The most important thing about abdominal obesity

Types of obesity

There are 3 types of obesity: abdominal (fat deposition in the abdomen and upper torso), gynoid (fat deposition in the buttocks and thighs) and mixed.

To understand what type of obesity you have, you need to determine your waist and hip circumferences and calculate their ratio. Waist circumference (WC) is measured below the lower edge of the ribs above the navel. The circumference of the hips is in their widest area at the level of the buttocks. The OT indicator of 94 cm in men and 80 cm in women is characteristic of the abdominal type of obesity (apple type) and is synonymous with a high risk for your health.

A WC/TB ratio exceeding 1.0 in men and 0.85 in women indicates an abdominal type of obesity.

Excess body weight is not only a cosmetic defect. Obesity creates many problems: with every extra kilogram, a piece of health is lost.

It should be remembered that obesity in general and the abdominal distribution of adipose tissue in particular are independent risk factors for the development of many diseases. Moreover, the abdominal type of distribution of adipose tissue, even with a slight increase in body weight, already poses a threat to health. Visceral adipose tissue has a different sensitivity to hormonal influences that regulate changes in lipid storage and metabolism. Visceral fat deposition correlates with metabolic abnormalities in the body - insulin resistance, hyperinsulinemia, IGT, hypertriglyceridemia, increased LDL cholesterol fractions and a decrease in HDL cholesterol, while total blood cholesterol may remain relatively low.

Possible complications of obesity affect almost all human internal organs and body systems - cardiovascular, respiratory, reproductive, etc., metabolic processes are disrupted.

• Cardiovascular : arterial hypertension - high blood pressure for a long time;
• heart failure - the inability of the heart to fully perform its function;
• stroke - brain damage as a result of acute cerebrovascular accident;
• myocardial infarction - death of a section of the heart muscle; Varicose veins.

Clinical studies have confirmed that body weight is an important prognostic criterion for increased mortality in young and middle age, both among men and among women.

The most serious diseases that develop in connection with obesity are arterial hypertension, diabetes mellitus and atherosclerosis. They can significantly reduce your quality of life, leading to disability and premature death.

In obese people, high blood pressure is 5 times more common than in people of normal body weight. And the assertion that weight loss in obese people is the most effective form of treatment for hypertension is completely justified. Your body can only cope with a temporary increase in blood pressure levels. Constant high blood pressure leads to dysfunction of the heart, kidneys, and brain. Losing weight, even 5 kilograms, improves blood pressure!

Obesity is often accompanied by the development of metabolic syndrome and diabetes. Metabolic syndrome is a complex of interrelated disorders of carbohydrate and fat metabolism, as well as mechanisms of regulation of blood pressure (BP) and endothelial function, the development of which is based on a decrease in tissue sensitivity to insulin - insulin resistance. Of course, not every obese person gets diabetes. For its occurrence, hereditary predisposition, age, sedentary lifestyle, and diet are of great importance. But obesity, its duration and severity are of decisive importance in the development of diabetes mellitus. Insulin resistance is directly related to abdominal obesity and is the cause of hyperinsulinemia and type 2 diabetes mellitus. Among patients suffering from non-insulin-dependent diabetes mellitus, 80% are overweight or obese. If you are obese or overweight, you need to regularly check your blood glucose levels.

You are obese. Increasingly, you are bothered by a headache, a feeling of heaviness in the chest, your legs swell in the evening, and shortness of breath appears when climbing stairs. These symptoms indicate disturbances in the functioning of the cardiovascular system. Or it could be like this: against the background of good health, a myocardial infarction or stroke suddenly develops. The main cause of all adversity is atherosclerosis. Atherosclerosis is a systemic disease that affects the arteries, or blood vessels. The walls of blood vessels become denser due to the deposition of cholesterol in them if it is found in excess in the blood. Atherosclerotic plaques form, which gradually increase and multiply, thereby narrowing the lumen of the arteries, impeding blood flow. As blood flow slows down, there is a risk of blood clots forming. Blood clots further disrupt normal blood circulation. Thus, less and less oxygen and nutrients reach the organs and tissues, and all the cells of your body. At this stage, atherosclerosis, which until now has been secretive and asymptomatic, makes itself known. The main culprit in the development of atherosclerosis is cholesterol. The same cholesterol that is an essential component of the outer membranes of all cells in our body. The same cholesterol, without which the formation of hormones is impossible. But everything is good in moderation, and even more so cholesterol, which we consume directly from food of animal origin and especially from fats. When the measure is violated, the development of atherosclerosis accelerates.

