Obesity is one of the important problems of modern medicine. Its frequency increases, and in developed countries, obesity acquiring the scale socially significant pathology.
It is authentically established, that fat people live on less in connection with the early occurrence of cardiovascular diseases, atherosclerosis, coronary heart disease and hypertensive disease, they are more often the defeat of the hepatobiliary system and first of all, cholelithiasis, and diabetes. Serious concern is the prevalence of obesity among people in the most active age and more "rejuvenation" of obesity.
Most researchers [Pokrovskiy A. A., 1964; Oleneva Century A., 1970; Beyul E. A., Oleneva Century A., 1980; Beyul E. A., Popov Yu P., 1984; Richmond, 1977; Foreyt et al, 1980; Hernande, 1980; Bray, 1981; Rodwell, 1981; Enzi, 1981] have a single opinion about the reasons for the dramatic expansion of obesity.
Obesity should be considered as an energy imbalance with a large flow of energy from food and lower it spending. Energy imbalance due in equal measure changes in the diet of the population since the beginning of the century to our days and low mobility of modern man. Therefore, increased obesity has become a logical consequence of modern life in highly developed countries.
Treating obesity in direct connection with the energy imbalance, both we and other researchers [Spesivtseva Century BC, 1979; Bray, 1981; Rodwell, 1981]available to primary exogenous constitutional or alimentary exchange obesity, corresponding to the term "simple (simple) obesity", proposed by foreign authors. This form of obesity in the modern world is most common and is more than 75% of all cases of the disease. In this book we use the term "exogenous-constitutional obesity."
At primary obesity is there any diseases that promote excessive accumulation of fat, i.e., diseases for which obesity occurs as a symptom of the General complex of syndromes pathological process - cerebral lesions, endocrine and especially pituitary-adrenal zone (a disease Itsenko - Kushinga, adipose-genital dystrophy, hypothyroidism, insuloma, inflammatory processes in the Central nervous system, traumas and tumors of the brain and other). These forms are referred to secondary obesity, and they are not discussed here.
Starting mechanism primary obesity, based on energy imbalance is the violation of the many stages of metabolism from receipt of nutrients to the final link of metabolism in lipocyte. The term "alimentary exchange or exogenous-constitutional obesity emphasizes that the leading starting exogenous point - of excess energy value of food consumed - can contribute to the weakness of separate parts of metabolic pipeline or cause exhaustion of adaptive mechanisms and persistent violations of metabolic processes due to the accumulation of energy in the body. This plan should be considered and the constitutional predisposition to redundancy of body weight, and hereditary predisposition to primary obesity. Recently emit so-called critical periods of life, when alimentary overload combined with reduced physical activity, especially contributes to the development of obesity, early childhood, puberty, pregnancy and lactation, menopause.
S. M. Leites (1967) considered critical in the sense of obesity the age of 30-35 years. In recent Rodwell, Bray (1981) already called the critical age 20 to 25 years.
However, the excessive accumulation of fat tissue and the formation of obesity is only possible if the excess energy value of nutrition and low energy, i.e. remains the main exogenous, or nutritional factor.
In accordance with the above, a number of researchers consider obesity as the number one problem today [Richmond, 1977; Foreyt et al., 1980]. In turn, this interpretation of the Genesis of obesity naturally takes the Central place in preventing obesity properly organized, to be exact rational nutrition and confirms the leading role of diet and increase physical activity in the treatment of obesity. Such treatment principle is not new. He was inviolable at all times, from the ancient medicine to our days.
Although there is no precise data about how century for the first time have started to treat obesity as a disease, in the famous treatise of Hippocrates "the healthy way of life" in the special section "How to lose weight" fat people were instructed to perform the most difficult exercises on an empty stomach, to sleep on bare planks, walking possible long and walk quickly, in the same light clothing in winter and in summer, enjoy the therapeutic hot baths, eat mainly herbs and vegetable oil. In the "Canon of medical science" Avicenna says about moderation in food and other life pleasures as a way to fight obesity: "Know that there is nothing worse than to overeat..." Fat Avicenna advised to eat a large amount, but little nutritional value, recommends a "permanent bathing in bath before eating" and "quick exercise." Similar information is contained in works of Aurelius. He appointed fat people "run fast, short sleep, skinny diet". You know the saying of Sirach (179 BC): "Not perepolnyali different delicious food and don't eat too greedy. So abundant food makes the sick, and the insatiable food leads to serious illness. Many deaths from overeating, but who abstains, lives long".
