Symptoms of obesity

Obesity is a polyetiological condition, so it is difficult to identify the main causes that led to the development of excess body weight. In this regard, there is currently no generally accepted, unified classification of obesity. Its various types are distinguished depending on the nature of fat distribution, etiology, and anatomical features. For practical purposes, it is possible to distinguish alimentary-constitutional, hypothalamic, and endocrine obesity.

Alimentary-constitutional obesity is familial in nature and develops, as a rule, with systematic overeating, poor diet, and insufficient physical activity.

Hypothalamic obesity occurs when the hypothalamus is damaged (mainly its ventromedial region) and is accompanied by disturbances in hypothalamic functions that determine the clinical features of the disease.

Endocrine obesity is a symptom of primary pathology of the endocrine glands (hypercorticism, hypothyroidism, hypogonadism, insulinoma ).

It should be emphasized that in all these forms of obesity, regardless of their etiology, there are hypothalamic disorders of varying severity, primary or revealed during the disease process. When studying the background electrical activity of the brain, as well as its activity after various functional loads (rhythmic phonostimulation, eye-opening test, hyperventilation test), both in patients with alimentary-constitutional and hypothalamic obesity, similar biorhythmic disorders are revealed, accompanied by bilaterally synchronized bursts of slow (theta rhythm) or frequent oscillations. In some patients, a "plus" curve with groups of low-amplitude theta waves can be recorded. In the alimentary-constitutional type, a higher index of the a-rhythm is observed in the background EEG or a more distinct increase after the application of functional loads, i.e., in both alimentary-constitutional and hypothalamic obesity, signs are revealed that indicate the interest of the hypothalamic structures, but in the latter they are more pronounced.

According to the type of distribution of adipose tissue in the body, android, gynoid and mixed types of obesity are distinguished. The first is characterized by the deposition of adipose tissue mainly in the upper part of the body, with gynoid - fat accumulates mainly in the lower part of the body and with mixed type there is a relatively uniform distribution of subcutaneous fat. A relationship has been revealed between the nature of the distribution of adipose tissue and the presence of metabolic complications. In particular, android type of obesity is more often than others combined with impaired glucose tolerance or diabetes, hypertension, hyperlipidemia, hyperandrogenism in women.

The anatomical classification is based on the morphological features of adipose tissue. Its increase in the body can occur due to an increase in the size of the cells it consists of (adipocytes), their number, or both simultaneously. The main number of adipocytes is laid down in the late prenatal and early postnatal periods; a slight increase in their number occurs at the beginning of puberty. There is evidence that fat cells can form throughout life. With the development of obesity due to an increase in the size of fat cells without a significant increase in their total number, a hypertrophic type of obesity occurs, which most often occurs in adulthood. Hyperplastic (due to an increase in the number of fat cells) or mixed obesity (a combination of hypertrophy and hyperplasia of adipocytes) is observed in individuals who have been overweight since childhood. A decrease in the amount of adipose tissue in obese people is accompanied by a change in only the size of fat cells, while their number remains almost constant, even in conditions of rapid weight loss. This explains the resistance to weight loss in hyperplastic and mixed types of obesity and the importance of obesity prevention from early childhood.

Complaints of patients with obesity are numerous and varied, depending on its severity and duration, concomitant diseases. With alimentary-constitutional obesity of I-II degree, patients usually do not present complaints; with more pronounced obesity, they may be bothered by weakness, increased fatigue, decreased performance, headaches, irritability, indifference to others, sleep disturbances. Shortness of breath during physical exertion, palpitations, pain in the heart, swelling of the lower extremities, pain in the joints, spine, caused by increased load on the musculoskeletal system and metabolic disorders are often noted. In the presence of changes in the gastrointestinal tract, patients may be bothered by heartburn, nausea, a feeling of bitterness in the mouth, pain in the right hypochondrium, constipation. In hypothalamic obesity, complaints associated with increased intracranial pressure are common: headaches, visual impairment, as well as those caused by psycho- and neurological disorders: mood swings, drowsiness, hypo- or hyperthermia, thirst, increased appetite, especially in the afternoon, feeling of hunger at night.

Women may experience menstrual dysfunction, most often of the hypomenstrual type in the form of opsomenorrhea or secondary amenorrhea, less often of the menometrorrhagia type (as a result of hyperestrogenism of peripheral genesis); primary or secondary infertility; hirsutism of varying severity, oily seborrhea, sometimes alopecia; diffuse fibrocystic mastopathy is possible.

Men with massive obesity may be concerned about decreased potency, enlarged mammary glands, and, less commonly, decreased hair growth on the face and body.

