Fourth-degree obesity

Obesity of the 4th degree is the most severe form of this disease. It is diagnosed when a person's weight exceeds the maximum permissible indicator by more than 100%. The norm can be calculated by BMI or other formulas, such as the ratio of the waist to the hips by width.

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Causes of grade 4 obesity

The main reasons for this problem include:

• sedentary lifestyle;
• overeating;
• hormonal or chronic diseases.

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Pathogenesis

The main variant of development of obesity in humans is considered to be disorders of the functions of the main central mechanisms, such as the cerebral cortex, as well as the hypothalamus - this is where the centers regulating appetite are located. Disorders can be not only congenital, but also acquired (in cases caused by upbringing, family lifestyle, nutritional diet, etc.). In the presence of injuries that affect the areas of location of these centers (with or without the development of an inflammatory process), obesity can also develop.

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Symptoms of grade 4 obesity

With the development of obesity of the 4th degree, the following symptoms are observed:

• Development of systemic disorders in the functioning of the heart - coronary heart disease, heart failure, and increased blood pressure (and these are only some of the diseases that occur in humans at stage 4 of this pathology). Fatty tissue begins to grow around the myocardium, as a result of which the heart experiences a lack of oxygen. Due to poor blood supply to tissues, which occurs due to atherosclerosis, their hypoxia begins;
• Since the cardiovascular system begins to function differently, changes also occur in the functioning of the respiratory system - the so-called non-specific resistance decreases. The process of ventilation of the lungs becomes much more complicated, which causes inflammation in the respiratory tract (for example, pneumonia or bronchitis). In some cases, as a result of obesity stage 4, tuberculosis developed;
• Since the body mass is too great, it begins to directly affect the musculoskeletal system – as a result, patients develop various pathologies of the spine and joints, including osteochondrosis.

Stages

Obesity can have a progressive stage - the volume of fat reserves gradually increases, as a result of which the body weight gradually increases. There is also a stable stage (this is the so-called residual stage, which is considered residual - it is noted after the loss of some of the weight).

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Forms

There are also several distinct types of obesity, which are classified based on where in the body fat is primarily stored:

• Abdominal type (or upper, android). In this case, fat deposits are mainly located in the upper body, and in addition on the stomach. More often, this type of obesity is observed in men. With this type of disease, the risk of affecting the general condition of the body is quite high, which manifests itself in the form of high blood pressure, diabetes, as well as strokes and heart attacks;
• Femorogluteal (lower) type. In general, the name itself tells you in which areas of the body fat deposits accumulate - on the hips and buttocks. This type of pathology is mainly observed in women, and accompanying complications include diseases such as venous insufficiency, and in addition, various diseases of the joints and spine;
• Mixed (intermediate) type. In this case, fat reserves are evenly deposited in all areas of the body.

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4th degree obesity in children

Nowadays, quite a lot of children suffer from obesity, and in some cases it even reaches stage 4. This trend can be explained by the fact that children lead a sedentary lifestyle and eat poorly. In addition, hereditary or acquired diseases play an important role. Therefore, it is very important to notice that the child's weight has begun to deviate from the norm in time. Timely treatment will help avoid problems associated with stage 4 obesity.

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Complications and consequences

In case of obesity development up to the 4th degree, problems begin in the whole organism – changes occur both in internal organs and in veins with arteries, hair and skin, as well as mucous membranes. Very serious diseases can develop – such as disorders of the endocrine system and diabetes. In the future, they lead to disability.

In case of prolonged course of the disease not under the supervision of a professional specialist, complications for men become such problems as deterioration of potency, which can lead to infertility. Women also have problems with reproductive function. Although they retain the ability to conceive, the process of bearing a child is associated with great risk, with severe toxicosis, which in many cases poses a threat to life. The children born often have developmental abnormalities, and outwardly they may resemble premature babies, although they themselves are quite large.

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Diagnostics of grade 4 obesity

Obesity can be diagnosed based on the calculation of a person's normal weight and BMI. Skin fold testing is performed to assess the amount of fat deposited under the skin.

Instrumental diagnostics

The most accurate indicators of the percentage content, volume and location of fat deposits are determined during procedures of such auxiliary methods of instrumental diagnostics: CT, ultrasound, MRI, and in addition, X-ray densitometry, etc.

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Treatment of grade 4 obesity

In case of obesity of the 4th stage, treatment begins with a thorough examination of the whole organism in order to determine all accompanying pathologies. It should be carried out under the supervision of doctors - this is a cardiologist with a nutritionist and a psychologist, etc.

Often, obesity at this stage is treated surgically. But before the operation itself, it is necessary to undergo a long period of preparation, consisting of:

• correction of the patient's eating behavior;
• compliance with nutritional regimen and dietary conditions;
• increasing physical activity;
• treatment of obesity along with associated pathologies using medications.

Medicines

Medicines for combating stage 4 obesity are used quite rarely, and they are approached very carefully, since the body's condition in this case is extremely severe.

The drugs used in this situation are Xenical, as well as Orlistat and Acarbose. These drugs help slow down the absorption of carbohydrates with fats. But it should be taken into account that any drugs have side effects, and they can further worsen the patient's condition.