Systematic study of the energy balance and disorder of metabolic processes, in particular carbohydrate and fat, with clinical manifestation of these violations - obesity began in the mid-nineteenth century. A number of monographs on obesity [Kallash Faberge company, 1822; Gilyarov M. I., 1852; Bobryk village K. I., 1885; Polyakov, 1894; Kurlov M. G., 1884, and others], in which as the only reliable means in the fight against obesity was offered a reduced diet and special gymnastic exercises.
So, in the 60-ies of the last century have become very popular diet named montegobay. This diet was developed Century by Harvey and for the first time successfully applied in obese people by name Bunting. Detailed reasons for obesity, the analysis of clinical manifestations of the disease and the treatment of obesity, including diet, physical exercises, hydrotherapy, given in the book Chandler-Barla "Obesity", published in 1884
Further obesity attracted the attention of large clinicians in our country [zaharyin Century Meters, 1914; Cashiers I. A., 1927; Konchalovsky M. P., 1929] and abroad [Noorden K., 1900, 1930; Umber F., 1926]. In these works, along with discussion of the pathogenesis and clinical aspects of the disease was based on methods of treatment and in the first place diet.
The founder of diet therapy of obesity in the Soviet Union was M. I. Pevzner (1937). The principles of clinical nutrition patients with obesity, proposed headed by him for many years the Clinic of medical nutrition nutrition Institute of the AMS of the USSR, was the basis of all further research in this direction.
Further development of pathophysiology, biochemistry and endocrinology contributed in-depth study of the mechanisms of the disease on the level of tissue and cell structures and helped to develop the principles of pathogenetically grounded treatment [Leites S. M., 1948, 1955, 1967; Egorov M. N., Levitsky L. M., 1957; Baranov Century BC, 1972; Pokrovskiy A. A., 1974; Shurygin D. J. and others, 1975; Kekwick, Pawan, 1964; Gordon, 1970, and others].
Long-term work on obesity in the Institute of nutrition of the Academy of medical Sciences of the USSR cover theoretical, clinical, and epidemiological aspects of the disease. Long and wide epidemiological studies carried out in several regions of the Soviet Union, has shown that obesity in our country is just as pressing, and as for the other developed countries of the world. Thus, excess body weight was observed in 50% of the adult population, and the true obese 26%. Identified increased obesity in young people and children, the progression of obesity among residents of both cities and villages. A direct link between changes in dietary habits, reduced physical activity and progression of obesity. In the diet of people prevail refined products, animal fats and digestible carbohydrates with an obvious deficit of products of grain crops, vegetable oil, fresh vegetables and fruits. This is combined with excess energy value of the daily diet and improper feeding [Noveller A. M., 1974; Priputina HP, 1975; Beyul E. A., Oleneva Century A., Popov Yu P. and others, 1980; Beyul E. A., Abdushelishvili, Century, Oleneva Century A. and others, 1981].
Theoretical researches and clinical observations allowed us to elaborate a complex of preventive and therapeutic interventions for obesity. Pathogenetic approach to solving these issues include the use of modern tests on tissue and cellular level: - studied enzyme ratio in adipose tissue, the functional state of adipose cells, clarified a number of parties in the relationship metabolism of fat and carbohydrates, defined hormonal changes and others Carried out researches have allowed to establish the severity of the deviation of these parameters from normal at different degrees and forms of the disease depending on the age of the patients, duration of suffering that became the basis for the development of differentiated and most effective measures therapy.
Frequent combination of obesity with different pathologies forces us to consider these diseases in the development of treatment and preventive measures. It is obvious that in all cases the leading role should play a health food, directed primarily to the correction of certain parts of a metabolism.
The material presented in this book, mostly obtained by the authors in the result of long-term observations made in the Institute of nutrition of the Academy of medical Sciences of the USSR.