Excess body weight and obesity are significant risk factors for the development of gastroesophageal reflux disease, erosive esophagitis, manifested by despotic disorders (belching of eaten food and air, bitterness in the mouth, nausea, night cough, hoarseness, reflux-associated bronchial asthma). The target organ for obesity is the liver, non-alcoholic fatty liver disease (NAFLD) is formed, NAFLD is associated with obesity, and inflammation: insulin resistance leading to oxidative stress, endothelial dysfunction, chronic inflammation; obesity leads to an increase in the size of the liver, mainly its left lobe, disruption of biochemical liver parameters, changes in the structure of the organ (steatosis, fibrosis, cirrhosis).

Currently, the problem of pelvic floor dysfunction has acquired particular relevance and social significance: every third woman suffers from prolapse and prolapse of the pelvic organs, urinary and fecal incontinence, and, consequently, problems in sexual life. Predictors of the development of pelvic dysfunction include pregnancy, childbirth with a long period of expulsion and a large fetus), birth trauma, damage to the pelvic nerves and muscles, and surgical interventions on the pelvic floor. However, the main provoking factors are chronic constipation, some somatic diseases and mainly obesity. An increase in body mass index by 5 units increases the risk of developing urinary incontinence by 60-100%, and a decrease in body weight by 5-8% leads to a reduction in the frequency of episodes of urinary incontinence of various origins by 50-70%.

Compared with the general population, individuals with extreme obesity have an increased incidence of anxiety, depression, and sleep disturbances. 50% of people with a body mass index over 40 have at least one mental disorder. The prevalence of depression in the population is 17%, and the prevalence of obesity in streets is 29-56%.

The risk of carcinogenesis in postmenopausal women is 20% greater in individuals with obesity than in those without it; in addition, obesity is associated with a large tumor size; the presence of obesity worsens the prognosis of the disease.

According to modern opinion, adipose tissue is an independent active endocrine organ that secretes a number of hormones and enzymes, inflammatory cytokines. One of the important features of adipose tissue is the presence in it of the aromatase enzyme, which converts testosterone into estradiol, as well as the presence of receptors for sex steroid hormones (estrogen, testosterone, progesterone). Obesity is accompanied by suppression of ovarian steroidogenesis and decreased production of estradiol by granulosa cells. In this case, the development of follicles stops, the level of sex steroid binding globulin decreases, the secretion of gonadotropins is disrupted, and the level of sex hormones decreases. In women, the main manifestations are: irregular menstrual cycle, hypomenstrual syndrome, secondary amenorrhea, acyclic bleeding against the background of hyperplastic processes in the endometrium, high incidence of infertility. According to research data, every 3rd woman who seeks medical help with the problem of MC disorders and infertility is overweight, and every 5th is obese. Abdominal adipose tissue, neurohormonal disorders accompanying abdominal obesity, and increased activity of the sympathetic nervous system play an important role in the development and progression of insulin resistance and associated metabolic disorders, with subsequent excessive secretion of insulin into the blood, which leads to hyperinsulinemia. Insulin resistance lies in the development of many diseases of the reproductive system, such as polycystic ovary syndrome (PCOS) and infertility. Obesity and insulin resistance are closely associated with the development of systemic oxidative stress, which has a multifaceted negative impact on the reproductive system, including the development of mitochondrial dysfunction of the egg and follicular oxidative stress, regardless of whether a woman has PCOS, which increases the risk of miscarriage. There is a direct relationship between an increase in body weight and the severity of ovarian disorders, accompanied by anovulation, inferiority of the luteal phase and a decreasing frequency of pregnancies. With a BMI of more than 29 kg/cm², each kilogram gained reduces the possibility of spontaneous pregnancy by 4%.

Vitamin D

Adipose tissue plays an important role in the regulation of phosphorus-calcium metabolism (the initial stages of vitamin D formation) and the metabolism of sex steroids (aromatase in fat cells promotes the conversion of adrenal androgens into estrogens).

When assessing vitamin D deficiency in various ethnic and age groups, a relationship was identified between obesity and vitamin D deficiency. Obesity is one of the factors for vitamin D deficiency and in the development of secondary hyperparathyroidism (SHPT), a more pronounced deficiency is experienced by people suffering from morbid obesity. SHPT in obese individuals in the absence of CKD or other somatic diseases may be considered a consequence of long-term vitamin D deficiency and hypocalcemia.

