Full text of the article:
Obesity
- this is not just excess weight, but a serious chronic disease that develops as a result of the influence of physiological and genetic factors, as well as under the influence of the environment. During the development of obesity, excess adipose tissue accumulates in the body, which is very difficult to get rid of. An obese person is forced to control his body weight throughout his life and keep it within acceptable limits.
Causes and consequences of obesity
A person can “earn” obesity on his own or “inherit it.” A common cause of obesity is regular overeating and low physical activity, i.e. burning insufficient energy when consuming high-calorie foods. Simply put, a person consumes too much and “spends” too little.
Obesity can also be caused by various malfunctions in the body. In particular, genetic and endocrine disorders can lead to obesity. True, this type of obesity is much less common than the first.
Obesity can cause a person not only moral discomfort and reduce his level of self-esteem, but also cause serious health problems, including the development of deadly diseases of the heart and gastrointestinal tract. Obese people are less productive and tire more quickly, and their life expectancy is shortened. Therefore, it is important that a person’s weight does not exceed the recommended norm and does not create additional stress on the body’s life support systems. Regular physical activity and a proper diet plan help you stay in shape. A therapist can help you form it.
Causes of obesity
The cause of obesity in the vast majority of cases is an imbalance between the energy entering the body and its expenditure. In 95% of cases, obesity is alimentary-constitutional, that is, it is familial in nature and develops with systematic overeating (not only the quantity, but also the composition of food is important), poor diet and insufficient physical activity.
Hypothalamic obesity occurs when the hypothalamus is damaged (as a result of injury, tumor growth or neuroinfection) and is only one of the components of the clinical picture of the disease.
Endocrine obesity occurs with pathology of the endocrine glands (hypercorticism, hypogonadism, hypothyroidism, insulinoma), in these cases the leading symptomatology is caused by damage to the corresponding endocrine gland.
One of the forms of obesity in adolescents is pubertal-adolescent dyspituitarism, which is characterized by a progressive increase in body weight with the onset of puberty, skin changes in the form of pink stretch marks, acne, folliculitis, accelerated growth, sexual and physical development. Adolescents with this type of obesity usually look older than their years; a common symptom of the disease is transient arterial hypertension, which in about half of cases turns into hypertension in adulthood.
How to calculate body mass index
Body Mass Index (BMI)
is a “marker” that makes it possible to assess how much a person’s weight corresponds to his height, i.e. whether current body weight is normal or outside the minimum or maximum threshold values. BMI is calculated using a simple formula: body weight in kilograms must be divided by height in meters squared.
1.7 meters tall
weight
80 kilograms
, then the BMI will be
27.7
, this is an indicator
of excess body weight
.
The World Health Organization offers the following interpretation of BMI indicators:
Body mass index
- a conditional value, it does not take into account a person’s physique or the ratio of fat and muscle mass, so BMI is usually not calculated for professional athletes and pregnant women. However, if your body mass index does not fall within the “normal weight” range, then this is a reason to see a general practitioner. He may order additional tests to rule out the possibility of developing diseases that could contribute to weight gain.
The patient may also be classified as a “risk group”, or the so-called “overweight” group. They include people who cannot yet be diagnosed as obese, but excess body weight can trigger the development of serious concomitant diseases. Doctors usually recommend changing lifestyle and diet for such patients.
Obesity treatment
To properly treat obesity, you need to consult a doctor to rule out endocrine causes of obesity, be examined for the presence and severity of complications, understand the causes of the disease in your particular case and develop a treatment regimen. Since the most common cause of obesity is overeating, treatment usually begins with nutritional correction. There are several types of reasons for overeating: psychological (“eating” stress, dissatisfaction with others, non-food desires, etc.), social (in the family it is customary to eat “to satiety”, a benevolent mother or wife puts food on your plate, and you it is inconvenient to refuse), physiological (overstretching of the stomach walls due to the habitual absorption of large portions of food).
How is a person's body composition analyzed?
Calculating body mass index is not the only and far from the most accurate way to diagnose obesity. There are special devices that can be used to perform bioimpedance measurements
, i.e. analyze body composition. This diagnostic method is based on human anthropometric data and the ability of different types of tissue to conduct electricity differently.
