Symptoms of obesity

Obesity refers to polyethiologic states, so there are difficulties in identifying the main causes that led to the development of excess body weight. In this regard, at present there is no generally accepted, uniform classification of obesity. There are different types of it depending on the nature of the distribution of fat, etiology, anatomical features. For practical purposes, it is possible to distinguish alimentary-constitutional, hypothalamic and endocrine obesity.

Alimentary-constitutional obesity is of a family nature, developing, as a rule, with systematic overeating, eating disorders, insufficient physical activity.

Hypothalamic obesity occurs with damage to the hypothalamus (mainly its ventromedial region) and is accompanied by impaired hypothalamic functions that determine the clinical features of the disease.

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

It must be emphasized that for all these forms of obesity, regardless of their etiology, hypothalamic disorders, primary or apparent in the course of the disease, are of varying degrees. When studying the background electrical activity of the brain, as well as its activity after various functional loads (rhythmic stimulation, eye opening, hyperventilation test), both in patients with alimentary-constitutional and hypothalamic obesity, similar violations of biorhythmics are revealed, sopr which are bilaterally synchronized with outbreaks of slow (theta rhythm) or frequent oscillations. In some patients, a "plus" curve with groups of low amplitude of theta waves can be recorded. With the alimentary-constitutional type, a higher a-rhythm index in the background EEG or a clearer increase after application of functional loads is observed, i.e., both in alimentary-constitutional and hypothalamic obesity, signs that indicate the interest of hypothalamic structures are revealed, but when the latter are more pronounced.

By the type of distribution of adipose tissue in the body androidoid, gynoid and mixed types of obesity are isolated. The first is characterized by the deposition of fat tissue mainly in the upper part of the trunk, with the gynoid - fat accumulates mainly in the lower part of the body and with a mixed type a relatively uniform distribution of subcutaneous fat occurs. The dependence between the distribution of fatty tissue and the presence of metabolic complications was revealed. In particular, the android type of obesity is more often than others, combined with impaired glucose tolerance or with diabetes, hypertension, hyperlipidemia, hyperandrogenism in women.

The basis of anatomical classification is the morphological features of adipose tissue. Its increase in the body can occur either due to the increase in the size of the cells from which it consists (adipocytes), and their numbers or both. The main number of adipocytes is laid 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 the increase in the size of fat cells without a significant increase in their total number, there is a hypertrophic type of obesity, often occurs in adulthood. Hyperplastic (due to the increase in the number of fat cells) or mixed obesity (a combination of hypertrophy and hyperplasia of adipocytes) is noted in individuals with overweight from childhood. Reducing the amount of adipose tissue in fat is accompanied by a change only in the size of fat cells, while the number of them 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 preventing obesity from early childhood.

Complaints of patients with obesity are numerous and varied, depend on its severity and duration, concomitant diseases. At alimentary-constitutional obesity of I-II degree patients usually do not make complaints; with more severe obesity, they may be troubled by weakness, increased fatigue, decreased performance, headaches, irritability, indifference to others, sleep disturbance. Often there are shortness of breath during exercise, palpitations, pain in the heart, swelling of the lower extremities, pain in the joints, spine, due to increased stress on the locomotor system and metabolic disorders. If there are changes from the gastrointestinal tract of patients, heartburn, nausea, a feeling of bitterness in the mouth, pain in the right hypochondrium region, constipation may be disturbing. In hypothalamic obesity, complaints associated with increased intracranial pressure are frequent: headaches, visual impairment, and also caused by psycho- and neurologic disorders: mood changes, drowsiness, hypo- or hyperthermia, thirst, increased appetite, especially in the afternoon, hunger at night.

Women may have violations of menstrual function, more often in the hypomenstrual type in the form of opsoniformes or secondary amenorrhea, less often - in the type of menometrorrhagia (as a result of hyperestrogenism of peripheral genesis); primary or secondary infertility; hirsutism of varying severity, oily seborrhea, and sometimes alopecia; the phenomena of diffuse fibrocystic mastopathy are possible.

Men with massive obesity may be concerned about a decrease in potency, an increase in the mammary glands, less often a decrease in the growth of hair on the face and body.