Vitamin D is present in a very limited amount of food, and its synthesis in the body is possible only when the skin is exposed to ultraviolet sunlight. Vitamin D promotes the absorption of calcium in the intestine and maintains adequate levels of calcium and phosphate in the blood to promote bone mineralization and prevent hypocalcemic seizures. It plays a major role in the prevention of rickets in children and osteomalacia in adults, and is necessary for bone growth and the process of bone remodeling. The function of vitamin D also affects neuromuscular conduction, immunity, and inflammation. Vitamin D is an important part of homeostasis: it reduces the risk of developing autoimmune pathologies and reduces the risk of infections. An important aspect is the interaction of the vitamin with the renin-angiotensin system - leveling molecular and clinical markers in diabetic nephropathy, reducing proteinuria, high blood pressure, inflammation and fibrosis. Vitamin D deficiency causes the development of myopathy, which is manifested by muscle weakness, difficulty walking, and many cases of falls and fractures in older people; It is also a predictor of cardiovascular accidents, dyslipidemia, and arterial hypertension. It plays an important role in reproductive health: with a deficiency, polycystic ovary syndrome is observed, the qualitative and quantitative characteristics of sperm and testosterone levels decrease. During pregnancy, vitamin D deficiency is associated with adverse outcomes: risk of preeclampia, infections, premature birth, cesarean section, gestational diabetes, and development of rickets in the child.

Hirsutism

In case of Achard-Thiers syndrome, it is necessary to determine the level of cortisol, glucose, and body mass index in the blood. In addition, the pituitary gland and adrenal glands are examined (MRI, CT, etc.) to exclude a tumor process. Which doctors should I contact?

Hirsutism therapy is also carried out. But in the process of making a diagnosis, consultation with other specialists may be required, such as a dermatologist (to exclude certain skin diseases), (for complex treatment of patients with manifestations of chronic diseases accompanying hirsutism, correction of their therapy if necessary), a cosmetologist (to select tactics for removing existing hair), surgeon or oncologist (in the presence of tumor processes).

Treatment of hirsutism

Increased hair growth in cases where it is not hereditary hirsutism is a symptom of a more serious disease of the endocrine or reproductive systems; therefore, an important component of therapy is to identify the root cause. When the tumor nature of hirsutism is proven to be localized in the adrenal cortex or pituitary gland, various methods are used to remove or reduce the tumor - surgical treatment, chemotherapy and radiation therapy, etc., which are carried out only by oncologists, chemotherapists, surgeons, neurologists and neurosurgeons with monitoring of organ function and body systems using numerous specialized tests.

Polycystic ovary syndrome requires an integrated approach with the inclusion in the treatment regimen of not only hormonal drugs, but also other medications.

In some cases, surgical removal of the ovary is performed. The choice of therapy is made by the gynecologist.

With correctly selected contraceptives and hormone replacement therapy by a doctor, the unpleasant symptoms of menopause are usually neutralized in menopausal women and the risk of developing hormonal imbalance is minimized.

The selection of medications is carried out by a gynecologist.

Diseases of the thyroid gland with a predominance of hyperfunction require the prescription of drugs that reduce the synthesis of thyroid-stimulating hormones, and can only be prescribed by an endocrinologist after assessing blood test results. Patients with hypothyroidism (reduced thyroid function) are prescribed drugs that replenish the level of thyroid hormones.

Complications

With hirsutism, menstrual irregularities, pathological uterine bleeding, and anemia may occur. Women experience severe psychological discomfort. But doctors consider infertility to be the most dangerous complication of hirsutism.

Prevention of hirsutism

The main preventive measure is timely consultation with a doctor. At the first signs of hair growth in androgen-dependent areas on the body or face and the addition of menstrual irregularities, you should see a gynecologist. Additional preventive measures include a healthy diet and weight control.

Sources:

1. .
2. Ilovaiskaya I.A. Hyperandrogenic disorders and diseases of women: differential diagnosis and treatment tactics. Gynecology. Endocrinology. No. 6(150). 2021. pp. 49-55.

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor.

Hormones responsible for weight change

Hormones such as epinephrine, norepinephrine, glucagon, ACTH, melanocyte-stimulating hormone, growth hormone and vasopressin accelerate the release of free fatty acids from adipose tissue and increase their concentration in the blood plasma, increasing the rate of triglyceride lipolysis.