The point is that the device can additionally evaluate tissue, distinguish muscle tissue from fat, determine skeletal muscle mass and fluid mass in the body. Using this analysis, we can say exactly how true the hypothesis is that a person has “heavy bones.” Knowledge of body composition helps doctors assess the risks of developing various diseases.
Diagnostics
To identify and accurately confirm the development of obesity, it is necessary to undergo a special diagnosis from a doctor in a hospital. If something starts to hurt, it is best to go to the hospital. Often, the disease is diagnosed after an analysis such as an ultrasound, which reveals problems in the internal organs. During the examination, the doctor must pay attention to the medical history, as well as the genetic predisposition to rapid weight gain. When determining a disease of an organ and an increase in body fat, a specialist determines what the maximum and minimum weight may be for a certain age. In addition, at the first stage of diagnosing internal organs, the doctor learns about the patient’s eating habits, possible diets, lifestyle, existing diseases, and past ultrasound results.
Obesity has its consequences, so after the first signs of excess weight appear, you should consult a doctor at the clinic and use traditional recovery principles. There is a whole special system for determining the distribution of adipose tissue in an organ, which is used by a specialist using calculations. To assess subcutaneous fat and treat obesity, you need to check the size of the skin fold, which is what a specialist will do during diagnosis.
Professional examination of obesity treatment uses modern principles and methods, thanks to which ultrasound and a number of other diagnostics are actively used, which help to understand whether the organs are in order.
The most used methods that diagnose the development of obesity of internal organs:
- Ultrasound;
- nuclear magnetic resonance;
- CT scan;
- densitometry;
- other methods.
Already at the first appointment, when the patient comes to be checked by the doctor and, in fact, the diagnosis begins, the specialist simultaneously recommends contacting a psychologist, nutritionist and enrolling in physical therapy. It is an integrated approach that allows you to save organs, understand which body shape is most favorable and heal the body. To make a diagnosis, the doctor must conduct an examination of internal organs, apply innovative principles, and check blood pressure readings. It is best to determine whether the patient suffers from diabetes or not, and before doing an ultrasound, refer him for an ECG.
Any diagnosis of excess weight must be carried out in a comprehensive manner so that it gives the best result and can make the correct diagnosis. Therefore, relying only on ultrasound indicators is not a very professional approach in a medical center. To find out the development and treat obesity, the patient must take a blood test, urine test, and check the level of cholesterol, lipoproteins, and hormones. But the most information, of course, comes from ultrasound, which clearly shows all the changes under the skin.
It is necessary to sign up for a diagnostic test and undergo an ultrasound scan too, as this will be a step towards recovery. People have a common habit. They endure pain and symptoms to the last, but it is better not to joke with obesity and periodically visit an ultrasound scan to know about the problem.
Who diagnoses obesity
A person can monitor their body weight independently, including by periodically calculating their body mass index and comparing it with the threshold values established by WHO. However, only a doctor can make a diagnosis of obesity. Typically a therapist.
If there is a suspicion of the development of diseases caused by obesity, the general practitioner can write a referral to the patient for consultations with other doctors. This is necessary to clarify the diagnosis and prescribe treatment. Obesity can also be treated with drug therapy, but the decision to prescribe it can only be made by a doctor if there are necessary medical indications.
Is genetics to blame?
— Many people are sure that they cannot lose weight due to genetic predisposition.
— Obesity is heterogeneous. Certain shapes are truly determined genetically. But such obesity occurs from birth and develops only with chromosomal and genetic syndromes. Some forms of secondary obesity (which occurs after another disease) are associated with endocrine disorders.
80% of all possible forms of obesity are due to nutritional-constitutional (simple) obesity - a consequence of an unhealthy lifestyle. And only 20% of obesity is associated with genetics, constitution and hormonal imbalance.
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The doctor talks about why children get sick and overweight - Who gains weight faster and gets rid of it easier - men or women?
— There are more obese women than obese men because they gain weight faster. For women, there are two periods (pregnancy and menopause) when weight gain is physiologically determined. Many ladies perceive them as a point of no return. Although physiologically the weight gain is no more than 5 kg, after the hormonal changes are completed, the excess weight should go away. In women, subcutaneous fat is more often deposited, which is considered the safest from the point of view of the development of complications.