The examination data reveal the excessive development of subcutaneous fat, the features of its distribution. When hypothalamic obesity - impurities and trophic skin disorders, small pink striae on the hips, abdomen, shoulders, axillary hollows, hyperpigmentation of the neck, elbows, places of friction, increased blood pressure; with severe obesity - lymphostasis of the lower extremities, symptoms of cardiopulmonary insufficiency.

On the radiographs of the skull, the Turkish saddle in patients, as a rule, is not changed, hyperostosis of the frontal bone and the cranial vault is often revealed, in the spine - the phenomena of osteochondrosis and spondylosis. To reliably distinguish true gynecomastia from false, a mammogram is performed.

When gynecological examination of women is often detected bilateral increase in the size of the ovaries. Due to obesity of the abdominal wall, more accurate data can be obtained by ultrasound examination of the pelvic organs.

Rectal temperature monophasic or with pronounced insufficiency of the second phase. Other tests of functional diagnostics confirm anovulation and allow us to judge the degree of hypoestrogenia, the presence of hyperestrogenia.

With endocrine forms of obesity, the leading symptomatology is caused by the defeat of the corresponding endocrine gland.

PUBLIC-YOUNG DISTIUDUTARISM. One of the forms of adolescent obesity is the syndrome of pubertal juvenile dyspitutarism or the hypothalamic syndrome of the pubertal period in adolescents with obesity. The period of puberty is characterized by physiological instability and increased sensitivity of the organism to the influence of various internal and external factors, which creates favorable conditions for the development of various deviations. There is a dramatic change in the activity of both the central nervous system and the endocrine (the secretion of ACTH increases, which leads to an increase in the rate of production of corticosteroids by the adrenal glands), the formation of a gonadotropic function that causes 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, growth, maturation of individual organs and systems. In recent decades, due to the use of various nutrient mixtures and a decrease in physical activity, the incidence of obesity in children and adolescents is increasing. 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 can be violated, which leads to the emergence of a syndrome of pubertal juvenile dyspituitarism.

The common and earliest symptom of the disease is obesity of varying severity, and with the onset of pubertal age, there is usually a sharp increase in body weight. The distribution of subcutaneous fat, as a rule, is uniform, in some cases, fat is deposited mainly in the lower part of the trunk (thighs, buttocks), which in young men causes some feminization of appearance. During the period of the greatest increase in body weight, multiple pink or red striae appear on the skin of the chest, shoulders, abdomen, and thighs, usually thin and superficial. There is also thinning of the skin, acne, folliculitis. 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 years, and by the age of 13-14 most of them have growth exceeding the average age norms, and some - corresponding to the average growth of adults. By the age of 14-15, growth is stopped due to the closure of growth zones, caused by a change in the ratio of androgens and estrogens toward an increase in the latter. This acceleration of growth is due to an increase in the secretion of growth hormone, which after 5-6 years from the onset of the disease normalizes or may fall below the norm. Hypersecretion of growth hormone also promotes the proliferation of fat cells and the increase in body weight. Sexual development of adolescents can be normal, accelerated and less likely with clear signs of lag. The girls menarche comes in earlier times compared with adolescents with normal body weight, but often anovulatory cycles, menstrual irregularities in the type of opso- and oligomenorrhoea or dysfunctional uterine bleeding. Polycystic ovary often develops. In connection with the increase in the secretion of the adrenals of androgens, girls may develop hirsutism of varying degrees. For young men with pubertal youthful dyspituitarism, the most characteristic is the acceleration of sexual development with the early formation of secondary sexual characteristics. Develop gynecomastia, often false. In a small number of adolescents, puberty can slow down, but at the end of the puberty period, as a rule, it accelerates and normalizes. Because of the pronounced obesity, it is often possible to suspect hypogenitalism, however, this can allow a thorough examination and palpation of the genitals. When studying the secretion of gonadotropic hormones in the pituitary gland, it is possible to detect both increased and decreased levels of LH, often in girls there is a lack of its ovulatory peaks.

One of the frequent symptoms of the disease is transient hypertension, and in young men it is observed more often than in girls. In its pathogenesis, the increased activity of hypothalamic structures, the functional state of the pituitary-adrenal system, and hyperinsulinemia are of particular importance. Approximately 50% of cases in the future formed hypertensive disease.

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