An increase in body weight may be due to a violation of the synthesis or production of biologically active substrates involved in the regulation of eating behavior. The most important monoamines and peptides that provide a balance between the feeling of hunger and satiety: orexigenic effects - norepinephrine (α2 receptors), neuropeptide-Y, β-endorphin, somatoliberin, galanin, ghrelin, somatostaitin; anorexigenic effects: norepinephrine (α1-, β-2 receptors), serotonin, cholecystokinin, melanocyte-stimulating hormone, corticoliberin, leptin, enterostatin, glucose, thyrotropin-releasing hormone, vasopressin, bombensin)

Standard laboratory and instrumental studies for obesity include a set of definitions:

• Lipid spectrum of blood,
• fasting blood glucose, OGTT if necessary,
• ALT, AST, GGTP, ALP, uric acid, creatinine,
• Blood pressure measurements,
• ECG,
• Ultrasound OBP,
• In all patients, hypercorism should be excluded by any of the following methods: excretion of 24-hour urinary cortisol, overnight suppressive test with 1 g of dexomethasone (small desamethasone test), assessment of the level of cortisol in saliva,
• Assessment of thyroid function TSH,
• Determination of the level of total, ionized calcium, 25(OH)D and PTH to diagnose vitamin D deficiency and exclude SHPT.

Nutrition for obesity

Fasting for obesity is contraindicated!

The minimum daily calorie intake should be at least 1500 kcal for men, 1200 kcal for women. The balance of main macronutrients is distributed as follows: fat intake 25-30% (saturated fat less than 10%), protein 15%, carbohydrates 50-60%,

The daily caloric intake should be distributed over 3 main and 2 additional meals (research has proven that with any diet, eating twice a day during the day leads to significantly greater weight gain than more frequent meals with the same caloric content of the daily diet).

Separate fluid intake from meals 30 minutes before or after meals.

The diet is compiled taking into account the patient’s body weight, age, gender, level of physical activity and food preferences. Limiting the need for fat to 25% of daily calories, animal fats to no more than 10% of the total amount of fat, cholesterol to 300 mg per day (The most cholesterol-rich food: offal (heart, tongue, liver, kidneys, offal and especially brains), salmon caviar and sturgeon fish, egg yolk, butter and ghee, crabs, shrimp, fatty meats, fish and cheeses, lard). You should also limit the consumption of quickly digestible carbohydrates and introduce large amounts of fiber into your diet. It should be noted that moderate consumption of vegetable fats in their natural form is even beneficial, as it helps the resorption of atherosclerotic plaques

Features of the figure

The female figure of the “apple” type resembles an oval in its outline. Fat deposits are concentrated in the waist and abdomen, and weight is gained quite quickly. Representatives of this type are characterized by:

• long beautiful legs;
• medium or tall height;
• narrow hips;
• flat buttocks;
• narrow sloping shoulders;
• Long neck;
• fairly lush breasts;
• high waistline;
• full hands;
• bulging belly.

Petite ladies of this type are rare. Even slender girls who are not overweight cannot boast of a thin waist. Visually it is almost not expressed, the abdominal muscles are weak. At the same time, “apple” women can rightfully be proud of their long legs and slender hips. Cellulite in the lower part of the body is mild, but unsightly stretch marks may appear in the abdomen and arms as you gain weight.

Even very slender girls of this type have a weakly defined waist and weak abdominal muscles.

“Apple” women tend to be overweight. Extra pounds are concentrated in the upper and middle parts of the body. The waist becomes blurred, ridges appear on the sides, the stomach increases and sags. The chest becomes more magnificent, the arms and neck lose their graceful outlines. At the same time, the legs and hips remain slim for a long time. If they get fatter, the volume increases evenly.

Girls with a round figure and a weakly defined waist can look very attractive, but only if they constantly monitor their diet and have sufficient physical activity. Many stars have an apple-shaped figure, for example, Britney Spears, Jessica Simpson, Kate Winslet and Drew Barrymore.

Basic principles of weight loss

• Sharp limitation of easily digestible carbohydrates
• Limit animal fat
• Limiting starchy foods
• Adequate (250-300 grams) consumption of protein foods
• Consumption of large quantities of vegetables and fruits (up to 1 kg in total)
• Limiting table salt
• Limiting spicy snacks, sauces, spices,
• Frequent eating

To achieve weight loss, try reducing your intake of the following foods by half: potatoes, bread and baked goods, pasta, sausages.

It is healthier to eat those foods that contain a lot of ballast substances: wholemeal bread, noodles and noodles made from gray flour, all tuberous (turnips, beets, carrots). But bread, noodles and noodles made from white flour, fruit and vegetable juices have little ballast substances, so they can contribute to weight gain.

Fruits, especially those rich in quickly digestible carbohydrates (grapes, bananas, dates), should, if possible, be excluded. It is healthier to give preference to low-calorie fruits and berries containing slowly digestible carbohydrates.