OBESITY – Programmed Implemented Reformulated excess fat voltage Frequency of pain GOVERNMENTAL obesity in various countries ranging letsya from 15 to 60%. Obese patients are persons whose weight transitions dit normal limits for their po hundred.
There are 4 degrees of obesity:
- I-coh and normal weight greater by 10 to 29%;
- II — by 30–49%;
- III — 50–99%
- IV — over 100%.
Obesity I and II degree is common, III-otno respect to rare and even more rarely IV ste stump. Many cases of obesity have been described for people weighing 200 to 490 kg.
Etiology.
Obesity – polietiologic Zabolev set. Causes of obesity can be various factors.
- Hereditary predisposition and the nutritional factors, main role belongs to these two factors, which are closely linked and constitute, according to various by the authors, 70% of all types of obesity.
- Endocrine disorders ;
- Cerebrates nye;
- Rare odds , we:
- Local obesity (segmentar Noah)
- Lipomatoses : adenolipomatoses , painful lipomatoses ( Derkum , Madelung disease), lipodystrophic form ( Lipodystrophy ).
According to an advantageous location with fat zheniyu
- Android – above the waist and obesity
- Gynoid – below the belt.
Classification of Obesity.
Obesity classification is not entirely odd kai, as many types of obesity re plestan together. Thus, for example measures in cerebral form Often dissolved and endocrine disorders. Ali tary form of obesity can go to the diencephalic and others.
For practical iCal purposes the following is the class fication of obesity proposed DY Shurygin (USSR, 1975).
- I. Forms of primary obesity:
- 1) nutritional-constitutional;
- 2) neuro- endocrine: a) hypothalamic-pituitary; b) adipose-genital dystrophy (children and adolescents);
- I I. Forms of secondary obesity:
- 1) cerebral;
2) endocrine: a) hypothyroid ; b) hypoovarian ; c) menopause; d) the adrenal gland.
Alimentary obesity often observed is given to those families where there is at the investigation and disposition made overeating overfeeding since childhood. When physical massiveness overeating blunts diencephalic centers and saturation in the future, this form can ne Reiten in diencephalic-alimentary. When the form of nutritional obesity fat throughout the body is distributed equally dimensional.
Endocrine forms of obesity are the result of hypothyroidism , hypogonadism , hypercorticism . The hypothyrogenic form of obesity develops both in childhood and in adults. The latter is often observed is given in women, it does not reach the high degrees. Gipogenitalnaya form of obesity often Global Developing etsya in his teenage years that Kvali fitsiruetsya how adipozo-genital dystrophy. In klimakteriche skom period ( post-castration ) fat accumulation occurs heads nym way the pelvis and Ms Vaught (hanging belly in an apron). Postpartum obesity would basically Vaeth two types:
- Hypovarial
- Diencephalic.
1. The first of these on walks as a result of infectious salpingoophoritis et al. The nature of lesions, leading to gipoovarizmu . For this type of obesity characterized Terno deposition of fat in the pelvic area, thighs, abdomen. The upper body, on the contrary, is losing weight. 2. The second type of diencephalic – obesity poslerodo howling hypothalamic develops due to trauma during labor and delivery (forceps, difficult birth) or postpartum: an anomaly or death of PLO yes, marital conflict, neuro -infektsii and others.
Clinically obese after generic hypothalamic type to remembers adipozo-genital di stanza: depigmentation of the nipples, wasps kuden body hair on pubis and armpits, increase the size of the chest. Postpartum obesity, adrenal origin in the rank during pregnancy and in the postpartum continues perio de. Obesity occurs with this form of simplex volumes Cushing , gipertri Hoza. A / D rises. Sugar load is manifested as in diabetes. Excretion of 17-KS with daily urine increased.
Pituitary obesity is often combined with cerebral form. This odds IU relates generally frontal ny hyperostosis .
Cerebral forms of obesity.
Various chayut:
- Cortical (psychosomatic),
- Diencephalic,
- Diencephalic-pituitary.
Usually arise from neuroinfection , trauma skull and the psychic Skim shocks.
Pathogenesis Caere bralnogo obesity is not entirely clear, although it is accepted to explain the increase in the threshold of sensitivity of the food center, a chronic brain anoxia, expressed drowsiness, pony disability zheniem Often accompanies Xia – metabolic and degenerative arthritis Tami, veins with disorders eat trophism of the skin of the lower extremities. Typical of central origin of obesity is obesity due to hyperostosis bone-sind skull rum Morgagni .
The fact that obesity in all its forms anyway due to the participation of diencephalic education Nij indicates fact increase with the content in the blood of endorphins in wasps novnom produced diencephalic formations in individuals with ozhi rhenium. For example, according to E. Epstein, the content of the a -endorphin in the blood of healthy individuals in media therein is 10.8 ± 3.0 nmol / l, in obese – according to the degree of obesity comes from 52,6 ± 6 5 to 66.8 ± 14.1. It is assumed that a- endorphin is a pituitary factor stimulating se Cretu insulin later when leading to obesity.
Hyperinsulinism in obesity, in all likelihood, is the trace Corollary injury the ventromedial hypothalamic nuclei, resulting first in the suppression activity nice yo cal nerve function and enhancing parasympathetic nerves. Obesity according to the extent and duration of negative current but affects the body as a whole. Most affected heart with sudistaya system comes giro -hand dystrophy infarction, vascular sclerosis and hypertension. There are changes in the digestive system. In the liver: fatty degeneration and stagnant floor nokrovie, dyskinesia of gall pu Zira and subsequent stone formation, a significant decrease in ventilation and vital capacity of the lungs, which leads to for congestive phenomena and the tendency to inflammation of the respiratory system. The hormonal system in Obesity. Insulin in obese individuals is not always functional completeness: it is not active against muscular TKA no, but it is active against the fatty tissue, which performs a lipo-geneticheskse action. In obese patients, in particular, in the presence of diabetes, a vicious circle is created: obesity – a functional defect in insulin – hyperglycemia – hyperinsulinemia – obesity. In obesity while maintaining glycemic homeostasis in the blood insulin level is significantly higher than norme.Ak ciency lipolytic processes in adipose tissue is controlled by a two mja systems: autoreguliruyushey and hormone. The first of these mo modulator of lipolysis serve NEFA (non-esterified fatty acids) and glucose. This increase urs nya intracellular NEFA Tormo zit, and lowering – activates lipolysis . The second hormonal system consists of catecholamines and their en tagonistov , mainly Ince ling . Catecholamines are amplifying dissolved lipolysis , insulin and vice versa – lipogenesis . It found that when ozhi rhenium, especially when it is a genetic form of the sensitivity of adipocytes to catecholamines is low. For labeled that adrenaline inhibitors contribute to the accumulation of fat. Nao versa, nicotine stimulates the adrenal system, resulting in on slimming.
It is found that in mice with genetic obesity in humans and in addition to the high content of immunoreactive insulin kro vi increased and the content of ACTH (adrenocorticotropic hormone) . At the same time, calorie restriction reduces both the ACTH and insulin levels. Patients alimentar nym obesity has been a shift of water and electrolyte balance, conclude schiysya in increasing both extracellular and intracellular fluid, extracellular with holding sodium ions and chlorine circulating blood volume. Hyperinsulinemia and circulatory failure play a special role in these processes . Pregnancy and ro dy in obese women are fraught times personal complications: toxemia baa belt, prolonged labor, poslero dovye bleeding; notes you sokaya infant mortality.