The examination data reveals excessive development of subcutaneous fat tissue, features of its distribution. In hypothalamic obesity - uncleanliness and trophic disorders of the skin, small pink striae on the thighs, abdomen, shoulders, armpits, hyperpigmentation of the neck, elbows, friction sites, increased blood pressure; in severe obesity - lymphostasis of the lower extremities, symptoms of cardiopulmonary insufficiency.

On skull radiographs, the sella turcica in patients is usually unchanged, hyperostosis of the frontal bone and cranial vault is often detected, and osteochondrosis and spondylosis are observed in the spine. Mammography is performed to reliably distinguish true gynecomastia from false gynecomastia.

During a gynecological examination of women, bilateral enlargement of the ovaries is often detected. Due to obesity of the abdominal wall, more accurate data can be obtained using an ultrasound examination of the pelvic organs.

Rectal temperature is monophasic or with a pronounced deficiency of the second phase. Other functional diagnostic tests confirm anovulation and allow us to judge the degree of hypoestrogenism, the presence of hyperestrogenism.

In endocrine forms of obesity, the leading symptoms are those caused by damage to the corresponding endocrine gland.

Pubertal-juvenile dyspituitarism. One of the forms of adolescent obesity is the syndrome of pubertal-juvenile dyspituitarism or hypothalamic syndrome of puberty in obese adolescents. The period of puberty is characterized by physiological instability and increased sensitivity of the body to the effects of various internal and external factors, which creates favorable conditions for the development of various deviations. There is a sharp change in the activity of both the central nervous system and the endocrine system (the secretion of ACTH increases, leading to an increase in the rate of production of corticosteroids by the adrenal glands), the formation of the gonadotropic function, causing an increase in the production of sex hormones; the activity of the pituitary-thyroid gland system changes. This leads to an increase in body weight, height, maturation of individual organs and systems. In recent decades, due to the use of various nutritional mixtures and a decrease in physical activity, there has been an increase in the incidence of obesity among children and adolescents. Against the background of alimentary-constitutional obesity during puberty, under the influence of various adverse effects (infection, intoxication, trauma), the activity of the hypothalamic-pituitary system may be disrupted, which leads to the development of pubertal-juvenile dyspituitarism syndrome.

The common and earliest symptom of the disease is obesity of varying degrees of severity, with the onset of puberty usually being marked by a sharp increase in body weight. The distribution of subcutaneous fat is usually uniform, in some cases fat is deposited mainly in the lower part of the body (hips, buttocks), which in young men causes some feminization of appearance. During the period of greatest weight gain, multiple pink or red striae, usually thin and superficial, appear on the skin of the chest, shoulders, abdomen, and thighs. Thinning of the skin, acne, and folliculitis are also noted. Along with obesity, there is an acceleration of growth, sexual and physical development. Usually, teenagers look older than their years. This occurs at the age of 11-13, and by the age of 13-14, most of them have a height that exceeds the average age norms, and some are the same height as adults. By the age of 14-15, growth stops due to the closure of growth zones caused by a change in the ratio of androgens and estrogens towards an increase in the latter. Such acceleration of growth is due to increased secretion of growth hormone, which after 5-6 years from the onset of the disease normalizes or may decrease below normal. Hypersecretion of growth hormone also promotes proliferation of fat cells and weight gain. Sexual development of adolescents can be normal, accelerated, and less often with clear signs of delay. In girls, menarche occurs earlier than in adolescents with normal body weight, but anovulatory cycles, menstrual dysfunction such as opso- and oligomenorrhea, or dysfunctional uterine bleeding are common. Polycystic ovary syndrome often develops. Due to increased secretion of androgens by the adrenal glands, girls may develop hirsutism of varying severity. For young men with pubertal-adolescent dyspituitarism, the most typical feature is the acceleration of sexual development with early formation of secondary sexual characteristics. Gynecomastia develops, often false. In a small number of teenagers, sexual maturation may slow down, but at the end of the pubertal period, as a rule, it accelerates and normalizes. Due to severe obesity, hypogenitalism can often be suspected, but careful examination and palpation of the genitals allow this to be rejected. When studying the secretion of pituitary gonadotropic hormones, both increased and decreased levels of LH can be detected; girls often have an absence of its ovulatory peaks.

One of the frequent symptoms of the disease is transient hypertension, and it is observed more often in young men than in girls. In its pathogenesis, an increase in the activity of hypothalamic structures, the functional state of the pituitary-adrenal system, and hyperinsulinemia are of certain importance. In approximately 50% of cases, hypertension develops later.

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