned its own individual set of measures.

Yes, it is a complex, not a single measure. Many know how difficult it is to get rid of even a couple or three extra pounds, but here we are talking about dozens. Only one diet to remove so much fat is unlikely to succeed, except in a few years. And the effectiveness of various diets is always reinforced by physical activity.

We will not sin against the truth, but not always diets and an active way of life in combination with sports at obesity of 2 degrees give the necessary result. Sometimes the weight reduction is so slow that you have to resort to medication and tested dietary supplements.

Forecast

The prognosis for obesity of grade 2 is mostly positive. It all depends on the desire and desire of the patient to return to normal forms. It is worth noting that obesity of the 2 nd degree is not a contraindication to work and service in the army, and it is there that the daily loads and the normalization of the diet regime will help solve this problem.

[55], [56], [57],