Nowadays, nutritionists speak extremely negatively about medications that suppress appetite. The whole point is that they are classified as narcotics, but they only suppress the body's condition even more.

But in any case, tablets and other medications may only be taken as prescribed by the attending physician.

Vitamins

The diet involves additional intake of vitamins A and D (in the form of drops).

Physiotherapy treatment

In case of stage IV obesity, it is allowed to use rain showers, and in addition, underwater shower massage (the water temperature should be 36-37°C), in which a special fan-shaped nozzle is used, and the water stream should be directed under pressure of 1-3 atm. The duration of such a procedure is 12-15 minutes, daily or every other day. The entire treatment course consists of 10/15/18 such procedures. After such a course, patients experience a decrease in cholesterol levels, as well as a noticeable reduction in weight.

The following physiotherapy treatment procedures will also be effective for this pathology:

• LPG or some other hardware massage that helps increase metabolism in skin cells;
• mesotherapy, in which injections of special substances are administered under the skin;
• hydrotherapy – the so-called Charcot shower, as well as other methods of water massage.

Surgical treatment

There are several types of surgeries used in cases of grade 4 obesity: liposuction, gastroplasty, and in addition gastric bypass or banding and biliopancreatic bypass.

Liposuction is the process of removing excess fat deposits. It is considered an urgent measure to eliminate excess weight, used to relieve the load on vital organs. However, it is not considered a method of treating this pathology.

Vertical gastroplasty is an operation on the stomach, during which it is divided into 2 parts vertically. As a result, the upper part, which is smaller in volume, is filled with food, and the patient experiences a feeling of satiety earlier than in a normal situation. Thus, a person loses weight due to the fact that the volume of food decreases.

Gastric bypass – this operation uses a band (a special silicone cuff) to create a small separate part of the stomach. To do this, a special device is inserted under the skin that regulates the width of the opening of this part and thus the amount of food eaten by the patient.

After this procedure, you need to follow a diet, limiting the consumption of all high-calorie foods. Otherwise, the weight loss process will be much slower.

Gastric bypass is a surgical treatment method in which a small part of the patient's stomach is completely isolated, causing the patient to consume less food. After this procedure, certain foods (such as butter, milk, and sweets) are quite unpleasant for the patient to eat. Therefore, in the future, the patient will have to additionally take special vitamins and mineral supplements.

In biliopancreatic bypass, a certain part of the stomach is completely removed. In this case, the patient loses weight regardless of the amount of food consumed. The operation is also effective for type 2 diabetes. After this procedure, the patient will have to take vitamins and mineral supplements for the rest of his life.

Diet for obesity stage 4

In the process of treating obesity stage 4, the elimination of excess calories begins with the first stage. Strict adherence to the prescribed diet with frequent fractional meals in small portions is required.

Since patients with this stage of obesity have a sedentary/bedridden lifestyle, they spend a minimum of energy. And they eat a lot of high-calorie food. Therefore, in this case, the main goal is to increase the energy expenditure of the patient's body. To do this, fish with fatty meat, as well as flour products and sweets, are completely excluded from the diet (or consumption is limited).

The therapeutic diet is based on the following principles:

• it is necessary to prescribe a completely balanced diet with the consumption of low-calorie foods;
• limit the consumption of carbohydrates that are quickly absorbed by the body (sugar);
• replace animal fats with vegetable fats;
• create a feeling of satiety by consuming low-calorie foods (vegetables, as well as certain fruits) in large quantities;
• provide fasting days for the patient;
• eat often, but in small portions - to reduce the feeling of hunger;
• limit fluid intake and salt;
• remove from your diet foods that stimulate appetite – smoked foods, pickles, alcoholic drinks, spices.

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Exercises for obesity stage 4

Physical education is considered one of the most important stages of treatment of pathology. But it is important to understand that exercises should be done carefully, as such patients often have problems with motor activity.

Patients are given special complexes consisting of therapeutic exercises that will help stabilize metabolism and develop the body's overall resistance to such stress. They are developed individually, taking into account the patient's physical condition and the presence of concomitant pathologies.

At the initial stage, the patient mainly exercises for 5 minutes. Exercises include torso rotations, slow walking, and raising/lowering limbs.

It should be taken into account that exercises that are beyond the patient's strength should not be prescribed. It is necessary to especially monitor the condition of his spine, as well as the heart. At the 4th stage of obesity, the main rule of therapeutic physical therapy is a daily progressive increase in loads.

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Prevention

To prevent obesity, you need to eat right, limiting the consumption of foods that are high in fat and carbohydrates. Instead, you should eat more food that contains a lot of protein. It is also effective to regularly exercise, do morning exercises and take long walks. Physical exercises should be selected taking into account age, as well as the state of the cardiovascular and other systems.

Obesity prevention is mainly needed by people who are genetically predisposed to it, as well as those over 40 years of age, especially if such a person leads a sedentary lifestyle.

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Forecast

Obesity stage 4 has a very unfavorable prognosis. Most often in such cases early death occurs.

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Disability

In case of obesity of the 4th degree, the 3rd disability group is usually established. In the presence of pronounced complications from the musculoskeletal system, as well as the cardiovascular system, a more severe group can be established.

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Army

Obesity of the 4th degree makes conscripts unfit for military service.

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