Men are more likely to have abdominal obesity (accumulation of fat around the waist), so they have a higher risk of developing heart complications (heart attacks, strokes, diabetes, metabolic disorders, including testosterone deficiency).
The easiest way to lose weight is for those who have recently become overweight. The longer a patient lives with unnecessary pounds, the more difficult it is to get rid of them.
Who treats the consequences of obesity?
Obesity
is a complex disease that can contribute to the development of other diseases. Therefore, a patient diagnosed with obesity may need consultation or assistance from other specialists.
Endocrinologist
will help identify the endocrine causes of obesity. To do this, the patient will need to undergo a test to determine the level of glucose and a number of hormones in the blood plasma, an oral glucose tolerance test and other recommended tests. If a doctor discovers an endocrine disease in a patient, he will prescribe the necessary drug treatment.
Excess weight in women can cause problems with pregnancy and the development of polycystic ovary syndrome. This should be determined by an obstetrician-gynecologist.
during the inspection. PCOS can be treated with medication or surgery. For effective treatment, it is necessary to take measures to normalize the patient’s weight. Recommendations for weight loss are given by your doctor.
Excess weight also affects the cardiovascular system. Obese people are at risk of developing hypertension, atherosclerosis, coronary heart disease and other dangerous diseases. For diagnosis and treatment, the general practitioner refers the patient to a cardiologist
.
If a general practitioner suspects that an obese patient has problems with the gastrointestinal tract, he will refer the patient to a doctor
-
gastroenterologist
. The hypothesis can be confirmed or refuted during the diagnostic process.
An obese man may experience decreased sexual function. A urologist will help solve this problem
. He will prescribe treatment based on the diagnostic results, but to restore sexual function the patient will have to work on normalizing his weight.
Sometimes excess weight can be a consequence of psychosomatic disorders. A neurologist helps to detect and eliminate the cause of these disorders.
or
a psychiatrist
. The general practitioner also refers the patient to him for an appointment. To treat depression, the patient may be prescribed antidepressants.
Excess weight can cause disturbances in static movement, a person can develop osteochondrosis, joint deformation occurs, and pain in the limbs occurs. An orthopedic traumatologist helps solve these problems.
.
In some cases, a patient diagnosed with obesity needs to visit several doctors at once in order to formulate a set of treatment measures. This will include recommendations on physical activity, dietary adjustments and the use of multi-target drugs. A number of medical institutions provide group classes to combat excess weight for obese patients.
Obesity and osteoporosis - which doctors will help you?
What to do if the local physician cannot cope with the problem on his own, and does not write a referral to a specialist?
And in general, which doctor should I contact? Expert, specialist in the field of healthcare organization, Elena Bobyak, answers these and other questions from Apteka.ru readers.
You can also ask her a question - just write it in the comments under this column.
Question: Densitometry showed the initial stage of osteoporosis. At the medical examination they said that I needed to take bisphosphonates, but they didn’t make prescriptions there; they told me to go to the doctor at my clinic. I wanted to take those that are administered intravenously once every three months or six months, but the therapist does not want to prescribe them, he says they are not her profile. She can only prescribe pills. The question, in fact, is where to go next. The therapist shrugs and doesn’t understand what I want if there are pills.
It’s good that you found out about your problem at the initial stage, during medical examination, and not after the so-called low-energy fracture (fracture “out of the blue”). Statistics say that every fourth woman and every fifth man over 50 years old either suffers from osteoporosis, or even suffered a fracture because of it.
The main risk factors for the development of osteoporosis are age over 50 years, female gender, menopause, especially early, hip fractures in close relatives, long-term use of glucocorticoids, anticonvulsants, antacids. Diseases of the intestines, liver, chronic renal failure, diseases of the parathyroid glands, and lack of vitamin D and calcium also contribute to the development of osteoporosis. Physical inactivity also contributes to the development of bone fragility.
X-ray densitometry is the gold standard for diagnosing osteoporosis. As far as I understand from your question, this is exactly what they did for you.
What should you do in this situation? First of all, eliminate the factors contributing to the development of pathology - stop smoking, excess alcohol and coffee intake, maintain normal body weight, be sure to increase physical activity, regularly consume foods high in calcium and eliminate vitamin D3 deficiency.
Drug treatment can only be prescribed by a specialist and, of course, not during a medical examination.
Usually, rheumatologists and endocrinologists deal with the problems of osteoporosis, and they are mainly the ones who work in osteoporosis centers.
If your local physician cannot independently decide whether you need bisphosphonates, he must refer you to a specialist. If he refuses to do this, write a statement addressed to the chief physician or the head of the clinic with a request to organize a consultation with an osteoporosis specialist. This is their direct responsibility.
Treatment is prescribed based on the individual characteristics of the body and the stage of osteoporosis. During menopause, women may be prescribed hormone therapy with medications containing estrogen and progesterone. Calcium supplements are also prescribed, including in combination with vitamin D.
At a certain stage (not at the initial stage), the doctor may prescribe stronger drugs - drugs from the group of bisphosphonates and aminobisphosphonates - synthetic analogues of pyrophosphates. These drugs have certain side effects, so they should not be prescribed at the first signs of osteoporosis.
______________________________________________________________
My brother is 45 years old, he weighs about 300 kg, it’s impossible to say more precisely, since we don’t have scales that would record such weight. He hasn't been going anywhere for a long time. Lately he has been feeling very unwell; swelling and redness have developed in the perineum. He’s afraid to go to the doctors, and he can’t. What to do?
This is a very serious problem, such weight leads to deep disability, patients need constant help from loved ones and experience physical and mental suffering. As a rule, almost all systems of the body are affected - joints are destroyed, the heart cannot cope with such a load, it is difficult for them to breathe, and even going to the toilet becomes a big problem.
Without medical help, your brother will not be able to cope with this. If this is possible, it is necessary to organize specialist consultations at home - at a minimum, he should be examined by a therapist, psychotherapist and surgeon. Possibly a urologist.
If there are no indications for emergency hospitalization, you need to start a weight loss program with medication support. Strict diet and... at least minimal movements, with increasing load every day. It sounds banal, but this is the only way to salvation in this situation.
If there are indications for emergency hospitalization, then, apparently, you will have to call rescuers or the Ministry of Emergency Situations, since without their help you will not be able to transport the patient even to an ambulance. Not every hospital is ready to accept a patient with such weight; special stretchers, beds, and operating tables are needed. Some types of diagnostics are also becoming completely unavailable - MRI, for example.
The easiest thing for you in this situation is to go to an appointment with the head of the clinic and discuss an action plan together. Of course, this will not be easy, but no one can deprive a patient of medical care on the grounds that he is overweight.
Elena Bobyak
Photo depositphotos.com
The author's opinion may not coincide with the opinion of the editors.
How to eat if you are obese
To treat and prevent obesity, doctors recommend switching to a healthy diet. This will be useful for everyone, even people with normal weight.
Doctors and nutritionists recommend taking food in small portions, but more often. It would be optimal to eat 4-5 times a day, avoiding overeating. The diet should be balanced and varied; you should definitely try to eat fresh fruits and vegetables all year round, and not just in season. It will be useful to switch to whole grain products. It is better to replace fatty meat with poultry; in rare cases, eating lean meat is allowed, but you will have to forget about meat and sausage products. You can consume milk and dairy products, but preference should be given to low-fat ones. Vegetable oils will be useful, but in moderation. The same goes for fish, nuts and legumes; it is recommended to include them in your diet at least 1-2 times a week. It is better to cook by steaming, avoiding frying.
Food should be chewed thoroughly and sufficient time should be given to eating. The last meal should be light; it is better to limit yourself to a glass of kefir or fruit. You should not eat immediately before bed; this will force the body to work again and will not give it the opportunity to prepare for rest. You need to leave at least a couple of hours for “unloading” before going to bed.
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Physical activity if you are overweight
Physical activity is one of the methods to combat excess weight. According to WHO recommendations, people who want to lose excess weight need to move more. Physical activity should be regular, a total of at least 2.5 hours per week
. But not only the volume of training is important, but also the energy balance. Golden rule: “You need to spend more than you receive.” Simple math. Food provides a person with the energy that he must spend so as not to gain a couple more extra pounds. Aerobic types of physical activity are considered the most useful: swimming, dancing, Nordic walking, etc.
The load recommended for the patient must be determined by the doctor. It will largely depend on the condition of the body and the presence of concomitant diseases. Therefore, before choosing a physical activity regimen, you need to consult with your doctor.
